Journal of Clinical Medicine

10 pages, 2713 KiB

Open AccessReview

Percutaneous Left Main Coronary Intervention: A Review of Plaque Modification in Left Main Percutaneous Coronary Intervention

by Chirag A. Shah and Steven E. Pfau

J. Clin. Med. 2018, 7(7), 180; https://doi.org/10.3390/jcm7070180 - 23 Jul 2018

Cited by 6 | Viewed by 4661

Abstract

Left main coronary artery (LMCA) stenosis has long been recognized as a marker of increased morbidity and mortality. Current treatment algorithms for LMCA stenosis consider both percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary bypass surgery, each with advantages based [...] Read more.

Left main coronary artery (LMCA) stenosis has long been recognized as a marker of increased morbidity and mortality. Current treatment algorithms for LMCA stenosis consider both percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary bypass surgery, each with advantages based on individual patient characteristics. Since the LMCA is the largest artery in the coronary tree, plaque volume and calcification is greater than other coronary segments and often extends to the distal bifurcation segment. In LMCA bifurcation lesions, larger minimal stent area is strongly associated with better outcome in the DES era. Plaque modification strategies such as rotational, orbital, or laser atherectomy are effective mechanisms to reduce plaque volume and alter compliance, facilitating stent delivery and stent expansion. We present a case of a calcified, medina class 1,1,1 LMCA lesion where intravascular ultrasound (IVUS) and orbital atherectomy were employed for optimal results. In this context, we review the evidence of plaque modification devices and the rationale for their use in unprotected left main PCI. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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15 pages, 656 KiB

Open AccessArticle

Investigation on the Use of Traditional Chinese Medicine for Polycystic Ovary Syndrome in a Nationwide Prescription Database in Taiwan

by Wan-Ting Liao, Jen-Huai Chiang, Chia-Jung Li, Ming-Tsung Lee, Cheng-Chiung Su and Hung-Rong Yen

J. Clin. Med. 2018, 7(7), 179; https://doi.org/10.3390/jcm7070179 - 22 Jul 2018

Cited by 24 | Viewed by 8829

Abstract

Polycystic ovary syndrome (PCOS) is a common condition, affecting 5–10% of women of reproductive age worldwide. It has serious reproductive implications and causes mood disorders and metabolic disorders, such as type-2 diabetes. Because PCOS reflects multiple abnormalities, there is no single drug that [...] Read more.

Polycystic ovary syndrome (PCOS) is a common condition, affecting 5–10% of women of reproductive age worldwide. It has serious reproductive implications and causes mood disorders and metabolic disorders, such as type-2 diabetes. Because PCOS reflects multiple abnormalities, there is no single drug that can treat all its symptoms. Existing pharmaceutical agents, such as oral contraceptives (OCs), are suggested as a first-line therapy for menstrual irregularities; however, OCs are not appropriate for women pursuing pregnancy. Additionally, insulin-sensitizing agents, which appear to decrease insulin levels and hyperandrogenemia in women with PCOS, have been associated with a high incidence of gastrointestinal adverse effects. It is a common practice in Chinese society to receive traditional Chinese medicine (TCM) for treatment of gynecological problems and infertility. Current research demonstrates that several herbs and herbal formulas show beneficial effects in PCOS treatment. In this study, we conducted the first large-scale survey through the Taiwan National Health Insurance Program database to analyze TCM utilization patterns among women with PCOS in Taiwan during 1997–2010. The survey results revealed that 89.22% women with newly diagnosed PCOS had received TCM therapy. Jia-Wei-Xiao-Yao-San and Xiang-Fu (Rhizoma Cyperi) were the most commonly used formula and single herb, respectively, in the database. In addition, we found that the top five commonly prescribed single herbs and herbal formulas have shown promise in treating symptoms associated with PCOS. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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8 pages, 210 KiB

Open AccessArticle

The Nutrition Knowledge of Croatian General Practitioners

by Albina Dumic, Maja Miskulin, Nika Pavlovic, Zelimir Orkic, Vesna Bilic-Kirin and Ivan Miskulin

J. Clin. Med. 2018, 7(7), 178; https://doi.org/10.3390/jcm7070178 - 19 Jul 2018

Cited by 15 | Viewed by 3358

Abstract

Nutrition care delivered in primary health care setting is an effective and necessary preventive health care measure. General practitioners (GPs) nutrition knowledge is related to their nutrition care practice. The aim of this study was to explore the nutrition knowledge of Croatian GPs, [...] Read more.

Nutrition care delivered in primary health care setting is an effective and necessary preventive health care measure. General practitioners (GPs) nutrition knowledge is related to their nutrition care practice. The aim of this study was to explore the nutrition knowledge of Croatian GPs, and to investigate its connection with the implementation of nutrition care in GPs’ offices. A cross-sectional study was conducted among 17.0% of randomly selected GPs, from May to July 2013, via an anonymous questionnaire. The study showed that only 35.8% of the Croatian GPs had an adequate level of nutrition knowledge (five or more correct answers to nutrition questions). The study further revealed that females, GPs with additional education in nutrition and GPs who had not suffered from chronic diseases with poor nutrition posing as a risk factor had better nutrition knowledge (p = 0.029, p < 0.001 and p = 0.041, respectively). The Spearman rank correlation between GPs’ nutrition knowledge and the implementation of nutrition care in their offices during daily work with patients was r_s = −0.190 (p < 0.001). To provide nutrition care in GPs’ offices in Croatia, strategies for improving GPs’ nutrition knowledge are needed. Full article

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

9 pages, 678 KiB

Open AccessArticle

Interference with Processing Negative Stimuli in Problematic Internet Users: Preliminary Evidence from an Emotional Stroop Task

by Adriano Schimmenti, Vladan Starcevic, Alessia M. Gervasi, Jory Deleuze and Joël Billieux

J. Clin. Med. 2018, 7(7), 177; https://doi.org/10.3390/jcm7070177 - 18 Jul 2018

Cited by 16 | Viewed by 4944

Abstract

Although it has been proposed that problematic Internet use (PIU) may represent a dysfunctional coping strategy in response to negative emotional states, there is a lack of experimental studies that directly test how individuals with PIU process emotional stimuli. In this study, we [...] Read more.

Although it has been proposed that problematic Internet use (PIU) may represent a dysfunctional coping strategy in response to negative emotional states, there is a lack of experimental studies that directly test how individuals with PIU process emotional stimuli. In this study, we used an emotional Stroop task to examine the implicit bias toward positive and negative words in a sample of 100 individuals (54 females) who also completed questionnaires assessing PIU and current affect states. A significant interaction was observed between PIU and emotional Stroop effects (ESEs), with participants who displayed prominent PIU symptoms showing higher ESEs for negative words compared to other participants. No significant differences were found on the ESEs for positive words among participants. These findings suggest that PIU may be linked to a specific emotional interference with processing negative stimuli, thus supporting the view that PIU is a dysfunctional strategy to cope with negative affect. A potential treatment implication for individuals with PIU includes a need to enhance the capacity to process and regulate negative feelings. Full article

(This article belongs to the Section Mental Health)

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6 pages, 1456 KiB

Open AccessCase Report

Septic Pulmonary Emboli or Pulmonary Metastasis in a Patient with Diabetes Mellitus?

by Meng-Yu Wu, Ling-Chi Lee, Yu-Long Chen, Yung-Hsiang Yeh, Chia-Jung Li and Giou-Teng Yiang

J. Clin. Med. 2018, 7(7), 176; https://doi.org/10.3390/jcm7070176 - 14 Jul 2018

Cited by 3 | Viewed by 4389

Abstract

Emphysematous pyelonephritis is a rare but life-threatening infection characterized by an accumulation of gas in the renal parenchyma. A high mortality rate was reported, and timely administration of broad-spectrum antibiotics for enteric gram-negative bacilli, such as Escherichia coli, Enterobacter, and Klebsiella [...] Read more.

Emphysematous pyelonephritis is a rare but life-threatening infection characterized by an accumulation of gas in the renal parenchyma. A high mortality rate was reported, and timely administration of broad-spectrum antibiotics for enteric gram-negative bacilli, such as Escherichia coli, Enterobacter, and Klebsiella pneumoniae, was recommended for improving the clinical outcome. Computed tomography is a useful tool for identifying gas accumulation within the perirenal space. Abdominal ultrasound and abdominal plain film are alternative options with lower accuracy rates. Here, we present the case of a 49-year-old male patient who presented with acute-onset progressive abdominal cramping pain and dysuria. Diffuse bilateral opacities over the lung field and a heterogeneous mass with air density in the abdomen were found on radiological examination. Multiple septic pulmonary emboli and emphysematous pyelonephritis were diagnosed using computed tomography. After emergency percutaneous nephrostomy and administration of broad-spectrum antibiotics, the patient was discharged in a stable condition and followed up at the outpatient department. This report also describes the clinical and imaging features of emphysematous pyelonephritis and highlights that early diagnosis and timely administration of broad-spectrum antibiotics may help avoid a potentially devastating outcome. Full article

(This article belongs to the Section Pulmonology)

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12 pages, 1675 KiB

Open AccessArticle

Differential Roles of Tumor Necrosis Factor Ligand Superfamily Members as Biomarkers in Pancreatic Cancer

by Ines Pombeiro, Sven H. Loosen, Sanchari Roy, Florian Schueller, Lukas Niewenhuisen, Mark Luedde, Mihael Vucur, Frank Tacke, Marcel Binnebösel, Wenzel Schoening, Christian Trautwein, Tom Luedde, Ulf Peter Neumann and Christoph Roderburg

J. Clin. Med. 2018, 7(7), 175; https://doi.org/10.3390/jcm7070175 - 13 Jul 2018

Cited by 6 | Viewed by 3777

Abstract

The tumor necrosis factor–related weak inducer of apoptosis (TWEAK) belongs to the tumor necrosis factor ligand superfamily, which was shown to play an important role in inflammatory and malignant gastrointestinal diseases, including colitis or colorectal cancer. However, in contrast to other members of [...] Read more.

The tumor necrosis factor–related weak inducer of apoptosis (TWEAK) belongs to the tumor necrosis factor ligand superfamily, which was shown to play an important role in inflammatory and malignant gastrointestinal diseases, including colitis or colorectal cancer. However, in contrast to other members of the TNF ligand superfamily, its role as a biomarker in pancreatic cancer is currently unknown. We analyzed serum levels of A proliferation-inducing ligand (APRIL) and TWEAK in 134 patients with pancreatic cancer. Results were compared with 50 healthy controls and correlated with clinical data. Intratumoral expression of APRIL and TWEAK in pancreatic cancer was analysed using the datasets made available by the TCGA-LIHC project. APRIL serum levels were significantly elevated in patients with pancreatic cancer compared to healthy controls, which is in line with previous findings. Notably, the diagnostic accuracy of circulating APRIL levels was similar to CA19-9, an established tumor marker for pancreatic cancer. In contrast, serum concentrations of TWEAK were decreased in pancreatic cancer patients. Interestingly, no differences in TWEAK concentrations became apparent between different clinical subgroups of pancreatic cancer. Moreover, within our cohort of patients, TWEAK levels did not correlate with the patients’ prognosis and the diagnostic as well as prognostic potential of TWEAK was lower than CA 19-9, when analyzed in this setting. Finally, using data from the TCGA-LIHC project, we demonstrate that expression levels of TWEAK and APRIL represent prognostic markers for patients’ survival according to Kaplan-Meier curve analyses. TWEAK and APRIL serum concentrations are regulated differently in patients with pancreatic cancer, highlighting diverse roles of variant TNF ligands in this type of cancer. Full article

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9 pages, 1344 KiB

Open AccessArticle

Pattern of Response to Bronchial Challenge with Histamine in Patients with Non-Atopic Cough-Variant and Classic Asthma

by Vladimir Zugic, Natasa Mujovic, Sanja Hromis, Jelena Jankovic, Mirjana Drvenica, Aleksandra Perovic, Ivan Kopitovic, Aleksandra Ilic and Dejan Nikolic

J. Clin. Med. 2018, 7(7), 174; https://doi.org/10.3390/jcm7070174 - 12 Jul 2018

Cited by 3 | Viewed by 3135

Abstract

Background: The aim of this study was to establish whether non-atopic patients with cough variant asthma (CVA) have different pattern of response to direct bronchoconstrictors than non-atopic patients with classic asthma (CA). Method: A total of 170 patients of both sexes with stable [...] Read more.

Background: The aim of this study was to establish whether non-atopic patients with cough variant asthma (CVA) have different pattern of response to direct bronchoconstrictors than non-atopic patients with classic asthma (CA). Method: A total of 170 patients of both sexes with stable CVA and CA were screened for the study and 153 were included. Patients with proven atopy were not included and 17 patients with worsening of their condition or with verified bronchial obstruction during screening were excluded. All included patients performed spirometry and underwent a bronchial challenge with histamine according to long-standing protocol in our laboratory. Results: Significantly higher frequency of bronchial hyper-responsiveness (BHR) was found in patients with CA than in patients with CVA (63.9% vs. 44.9%, respectively; p < 0.05). Sensitivity was significantly lower in patients with CVA (p < 0.05), while no significant difference was found in maximal response and responsiveness. Only patients with positive challenge tests were included in the analysis. Conclusion: Adult non-atopic patients with CVA and CA have a pattern of response to non-specific bronchial stimuli similar to atopic patients with same conditions, with the exception of similar maximal response, which may reflect the efficacy of previous treatment. We believe that further studies are needed to clarify the mechanisms involved in airway response to non-specific stimuli in CVA and CA, especially in non-atopic patients. Further studies should also clarify whether this response pattern has any implications on clinical presentation or on treatment options. Full article

(This article belongs to the Section Pulmonology)

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16 pages, 1195 KiB

Open AccessArticle

Automatic Infants’ Pain Assessment by Dynamic Facial Representation: Effects of Profile View, Gestational Age, Gender, and Race

by Ruicong Zhi, Ghada Zamzmi Dmitry Zamzmi, Dmitry Goldgof, Terri Ashmeade and Yu Sun

J. Clin. Med. 2018, 7(7), 173; https://doi.org/10.3390/jcm7070173 - 11 Jul 2018

Cited by 15 | Viewed by 4679

Abstract

Infants’ early exposure to painful procedures can have negative short and long-term effects on cognitive, neurological, and brain development. However, infants cannot express their subjective pain experience, as they do not communicate in any language. Facial expression is the most specific pain indicator, [...] Read more.

Infants’ early exposure to painful procedures can have negative short and long-term effects on cognitive, neurological, and brain development. However, infants cannot express their subjective pain experience, as they do not communicate in any language. Facial expression is the most specific pain indicator, which has been effectively employed for automatic pain recognition. In this paper, dynamic pain facial expression representation and fusion scheme for automatic pain assessment in infants is proposed by combining temporal appearance facial features and temporal geometric facial features. We investigate the effects of various factors that influence pain reactivity in infants, such as individual variables of gestational age, gender, and race. Different automatic infant pain assessment models are constructed, depending on influence factors as well as facial profile view, which affect the model ability of pain recognition. It can be concluded that the profile-based infant pain assessment is feasible, as its performance is almost as good as that of the whole face. Moreover, gestational age is the most influencing factor for pain assessment, and it is necessary to construct specific models depending on it. This is mainly because of a lack of behavioral communication ability in infants with low gestational age, due to limited neurological development. To our best knowledge, this is the first study investigating infants’ pain recognition, highlighting profile facial views and various individual variables. Full article

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

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15 pages, 1438 KiB

Open AccessArticle

Tumor B7-H3 (CD276) Expression and Survival in Pancreatic Cancer

by Kentaro Inamura, Yutaka Takazawa, Yosuke Inoue, Yusuke Yokouchi, Maki Kobayashi, Akio Saiura, Tomoko Shibutani and Yuichi Ishikawa

J. Clin. Med. 2018, 7(7), 172; https://doi.org/10.3390/jcm7070172 - 10 Jul 2018

Cited by 49 | Viewed by 5168

Abstract

B7-H3 (CD276), a member of the family of immune modulators, orchestrates antitumor immunity. To date, only small-sized studies have examined the association of B7-H3 expression with survival in pancreatic cancer, yielding inconclusive results. We evaluated tumor B7-H3 expression in 150 consecutive patients with [...] Read more.

B7-H3 (CD276), a member of the family of immune modulators, orchestrates antitumor immunity. To date, only small-sized studies have examined the association of B7-H3 expression with survival in pancreatic cancer, yielding inconclusive results. We evaluated tumor B7-H3 expression in 150 consecutive patients with pancreatic ductal adenocarcinoma using immunohistochemistry. B7-H3 expression was positive (≥10% tumor cells) in 99 of 150 (66%) cases of pancreatic cancer. We classified the tumors into four groups depending on B7-H3 expression (negative, low, intermediate, and high) and found that higher B7-H3 expression was independently associated with lower disease-free survival (DFS; for high vs. negative B7-H3 expression: multivariable hazard ratio (HR) = 3.12; 95% confidence interval (CI) = 1.48–6.15; P_trend = 0.0026). Furthermore, the association of B7-H3 expression with survival differed according to the pathological stage (p-stage) (P_interaction = 0.048, between p-stages I–II and III–IV). The association of B7-H3 positivity with lower DFS was stronger in tumors with p-stage I–II (multivariable HR = 3.10, 95% CI = 1.75–5.69; P < 0.0001) than in those with p-stage III–IV (multivariable HR = 1.20, 95% CI = 0.67–2.28; P = 0.55). We demonstrated that tumor high B7-H3 expression is independently associated with poor survival in patients with pancreatic cancer and that this association is stronger in tumors with p-stage I–II than in those with p-stage III–IV. B7-H3 expression may be a useful prognostic biomarker for identifying aggressive early-stage pancreatic cancer. Full article

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8 pages, 747 KiB

Open AccessArticle

Association between Urinary Calcium Excretion and Estimated Glomerular Filtration Rate Decline in Patients with Type 2 Diabetes Mellitus: A Retrospective Single-center Observational Study

by Hodaka Yamada, Shunsuke Funazaki, Daisuke Suzuki, Rika Saikawa, Masashi Yoshida, Masafumi Kakei, San-e Ishikawa, Yoshiyuki Morisita and Kazuo Hara

J. Clin. Med. 2018, 7(7), 171; https://doi.org/10.3390/jcm7070171 - 10 Jul 2018

Cited by 5 | Viewed by 2817

Abstract

Urinary calcium excretion is not known to predict progression of renal dysfunction in patients with type 2 diabetes mellitus. This study aimed to investigate associations between urinary calcium excretion and progression of estimated glomerular filtration rate (eGFR) in type 2 diabetic patients. This [...] Read more.

Urinary calcium excretion is not known to predict progression of renal dysfunction in patients with type 2 diabetes mellitus. This study aimed to investigate associations between urinary calcium excretion and progression of estimated glomerular filtration rate (eGFR) in type 2 diabetic patients. This study was a retrospective, single-center, observational cohort study. We enrolled a total of 89 patients with type 2 diabetes mellitus and the average follow-up period was 7.2 ± 1.0 years. We divided patients into two groups based on the median of annual decline in the slope of eGFR, then defined the over-median population as the progressed group and under-median population as the non-progressed group. Median of annual decline in the slope of eGFR was −1.1 mL/min/1.73 m²/year. Correlation coefficient analysis showed positive correlation of urinary calcium excretion with eGFR (r = 0.39, p < 0.001). Multivariate logistic analysis showed that baseline eGFR and urinary calcium excretion were independent variables for progression of eGFR decline. Urinary calcium excretion could be a useful metabolic parameter for predicting decline in slope of eGFR in patients with type 2 diabetes mellitus. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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15 pages, 437 KiB

Open AccessReview

Endothelial Cell Aging: How miRNAs Contribute?

by Munekazu Yamakuchi and Teruto Hashiguchi

J. Clin. Med. 2018, 7(7), 170; https://doi.org/10.3390/jcm7070170 - 10 Jul 2018

Cited by 22 | Viewed by 5847

Abstract

Endothelial cells (ECs) form monolayers and line the interior surfaces of blood vessels in the entire body. In most mammalian systems, the capacity of endothelial cells to divide is limited and endothelial cells are prone to be senescent. Aging of ECs and resultant [...] Read more.

Endothelial cells (ECs) form monolayers and line the interior surfaces of blood vessels in the entire body. In most mammalian systems, the capacity of endothelial cells to divide is limited and endothelial cells are prone to be senescent. Aging of ECs and resultant endothelial dysfunction lead to a variety of vascular diseases such as atherosclerosis, diabetes mellites, hypertension, and ischemic injury. However, the mechanism by which ECs get old and become senescent and the impact of endothelial senescence on the vascular function are not fully understood. Recent research has unveiled the crucial roles of miRNAs, which are small non-coding RNAs, in regulating endothelial cellular functions, including nitric oxide production, vascular inflammation, and anti-thromboformation. In this review, how senescent-related miRNAs are involved in controlling the functions of ECs will be discussed. Full article

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12 pages, 4976 KiB

Open AccessArticle

Physical Frailty and Amyloid-β Deposits in the Brains of Older Adults with Cognitive Frailty

by Dong Hyun Yoon, Jun-Young Lee, Seong A Shin, Yu Kyeong Kim and Wook Song

J. Clin. Med. 2018, 7(7), 169; https://doi.org/10.3390/jcm7070169 - 09 Jul 2018

Cited by 22 | Viewed by 3864

Abstract

Background: Cognitive frailty and impairment are phenotypically and pathophysiologically correlated with physical frailty. We examined associations between accumulation of amyloid-β in the brain as a brain imaging biomarker and phenotypes of physical frailty (weight loss, weakness, exhaustion, slowness, low physical activity) in older [...] Read more.

Background: Cognitive frailty and impairment are phenotypically and pathophysiologically correlated with physical frailty. We examined associations between accumulation of amyloid-β in the brain as a brain imaging biomarker and phenotypes of physical frailty (weight loss, weakness, exhaustion, slowness, low physical activity) in older adults with mild cognitive impairment (MCI) and cognitive frailty. Methods: Cross-sectional associations between brain amyloid-β accumulation measured with ¹¹C-Pittsburgh compound B (PiB)-positron emission tomography (PET) and physical frailty were examined in 48 elderly participants (mean age: 75.1 ± 6.6 years; 73% female). Cortical and regional standard uptake value ratios (SUVRs) were obtained. Main outcome measures included frailty phenotypes and physical functions (gait speed, short physical performance battery, and Timed Up and Go tests). Results: Mean cortical region of interest and regional SUVRs (frontal cortex, temporal cortex, parietal cortex, precuneus/posterior cingulate cortex (PC/PCC), hippocampus, basal ganglia, and global SUVR) were associated with gait speed, Timed Up and Go, and short physical performance battery (PC/PCC, basal ganglia). In addition, SUVRs of all brain regions were significantly linked to weakness. Conclusion: SUVRs of all brain regions revealed an association between brain amyloid-β accumulation and weakness. Furthermore, global SUVRs (frontal cortex, temporal cortex, parietal cortex, PC/PCC, hippocampus, basal ganglia) were associated with gait parameters. Full article

(This article belongs to the Special Issue Mild Cognitive Impairment)

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9 pages, 392 KiB

Open AccessArticle

A Survey on the Knowledge and Attitudes of Italian Medical Students toward Body Donation: Ethical and Scientific Considerations

by Rosagemma Ciliberti, Matteo Gulino, Valentina Gazzaniga, Fabio Gallo, Valerio Gaetano Vellone, Francesco De Stefano, Pierluigi Santi and Ilaria Baldelli

J. Clin. Med. 2018, 7(7), 168; https://doi.org/10.3390/jcm7070168 - 09 Jul 2018

Cited by 27 | Viewed by 4026

Abstract

Post mortem body donation (PMBD) for medical training and research plays a key role in medical-surgical education. The aim of this study is to evaluate Italian medical students’ awareness and attitudes regarding this practice. A questionnaire was sent to 1781 Italian medical students [...] Read more.

Post mortem body donation (PMBD) for medical training and research plays a key role in medical-surgical education. The aim of this study is to evaluate Italian medical students’ awareness and attitudes regarding this practice. A questionnaire was sent to 1781 Italian medical students (MS). A total of 472 MS responded: 406 (92.91%) had a strongly positive attitude to PMBD, while 31 (7.09%) were not in favor. The majority of subjects were Catholic (56.36%), while 185 and 21 subjects, said that they did not hold any religious beliefs, or were of other religions, respectively. Multivariate analysis showed significant associations (p-values < 0.05) between PMBD and religion, as well as perceptions of PMBD as an act of altruism, a tool for learning surgical practices, body mutilation, and an act contrary to faith. Although Italian MS believed cadaver dissection to be an important part of their education, they did not know much about it and had not received training on this altruistic choice. As future doctors, MS can play an important role in raising public awareness of the importance of PMBD for medical education and research. Specific educational programs to improve knowledge of this topic among MS are needed. Full article

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

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9 pages, 448 KiB

Open AccessArticle

Effect of Squat Exercises on Lung Function in Elderly Women with Sarcopenia

by Yun Kyung Jeon, Myung Jun Shin, Cheol Min Kim, Byeong-Ju Lee, Sang Hun Kim, Da Som Chae, Jong-Hwan Park, Yong Seok So, Hyuntae Park, Chang Hyung Lee, Byoung Chul Kim, Jae Hyeok Chang, Yong Beom Shin and In Joo Kim

J. Clin. Med. 2018, 7(7), 167; https://doi.org/10.3390/jcm7070167 - 05 Jul 2018

Cited by 17 | Viewed by 5014

Abstract

We explored whether a mechanically-assisted squat exercise improved muscle mass, muscle function, and pulmonary function in elderly women with or without sarcopenia. In total, 76 community-dwelling elderly subjects (>60 years of age) were screened. We ultimately included 30 subjects who completed more than [...] Read more.

We explored whether a mechanically-assisted squat exercise improved muscle mass, muscle function, and pulmonary function in elderly women with or without sarcopenia. In total, 76 community-dwelling elderly subjects (>60 years of age) were screened. We ultimately included 30 subjects who completed more than 80% of the six-week course of mechanically-assisted squat exercises (three days per week, 30 min per day). We measured body composition, lung function, knee extensor strength, hand grip strength, and the 3-min walk distance (3MWD) before and after the exercise program. Subjects with sarcopenia had poor hand grip strength and knee extensor strength, and a slow walking speed. Their lung function parameters, including forced vital capacity (FVC), was lower than those of the controls. After six weeks of squat exercises, the hand grip strength, knee extensor strength, and 3MWD increased significantly in both groups. Appendicular skeletal muscle mass and leg lean mass were increased in subjects without sarcopenia. The FVC (L) increased significantly only in the sarcopenia group (p = 0.019). The mechanically-assisted squat exercise program increased muscle function and lung function, including FVC, in patients with sarcopenia. Muscle mass increased in subjects without sarcopenia. Full article

(This article belongs to the Section Pulmonology)

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11 pages, 377 KiB

Open AccessReview

Effects of Low Energy Availability on Reproductive Functions and Their Underlying Neuroendocrine Mechanisms

by Takeshi Iwasa, Toshiya Matsuzaki, Kiyohito Yano, Yiliyasi Mayila, Rie Yanagihara, Yuri Yamamoto, Akira Kuwahara and Minoru Irahara

J. Clin. Med. 2018, 7(7), 166; https://doi.org/10.3390/jcm7070166 - 05 Jul 2018

Cited by 13 | Viewed by 3634

Abstract

It is known that metabolic disturbances suppress reproductive functions in females. The mechanisms underlying metabolic and nutritional effects on reproductive functions have been established based on a large body of clinical and experimental data. From the 1980s to 1990s, it was revealed that [...] Read more.

It is known that metabolic disturbances suppress reproductive functions in females. The mechanisms underlying metabolic and nutritional effects on reproductive functions have been established based on a large body of clinical and experimental data. From the 1980s to 1990s, it was revealed that disrupted gonadotropin-releasing hormone (GnRH) secretion is the main cause of reproductive impairments in metabolic and nutritional disorders. From the late 1990s to early 2000s, it was demonstrated that, in addition to their primary functions, some appetite- or metabolism-regulating factors affect GnRH secretion. Furthermore, in the early 2000s, kisspeptin, which is a potent positive regulator of GnRH secretion, was newly discovered, and it has been revealed that kisspeptin integrates the effects of metabolic status on GnRH neurons. Recent studies have shown that kisspeptin mediates at least some of the effects of appetite- and metabolism-regulating factors on GnRH neurons. Thus, kisspeptin might be a useful clinical target for treatments aimed at restoring reproductive functions in individuals with metabolic or nutritional disturbances, such as those who exercise excessively, experience marked weight loss, or suffer from eating disorders. This paper presents a review of what is currently known about the effects of metabolic status on reproductive functions and their underlying mechanisms by summarizing the available evidence. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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10 pages, 374 KiB

Open AccessArticle

Technology-Enhanced Classroom Activity Breaks Impacting Children’s Physical Activity and Fitness

by Heidi Buchele Harris and Weiyun Chen

J. Clin. Med. 2018, 7(7), 165; https://doi.org/10.3390/jcm7070165 - 29 Jun 2018

Cited by 16 | Viewed by 5258

Abstract

Background: This study examined the effects of a 4-week technology-enhanced physical activity (PA) interventions on students’ real-time daily PA and aerobic fitness levels. Methods: 116 fifth-graders were assigned to one intervention group (n = 31) participating in daily physical activity engaging the [...] Read more.

Background: This study examined the effects of a 4-week technology-enhanced physical activity (PA) interventions on students’ real-time daily PA and aerobic fitness levels. Methods: 116 fifth-graders were assigned to one intervention group (n = 31) participating in daily physical activity engaging the brain with Fitbit Challenge (PAEB-C), another intervention group (n = 29) wearing Fitbits only (Fitbit-O) daily, five days per week, or the comparison group (n = 56). Four-week real-time PA data were collected from the intervention students via Fitbase. Three groups were pre- and post-tested aerobic fitness. Results: The PAEB-C students showed significantly higher steps and minutes of being very active and fairly active (F = 7.999, p = 0.014, ŋ = 0.121; F = 5.667, p = 0.021, ŋ = 0.089; F = 10.572, p = 0.002, ŋ = 0.154) and lower minutes of being sedentary daily (F = 4.639, p = 0.035, ŋ = 0.074) than the Fitbit-O group. Both Fitbit groups exhibited significantly greater increases in aerobic fitness scores than the comparison group over time (F = 21.946, p = 0.001, ŋ = 0.303). Boys were more physically active and fit than girls. Conclusions: Technology-enhanced PA intervention was effective for improving real-time PA and aerobic fitness. Full article

(This article belongs to the Special Issue Emerging Technology Applications to Promote Physical Activity and Health)

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5 pages, 1194 KiB

Open AccessCase Report

An Unusual and Fatal Cause of Miliary Nodules on Chest Radiography

by Anmol Cheema, Saira Chaughtai, Usman Mazahir, Manimala Roy and Mohammad A. Hossain

J. Clin. Med. 2018, 7(7), 164; https://doi.org/10.3390/jcm7070164 - 29 Jun 2018

Cited by 1 | Viewed by 3728

Abstract

Foreign body granulomatosis has many etiologies, including the injection of oral medications intravenously. The insoluble filler materials that are used in the medications can lodge in pulmonary arterioles and capillaries, which can trigger foreign body giant cell reaction, chronic inflammation, thrombosis, and fibrosis, [...] Read more.

Foreign body granulomatosis has many etiologies, including the injection of oral medications intravenously. The insoluble filler materials that are used in the medications can lodge in pulmonary arterioles and capillaries, which can trigger foreign body giant cell reaction, chronic inflammation, thrombosis, and fibrosis, resulting in pulmonary hypertension, progressive shortness of breath, and, potentially, fatal conditions. On imaging, this may present with multiple miliary mottling’s/nodules. The use of a bronchoscopy with biopsy can be an excellent way to establish a diagnosis in appropriate clinical settings. Here, we present a case of a 37-year-old old male found to have multiple miliary densities on imaging due to intravenous use of oral medication. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

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12 pages, 514 KiB

Open AccessReview

Diagnosing Lung Cancer: The Complexities of Obtaining a Tissue Diagnosis in the Era of Minimally Invasive and Personalised Medicine

by Anna E. B. McLean, David J. Barnes and Lauren K. Troy

J. Clin. Med. 2018, 7(7), 163; https://doi.org/10.3390/jcm7070163 - 29 Jun 2018

Cited by 41 | Viewed by 8035

Abstract

The role of the respiratory physician in diagnosing lung cancer has increased in complexity over the last 20 years. Adenocarcinoma is now the prevailing histopathological sub-type of non-small cell lung cancer (NSCLC) resulting in more peripheral cancers. Conventional bronchoscopy is often not sufficient [...] Read more.

The role of the respiratory physician in diagnosing lung cancer has increased in complexity over the last 20 years. Adenocarcinoma is now the prevailing histopathological sub-type of non-small cell lung cancer (NSCLC) resulting in more peripheral cancers. Conventional bronchoscopy is often not sufficient to obtain adequate tissue samples for diagnosis. Radiologically guided transthoracic biopsy is a sensitive alternative, but carries significant risks. These limitations have driven the development of complimentary bronchoscopic navigation techniques for peripheral tumour localisation and sampling. Furthermore, linear endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is increasingly being chosen as the initial diagnostic procedure for those with central lesions and/or radiological evidence of node-positive disease. This technique can diagnose and stage patients in a single, minimally invasive procedure with a diagnostic yield equivalent to that of surgical mediastinoscopy. The success of molecular targeted therapies and immune checkpoint inhibitors in NSCLC has led to the increasing challenge of obtaining adequate specimens for accurate tumour subtyping through minimally invasive procedures. This review discusses the changing epidemiology and treatment landscape of lung cancer and explores the utility of current diagnostic options in obtaining a tissue diagnosis in this new era of precision medicine. Full article

(This article belongs to the Special Issue Personalized Therapy in Non-Small Cell Lung Cancer: The Role of Biological Agents and Immunotherapy)

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10 pages, 1507 KiB

Open AccessArticle

Morphogenetic Variability and Hypertension in Ischemic Stroke Patients—Preliminary Study

by Milan Savic, Suzana Cvjeticanin, Milica Lazovic, Ljubica Nikcevic and Dejan Nikolic

J. Clin. Med. 2018, 7(7), 162; https://doi.org/10.3390/jcm7070162 - 26 Jun 2018

Cited by 5 | Viewed by 2907

Abstract

In this study, we evaluated and compared the morphogenetic variability and the degree of recessive homozygosity in patients with manifested ischemic stroke compared to healthy controls. We have evaluated 120 patients with manifested ischemic stroke, of which 64 did not have hypertension and [...] Read more.

In this study, we evaluated and compared the morphogenetic variability and the degree of recessive homozygosity in patients with manifested ischemic stroke compared to healthy controls. We have evaluated 120 patients with manifested ischemic stroke, of which 64 did not have hypertension and 56 have hypertension. For comparison, we additionally tested 194 healthy individuals without manifested ischemic stroke (controls). For the estimation of the degree of recessive homozygosity, we have performed the homozygously recessive characteristics (HRC) test and tested 19 HRCs. There was a significant difference in the individual variations of 19 HRCs between the controls and patients with manifested ischemic stroke (∑χ² = 60.162, p < 0.01). The mean values of the tested HRCs significantly differed between the controls and group with manifested ischemic stroke (Controls − 5.71 ± 1.61, Ischemic stroke group − 6.25 ± 1.54, p = 0.012). For the tested individuals with hypertension, the mean values of HRCs did not significantly differ between the controls and those that had manifested ischemic stroke (Controls − 5.28 ± 1.75, Ischemic stroke group − 5.64 ± 1.48, p = 0.435). We found a significant difference in the frequencies of HRCs between those with and without hypertension for controls (p < 0.003) and for those with manifested ischemic stroke (p < 0.001). There are increased degrees of recessive homozygosity along with decreased variability in patients with manifested ischemic stroke compared to controls. Full article

(This article belongs to the Section Hematology)

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13 pages, 4102 KiB

Open AccessArticle

Healing of Ischemic Colon Anastomosis in Rats Could Be Provided by Administering Dexpanthenol or Coenzyme Q10

by Faruk Pehlivanlı, Oktay Aydin, Gökhan Karaca, Gülçin Aydin, Tuba Devrim, Huri Bulut, Bülent Bakar and Çağatay Erden Daphan

J. Clin. Med. 2018, 7(7), 161; https://doi.org/10.3390/jcm7070161 - 25 Jun 2018

Cited by 5 | Viewed by 3095

Abstract

Background: In this study, the effectiveness of dexpanthenol and coenzyme Q10 (CoQ10) on the healing of ischemic colon anastomosis was investigated. Methods: Forty eight male Wistar Albino rats were divided into four equal groups (Sham-S, Sham-I, DXP, Q10). Following full layer colon resection, [...] Read more.

Background: In this study, the effectiveness of dexpanthenol and coenzyme Q10 (CoQ10) on the healing of ischemic colon anastomosis was investigated. Methods: Forty eight male Wistar Albino rats were divided into four equal groups (Sham-S, Sham-I, DXP, Q10). Following full layer colon resection, single layer colon anastomosis, without creating ischemia, was performed on the Sham-S group. The same experimental model was performed on remaining groups after ischemia was created. Intraperitoneal dexpanthenol and CoQ10 was administered to the DXP and Q10 groups once a day for three days. Ten days later, all colon anastomoses were investigated histopathologically and biochemically, as well as their burst pressure values, in all sacrificed rats. Results: The highest burst pressure value was observed in the Sham-S group, decreasing from high to low in the DXP, Q10, and Sham-I groups, respectively (p = 0.008). Furthermore, tissue hydroxyproline (p = 0.001) level values were significantly different among the groups. Additionally, histopathological analysis revealed a significant difference among groups regarding reepithelization (p = 0.027) and polymorphonuclear leukocyte density (p = 0.022). Conclusions: This preliminary study has shown that ischemia-reperfusion injury may impair the healing of colon anastomosis and it has been concluded that dexpanthenol and CoQ10 may have positive effects on the healing of ischemic colon anastomosis in rat, although re-epithelization may be adversely affected using CoQ10. Full article

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9 pages, 896 KiB

Open AccessArticle

Relationship between Inflammatory and Biological Markers and Lung Cancer

by Füsun Şahin and Ayşe Feyza Aslan

J. Clin. Med. 2018, 7(7), 160; https://doi.org/10.3390/jcm7070160 - 25 Jun 2018

Cited by 39 | Viewed by 4351

Abstract

We seek to define inflammatory markers, lipid and protein profiles that may aid in distinguishing lung cancer cases from those who are healthy and to determine the relationships between these levels and cancer stage and cell type. Lung cancer patients (n = [...] Read more.

We seek to define inflammatory markers, lipid and protein profiles that may aid in distinguishing lung cancer cases from those who are healthy and to determine the relationships between these levels and cancer stage and cell type. Lung cancer patients (n = 140, Group 1) and healthy cases (n = 50, Group 2) were enrolled. We retrieved platelet, platelet-associated markers (plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW)), neutrophil/lymphocyte ratio-NLR, platelet/lymphocyte ratio-PLR, lipids (total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), triglycerides), proteins (total protein (TP) and albumin), and C-reactive protein (CRP) from electronic records and compared the data from lung cancer patients with those from healthy controls. Platelet, PCT, neutrophil, NLR, PLR, triglycerides, VLDL, and CRP levels were significantly higher in Group 1 compared with Group 2. MPV, lymphocyte, albumin, and HDL levels were significantly lower in Group 1 compared with Group 2. No significant relationship was evident between histopathological types and the level of any marker. Compared to those with early-stage cancer, changes in marker levels in those with advanced-stage cancer were statistically significant. CRP and NLR were significantly higher; albumin and HDL were lower in metastatic patients. We found that platelet, PCT, NLR and PLR, albumin, HDL, and CRP levels aided in lung cancer diagnosis and the detection of late-stage disease. Furthermore, these inflammatory and biological markers are thought to be particularly useful in following the severity of lung cancer. Full article

(This article belongs to the Special Issue Big Data and Precision Medicine Series I: Lung Cancer Early Diagnosis)

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8 pages, 235 KiB

Open AccessArticle

Serum Levels of Angiopoietin-Like Protein 2 and Obestatin in Iranian Women with Polycystic Ovary Syndrome and Normal Body Mass Index

by Elham Rahmani, Samad Akbarzadeh, Ainaz Broomand, Fatemeh Torabi, Niloofar Motamed and Marzieh Zohrabi

J. Clin. Med. 2018, 7(7), 159; https://doi.org/10.3390/jcm7070159 - 22 Jun 2018

Cited by 4 | Viewed by 3168

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disease in women of reproduction age and a major cause of anovulatory infertility. Insulin resistance plays an important role in the development and durability of this disorder. ANGPTL2 is known as an inflammatory mediator [...] Read more.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disease in women of reproduction age and a major cause of anovulatory infertility. Insulin resistance plays an important role in the development and durability of this disorder. ANGPTL2 is known as an inflammatory mediator derived from adipose tissue that links obesity to systemic insulin resistance, and obestatin has been identified as a hormone associated with insulin resistance that suppresses food reabsorption, inhibits gastric emptying and decreases weight gain. The aim of this study was to evaluate serum levels of ANGPTL2 and obestatin in PCOS women with normal body mass index (BMI). Methods: In this case-control study, 26 PCOS women based on the Rotterdam 2003 diagnostic criteria as the case group and 26 women with normal menstrual cycles as the control group were enrolled. Serum levels of ANGPTL2, obestatin, insulin and other hormone factors related with PCOS were measured by ELISA method and biochemical parameters were measured by an autoanalyzer. Data were analyzed by independent samples-T test, Chi Square, Correlation and a single sample Kolmogrov–Smirnov test using SPSS software, version 16. Results: There were no significant variations in the amount of ANGPTL2, obestatin, cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein, cholesterol, creatinine and dehydroepiandrosterone-sulfate between the two groups. There were significant increases in serum levels of fasting blood sugar (p = 0.01), insulin (p = 0.04), homeostasis model assessments of insulin resistance (p = 0.04), testosterone (p = 0.02), luteinizing hormone (p = 0.004), luteinizing hormone/follicle stimulating hormone (p = 0.006) and prolactin (p = 0.04) in case group compared to the control group. A significant positive correlation was observed between ANGPTL2 and insulin (p = 0.02), HOMA-IR (p = 0.01) and, on the other hand, a significant negative correlation was observed between obestatin and insulin (p = 0.01), HOMA-IR (p = 0.008) in PCOS group. Conclusions: In this study, no significant variations were observed in serum levels of ANGPTL2 and obestatin in PCOS women with normal BMI. Full article

12 pages, 608 KiB

Open AccessArticle

Tobramycin-Linked Efflux Pump Inhibitor Conjugates Synergize Fluoroquinolones, Rifampicin and Fosfomycin against Multidrug-Resistant Pseudomonas aeruginosa

by Xuan Yang, Ronald Domalaon, Yinfeng Lyu, George G. Zhanel and Frank Schweizer

J. Clin. Med. 2018, 7(7), 158; https://doi.org/10.3390/jcm7070158 - 22 Jun 2018

Cited by 22 | Viewed by 4844

Abstract

In this study, we examined the in vitro effect of tobramycin-efflux pump inhibitor (TOB-EPI) conjugates in combinations with fluoroquinolones, rifampicin and fosfomycin on the growth of multi-drug resistant (MDR) and extremely-drug resistant (XDR) Pseudomonas aeruginosa. The TOB-EPI conjugates include tobramycin covalently linked [...] Read more.

In this study, we examined the in vitro effect of tobramycin-efflux pump inhibitor (TOB-EPI) conjugates in combinations with fluoroquinolones, rifampicin and fosfomycin on the growth of multi-drug resistant (MDR) and extremely-drug resistant (XDR) Pseudomonas aeruginosa. The TOB-EPI conjugates include tobramycin covalently linked to 1-(1-naphthylmethyl)-piperazine (NMP) (1), paroxetine (PAR) (2) and a dibasic peptide analogue of MC-04,124 (DBP) (3). Potent synergism was found for combinations of TOB-NMP (1), TOB-PAR (2) or TOB-DBP (3) with either fluoroquinolones (moxifloxacin, ciprofloxacin), rifampicin or fosfomycin against a panel of multidrug-resistant/extensively drug-resistant (MDR/XDR) P. aeruginosa clinical isolates. In the presence of ≤8 mg/L (6.1–7.2 µM) (≤¼ × MIC_adjuvant) concentration of the three conjugates, the MIC₈₀ of moxifloxacin, ciprofloxacin, rifampicin and fosfomycin were dramatically reduced. Furthermore, the MIC₈₀ of rifampicin (0.25–0.5 mg/L) and fosfomycin (8–16 mg/L) were reduced below their interpretative susceptibility breakpoints. Our data confirm the ability of TOB-NMP (1), TOB-PAR (2) and TOB-DBP (3) conjugates to strongly synergize with moxifloxacin, ciprofloxacin, rifampicin and fosfomycin against MDR/XDR P. aeruginosa. These synergistic combinations warrant further studies as there is an urgent need to develop new strategies to treat drug-resistant P. aeruginosa infections. Full article

(This article belongs to the Special Issue Advances in Antibacterial Drug Discovery and Therapy)

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7 pages, 467 KiB

Open AccessArticle

Experimental Investigation of the Time Course Effects of Acute Exercise on False Episodic Memory

by Ali Siddiqui and Paul D. Loprinzi

J. Clin. Med. 2018, 7(7), 157; https://doi.org/10.3390/jcm7070157 - 21 Jun 2018

Cited by 40 | Viewed by 4955

Abstract

Previous experimental work suggests that acute exercise may positively influence the accurate recall of past episodic events. However, few studies have examined whether acute exercise also reduces the number of false episodic memories. We evaluated this paradigm in conjunction with an examination of [...] Read more.

Previous experimental work suggests that acute exercise may positively influence the accurate recall of past episodic events. However, few studies have examined whether acute exercise also reduces the number of false episodic memories. We evaluated this paradigm in conjunction with an examination of the temporal effects of acute exercise, which have previously been shown to play an important role in subserving episodic memory function. Twenty young adults participated in three experimental visits, including a non-exercise control visit, a visit involving an acute bout (20 min) of moderate-intensity exercise occurring prior to the memory task, and a visit involving an acute bout of exercise occurring during the encoding of the memory task. All visits were counterbalanced and occurred at least 24 h apart. The Deese–Roediger–McDermott (DRM) Paradigm, involving a separate word list trial for each visit, was employed to assess accurate and false episodic memory recall. For each visit, a short-term (immediate recall) and a long-term (25-min delay) memory recall was assessed. For both time points, the visit that involved exercise prior to encoding resulted in better short-term and long-term memory function (F(2) = 11.56, p < 0.001, η²_p = 0.38). For both time points, the control visit resulted in a greater number of false memories. These findings suggest that acute moderate-intensity exercise may help to increase the accurate recall of past episodic memories and may help to reduce the rate of false memories. Full article

(This article belongs to the Special Issue The Effects of Exercise on Cognitive Function)

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J. Clin. Med., Volume 7, Issue 7 (July 2018) – 24 articles

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