Journal of Clinical Medicine

Open AccessArticle

Assessment of Pain in Glaucoma Patients Undergoing Micropulse Transscleral Laser Therapy

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Janrapee Sukkee

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Natnaree Taechajongjintana

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Kitiya Ratanawongphaibul

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J. Clin. Med. 2023, 12(7), 2634; https://doi.org/10.3390/jcm12072634 (registering DOI) - 31 Mar 2023

Abstract

Background: This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. Methods: This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All [...] Read more.

Background: This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. Methods: This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression. Results: The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0–10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0–9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain (p < 0.05). Conclusions: Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain. Full article

(This article belongs to the Section Ophthalmology)

Open AccessArticle

Enzymatic Debridement in Geriatric Burn Patients—A Reliable Option for Selective Eschar Removal

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Christian Tapking

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Victoria G. Rontoyanni

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J. Clin. Med. 2023, 12(7), 2633; https://doi.org/10.3390/jcm12072633 (registering DOI) - 31 Mar 2023

Abstract

The treatment of geriatric burn patients represents a major challenge in burn care. The objective of this study was to evaluate the efficacy of enzymatic debridement (ED) in geriatric burn patients. Adult patients who received ED for treatment of mixed pattern and full [...] Read more.

The treatment of geriatric burn patients represents a major challenge in burn care. The objective of this study was to evaluate the efficacy of enzymatic debridement (ED) in geriatric burn patients. Adult patients who received ED for treatment of mixed pattern and full thickness burns (August 2017–October 2022) were included in this study and grouped in the younger (18–65 years) and geriatric (≥65 years) groups. Primary outcome was a necessity of surgery subsequent to ED. Both groups (patient characteristics, surgical and non-surgical treatment) were compared. Multiple logistic and linear regression models were used to identify the effect of age on the outcomes. A total of 169 patients were included (younger group: 135 patients, geriatric group: 34 patients). The burn size as indicated by %TBSA (24.2 ± 20.4% vs. 26.8 ± 17.1%, p = 0.499) was similar in both groups. The ASA (2.5 ± 1.1 vs. 3.4 ± 1.1, p < 0.001) and ABSI scores (6.1 ± 2.8 vs. 8.6 ± 2.3, p < 0.001) were significantly higher in the geriatric group. The %TBSA treated with ED (5.4 ± 5.0% vs. 4.4 ± 4.3%, p = 0.245) were similar in both groups. The necessity of additional surgical interventions (63.0 % vs. 58.8 %, = 0.763) and the wound size debrided and grafted (2.9 ± 3.5% vs. 2.2 ± 2.1%; p = 0.301) were similar in both groups. Regression models yielded that age did not have an effect on efficacy of ED. We showed that ED is reliable and safe to use in geriatric patients. Age did not have a significant influence on the surgical outcomes of ED. In both groups, the size of the grafted area was reduced and, in many patients, surgery was avoided completely. Full article

(This article belongs to the Section General Surgery)

Open AccessArticle

Guided Growth for the Treatment of Cubitus Varus in Children: Medium- to Long-Term Results

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Sergio Martínez-Álvarez

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María Galán-Olleros

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Javier Alonso-Hernández

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Isabel Vara-Patudo

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Carlos Miranda-Gorozarri

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Ángel Palazón-Quevedo

J. Clin. Med. 2023, 12(7), 2632; https://doi.org/10.3390/jcm12072632 (registering DOI) - 31 Mar 2023

Abstract

Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate [...] Read more.

Correction of cubitus varus is commonly attempted through supracondylar humeral osteotomy. We hypothesized that lateral distal humeral hemiepiphysiodesis (LDHH) could be used to gradually correct this deformity in children. We conducted a retrospective study including all patients who underwent LDHH with the eight-Plate system between 2008 and 2018, with a minimum 4-year follow-up. We collected demographic, fracture-related, pre- and postoperative clinical (carrying angle (CA), ROM), and radiological data (humeral-ulnar angle (HUA), Baumann angle (BA), shaft-condylar angle (SCA), lateral capitellohumeral angle (LCHA)), as well as data on complications and satisfaction at last follow-up. Fifteen patients were included, with a median follow-up of 81 (64–103) months. All the variables had improved significantly as follows: CA −16 (−18 to −9)°, HUA −16 (−19 to −12)°, BA −11 (−17 to −7)°, SCA 7.5 (3.3 to 13.8)°, LCHA −4.8 (−6.8 to 0.6), flexion 10 (0 to 24)°, and extension 10 (0 to 10)°. The annual correction rate in terms of HUA was 2.41° (1.9 to 3.2). There were 5 cases of aseptic screw loosening, 4 of them requiring replacement, without relation to age at surgery (p = 0.324). Most patients (86.67%) were satisfied, and a relationship was found with younger age at surgery (p = 0.037). In conclusion, preliminary results show that LDHH with the eight-Plate system is an effective technique for mild to moderate cubitus varus deformity correction in children. Patients should be advised of the relatively long duration of implant retention and the possibility of reoperation for screw replacement or implant removal. Full article

(This article belongs to the Special Issue Challenges in Hand and Upper Limb Surgery)

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Open AccessBrief Report

Machine Learning for Onset Prediction of Patients with Intracerebral Hemorrhage

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Thilo Rusche

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Jakob Wasserthal

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Hanns-Christian Breit

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Urs Fischer

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Raphael Guzman

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Jens Fiehler

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Marios-Nikos Psychogios

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Peter B. Sporns

J. Clin. Med. 2023, 12(7), 2631; https://doi.org/10.3390/jcm12072631 - 31 Mar 2023

Abstract

Objective: Intracerebral hemorrhage (ICH) has a high mortality and long-term morbidity and thus has a significant overall health–economic impact. Outcomes are especially poor if the exact onset is unknown, but reliable imaging-based methods for onset estimation have not been established. We hypothesized that [...] Read more.

Objective: Intracerebral hemorrhage (ICH) has a high mortality and long-term morbidity and thus has a significant overall health–economic impact. Outcomes are especially poor if the exact onset is unknown, but reliable imaging-based methods for onset estimation have not been established. We hypothesized that onset prediction of patients with ICH using artificial intelligence (AI) may be more accurate than human readers. Material and Methods: A total of 7421 computed tomography (CT) datasets between January 2007–July 2021 from the University Hospital Basel with confirmed ICH were extracted and an ICH-segmentation algorithm as well as two classifiers (one with radiomics, one with convolutional neural networks) for onset estimation were trained. The classifiers were trained based on the gold standard of 644 datasets with a known onset of >1 and <48 h. The results of the classifiers were compared to the ratings of two radiologists. Results: Both the AI-based classifiers and the radiologists had poor discrimination of the known onsets, with a mean absolute error (MAE) of 9.77 h (95% CI (confidence interval) = 8.52–11.03) for the convolutional neural network (CNN), 9.96 h (8.68–11.32) for the radiomics model, 13.38 h (11.21–15.74) for rater 1 and 11.21 h (9.61–12.90) for rater 2, respectively. The results of the CNN and radiomics model were both not significantly different to the mean of the known onsets (p = 0.705 and p = 0.423). Conclusions: In our study, the discriminatory power of AI-based classifiers and human readers for onset estimation of patients with ICH was poor. This indicates that accurate AI-based onset estimation of patients with ICH based only on CT-data may be unlikely to change clinical decision making in the near future. Perhaps multimodal AI-based approaches could improve ICH onset prediction and should be considered in future studies. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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Open AccessArticle

The Annoying Nature of Snoring Sounds Is Not Only about Intensity: A Pilot Study on Exposed Test Subjects

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Zhengfei Huang

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Ghizlane Aarab

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Madeline J. L. Ravesloot

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Nico de Vries

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Antonius A. J. Hilgevoord

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Frank Lobbezoo

J. Clin. Med. 2023, 12(7), 2630; https://doi.org/10.3390/jcm12072630 - 31 Mar 2023

Abstract

This study aims to assess (i) which acoustic characteristics of snoring sounds are associated with the annoying nature of snoring sounds; (ii) whether listeners’ heart rates correlate with their perceived annoyance; and (iii) whether perceived annoyance is different between listeners with different experiences [...] Read more.

This study aims to assess (i) which acoustic characteristics of snoring sounds are associated with the annoying nature of snoring sounds; (ii) whether listeners’ heart rates correlate with their perceived annoyance; and (iii) whether perceived annoyance is different between listeners with different experiences with their bedpartners’ snoring sounds. Six snoring epochs with distinct acoustic characteristics (viz., reference, high pitch, high intensity, short interval, irregular intensity, and irregular intervals) were collected from snoring patients. Twenty physicians and technicians were involved in the healthcare of snoring patients, and were divided into three groups based on personal experience with their bedpartners’ snoring sounds (viz., non-snoring, snoring but not annoying, and snoring and annoying). The test subjects listened to each epoch and rated its level of annoyance. Listeners’ heart rates were also recorded during the test using a finger plethysmograph. Within the limitations of this study, it was found that, compared with other snoring sounds, snoring sounds with high intensity and irregularity were associated with higher perceived annoyance. However, higher perceived annoyance of snoring sound was not reflected in heart rate-related parameters. In addition, listeners’ personal experiences do not seem to affect their perceived annoyance. Full article

(This article belongs to the Section Pulmonology)

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Open AccessArticle

Haematological Trends and Transfusion during Adult Extracorporeal Membrane Oxygenation: A Single Centre Study

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J. Clin. Med. 2023, 12(7), 2629; https://doi.org/10.3390/jcm12072629 - 31 Mar 2023

Abstract

The temporal trends in haematological parameters and their associations with blood product transfusion requirements in patients supported with extracorporeal membrane oxygenation (ECMO) are poorly understood. We performed a retrospective data analysis to better understand the behaviour of haematological and coagulation parameters and their [...] Read more.

The temporal trends in haematological parameters and their associations with blood product transfusion requirements in patients supported with extracorporeal membrane oxygenation (ECMO) are poorly understood. We performed a retrospective data analysis to better understand the behaviour of haematological and coagulation parameters and their associations with transfusion requirements during ECMO. Methods: Patient demographics, haematological and coagulation parameters, plasma haemoglobin and fibrinogen concentrations, platelet count, the international normalised ratio (INR), the activated partial thromboplastin time (APTT), and blood product transfusion data from 138 patients who received ECMO in a single high-volume centre were analysed. Results: Ninety-two patients received venoarterial (VA) ECMO and 46 patients received venovenous (VV) ECMO. The median (IQR) duration of VA, and VV ECMO was 8 (5–13) days and 13 (8–23) days, respectively. There were significant reductions in haemoglobin, the platelet count, and the fibrinogen concentration upon initiation of ECMO. On average, over time, patients on VV ECMO had platelet counts 44 × 10⁹/L higher than those on VA ECMO (p ≤ 0.001). Fibrinogen and APTT did not vary significantly based on the mode of ECMO (p = 0.55 and p = 0.072, respectively). A platelet count < 50 × 10⁹/L or a fibrinogen level < 1.8 g/L was associated with 50% chance of PRBC transfusion, regardless of the ECMO type, and packed red blood cell (PRBC) transfusion was more common with VA ECMO. APTT was predictive of the transfusion requirement, and the decrement in APTT was discriminatory between VVECMO survivors and nonsurvivors. Conclusion: ECMO support is associated with reductions in haemoglobin, platelet count, and fibrinogen. Patients supported with VA ECMO are more likely to receive a PRBC transfusion compared to those on VV ECMO. Thrombocytopaenia, hypofibrinogenaemia, and anticoagulation effect the likelihood of requiring PRBC transfusion. Further research is needed to define optimal blood management during ECMO, including appropriate transfusion triggers and the anticoagulation intensity. Full article

(This article belongs to the Special Issue Extracorporeal Life Support during Cardiac Arrest and Cardiogenic Shock)

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Open AccessArticle

Optimal Timing of Targeted Temperature Management for Post-Cardiac Arrest Syndrome: Is Sooner Better?

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J. Clin. Med. 2023, 12(7), 2628; https://doi.org/10.3390/jcm12072628 - 31 Mar 2023

Abstract

Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) [...] Read more.

Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, p = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; p = 0.001) and survival at 28 days (58.06% vs. 29.25%; p = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM. Full article

(This article belongs to the Special Issue Clinical Advances in Ventricular Arrhythmia and Cardiac Arrest)

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Open AccessArticle

Disparities in the Prevalence and Risk Factors for Carotid and Lower Extremities Atherosclerosis in a General Population—Bialystok PLUS Study

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J. Clin. Med. 2023, 12(7), 2627; https://doi.org/10.3390/jcm12072627 - 31 Mar 2023

Abstract

This study was conducted in a representative sample of area residents aged 20–80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in [...] Read more.

This study was conducted in a representative sample of area residents aged 20–80 years old. The aim of the study was to assess the prevalence of classic risk factors of atherosclerosis in the studied population and to search for new risk factors in these patient subpopulations. A total of 795 people (mean age 48.64 ± 15.24 years, 45.5% male) were included in the study group. Two independent data analyses were performed. In the first analysis, the study group was divided into two subgroups depending on the presence or absence of atherosclerotic plaques in carotid arteries (APCA). APCA were observed in 49.7% of the study group: in the population aged between 41 and 60 years in 49.3%, and those between 61 and 70 years in 86.3%. Patients with APCA were more often diagnosed with arterial hypertension, diabetes, and hypercholesterolemia. In the second analysis, the study group was divided into two subgroups depending on the presence of lower extremities atherosclerotic disease (LEAD). Patients with an ABI (ankle-brachial index) ≤ 0.9 constituted 8.5% of the study group, and they were significantly older, and more often diagnosed with diabetes and APCA. To identify the factors most strongly associated with APCA and an ABI ≤ 0.9, logistic regression was used, with stepwise elimination of variables. The strongest factors associated with APCA were current smoking and diastolic central pressure. We did not note such an association and did not find additional parameters to facilitate the diagnosis of LEAD in asymptomatic patients. The most important observation in our study was the high prevalence of APCA in the study population, especially in the group of young people under the age of 60. Full article

(This article belongs to the Section Cardiovascular Medicine)

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Open AccessReview

Mechanical Insufflation-Exsufflation: Considerations for Improving Clinical Practice

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Michelle Chatwin

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Ruth Helen Wakeman

J. Clin. Med. 2023, 12(7), 2626; https://doi.org/10.3390/jcm12072626 - 31 Mar 2023

Abstract

The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base [...] Read more.

The provision of mechanical insufflation-exsufflation (MI-E) devices to enhance cough efficacy is increasing. Typically, MI-E devices are used to augment cough in patients with neuromuscular disorders but also in patients who are weak in an acute care setting. Despite a growing evidence base for the use of these devices, there are barriers to the provision of MI-E, including clinician lack of knowledge and confidence. Enhancing clinician education and confidence is key. Individualized or protocolized approaches can be used to initiate MI-E. Evaluation of MI-E efficacy is critical. One method to evaluate effectiveness of MI-E is the MI-E-assisted cough peak flow (CPF). However, this should always be considered alongside other factors discussed in this review. The purpose of this review is to increase the theoretical understanding of the provision and evaluation of MI-E and provide insight into how this knowledge can be applied into clinical practice. Approaches to initiation and titration can be selected based on the clinical situation, patient diagnosis (including and beyond neuromuscular disorders), and clinician’s confidence. Full article

(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine)

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Open AccessArticle

Factors Associated with Esthetic Outcomes of Flapless Immediate Placed and Loaded Implants in the Maxillary Incisor Region—Three-Year Results of a Prospective Case Series

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Edith Groenendijk

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Tristan Ariaan Staas

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Ewald Maria Bronkhorst

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Gerry Max Raghoebar

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Gert Jacobus Meijer

J. Clin. Med. 2023, 12(7), 2625; https://doi.org/10.3390/jcm12072625 - 31 Mar 2023

Abstract

Flapless immediate implant placement and provisionalization (FIIPP) is often associated with an increased risk of buccal soft-tissue recession. This study aims to assess the 3-year esthetic outcome. In 100 consecutive patients, one maxillary incisor, with or without a pre-extraction buccal bone defect (≤5 [...] Read more.

Flapless immediate implant placement and provisionalization (FIIPP) is often associated with an increased risk of buccal soft-tissue recession. This study aims to assess the 3-year esthetic outcome. In 100 consecutive patients, one maxillary incisor, with or without a pre-extraction buccal bone defect (≤5 mm), was replaced by an implant installed in a maximal palatal position (buccal gap ≥2 mm). The created gaps were filled with bovine bone substitute. Patient satisfaction (PS), pink esthetic scores (PES/modPES), and white esthetic score (WES) were calculated at different time points. A multilevel regression analysis (MRA) was performed to analyze which factors may be associated with the esthetics. After three years, PS scored 8.9 ± 0.84 on a scale of 10 (n = 83), and the soft-tissue esthetics were high (PES = 12.2; modPES = 8.5), as was the WES (8.2), showing no decrease from one year. Buccal bone defect size and smoking could not be associated with the soft-tissue outcome; however, implant location, gap size, and emergence profiles could. Performing FIIPP, the final crown (WES) scored highest when it was cemented, the soft tissue (PES/modPES) in central-incisor positions, and all (WES/PES/modPES) with concave emergence profiles. Full article

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

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Open AccessArticle

Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO

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J. Clin. Med. 2023, 12(7), 2624; https://doi.org/10.3390/jcm12072624 - 31 Mar 2023

Abstract

Sinonasal cancers (SNCs) are rare and heterogeneous in histology and biological behavior. The prognosis is generally unfavorable, especially in inoperable cases. In recent years, for some histologies, such as undifferentiated sinonasal carcinoma (SNUC), multimodal treatment with a combination of induction chemotherapy, surgery, and [...] Read more.

Sinonasal cancers (SNCs) are rare and heterogeneous in histology and biological behavior. The prognosis is generally unfavorable, especially in inoperable cases. In recent years, for some histologies, such as undifferentiated sinonasal carcinoma (SNUC), multimodal treatment with a combination of induction chemotherapy, surgery, and chemo/radiotherapy (RT) has improved the prognosis. Nevertheless, still about half of the patients treated incur a recurrence, in most of the cases at the local site. Surgery with and without RT is usually the treatment choice in cases of recurrence after previous RT in combination with systemic therapy or RT in a histology-driven fashion. In the case of inoperable disease or contraindications to surgery, RT is still a valid treatment option. In this context, hadron therapy with protons (PT) or carbon ions (CIRT) is often preferred due to the physical and biological characteristics of charged particles, allowing the administration of high doses to the tumor target while sparing the surrounding healthy tissues and potentially limiting the side effects due to the high cumulative dose. In the absence of a standard of care for the recurrent setting, we aimed to investigate the role of re-RT with PT or CIRT. We retrospectively analysed 15 patients with recurrent, previously irradiated, SNCs treated at our institution between 2013 and 2020. Local control (LC) and overall survival (OS) were estimated by the Kaplan–Meier method. Acute and late toxicities were scored according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events CTCAE version 5.0. A total of 13 patients received CIRT and 2 patients received PT. The median re-RT dose was 54 GyRBE (range 45–64 GyRBE) delivered in 3 or 4 GyRBE/fr (fraction) for the CIRT, and 2 Gy RBE/fr for the PT schedule. LC was 44% at the 1-year follow-up and 35.2% at the 3-year follow-up. OS at 1 and 3 years were 92.9% and 38.2%, respectively. Fourteen patients developed G1–G2 acute toxicity (dermatitis and mucositis), and no patients developed G3–G5. Regarding late toxicity, 10 patients encountered at maximum G1–2 events, and 4 did not experience any toxicity. Only for one patient G3 late toxicity was reported (dysphagia requiring a percutaneous endoscopic gastrostomy). Full article

(This article belongs to the Special Issue State of the Art—Treatment of Skull Base Diseases)

Open AccessArticle

Nutrients Associated with Sleep Bruxism

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J. Clin. Med. 2023, 12(7), 2623; https://doi.org/10.3390/jcm12072623 - 31 Mar 2023

Abstract

Background: The purpose of the present research was to identify nutrients related to sleep bruxism and to establish a hypothesis regarding the relationship between sleep bruxism and nutrients. Methods: We recruited 143 Japanese university students in 2021 and assigned them to sleep bruxism [...] Read more.

Background: The purpose of the present research was to identify nutrients related to sleep bruxism and to establish a hypothesis regarding the relationship between sleep bruxism and nutrients. Methods: We recruited 143 Japanese university students in 2021 and assigned them to sleep bruxism (n = 58) and non-sleep bruxism groups (n = 85), using an identical single-channel wearable electromyography device. To investigate nutrient intakes, participants answered a food frequency questionnaire based on food groups. We assessed differences in nutrient intakes between the sleep bruxism and non-sleep bruxism groups. Results: Logistic regression modeling showed that sleep bruxism tended to be associated with dietary fiber (odds ratio, 0.91; 95% confidence interval, 0.83–1.00; p = 0.059). In addition, a subgroup analysis selecting students in the top and bottom quartiles of dietary fiber intake showed that students with sleep bruxism had a significantly lower dietary fiber intake (10.4 ± 4.6 g) than those without sleep bruxism (13.4 ± 6.1 g; p = 0.022). Conclusion: The present research showed that dietary fiber intake may be related to sleep bruxism. Therefore, we hypothesized that dietary fiber would improve sleep bruxism in young adults. Full article

(This article belongs to the Special Issue Bruxism in General: Current Challenges and Innovative Treatment)

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Open AccessArticle

Hand and Wrist Involvement in Seropositive Rheumatoid Arthritis, Seronegative Rheumatoid Arthritis, and Psoriatic Arthritis—The Value of Classic Radiography

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Ewa Żelnio

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Mihra Taljanovic

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Małgorzata Mańczak

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Iwona Sudoł-Szopińska

J. Clin. Med. 2023, 12(7), 2622; https://doi.org/10.3390/jcm12072622 - 30 Mar 2023

Abstract

The hand and wrist are among the most common anatomical areas involved in rheumatic diseases, especially seropositive and seronegative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The purpose of this study was to identify the most differentiating radiographic characteristics of PsA, seropositive RA, [...] Read more.

The hand and wrist are among the most common anatomical areas involved in rheumatic diseases, especially seropositive and seronegative rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The purpose of this study was to identify the most differentiating radiographic characteristics of PsA, seropositive RA, and seronegative RA, particularly in the early stages. A retrospective analysis of radiographic hand findings was performed on 180 seropositive RA patients (29 males, 151 females, mean age at the point of acquisition of the analyzed radiograph of 53.4 y/o, SD 12.6), 154 PsA patients (45 males, 109 females, age median of 48.1 y/o, SD 12.4), and 36 seronegative RA patients (4 males, 32 females, age median of 53.1 y/o, SD 17.1) acquired during the period 2005–2020. Posterior–anterior and Nørgaard views were analyzed in all patients. The radiographs were evaluated for three radiographic findings: type of symmetry (asymmetric/bilateral/changes in corresponding joint compartments/‘mirror-image’ symmetry), anatomic location (e.g., wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP), distal interphalangeal (DIP) joints), and type of lesions (e.g., juxta-articular osteoporosis, bone cysts, erosions, proliferative bone changes). The study showed that symmetric distribution of lesions defined as ‘lesions present in corresponding compartments’ was more suggestive of seropositive or seronegative RA than PsA. Lesions affecting the PIP joints, wrist, or styloid process of the radius; juxta-articular osteoporosis, joint space narrowing, joint subluxations, or dislocations were more common in patients with seropositive RA than in those with PsA, whereas DIP joints’ involvement and proliferative bone changes were more likely to suggest PsA than seropositive RA. Lesions in PIP, MCP, and wrist joints, as well as erosions, advanced bone damage, joint subluxations, dislocations, and joint space narrowing, were more common in seropositive RA patients than in seronegative RA patients. The ulnar styloid was more commonly affected in seronegative RA patients than in PsA patients. The study confirmed that types of bone lesions and their distribution in the hands and wrists can be useful in differentiating seropositive RA from PsA and suggests that seronegative RA varies in radiological presentation from seropositive RA and PsA. Full article

(This article belongs to the Special Issue Imaging of Arthropathies and Tendinopathies)

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Open AccessArticle

Incidence of Healthcare-Associated Infections in a Neonatal Intensive Care Unit before and during the COVID-19 Pandemic: A Four-Year Retrospective Cohort Study

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J. Clin. Med. 2023, 12(7), 2621; https://doi.org/10.3390/jcm12072621 - 30 Mar 2023

Abstract

The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All [...] Read more.

The COVID-19 pandemic may have had an impact on healthcare-associated infection (HAI) rates. In this study, we analyzed the occurrence of HAIs in a neonatal intensive care unit (NICU) of the Umberto I teaching hospital in Rome before and during the pandemic. All infants admitted from 1 March 2018 to 28 February 2022 were included and were divided into four groups according to their admission date: two groups before the pandemic (periods I and II) and two during the pandemic (periods III and IV). The association between risk factors and time-to-first event was analyzed using a multivariable Cox regression model. Over the four-year period, a total of 503 infants were included, and 36 infections were recorded. After adjusting for mechanical ventilation, birth weight, sex, type of delivery, respiratory distress syndrome, and previous use of netilmicin and fluconazole, the multivariable analysis confirmed that being hospitalized during the pandemic periods (III and IV) was the main risk factor for HAI acquisition. Furthermore, a change in the etiology of these infections was observed across the study periods. Together, these findings suggest that patient management during the pandemic was suboptimal and that HAI surveillance protocols should be implemented in the NICU setting promptly. Full article

(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)

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Open AccessArticle

Can We Completely Trust in Automated Software for Preoperative Planning of Shoulder Arthroplasty? Software Update May Modify Glenoid Version, Glenoid Inclination and Humeral Head Subluxation Values

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J. Clin. Med. 2023, 12(7), 2620; https://doi.org/10.3390/jcm12072620 - 30 Mar 2023

Abstract

Background: The purpose of this study was to evaluate the impact of software updating on measurements of the glenoid inclination and version, along with humeral head subluxation performed by an automated 3D planning program. The hypothesis was that the software update could significantly [...] Read more.

Background: The purpose of this study was to evaluate the impact of software updating on measurements of the glenoid inclination and version, along with humeral head subluxation performed by an automated 3D planning program. The hypothesis was that the software update could significantly modify the values of the glenoid inclination and version, as well as of the humeral head subluxation. Methods: A comprehensive pool of 76 shoulder computed tomography (CT) scans of patients who underwent total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA) were analyzed with the automated program Blueprint in 2018 and again in 2020 after a software update. Results: A statistically significant difference of 8.1 ± 8.2 and 5.4 ± 7.8 (mean difference of −2.8 ± 5.0, p < 0.001) was indeed reached when comparing the mean glenoid inclination achieved with Blueprint 2018 and Blueprint 2020, respectively. The glenoid version, as well as the humeral head subluxation evaluations, were not significantly different between the two software versions, with mean values being −9.4 ± 8.9 and −9.0 ± 7.4 and 60.1 ± 12.6 and 61.8 ± 12.0, respectively (p = 0.708 and p = 0.115, respectively). In 22% of CT scans, the software update determined a variation of the glenoid inclination of more than 5° or 10°. Conclusion: The present study shows the software update of an automated preoperative planning program may significantly modify the values of glenoid inclination. Even though without a significant difference, variations were also found for the glenoid version and humeral head subluxation. Accordingly, these results should further advise surgeons to carefully and critically evaluate data acquired with automated software. Full article

(This article belongs to the Special Issue Reverse Total Shoulder Arthroplasty: Clinical Updates and Perspectives, Opportunities and Challenges)

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Open AccessArticle

Developing a Warning Model of Potentially Inappropriate Medications in Older Chinese Outpatients in Tertiary Hospitals: A Machine-Learning Study

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J. Clin. Med. 2023, 12(7), 2619; https://doi.org/10.3390/jcm12072619 - 30 Mar 2023

Abstract

Due to multiple comorbid illnesses, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics in older adults, the prevalence of potentially inappropriate medications (PIMs) is high, which affects the quality of life of older adults. Building an effective warning model is necessary for the [...] Read more.

Due to multiple comorbid illnesses, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics in older adults, the prevalence of potentially inappropriate medications (PIMs) is high, which affects the quality of life of older adults. Building an effective warning model is necessary for the early identification of PIMs to prevent harm caused by medication in geriatric patients. The purpose of this study was to develop a machine learning-based model for the warning of PIMs in older Chinese outpatients. This retrospective study was conducted among geriatric outpatients in nine tertiary hospitals in Chengdu from January 2018 to December 2018. The Beers criteria 2019 were used to assess PIMs in geriatric outpatients. Three problem transformation methods were used to tackle the multilabel classification problem in prescriptions. After the division of patient prescriptions into the training and test sets (8:2), we adopted six widely used classification algorithms to conduct the classification task and assessed the discriminative performance by the accuracy, precision, recall, F1 scores, subset accuracy (ss Acc), and Hamming loss (hm) of each model. The results showed that among 11,741 older patient prescriptions, 5816 PIMs were identified in 4038 (34.39%) patient prescriptions. A total of 41 types of PIMs were identified in these prescriptions. The three-problem transformation methods included label power set (LP), classifier chains (CC), and binary relevance (BR). Six classification algorithms were used to establish the warning models, including Random Forest (RF), Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), CatBoost, Deep Forest (DF), and TabNet. The CC + CatBoost model had the highest accuracy value (97.83%), recall value (89.34%), F1 value (90.69%), and ss Acc value (97.79%) with a good precision value (92.18%) and the lowest hm value (0.0006). Therefore, the CC + CatBoost model was selected to predict the occurrence of PIM in geriatric Chinese patients. This study’s novelty establishes a warning model for PIMs in geriatric patients by using machine learning. With the popularity of electronic patient record systems, sophisticated computer algorithms can be implemented at the bedside to improve medication use safety in geriatric patients in the future. Full article

(This article belongs to the Special Issue Clinical, Translational and Experimental Pharmacotherapeutics Advances)

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Open AccessArticle

Plasma Levels of Metalloproteinase 3 (MMP-3) and Metalloproteinase 7 (MMP-7) as New Candidates for Tumor Biomarkers in Diagnostic of Breast Cancer Patients

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Monika Zbucka-Krętowska

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Sławomir Ławicki

J. Clin. Med. 2023, 12(7), 2618; https://doi.org/10.3390/jcm12072618 - 30 Mar 2023

Abstract

Matrix metalloproteinases (MMPs) are a group of enzymes that mediate both physiological and pathological processes such as carcinogenesis. The role of matrix metalloproteinase-3 (MMP-3) and (MMP-7) in the pathogenesis of breast cancer (BC) has been demonstrated, suggesting that they may be considered as [...] Read more.

Matrix metalloproteinases (MMPs) are a group of enzymes that mediate both physiological and pathological processes such as carcinogenesis. The role of matrix metalloproteinase-3 (MMP-3) and (MMP-7) in the pathogenesis of breast cancer (BC) has been demonstrated, suggesting that they may be considered as potential markers of this condition. The aim of this study was to assess plasma concentrations and diagnostic utility of MMP-3 and MMP-7 in 100 patients with early-stage breast cancer with Luminal A subtype or Luminal B HER-negative subtype, before and after surgical treatment, and in the following control groups: patients with a benign tumor (fibroadenoma) and healthy subjects. The concentrations of MMP-3 and MMP-7 were referenced to the levels of the widely recognized marker for BC diagnosis CA 15-3. MMP-3 and MMP-7 was measured by ELISA method and CA 15-3 by CMIA. Plasma levels of MMP-7 were significantly higher in Luminal A and Luminal B HER2-negative subtype breast cancer patients as compared to the healthy group. MMP-7 demonstrated comparable but mostly higher to CA 15-3 or MMP-3 values of diagnostic sensitivity, specificity, positive and negative predictive values and AUC (0.6888 for Luminal A subtype; 0.7612 for Luminal B HER2-negative; 0.7250 for BC total group, respectively) in the groups tested. The combined use of the tested parameters resulted in a further increase in diagnostic criteria and AUC. These results suggest the usefulness of combining MMP-7 with CA 15-3 in the diagnostics of breast cancer, especially in Luminal B HER2-negative subtypes patients, as a new candidate for tumor markers. Full article

(This article belongs to the Special Issue Breast Cancer: Pathology, Diagnosis and Treatment)

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Open AccessSystematic Review

Endovascular Treatment for Acute Basilar Artery Occlusion: A Fragility Index Meta-Analysis

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Lina Palaiodimou

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Andreas Eleftheriou

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Aristeidis H. Katsanos

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Diana Aguiar de Sousa

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Guillaume Turc

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Daniel Strbian

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Georgios Tsivgoulis

J. Clin. Med. 2023, 12(7), 2617; https://doi.org/10.3390/jcm12072617 - 30 Mar 2023

Abstract

Introduction: High-quality evidence regarding the use of endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO) has been provided by recently completed randomized controlled clinical trials (RCTs). Methods: We conducted a systematic review and meta-analysis including all available RCTs that investigated [...] Read more.

Introduction: High-quality evidence regarding the use of endovascular treatment (EVT) in patients with acute basilar artery occlusion (BAO) has been provided by recently completed randomized controlled clinical trials (RCTs). Methods: We conducted a systematic review and meta-analysis including all available RCTs that investigated efficacy and safety of EVT in addition to best medical treatment (BMT) versus BMT alone for BAO. The random-effects model was used, while the fragility index (FI) was calculated for dichotomous outcomes of interest. Results: Four RCTs were included comprising a total of 988 patients with acute BAO (mean age: 65.6 years, 70% men, median NIHSS: 24, 39% pretreatment with intravenous thrombolysis). EVT was related to higher likelihood of good functional outcome (RR: 1.54; 95% CI: 1.16–2.05; I² = 60%), functional independence (RR: 1.83; 95% CI: 1.08–3.08; I² = 79%) and reduced disability at 3 months (adjusted common OR: 1.96; 95% CI: 1.26–3.05; I² = 59%) compared to BMT alone. Despite that EVT was associated with a higher risk for symptomatic intracranial hemorrhage (RR: 7.78; 95% CI: 2.36–25.61; I² = 0%) and any intracranial hemorrhage (RR: 2.85; 95% CI: 1.50–5.44; I² = 16%), mortality at 3 months was lower among patients that received EVT plus BMT versus BMT alone (RR: 0.76; 95% CI: 0.65–0.89; I² = 0%). However, sufficient robustness was not evident in any of the reported associations (FI < 10) including the overall effect regarding the primary outcome. The former associations were predominantly driven by RCTs with recruitment limited in China. Conclusions: EVT combined with BMT is associated with a higher likelihood of achieving good functional outcomes and a lower risk of death at 3 months compared to BMT alone, despite the higher risk of sICH. An individual-patient data meta-analysis is warranted to uncover and adjust for potential sources of heterogeneity and to provide further insight. Full article

(This article belongs to the Section Clinical Neurology)

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Open AccessArticle

Caregiving for Dementia Patients during the Coronavirus Pandemic

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Ana Claudia Damian

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Adela Magdalena Ciobanu

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Cristina Anghele

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Ioana Raluca Papacocea

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Mihnea Costin Manea

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Floris Petru Iliuță

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Constantin Alexandru Ciobanu

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Șerban Papacocea

J. Clin. Med. 2023, 12(7), 2616; https://doi.org/10.3390/jcm12072616 - 30 Mar 2023

Abstract

The coronavirus pandemic has had a global impact on both mental and physical health. Caregiving has become more difficult during this time due to the quick spread of this respiratory disease, dread of the unknown, congested hospitals, and many restrictions, particularly for people [...] Read more.

The coronavirus pandemic has had a global impact on both mental and physical health. Caregiving has become more difficult during this time due to the quick spread of this respiratory disease, dread of the unknown, congested hospitals, and many restrictions, particularly for people with multiple comorbidities. We aimed to assess the impact of this pandemic on a group of caregivers of patients with dementia and their needs during this time. The study’s findings indicate that females assumed the role of the caregiver more often than men (88.5% of the participants) and scored lower on the life quality scale. The most often issue encountered during the pandemic was difficulty in accessing health care facilities (36%). Participants with a higher education level scored better in the physical (24.67, p = 0.01 and 24.48, p = 0.01) and mental health (20.67, p = 0.002; 19,82, p = 0.008) domains of the life quality test. The fear of COVID questionnaire showed a low level of concern in the category of participants with a high education level. Overall, this pandemic emphasizes the importance of social interaction and the possibilities to improve health care services through telemedicine. Caregivers could benefit from socialization and support programs as well as the early detection of affective disorders. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Emergency on the Quality of Life of the General Population, Part II)

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