Journal of Clinical Medicine

17 pages, 1329 KiB

Open AccessArticle

Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years’ Korean Genome and Epidemiology Study (KoGES)

by Jong Hyun Jhee, Seun Deuk Hwang, Joon Ho Song and Seoung Woo Lee

J. Clin. Med. 2018, 7(11), 463; https://doi.org/10.3390/jcm7110463 - 21 Nov 2018

Cited by 9 | Viewed by 6622

Abstract

Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m², a dilemma arises, as [...] Read more.

Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m², a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m² were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m² on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m². The incidence of the development of eGFR <60 mL/min/1.73 m² was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m² (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29–6.74 in females; HR, 12.77; 95% CI, 7.69–21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m² (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development. Full article

(This article belongs to the Special Issue Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD))

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18 pages, 2512 KiB

Open AccessArticle

Lung Protection Strategies during Cardiopulmonary Bypass Affect the Composition of Blood Electrolytes and Metabolites—A Randomized Controlled Trial

by Katrine B. Buggeskov, Raluca G. Maltesen, Bodil S. Rasmussen, Munsoor A. Hanifa, Morten A.V. Lund, Reinhard Wimmer and Hanne B. Ravn

J. Clin. Med. 2018, 7(11), 462; https://doi.org/10.3390/jcm7110462 - 21 Nov 2018

Cited by 7 | Viewed by 4005

Abstract

Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute lung ischemia-reperfusion injury, which can develop to pulmonary dysfunction postoperatively. This sub-study of the Pulmonary Protection Trial aimed to elucidate changes in arterial blood gas analyses, inflammatory protein interleukin-6, and metabolites of 90 chronic [...] Read more.

Cardiac surgery with cardiopulmonary bypass (CPB) causes an acute lung ischemia-reperfusion injury, which can develop to pulmonary dysfunction postoperatively. This sub-study of the Pulmonary Protection Trial aimed to elucidate changes in arterial blood gas analyses, inflammatory protein interleukin-6, and metabolites of 90 chronic obstructive pulmonary disease patients following two lung protective regimens of pulmonary artery perfusion with either hypothermic histidine-tryptophan-ketoglutarate (HTK) solution or normothermic oxygenated blood during CPB, compared to the standard CPB with no pulmonary perfusion. Blood was collected at six time points before, during, and up to 20 h post-CPB. Blood gas analysis, enzyme-linked immunosorbent assay, and nuclear magnetic resonance spectroscopy were used, and multivariate and univariate statistical analyses were performed. All patients had decreased gas exchange, augmented inflammation, and metabolite alteration during and after CPB. While no difference was observed between patients receiving oxygenated blood and standard CPB, patients receiving HTK solution had an excess of metabolites involved in energy production and detoxification of reactive oxygen species. Also, patients receiving HTK suffered a transient isotonic hyponatremia that resolved within 20 h post-CPB. Additional studies are needed to further elucidate how to diminish lung ischemia-reperfusion injury during CPB, and thereby, reduce the risk of developing severe postoperative pulmonary dysfunction. Full article

(This article belongs to the Section Pulmonology)

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Graphical abstract

17 pages, 700 KiB

Open AccessPerspective

The Role of Long Noncoding RNAs in Diabetic Alzheimer’s Disease

by Young-Kook Kim and Juhyun Song

J. Clin. Med. 2018, 7(11), 461; https://doi.org/10.3390/jcm7110461 - 21 Nov 2018

Cited by 18 | Viewed by 3211

Abstract

Long noncoding RNAs (lncRNAs) are involved in diverse physiological and pathological processes by modulating gene expression. They have been found to be dysregulated in the brain and cerebrospinal fluid of patients with neurodegenerative diseases, and are considered promising therapeutic targets for treatment. Among [...] Read more.

Long noncoding RNAs (lncRNAs) are involved in diverse physiological and pathological processes by modulating gene expression. They have been found to be dysregulated in the brain and cerebrospinal fluid of patients with neurodegenerative diseases, and are considered promising therapeutic targets for treatment. Among the various neurodegenerative diseases, diabetic Alzheimer’s disease (AD) has been recently emerging as an important issue due to several unexpected reports suggesting that metabolic issues in the brain, such as insulin resistance and glucose dysregulation, could be important risk factors for AD. To facilitate understanding of the role of lncRNAs in this field, here we review recent studies on lncRNAs in AD and diabetes, and summarize them with different categories associated with the pathogenesis of the diseases including neurogenesis, synaptic dysfunction, amyloid beta accumulation, neuroinflammation, insulin resistance, and glucose dysregulation. It is essential to understand the role of lncRNAs in the pathogenesis of diabetic AD from various perspectives for therapeutic utilization of lncRNAs in the near future. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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8 pages, 232 KiB

Open AccessArticle

Prophylactic Transcatheter Arterial Embolization Helps Intraoperative Hemorrhagic Control for REMOVING Invasive Placenta

by Kun-Long Huang, Ching-Chang Tsai, Hung-Chun Fu, Hsin-Hsin Cheng, Yun-Ju Lai, Hsuan-Ning Hung, Leo Leung-Chit Tsang and Te-Yao Hsu

J. Clin. Med. 2018, 7(11), 460; https://doi.org/10.3390/jcm7110460 - 21 Nov 2018

Cited by 10 | Viewed by 2511

Abstract

Objectives: The purpose of this article is to investigate the estimated blood loss in pregnant women undergoing cesarean section and placental extirpation to treat abnormal placentation and compare the outcomes of those who underwent prophylactic transcatheter arterial embolization (TAE) with those who did [...] Read more.

Objectives: The purpose of this article is to investigate the estimated blood loss in pregnant women undergoing cesarean section and placental extirpation to treat abnormal placentation and compare the outcomes of those who underwent prophylactic transcatheter arterial embolization (TAE) with those who did not. Methods: A retrospective study was conducted on 17 pregnant women diagnosed with abnormal placentation in 2001–2018 in a single tertiary center. The patients were diagnosed by surgical finding, ultrasound, or magnetic resonance imaging (MRI). These patients were divided into two groups: a prophylactic TAE group (11 patients) and a control group (6 patients). In the former group, prophylactic TAE of the bilateral uterine artery (UA) and/or internal iliac artery (IIA) was performed immediately after delivery of the infant. The placenta was removed in both groups. The primary outcomes were estimated blood loss (EBL), units of packed red blood cell (pRBC) transfusion, operative time, whether hysterectomy was performed, whether the patient was transferred to the intensive care unit (ICU), and hospitalization days. The secondary outcome was maternal complications. Results: Patients who received prophylactic TAE had significantly reduced intraoperative blood loss (990.9 ± 701.7 mL vs. 3448.3 ± 1767.4 mL, p = 0.018). Units of pRBC transfusion, operative time, hysterectomy, transfer to the ICU, and postoperative hospitalization days were not significantly different between the two groups. Thirteen patients (9 in the TAE group and 4 in the control group) received a blood transfusion during the operation. Three patients underwent a hysterectomy (1 in the TAE group and 2 in the control group). Five patients were transferred to the ICU (3 in the TAE group and 2 in the control group) for maternal complications or monitoring. In the prophylactic TAE group, 3 patients (27%) had a subsequent pregnancy within the next 5 years. Conclusions: Prophylactic TAE was safe and effective for reducing intraoperative hemorrhage from removing an invasive placenta in patients with abnormal placentation. Full article

(This article belongs to the Section Obstetrics & Gynecology)

19 pages, 1721 KiB

Open AccessArticle

Long-Term Effects of Spironolactone on Kidney Function and Hyperkalemia-Associated Hospitalization in Patients with Chronic Kidney Disease

by Chen-Ta Yang, Chew-Teng Kor and Yao-Peng Hsieh

J. Clin. Med. 2018, 7(11), 459; https://doi.org/10.3390/jcm7110459 - 21 Nov 2018

Cited by 34 | Viewed by 5972

Abstract

Background: Spironolactone, a non-selective mineralocorticoid receptor antagonist, can protect against cardiac fibrosis and left ventricular dysfunction, and improve endothelial dysfunction and proteinuria. However, the safety and effects of spironolactone on patient-centered cardiovascular and renal endpoints remain unclear. Methods: We identified predialysis stage 3–4 [...] Read more.

Background: Spironolactone, a non-selective mineralocorticoid receptor antagonist, can protect against cardiac fibrosis and left ventricular dysfunction, and improve endothelial dysfunction and proteinuria. However, the safety and effects of spironolactone on patient-centered cardiovascular and renal endpoints remain unclear. Methods: We identified predialysis stage 3–4 chronic kidney disease (CKD) patients between 2000 and 2013 from the Longitudinal Health Insurance Database 2005 (LHID 2005). The outcomes of interest were end-stage renal disease (ESRD), major adverse cardiovascular events (MACE), hospitalization for heart failure (HHF), hyperkalemia-associated hospitalization (HKAH), all-cause mortality and cardiovascular mortality. The Fine and Gray sub-distribution hazards approach was adopted to adjust for the competing risk of death. Results: After the propensity score matching, 693 patients with stage 3–4 CKD were spironolactone users and 1386 were nonusers. During the follow-up period, spironolactone users had a lower incidence rate for ESRD than spironolactone non-users (39.2 vs. 53.69 per 1000 person-years) and a higher incidence rate for HKAH (54.79 vs. 18.57 per 1000 person-years). The adjusted hazard ratios for ESRD of spironolactone users versus non-users were 0.66 (95% CI, 0.51–0.84; p value < 0.001) and 3.17 (95% CI, 2.41–4.17; p value < 0.001) for HKAH. A dose-response relationship was found between spironolactone use and risk of ESRD and HKAH. There were no statistical differences in MACE, HHF, all-cause mortality and cardiovascular mortality between spironolactone users and non-users. Conclusion: Spironolactone represented a promising treatment option to retard CKD progression to ESRD amongst stage 3–4 CKD patients, but strategic treatments to prevent hyperkalemia should be enforced. Full article

(This article belongs to the Special Issue Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD))

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21 pages, 589 KiB

Open AccessArticle

Bidirectional Association between Nonalcoholic Fatty Liver Disease and Gallstone Disease: A Cohort Study

by Yoosoo Chang, Yoo-Hun Noh, Byung-Seong Suh, Yejin Kim, Eunju Sung, Hyun-Suk Jung, Chan-Won Kim, Min-Jung Kwon, Kyung Eun Yun, Jin-Won Noh, Hocheol Shin, Yong Kyun Cho and Seungho Ryu

J. Clin. Med. 2018, 7(11), 458; https://doi.org/10.3390/jcm7110458 - 21 Nov 2018

Cited by 23 | Viewed by 9216

Abstract

Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are often found to coexist but the sequential relationship of NAFLD and GD to each other remains controversial. We prospectively evaluated the bidirectional relationship of NAFLD with GD. A cohort study was performed on [...] Read more.

Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are often found to coexist but the sequential relationship of NAFLD and GD to each other remains controversial. We prospectively evaluated the bidirectional relationship of NAFLD with GD. A cohort study was performed on Korean adults who underwent a health checkup and were followed annually or biennially for a mean of 6.0 years. Fatty liver and gallstones were diagnosed by ultrasound. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. The NAFLD severity was determined by non-invasive fibrosis markers. Among 283,446 participants without either gallstones or cholecystectomy at baseline, 6440 participants developed gallstones. Among 219,641 participants without NAFLD at baseline, 49,301 participants developed NAFLD. The multivariable-adjusted hazard ratio (95% confidence interval) for incident gallstone comparing the NAFLD group vs. the non-NAFLD group was 1.26 (1.17–1.35). Increased non-invasive fibrosis markers of NAFLD were positively associated with an increased incidence of gallstones in a graded and dose-responsive manner (p-trend < 0.01). The multivariable-adjusted hazard ratios (95% confidence intervals) for incident NAFLD comparing gallstone and cholecystectomy to no GD were 1.14 (1.07–1.22) and 1.17 (1.03–1.33), respectively. This large-scale cohort study of young and middle-aged individuals demonstrated a bidirectional association between NAFLD and GD. NAFLD and its severity were independently associated with an increased incidence of gallstones, while GD and cholecystectomy were also associated with incident NAFLD. Our findings indicate that the conditions may affect each other, requiring further studies to elucidate the potential mechanisms underlying this association. Full article

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

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Graphical abstract

26 pages, 5664 KiB

Open AccessReview

Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications

by Ke-Vin Chang, Kamal Mezian, Ondřej Naňka, Wei-Ting Wu, Yueh-Ming Lou, Jia-Chi Wang, Carlo Martinoli and Levent Özçakar

J. Clin. Med. 2018, 7(11), 457; https://doi.org/10.3390/jcm7110457 - 21 Nov 2018

Cited by 96 | Viewed by 17457

Abstract

Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or [...] Read more.

Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve. Full article

(This article belongs to the Section Clinical Neurology)

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12 pages, 2247 KiB

Open AccessArticle

Static Range of Motion of the First Metatarsal in the Sagittal and Frontal Planes

by Sandra Priscila Tavara-Vidalón, Manuel Ángel Monge-Vera, Guillermo Lafuente-Sotillos, Gabriel Domínguez-Maldonado and Pedro V. Munuera-Martínez

J. Clin. Med. 2018, 7(11), 456; https://doi.org/10.3390/jcm7110456 - 21 Nov 2018

Cited by 14 | Viewed by 3390

Abstract

The first metatarsal and medial cuneiform form an important functional unit in the foot, called “first ray”. The first ray normal range of motion (ROM) is difficult to quantify due to the number of joints that are involved. Several methods have previously been [...] Read more.

The first metatarsal and medial cuneiform form an important functional unit in the foot, called “first ray”. The first ray normal range of motion (ROM) is difficult to quantify due to the number of joints that are involved. Several methods have previously been proposed. Controversy exists related to normal movement of the first ray frontal plane accompanying that in the sagittal plane. The objective of this study was to investigate the ROM of the first ray in the sagittal and frontal planes in normal feet. Anterior-posterior radiographs were done of the feet of 40 healthy participants with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. They were digitalized and the distance between the tibial malleolus and the intersesamoid crest in the three positions mentioned was measured. The rotation of the first ray in these three positions was measured. A polynomic function that fits a curve describing the movement observed in the first ray was obtained using the least squares method. ROM of the first ray in the sagittal plane was 6.47 (SD 2.59) mm of dorsiflexion and 6.12 (SD 2.55) mm of plantarflexion. ROM in the frontal plane was 2.69 (SD 4.03) degrees of inversion during the dorsiflexion and 2.97 (SD 2.72) degrees during the plantarflexion. A second-degree equation was obtained, which represents the movement of the first ray. Passive dorsiflexion and plantarflexion of the first ray were accompanied by movements in the frontal plane: 0.45 degrees of movement were produced in the frontal plane for each millimeter of displacement in the sagittal plane. These findings might be useful for the future design of instruments for clinically quantifying first ray mobility. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 616 KiB

Open AccessArticle

Gallbladder Stone Disease Is Associated with an Increased Risk of Migraines

by Chien-Hua Chen, Cheng-Li Lin and Chia-Hung Kao

J. Clin. Med. 2018, 7(11), 455; https://doi.org/10.3390/jcm7110455 - 21 Nov 2018

Cited by 6 | Viewed by 3408

Abstract

Background: Several pathophysiological mechanisms are shared in both gallbladder stone disease (GSD) and migraines. We assessed the migraine risk for patients diagnosed with GSD. Methods: We identified 20,427 patients who were diagnosed with GSD between 2000 and 2011 from Taiwan’s National Health Insurance [...] Read more.

Background: Several pathophysiological mechanisms are shared in both gallbladder stone disease (GSD) and migraines. We assessed the migraine risk for patients diagnosed with GSD. Methods: We identified 20,427 patients who were diagnosed with GSD between 2000 and 2011 from Taiwan’s National Health Insurance Research Database (NHIRD) as the study cohort. We randomly selected 81,706 controls from the non-GSD population with frequency matching by age and index year for the control cohort. All patient cases were followed until the end of 2011 to measure the incidence of migraines. Results: The cumulative incidence of migraines was greater in patients with GSD than in those without GSD (log-rank test: p < 0.001). The risk of migraine (3.89 vs. 2.30 per 10,000 person-years, adjusted hazard ratio (aHR) = 1.56, 95% confidence interval (CI) = 1.41–1.73) was greater for the GSD cohort than that for the non-GSD cohort. The risk of migraine increased with the time of follow-up after a diagnosis of GSD. The risk of migraine contributed by GSD was greater for all age groups. The risk of migraine for GSD patients with depression (aHR = 2.89, 95% CI = 2.21–3.77), anxiety (aHR = 2.07, 95% CI = 1.58–2.70), and coronary artery disease (CAD) (aHR = 2.05, 95% CI = 1.69–2.48) tended to be greater than that for GSD patients without depression (aHR = 1.54, 95% CI = 1.39–1.72), anxiety (aHR = 1.62, 95% CI = 1.46–1.81), and CAD (aHR = 1.65, 95% CI = 1.47–1.85), respectively. Compared with the patients without GSD, the risk of developing migraines was greater in those GSD patients either with (aHR = 1.39, 95% CI = 1.19–1.63) or without (aHR = 1.67, 95% CI = 1.48–1.88) cholecystectomy. Compared with the GSD patients that have not had a cholecystectomy, the risk of developing migraines was lower in the GSD patients that had a cholecystectomy (aHR = 0.83, 95% CI = 0.69–0.99). Conclusions: GSD is associated with an increased risk of migraines in the Taiwanese population, but the risk diminishes after a cholecystectomy. Furthermore, in the development of migraines, GSD is synergic with some migraine-associated comorbidities, such as CAD, depression, and anxiety. Further study is necessary to clarify whether GSD is a causal risk factor for migraine. Full article

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

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8 pages, 684 KiB

Open AccessArticle

Effects of Compressive Stockings and Standard Stockings in Skin Temperature and Pressure Pain Threshold in Runners with Functional Ankle Equinus Condition

by David Rodríguez-Sanz, Ricardo Becerro-de-Bengoa-Vallejo, Marta Elena Losa-Iglesias, Eva María Martínez-Jiménez, Daniel Muñoz-García, Eduardo Pérez-Boal, César Calvo-Lobo and Daniel López-López

J. Clin. Med. 2018, 7(11), 454; https://doi.org/10.3390/jcm7110454 - 21 Nov 2018

Cited by 14 | Viewed by 3699

Abstract

Objective: To assess clinical differences in the Achilles tendons of runners with ankle equinus wearing either compressive or standard stockings. Design: Case–control study. Methods: In this study, we conducted clinical examinations of 98 sportsmen (runners) with equinus, before and after 30 min of [...] Read more.

Objective: To assess clinical differences in the Achilles tendons of runners with ankle equinus wearing either compressive or standard stockings. Design: Case–control study. Methods: In this study, we conducted clinical examinations of 98 sportsmen (runners) with equinus, before and after 30 min of running on a treadmill; 49 runners wore compressive stockings and 49 wore standard stockings. Clinical assessments of the runners’ Achilles tendons were based on the pressure pain threshold (PPT) and skin temperature analysis. Results: Achilles tendon evaluations identified significant differences in skin temperature modification and PPT between the compressive and standard stocking groups. Conclusions: Based on our findings, we propose that higher skin temperatures are associated with lower pressure pain thresholds in the Achilles tendons of runners with ankle equinus. Full article

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

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12 pages, 2016 KiB

Open AccessReview

Broken Energy Homeostasis and Obesity Pathogenesis: The Surrounding Concepts

by Abdelaziz Ghanemi, Mayumi Yoshioka and Jonny St-Amand

J. Clin. Med. 2018, 7(11), 453; https://doi.org/10.3390/jcm7110453 - 20 Nov 2018

Cited by 65 | Viewed by 12630

Abstract

Obesity represents an abnormal fat accumulation resulting from energy imbalances. It represents a disease with heavy consequences on population health and society economy due to its related morbidities and epidemic proportion. Defining and classifying obesity and its related parameters of evaluation is the [...] Read more.

Obesity represents an abnormal fat accumulation resulting from energy imbalances. It represents a disease with heavy consequences on population health and society economy due to its related morbidities and epidemic proportion. Defining and classifying obesity and its related parameters of evaluation is the first challenge toward understanding this multifactorial health problem. Therefore, within this review we report selected illustrative examples of the underlying mechanisms beyond the obesity pathogenesis which is systemic rather than limited to fat accumulation. We also discuss the gut-brain axis and hormones as the controllers of energy homeostasis and report selected impacts of obesity on the key metabolic tissues. The concepts of “broken energy balance” is detailed as the obesity starting key step. Sleep shortage and psychological factors are also reported with influences on obesity development. Importantly, describing such mechanistic pathways would allow clinicians, biologists and researchers to develop and optimize approaches and methods in terms of diagnosis, classification, clinical evaluation, treatment and prognosis of obesity. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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9 pages, 432 KiB

Open AccessArticle

Associations with the In-Hospital Survival Following Extracorporeal Membrane Oxygenation in Adult Acute Fulminant Myocarditis

by Shaur-Zheng Chong, Chih-Yuan Fang, Hsiu-Yu Fang, Huang-Chung Chen, Chien-Jen Chen, Cheng-Hsu Yang, Chi-Ling Hang, Hon-Kan Yip, Chiung-Jen Wu and Wei-Chieh Lee

J. Clin. Med. 2018, 7(11), 452; https://doi.org/10.3390/jcm7110452 - 20 Nov 2018

Cited by 23 | Viewed by 3368

Abstract

Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses rapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse the patient’s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the most effective, supportive and adjunct strategy. In [...] Read more.

Background: Acute fulminant myocarditis (AFM) is a serious disease that progresses rapidly, and leads to failing respiratory and circulatory systems. When medications fail to reverse the patient’s clinical course, extracorporeal membrane oxygenation (ECMO) is considered the most effective, supportive and adjunct strategy. In this paper we analyzed our experience in managing AFM with ECMO support. Methods: During October 2003 and February 2017, a total of 35 patients (≥18 years) were enrolled in the study. Twenty patients survived, and another 15 patients expired. General demographics, the hemodynamic condition, timing of ECMO intervention, and laboratory data were compared for the survival and non-survival groups. Univariate and multivariate Cox regression analyses were performed to identify the associations with in-hospital mortality following ECMO use in this situation. Results: The survival rate was 57.1% during the in-hospital period. The average age, gender, severity of the hemodynamic condition, and cardiac rhythm were similar between the survival and non-survival groups. Higher serum lactic acid (initial and 24 h later), higher peak cardiac biomarkers, higher incidence of acute kidney injury and the need for hemodialysis were noted in the non-survival group. Higher 24-h lactic acid levels and higher peak troponin-I levels were associated with in-hospital mortality. Conclusions: When ECMO was used for AFM, related cardiogenic shock and decompensated heart failure, higher peak serum troponin-I levels and 24-h serum lactic acid levels following ECMO use were independently associated with in-hospital mortality. Full article

(This article belongs to the Section Cardiology)

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12 pages, 241 KiB

Open AccessArticle

Barriers and Facilitators in Implementing Non-Face-to-Face Chronic Care Management in an Elderly Population with Diabetes: A Qualitative Study of Physician and Health System Perspectives

by Alessandra N. Bazzano, M. Kristina Wharton, Alisha Monnette, Elizabeth Nauman, Eboni Price-Haywood, Cathy Glover, Patricia Dominick, Peggy Malone, Gang Hu and Lizheng Shi

J. Clin. Med. 2018, 7(11), 451; https://doi.org/10.3390/jcm7110451 - 20 Nov 2018

Cited by 15 | Viewed by 3771

Abstract

The burden of illness related to diabetes and its complications is exceedingly high and growing globally. Systematic approaches to managing chronic care are needed to address the complex nature of the disease, taking into account health system structures. This study presents data collected [...] Read more.

The burden of illness related to diabetes and its complications is exceedingly high and growing globally. Systematic approaches to managing chronic care are needed to address the complex nature of the disease, taking into account health system structures. This study presents data collected from interviews with physicians, health system administrators, and other healthcare staff about chronic care management for elderly people with diabetes co-morbid with other chronic conditions in light of new programs intended to reduce barriers by incentivizing care encounters that take place through telephone and electronic communications (non-face-to-face care). Results indicate that health system personnel view non-face-to-face care as potentially providing value for patients and addressing systemic needs, yet challenging to implement in practice. Barriers and facilitators to this approach for managing diabetes and chronic care management for its complications are presented, with consideration to different types of health systems, and recommendations are provided for implementation. Full article

(This article belongs to the Section Endocrinology & Metabolism)

12 pages, 786 KiB

Open AccessArticle

Prevention of Occupational Strain: Can Psychological Empowerment and Organizational Commitment Decrease Dissatisfaction and Intention to Quit?

by Marta Llorente-Alonso and Gabriela Topa

J. Clin. Med. 2018, 7(11), 450; https://doi.org/10.3390/jcm7110450 - 20 Nov 2018

Cited by 6 | Viewed by 3274

Abstract

In the present study, the demands-control-support model has served as the basis for the assessment of occupational strain. This model has been used as a predictor of health problems. It has also been associated with organizational outcomes and behaviors. The purpose of this [...] Read more.

In the present study, the demands-control-support model has served as the basis for the assessment of occupational strain. This model has been used as a predictor of health problems. It has also been associated with organizational outcomes and behaviors. The purpose of this study is to relate job demands and resources with job satisfaction and intention to quit the union. We intend to test a multiple mediation model with psychological empowerment and union commitment as mediator variables. The investigation was carried out with 953 delegates of a Spanish trade union (healthcare professionals). We collected 401 questionnaires. Multiple mediation analyses were performed with bootstrapping techniques using the SPSS PROCESS macro. The results underlined the effects of multiple mediation of empowerment and commitment in the relation between resources and job satisfaction. This mediation was also observed in the relation between resources and intention to quit. The lack of relation between demands and satisfaction or intention to quit is of interest. In the presence of adequate resources, delegates are empowered and committed to their union, which leads to lower dissatisfaction and lower rates of quitting. This study advises organizations to give greater importance to motivational and attitudinal factors to attenuate occupational strain. Full article

(This article belongs to the Special Issue Occupational Diseases: From Cure to Prevention)

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16 pages, 2805 KiB

Open AccessArticle

Effects of the Extracts from Fruit and Stem of Camellia japonica on Induced Pluripotency and Wound Healing

by Hyejin Jeon, Jae Yun Kim, Jung‐Kyun Choi, Enna Han, Cho-Lok Song, Jungwoon Lee and Yee Sook Cho

J. Clin. Med. 2018, 7(11), 449; https://doi.org/10.3390/jcm7110449 - 20 Nov 2018

Cited by 13 | Viewed by 3996

Abstract

Small molecules that improve reprogramming, stem cell properties, and regeneration can be widely applied in regenerative medicine. Natural plant extracts represent an abundant and valuable source of bioactive small molecules for drug discovery. Natural products themselves or direct derivatives of them have continued [...] Read more.

Small molecules that improve reprogramming, stem cell properties, and regeneration can be widely applied in regenerative medicine. Natural plant extracts represent an abundant and valuable source of bioactive small molecules for drug discovery. Natural products themselves or direct derivatives of them have continued to provide small molecules that have entered clinical trials, such as anticancer and antimicrobial drugs. Here, we tested 3695 extracts from native plants to examine whether they can improve induced pluripotent stem cell (iPSC) generation using genetically homogeneous secondary mouse embryonic fibroblasts (MEFs) harboring doxycycline (dox)-inducible reprograming transgenes. Among the tested extracts, extracts from the fruit and stem of Camellia japonica (CJ) enhanced mouse and human iPSC generation and promoted efficient wound healing in an in vivo mouse wound model. CJ is one of the best-known species of the genus Camellia that belongs to the Theaceae family. Our findings identified the natural plant extracts from the fruit and stem of CJ as novel regulators capable of enhancing cellular reprogramming and wound healing, providing a useful supplement in the development of a more efficient and safer method to produce clinical-grade iPSCs and therapeutics. Full article

(This article belongs to the Section Pharmacology)

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14 pages, 4681 KiB

Open AccessArticle

Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

by Mateusz Rubinkiewicz, Agata Czerwińska, Piotr Zarzycki, Piotr Małczak, Michał Nowakowski, Piotr Major, Andrzej Budzyński and Michał Pędziwiatr

J. Clin. Med. 2018, 7(11), 448; https://doi.org/10.3390/jcm7110448 - 19 Nov 2018

Cited by 26 | Viewed by 3379

Abstract

Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, [...] Read more.

Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications. Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31–0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin. Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials. Full article

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

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10 pages, 846 KiB

Open AccessArticle

Predictors of Exercise Capacity in Patients with Hypertrophic Obstructive Cardiomyopathy

by Joshua R. Smith, Jose R. Medina-Inojosa, Veronica Layrisse, Steve R. Ommen and Thomas P. Olson

J. Clin. Med. 2018, 7(11), 447; https://doi.org/10.3390/jcm7110447 - 18 Nov 2018

Cited by 20 | Viewed by 3339

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) patients exhibit compromised peak exercise capacity (VO₂peak). Importantly, severely reduced VO₂peak is directly related to increased morbidity and mortality in these patients. Therefore, we sought to determine clinical predictors of VO₂peak in HOCM [...] Read more.

Hypertrophic obstructive cardiomyopathy (HOCM) patients exhibit compromised peak exercise capacity (VO₂peak). Importantly, severely reduced VO₂peak is directly related to increased morbidity and mortality in these patients. Therefore, we sought to determine clinical predictors of VO₂peak in HOCM patients. HOCM patients who performed symptom-limited cardiopulmonary exercise testing between 1995 and 2016 were included for analysis. Peak VO₂ was reported as absolute peak VO₂, indexed to body weight and analyzed as quartiles, with quartile 1 representing the lowest VO₂peak. Step-wise regression models using demographic features and clinical and physiologic characteristics were created to determine predictors of HOCM patients with the lowest VO₂peak. We included 1177 HOCM patients (age: 53 ± 14 years; BMI: 24 ± 12 kg/m²) with a VO₂peak of 18.0 ± 5.6 mL/kg/min. Significant univariate predictors of the lowest VO₂peak included age, female sex, New York Health Association (NYHA) class, BMI, left atrial volume index, E/e’, E/A, hemoglobin, N-terminal pro b-type natriuretic peptide (NT-proBNP), and a history of diabetes, hypertension, stroke, atrial fibrillation, or coronary artery disease. Independent predictors of the lowest VO₂peak included age (OR, CI: 1.03, 1.02–1.06; p < 0.0001), women (4.66, 2.94–7.47; p = 0.001), a history of diabetes (2.05, 1.17–3.60; p = 0.01), BMI (0.94, 0.92–0.96; p < 0.0001), left atrial volume index (1.07, 1.05–1.21; p = 0.04), E/e’ (1.05, 1.01–1.08; p = 0.004), hemoglobin (0.76, 0.65–0.88; p = 0.0004), and NT-proBNP (1.72, 1.42–2.11; p < 0.0001). These findings demonstrate that demographic factors (i.e., age and sex), comorbidities (e.g., diabetes and obesity), echocardiography indices, and biomarkers (e.g., hemoglobin and NT-proBNP) are predictive of severely compromised VO₂peak in HOCM patients. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation)

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13 pages, 4546 KiB

Open AccessArticle

Genome-Wide Scan for Copy Number Alteration Association with Relapse-Free Survival in Colorectal Cancer with Liver Metastasis Patients

by Po-Sheng Yang, Hsi-Hsien Hsu, Tzu-Chi Hsu, Ming-Jen Chen, Cin-Di Wang, Sung-Liang Yu, Yi-Chiung Hsu and Ker-Chau Li

J. Clin. Med. 2018, 7(11), 446; https://doi.org/10.3390/jcm7110446 - 18 Nov 2018

Cited by 9 | Viewed by 3094

Abstract

Predicting a patient’s risk of recurrence after the resection of liver metastases from colorectal cancer is critical for evaluating and selecting therapeutic approaches. Clinical and pathologic parameters have shown limited accuracy thus far. Therefore, we combined the clinical status with a genomic approach [...] Read more.

Predicting a patient’s risk of recurrence after the resection of liver metastases from colorectal cancer is critical for evaluating and selecting therapeutic approaches. Clinical and pathologic parameters have shown limited accuracy thus far. Therefore, we combined the clinical status with a genomic approach to stratify relapse-free survival in colorectal cancer liver metastases patients. To identify new molecular and genetic signatures specific to colorectal cancer with liver metastasis (CRCLM) patients, we conducted DNA copy number profiling on a cohort of 21 Taiwanese CRCLM patients using a comparative genomic hybridization (CGH) array. We identified a three-gene signature based on differential copy number alteration between patients with different statuses of (1) recurrence and (2) synchronous metastasis. In relapse hotspot regions, only three genes (S100PBP, CSMD2, and TGFBI) were significantly associated with the synchronous liver metastasis factor. A final set of three genes—S100PBP, CSMD2, TGFBI—significantly predicted relapse-free survival in our cohort (p = 0.04) and another CRCLM cohort (p = 0.02). This three-gene signature is the first genomic signature validated for relapse-free survival in post-hepatectomy CRCLM patients. Our three-gene signature was developed using a whole-genome CGH array and has a good prognostic position for the relapse-free survival of CRCLM patients after hepatectomy. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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22 pages, 1549 KiB

Open AccessReview

Risk of Depression and Suicidality among Diabetic Patients: A Systematic Review and Meta-Analysis

by Rasha Elamoshy, Yelena Bird, Lilian Thorpe and John Moraros

J. Clin. Med. 2018, 7(11), 445; https://doi.org/10.3390/jcm7110445 - 16 Nov 2018

Cited by 29 | Viewed by 5661

Abstract

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. Methods: Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was [...] Read more.

The purpose of this study is to conduct a systematic review and meta-analysis to evaluate the risk of depression and suicidality among diabetic patients. Methods: Medline, PubMed, EMBASE, Cochrane library, and Psych INFO were searched for studies published from 2008 onwards. Meta-analysis was conducted to estimate the pooled effect size. Sources of heterogeneity were investigated by subgroup analysis and meta-regression. Results: In total, 5750 articles were identified and of those, 17 studies on suicidality and 36 on depression were included in this study. Our analysis suggests a positive relationship between diabetes and depression (cohort studies odds ratio (OR) 1.49, 95% confidence interval (CI): 1.36–1.64 and cross-sectional studies OR 2.04, 95% CI, 1.73–2.42). Pooled OR values for suicidal ideation, attempted suicide, and completed suicide were 1.89 (95% CI: 1.36–2.63), 1.45 (95% CI: 1.07–1.96), and 1.85 (95% CI: 0.97–3.52), respectively. All findings were statistically significant except for completed suicide. Conclusions: The increased risk of depression and suicidality in diabetic patients highlights the importance of integrating the evaluation and treatment of depression with diabetes management in primary healthcare settings. Further research in this area is needed. Full article

(This article belongs to the Special Issue Treatment of Bipolar Depression)

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14 pages, 2534 KiB

Open AccessArticle

Androgen Receptor Splice Variant 7 Drives the Growth of Castration Resistant Prostate Cancer without Being Involved in the Efficacy of Taxane Chemotherapy

by Yasuomi Shimizu, Satoshi Tamada, Minoru Kato, Yukiyoshi Hirayama, Yuji Takeyama, Taro Iguchi, Marianne D. Sadar and Tatsuya Nakatani

J. Clin. Med. 2018, 7(11), 444; https://doi.org/10.3390/jcm7110444 - 16 Nov 2018

Cited by 17 | Viewed by 5298

Abstract

Expression of androgen receptor (AR) splice variant 7 (AR-V7) has been identified as the mechanism associated with the development of castration-resistant prostate cancer (CRPC). However, a potential link between AR-V7 expression and resistance to taxanes, such as docetaxel or cabazitaxel, has not been [...] Read more.

Expression of androgen receptor (AR) splice variant 7 (AR-V7) has been identified as the mechanism associated with the development of castration-resistant prostate cancer (CRPC). However, a potential link between AR-V7 expression and resistance to taxanes, such as docetaxel or cabazitaxel, has not been unequivocally demonstrated. To address this, we used LNCaP95-DR cells, which express AR-V7 and exhibit resistance to enzalutamide and docetaxel. Interestingly, LNCaP95-DR cells showed cross-resistance to cabazitaxel. Furthermore, these cells had increased levels of P-glycoprotein (P-gp) and their sensitivity to both docetaxel and cabazitaxel was restored through treatment with tariquidar, a P-gp antagonist. Results generated demonstrated that P-gp mediated cross-resistance between docetaxel and cabazitaxel. Although the LNCaP95-DR cells had increased expression of AR-V7 and its target genes (UBE2C, CDC20), the knockdown of AR-V7 did not restore sensitivity to docetaxel or cabazitaxel. However, despite resistance to docetaxel and carbazitaxel, EPI-002, an antagonist of the AR amino-terminal domain (NTD), had an inhibitory effect on the proliferation of LNCaP95-DR cells, which was similar to that achieved with the parental LNCaP95 cells. On the other hand, enzalutamide had no effect on the proliferation of either cell line. In conclusion, our results suggested that EPI-002 may be an option for the treatment of AR-V7-driven CRPC, which is resistant to taxanes. Full article

(This article belongs to the Special Issue Cytobiology of Human Prostate Cancer Cells and Its Clinical Applications)

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7 pages, 1169 KiB

Open AccessCase Report

First Case of Human Primary Vertebral Cystic Echinococcosis Due to Echinococcus Ortleppi

by Louise Basmaciyan, Bénédicte Burlet, Selim Ramla, Mathieu Blot, Sophie Mahy, Marie-Hélène Aubriot-Lorton, Stéphane Valot, Mickael Grelat, Marc Sautour, Frederic Grenouillet, Jenny Knapp, Laurence Millon, Lionel Piroth, Laurent Martin and Frederic Dalle

J. Clin. Med. 2018, 7(11), 443; https://doi.org/10.3390/jcm7110443 - 15 Nov 2018

Cited by 8 | Viewed by 3277

Abstract

Cystic echinococcosis (CE) is a cosmopolitan parasitic zoonosis affecting more than one million people worldwide. In humans, primary bone CE is rare and involvement of E. ortleppi is very uncommon. We report here the first case of primary vertebral cystic echinococcosis due to [...] Read more.

Cystic echinococcosis (CE) is a cosmopolitan parasitic zoonosis affecting more than one million people worldwide. In humans, primary bone CE is rare and involvement of E. ortleppi is very uncommon. We report here the first case of primary vertebral cystic echinococcosis due to E. ortleppi in Burgundy, France. Full article

(This article belongs to the Section Infectious Diseases)

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11 pages, 1021 KiB

Open AccessArticle

Cangrelor Induces More Potent Platelet Inhibition without Increasing Bleeding in Resuscitated Patients

by Florian Prüller, Lukasz Bis, Oliver Leopold Milke, Friedrich Fruhwald, Sascha Pätzold, Siegfried Altmanninger-Sock, Jolanta M. Siller-Matula, Friederike Von Lewinski, Klemens Ablasser, Michael Sacherer and Dirk Von Lewinski

J. Clin. Med. 2018, 7(11), 442; https://doi.org/10.3390/jcm7110442 - 15 Nov 2018

Cited by 19 | Viewed by 3466

Abstract

Dual antiplatelet therapy is the standard of care for patients with myocardial infarction (MI), who have been resuscitated and treated with therapeutic hypothermia (TH). We compare the antiplatelet effect and bleeding risk of intravenous cangrelor to oral P2Y12-inhibitors in patients with MI receiving [...] Read more.

Dual antiplatelet therapy is the standard of care for patients with myocardial infarction (MI), who have been resuscitated and treated with therapeutic hypothermia (TH). We compare the antiplatelet effect and bleeding risk of intravenous cangrelor to oral P2Y12-inhibitors in patients with MI receiving TH in a prospective comparison of two matched patient cohorts. Twenty-five patients within the CANGRELOR cohort were compared to 17 patients receiving oral P2Y12-inhibitors. CANGRELOR group (NCT03445546) and the ORAL P2Y12 Group (NCT02914795) were registered at clinicaltrials.gov. Platelet function testing was performed using light-transmittance aggregometry and monitored for 4 days. P2Y12-inhibition was stronger in CANGRELOR compared to ORAL P2Y12 (adenosine diphosphate (ADP) (area under the curve (AUC)) 26.0 (5.9–71.6) vs. 160.9 (47.1–193.7)) at day 1. This difference decreased over the following days as more patients were switched from CANGRELOR to oral P2Y12-inhibitor treatment. There was no difference in the effect of aspirin between the two groups. We did not observe significant differences with respect to thrombolysis in myocardial infarction (TIMI) or Bleeding Academic Research Consortium (BARC) classified bleedings, number of blood transfusions or drop in haemoglobin B (Hb) or hematocrit (Hct) over time. Cangrelor treatment is not only feasible and effective in resuscitated patients, but also inhibited platelet function more effectively than orally administered P2Y12-inhibitors without an increased event rate for bleeding. Full article

(This article belongs to the Section Hematology)

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13 pages, 1957 KiB

Open AccessReview

Accuracy of Commonly-Used Imaging Modalities in Assessing Left Atrial Appendage for Interventional Closure: Review Article

by Ramez Morcos, Haider Al Taii, Priya Bansal, Joel Casale, Rupesh Manam, Vikram Patel, Anthony Cioci, Michael Kucharik, Arjun Malhotra and Brijeshwar Maini

J. Clin. Med. 2018, 7(11), 441; https://doi.org/10.3390/jcm7110441 - 14 Nov 2018

Cited by 7 | Viewed by 3880

Abstract

Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it [...] Read more.

Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion. Institutional Review Board (IRB) approval was waived as we only reviewed published data. By utilizing PUBMED which is an integrated online website to list the published literature based on its relevance, we retrieved thirty-two articles on the accuracy of most commonly used imaging modalities for pre-procedural assessment of the left atrial appendage morphology, namely, two-dimensional transesophageal echocardiography, three-dimensional transesophageal echocardiography, computed tomography, and three-dimensional printing. There is strong evidence that real-time three-dimensional transesophageal echocardiography is more accurate than two-dimensional transesophageal echocardiography. Three-dimensional computed tomography has recently emerged as an imaging modality and it showed exceptional accuracy when merged with three-dimensional printing technology. However, real time three-dimensional transesophageal echocardiography may be considered the preferred imaging modality as it can provide accurate measurements without requiring radiation exposure or contrast administration. We will present the most common imaging modality used for LAA assessment and will provide an algorithmic approach including preprocedural, periprocedural, intraprocedural, and postprocedural. Full article

(This article belongs to the Special Issue New Technologies for the Treatment of Coronary and Structural Heart Diseases)

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15 pages, 4322 KiB

Open AccessArticle

An Antithrombotic Strategy by Targeting Phospholipase D in Human Platelets

by Wan Jung Lu, Chi Li Chung, Ray Jade Chen, Li Ting Huang, Li Ming Lien, Chao Chien Chang, Kuan Hung Lin and Joen Rong Sheu

J. Clin. Med. 2018, 7(11), 440; https://doi.org/10.3390/jcm7110440 - 14 Nov 2018

Cited by 7 | Viewed by 3624

Abstract

Phospholipase D (PLD) is involved in many biological processes. PLD1 plays a crucial role in regulating the platelet activity of mice; however, the role of PLD in the platelet activation of humans remains unclear. Therefore, we investigated whether PLD is involved in the [...] Read more.

Phospholipase D (PLD) is involved in many biological processes. PLD1 plays a crucial role in regulating the platelet activity of mice; however, the role of PLD in the platelet activation of humans remains unclear. Therefore, we investigated whether PLD is involved in the platelet activation of humans. Our data revealed that inhibition of PLD1 or PLD2 using pharmacological inhibitors effectively inhibits platelet aggregation in humans. However, previous studies have showed that PLD1 or PLD2 deletion did not affect mouse platelet aggregation in vitro, whereas only PLD1 deletion inhibited thrombus formation in vivo. Intriguingly, our data also showed that the pharmacological inhibition of PLD1 or PLD2 does not affect mouse platelet aggregation in vitro, whereas the inhibition of only PLD1 delayed thrombus formation in vivo. These findings indicate that PLD may play differential roles in humans and mice. In humans, PLD inhibition attenuates platelet activation, adhesion, spreading, and clot retraction. For the first time, we demonstrated that PLD1 and PLD2 are essential for platelet activation in humans, and PLD plays different roles in platelet function in humans and mice. Our findings also indicate that targeting PLD may provide a safe and alternative therapeutic approach for preventing thromboembolic disorders. Full article

(This article belongs to the Section Vascular Medicine)

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12 pages, 3741 KiB

Open AccessArticle

Non-Hepatic Alkaline Phosphatase, hs-CRP and Progression of Vertebral Fracture in Patients with Rheumatoid Arthritis: A Population-Based Longitudinal Study

by Jih-Chen Yeh, Chang-Chin Wu, Cheuk-Sing Choy, Shu-Wei Chang, Jian-Chiun Liou, Kuo-Shu Chen, Tao-Hsin Tung, Wei-Ning Lin, Chih-Yu Hsieh, Chun-Ta Ho, Ting-Ming Wang and Jia-Feng Chang

J. Clin. Med. 2018, 7(11), 439; https://doi.org/10.3390/jcm7110439 - 13 Nov 2018

Cited by 12 | Viewed by 3495

Abstract

Background: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could [...] Read more.

Background: Interactions and early warning effects of non-hepatic alkaline phosphatase (NHALP) and high-sensitivity C-reactive protein (hs-CRP) on the progression of vertebral fractures (VFs) in patients with rheumatoid arthritis (RA) remain unclear. We aim to explore whether serum concentrations of NHALP and hs-CRP could serve as a promising dual biomarker for prognostic assessment of VF progression. Methods: Unadjusted and adjusted hazard ratios (aHRs) of VF progression were calculated for different categories of serum NHALP and hs-CRP using the Cox regression model in RA patients. The modification effect between serum NHALP and hs-CRP on VF progression was determined using an interaction product term. Results: During 4489 person-years of follow-up, higher NHALP (>125 U/L) and hs-CRP (>3.0 mg/L) were robustly associated with incremental risks of VF progression in RA patients (aHR: 2.2 (95% confidence intervals (CIs): 1.2–3.9) and 2.0 (95% CI: 1.3–3.3) compared to the lowest HR category, respectively). The interaction between NHALP and hs-CRP on VF progression was statistically significant (p < 0.05). In the stratified analysis, patients with combined highest NHALP and hs-CRP had the greatest risk of VF progression (aHR: 4.9 (95% CI: 2.5–9.6)) compared to the lowest HR group (NHALP < 90 U/L and hs-CRP < 1 mg/L). Conclusions: In light of underdiagnoses of VFs and misleading diagnosis by single test, NHALP and hs-CRP could serve as compensatory biomarkers to predict subclinical VF progression in RA patients. Full article

(This article belongs to the Section Orthopedics)

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10 pages, 239 KiB

Open AccessArticle

Nutritional Status of Men with Ulcerative Colitis in Remission in a Pair–Matched Case–Control Study

by Dominika Głąbska, Dominika Guzek and Gustaw Lech

J. Clin. Med. 2018, 7(11), 438; https://doi.org/10.3390/jcm7110438 - 13 Nov 2018

Cited by 12 | Viewed by 2499

Abstract

The aim of the presented research was to analyze the nutritional status of male subjects with ulcerative colitis in remission by using body composition that was assessed by bioelectrical impedance measurement against a gender-matched control group. Forty-four male patients in remission with ulcerative [...] Read more.

The aim of the presented research was to analyze the nutritional status of male subjects with ulcerative colitis in remission by using body composition that was assessed by bioelectrical impedance measurement against a gender-matched control group. Forty-four male patients in remission with ulcerative colitis were recruited for the case-control study and simultaneously, a matched control group of 44 male individuals without inflammatory bowel diseases was pair-matched (general community individuals). The body composition measurement was conducted by the bioelectrical impedance method using BodyComp MF Plus and Bodygram Pro 3.0 software. Parameters assessed include body cell mass (BCM), total body water (TBW), extracellular body water (EBW), intracellular body water (IBW), fat mass (FM), fat-free mass (FFM), muscle mass (MM), and the body cell mass (BCM) index. A significant between-group difference was observed only for EBW, where subjects with ulcerative colitis were characterized by a higher mass of extracellular water (p = 0.0405). Individuals with ulcerative colitis were characterized by a lower BCM share than the control group (p = 0.0192). A comparative analysis of the body composition of male patients with ulcerative colitis with those who did not have ulcerative colitis revealed only minor differences. The risk of malnutrition, assessed using both BMI and bioelectrical impedance, in men with ulcerative colitis in remission is the same as in healthy males in the matched general population. Full article

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

12 pages, 1353 KiB

Open AccessArticle

Serum Renalase Levels Are Predicted by Brain-Derived Neurotrophic Factor and Associated with Cardiovascular Events and Mortality after Percutaneous Coronary Intervention

by I-Te Lee and Wayne Huey-Herng Sheu

J. Clin. Med. 2018, 7(11), 437; https://doi.org/10.3390/jcm7110437 - 12 Nov 2018

Cited by 9 | Viewed by 3436

Abstract

Circulating brain-derived neurotrophic factor (BDNF) predicts survival rate in patients with coronary artery disease (CAD). We examined the relationship between BDNF and renalase before and after percutaneous coronary intervention (PCI) and the role of renalase in patients with CAD. Serum BDNF and renalase [...] Read more.

Circulating brain-derived neurotrophic factor (BDNF) predicts survival rate in patients with coronary artery disease (CAD). We examined the relationship between BDNF and renalase before and after percutaneous coronary intervention (PCI) and the role of renalase in patients with CAD. Serum BDNF and renalase levels were determined using blood samples collected before and after PCI. Incident myocardial infarction, stroke, and mortality were followed up longitudinally. A total of 152 patients completed the assessment. BDNF levels were not significantly changed after PCI compared to baseline levels (24.7 ± 11.0 vs. 23.5 ± 8.3 ng/mL, p = 0.175), although renalase levels were significantly reduced (47.5 ± 17.3 vs. 35.9 ± 11.3 ng/mL, p < 0.001). BDNF level before PCI was an independent predictor of reduction in renalase (95% confidence interval (CI): −1.371 to −0.319). During a median 4.1 years of follow-up, patients with serum renalase levels of ≥35 ng/mL had a higher risk of myocardial infarction, stroke, and death than those with renalase of <35 ng/mL (hazard ratio = 5.636, 95% CI: 1.444–21.998). In conclusion, our results show that serum BDNF levels before PCI were inversely correlated with the percentage change in renalase levels after PCI. Nevertheless, post-PCI renalase level was a strong predictor for myocardial infarction, stroke, and death. Full article

(This article belongs to the Special Issue Antithrombotic Treatment after Percutaneous Coronary or Aortic Valve Interventions)

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17 pages, 2125 KiB

Open AccessReview

Risk Stratification of Sudden Cardiac Death in Patients with Heart Failure: An update

by Daniele Masarone, Giuseppe Limongelli, Ernesto Ammendola, Marina Verrengia, Rita Gravino and Giuseppe Pacileo

J. Clin. Med. 2018, 7(11), 436; https://doi.org/10.3390/jcm7110436 - 10 Nov 2018

Cited by 25 | Viewed by 5368

Abstract

Heart failure (HF) is a complex clinical syndrome in which structural/functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, [...] Read more.

Heart failure (HF) is a complex clinical syndrome in which structural/functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, with most being either sudden cardiac death (SCD) or death caused by progressive pump failure. Risk stratification of SCD in patients with HF and preserved (HFpEF) or reduced ejection fraction (HFrEF) represents a clinical challenge. This review will give an update of current strategies for SCD risk stratification in both HFrEF and HFpEF. Full article

(This article belongs to the Section Cardiology)

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9 pages, 467 KiB

Open AccessArticle

Diagnostic Performance of Initial Serum Albumin Level for Predicting In-Hospital Mortality among Necrotizing Fasciitis Patients

by Chia-Peng Chang, Wen-Chih Fann, Shu-Ruei Wu, Chun-Nan Lin, I-Chuan Chen and Cheng-Ting Hsiao

J. Clin. Med. 2018, 7(11), 435; https://doi.org/10.3390/jcm7110435 - 10 Nov 2018

Cited by 12 | Viewed by 3378

Abstract

Background: Hypoalbuminemia is known to be associated with adverse outcomes in critical illness. In this study, we attempted to identify whether hypoalbuminemia on emergency department (ED) arrival is a reliable predictor for in-hospital mortality in necrotizing fasciitis (NF). patients. Method: A [...] Read more.

Background: Hypoalbuminemia is known to be associated with adverse outcomes in critical illness. In this study, we attempted to identify whether hypoalbuminemia on emergency department (ED) arrival is a reliable predictor for in-hospital mortality in necrotizing fasciitis (NF). patients. Method: A retrospective cohort study of hospitalized adult patients with NF was conducted in a tertiary teaching hospital in Taiwan between March 2010 and March 2018. Blood samples were collected in the ED upon arrival, and serum albumin levels were determined. We evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. All collected data were statistically analyzed. Result: Of the 707 NF patients, 40 (5.66%) died in the hospital. The mean serum albumin level was 3.1 ± 0.9 g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (2.8 ± 0.7 g/dL vs. 3.5 ± 0.8 g/dL). In the multivariable logistic regression model, albumin was significantly associated with in-hospital mortality (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.88–0.96, p < 0.001). The area under-the-receiver-operating-characteristic curve (AUC) for in-hospital survival was 0.77 (95% CI 0.72–0.82) and corresponding sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 66%, 74%, 33%, 88%, 2.25, and 0.48, respectively. High sensitivity (96%) for survival was shown at albumin level of 4.0 g/dL and high specificity (91%) for mortality was shown at a level of 2.5 g/dL. Conclusion: Initial serum albumin levels strongly predicted in-hospital mortality among patients with necrotizing fasciitis. NF patients with hypoalbuminemia on ED arrival should be closely monitored for signs of deterioration and early and aggressive intervention should be considered to prevent mortality. Full article

(This article belongs to the Special Issue Advanced Analytical Methods in Clinical Diagnosis and Therapy)

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14 pages, 1426 KiB

Open AccessReview

Aromatherapy for Managing Pain in Primary Dysmenorrhea: A Systematic Review of Randomized Placebo-Controlled Trials

by Myeong Soo Lee, Hye Won Lee, Mohamed Khalil, Hyun Suk Lim and Hyun-Ja Lim

J. Clin. Med. 2018, 7(11), 434; https://doi.org/10.3390/jcm7110434 - 10 Nov 2018

Cited by 27 | Viewed by 11701

Abstract

Aromatherapy, the therapeutic use of essential oils, is often used to reduce pain in primary dysmenorrhea. Eleven databases, including four English (PubMed, AMED, EMBASE, and the Cochrane Library) and seven Korean medical databases, were searched from inception through August 2018 without restrictions on [...] Read more.

Aromatherapy, the therapeutic use of essential oils, is often used to reduce pain in primary dysmenorrhea. Eleven databases, including four English (PubMed, AMED, EMBASE, and the Cochrane Library) and seven Korean medical databases, were searched from inception through August 2018 without restrictions on publication language. Randomized controlled trials (RCTs) testing aromatherapy for pain reduction in primary dysmenorrhea were considered. Data extraction and risk-of-bias assessments were performed by two independent reviewers. All of the trials reported superior effects of aromatherapy for pain reduction compared to placebo (n = 1787, standard mean difference (SMD): −0.91, 95% CI: −1.17 to −0.64, p < 0.00001) with high heterogeneity (I² = 88%). A sub-analysis for inhalational aromatherapy for the alleviation of pain also showed superior effects compared to placebo (n = 704, SMD: −1.02, 95% CI: −1.59 to −0.44, p = 0.0001, I² = 95%). With regard to aromatherapy massage, the pooled results of 11 studies showed favorable effects of aromatherapy massage on pain reduction compared to placebo aromatherapy massage (n = 793, SMD: −0.87, 95% CI: −1.14 to −0.60, p < 0.00001, I² = 70%). Oral aromatherapy had superior effects compared to placebo (n = 290, SMD: −0.61, 95% CI: −0.91 to −0.30, p < 0.0001, I² = 0%). In conclusion, our systemic review provides a moderate level of evidence on the superiority of aromatherapy (inhalational, massage, or oral use) for pain reduction over placebo in primary dysmenorrhea. Full article

(This article belongs to the Section Anesthesiology)

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J. Clin. Med., Volume 7, Issue 11 (November 2018) – 86 articles

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