Journal of Clinical Medicine

11 pages, 1974 KiB

Open AccessEditor’s ChoiceSystematic Review

Effectiveness of Antiviral Therapy on Long COVID: A Systematic Review and Meta-Analysis

by Yu Jung Choi, Yu Bin Seo, Jun-Won Seo, Jacob Lee, Eliel Nham, Hye Seong, Jin Gu Yoon, Ji Yun Noh, Hee Jin Cheong, Woo Joo Kim, Eun Jung Kim and Joon Young Song

J. Clin. Med. 2023, 12(23), 7375; https://doi.org/10.3390/jcm12237375 - 28 Nov 2023

Cited by 4 | Viewed by 3202

Abstract

Antiviral treatment reduces the severity and mortality of SARS-CoV-2 infection; however, its effectiveness against long COVID-19 is unclear. This study aimed to evaluate the effectiveness of antiviral drugs in preventing long COVID and related hospitalizations/deaths. Scientific and medical databases were searched from 1 [...] Read more.

Antiviral treatment reduces the severity and mortality of SARS-CoV-2 infection; however, its effectiveness against long COVID-19 is unclear. This study aimed to evaluate the effectiveness of antiviral drugs in preventing long COVID and related hospitalizations/deaths. Scientific and medical databases were searched from 1 January 2020 to 30 June 2023. We included observational cohort studies comparing individuals receiving early antiviral therapy for COVID-19 and those receiving supportive treatment. A fixed-effects model was used to merge the effects reported in two or more studies. The risk of post-acute sequelae of COVID-19 (PASC) was combined as an odds ratio (OR). Six studies were selected, including a total of 3,352,235 participants. The occurrence of PASC was 27.5% lower in patients who received antiviral drugs during the early stages of SARS-CoV-2 infection (OR = 0.725; 95% confidence interval [CI] = 0.409–0.747) than in the supportive treatment group. Moreover, the risk of PASC-associated hospitalization and mortality was 29.7% lower in patients receiving early antiviral therapy than in the supportive treatment group (OR = 0.721; 95% CI = 0.697–0.794). Early antiviral therapy was associated with a reduced risk of PASC and related hospitalization or death. Thus, early antiviral therapy is recommended for at-risk individuals. Full article

(This article belongs to the Collection Coronavirus Disease 2019: Clinical Presentation, Pathogenesis and Treatment)

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13 pages, 5454 KiB

Open AccessEditor’s ChoiceReview

Catheter Ablation for Tachyarrhythmias in Left Ventricular Assist Device Recipients: Clinical Significance and Technical Tips

by Naoya Kataoka and Teruhiko Imamura

J. Clin. Med. 2023, 12(22), 7111; https://doi.org/10.3390/jcm12227111 - 15 Nov 2023

Cited by 3 | Viewed by 714

Abstract

The demand for durable left ventricular assist devices (LVADs) has been increasing worldwide in tandem with the rising population of advanced heart failure patients. Especially in cases of destination therapy, instead of bridges to transplantation, LVADs require a lifelong commitment. With the increase [...] Read more.

The demand for durable left ventricular assist devices (LVADs) has been increasing worldwide in tandem with the rising population of advanced heart failure patients. Especially in cases of destination therapy, instead of bridges to transplantation, LVADs require a lifelong commitment. With the increase in follow-up periods after implantation and given the lack of donor hearts, the need for managing concomitant tachyarrhythmias has arisen. Atrial and ventricular arrhythmias are documented in approximately 20% to 50% of LVAD recipients during long-term device support, according to previous registries. Atrial arrhythmias, primarily atrial fibrillation, generally exhibit good hemodynamic tolerance; therefore, catheter ablation cannot be easily recommended due to the risk of a residual iatrogenic atrial septal defect that may lead to a right-to-left shunt under durable LVAD supports. The clinical impacts of ventricular arrhythmias, mainly ventricular tachycardia, may vary depending on the time periods following the index implantation. Early occurrence after the operation affects the hospitalization period and mortality; however, the late onset of ventricular tachycardia causes varying prognostic impacts on a case-by-case basis. In cases of hemodynamic instability, catheter ablation utilizing a trans-septal approach is necessary to stabilize hemodynamics. Nonetheless, in some cases originating from the intramural region or the epicardium, procedural failure may occur with the endocardial ablation. Specialized complications associated with the state of LVAD support should be carefully considered when conducting procedures. In LVAD patients, electrophysiologists, circulatory support specialists, and surgeons should collaborate as an integrated team to address the multifaceted issues related to arrhythmia management. Full article

(This article belongs to the Section Cardiology)

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19 pages, 1757 KiB

Open AccessEditor’s ChoiceArticle

Risk for Esophageal Cancer Based on Lifestyle Factors–Smoking, Alcohol Consumption, and Body Mass Index: Insight from a South Korean Population Study in a Low-Incidence Area

by Mi Jung Kwon, Ho Suk Kang, Hyo Geun Choi, Joo-Hee Kim, Ji Hee Kim, Woo Jin Bang, Sung Kwang Hong, Nan Young Kim, Sangkyoon Hong and Hong Kyu Lee

J. Clin. Med. 2023, 12(22), 7086; https://doi.org/10.3390/jcm12227086 - 14 Nov 2023

Cited by 3 | Viewed by 950

Abstract

Esophageal cancer constitutes a global public health challenge. However, South Korean population-specific information on the association of lifestyle (smoking, alcohol consumption, and obesity status) with esophageal cancer risk is sparse. This nested case–control study analyzed the Korean national health screening cohort data (2002–2019) [...] Read more.

Esophageal cancer constitutes a global public health challenge. However, South Korean population-specific information on the association of lifestyle (smoking, alcohol consumption, and obesity status) with esophageal cancer risk is sparse. This nested case–control study analyzed the Korean national health screening cohort data (2002–2019) of 1114 patients with esophageal cancer and 4456 controls (1:4 propensity-score matched for sex, age, income, and residential region). Conditional and unconditional logistic regression analyses, after adjustment for multiple covariates, determined the effects of lifestyle factors on esophageal cancer risk. Smoking and alcohol consumption increased the esophageal cancer risk (adjusted odds ratio [95% confidence interval]: 1.37 [1.15–1.63] and 1.89 [1.60–2.23], respectively). Overweight (body mass index [BMI] ≥ 23 to <25 kg/m²), obese I (BMI ≥ 25 to <30 kg/m²), or obese II (BMI ≥ 30 kg/m²) categories had reduced odds of esophageal cancer (0.76 [0.62–0.92], 0.59 [0.48–0.72], and 0.47 [0.26–0.85], respectively). In the subgroup analyses, the association of incident esophageal cancer with smoking and alcohol consumption persisted, particularly in men or those aged ≥55 years, whereas higher BMI scores remained consistently associated with a reduced esophageal cancer likelihood across all age groups, in both sexes, and alcohol users or current smokers. Underweight current smokers exhibited a higher propensity for esophageal cancer. In conclusion, smoking and alcohol drinking may potentially increase the risk, whereas weight maintenance, with BMI ≥ 23 kg/m², may potentially decrease the risk, for esophageal cancer in the South Korean population. Lifestyle modification in the specific subgroups may be a potential strategy for preventing esophageal cancer. Full article

(This article belongs to the Special Issue Gastrointestinal Malignancies: Screening, Diagnosis, and Treatment—Volume II)

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34 pages, 3729 KiB

Open AccessEditor’s ChoiceReview

Resorbable GBR Scaffolds in Oral and Maxillofacial Tissue Engineering: Design, Fabrication, and Applications

by Seyed Ebrahim Alavi, Max Gholami, Hasan Ebrahimi Shahmabadi and Peter Reher

J. Clin. Med. 2023, 12(22), 6962; https://doi.org/10.3390/jcm12226962 - 07 Nov 2023

Cited by 4 | Viewed by 1261

Abstract

Guided bone regeneration (GBR) is a promising technique in bone tissue engineering that aims to replace lost or injured bone using resorbable scaffolds. The promotion of osteoblast adhesion, migration, and proliferation is greatly aided by GBR materials, and surface changes are critical in [...] Read more.

Guided bone regeneration (GBR) is a promising technique in bone tissue engineering that aims to replace lost or injured bone using resorbable scaffolds. The promotion of osteoblast adhesion, migration, and proliferation is greatly aided by GBR materials, and surface changes are critical in imitating the natural bone structure to improve cellular responses. Moreover, the interactions between bioresponsive scaffolds, growth factors (GFs), immune cells, and stromal progenitor cells are essential in promoting bone regeneration. This literature review comprehensively discusses various aspects of resorbable scaffolds in bone tissue engineering, encompassing scaffold design, materials, fabrication techniques, and advanced manufacturing methods, including three-dimensional printing. In addition, this review explores surface modifications to replicate native bone structures and their impact on cellular responses. Moreover, the mechanisms of bone regeneration are described, providing information on how immune cells, GFs, and bioresponsive scaffolds orchestrate tissue healing. Practical applications in clinical settings are presented to underscore the importance of these principles in promoting tissue integration, healing, and regeneration. Furthermore, this literature review delves into emerging areas of metamaterials and artificial intelligence applications in tissue engineering and regenerative medicine. These interdisciplinary approaches hold immense promise for furthering bone tissue engineering and improving therapeutic outcomes, leading to enhanced patient well-being. The potential of combining material science, advanced manufacturing, and cellular biology is showcased as a pathway to advance bone tissue engineering, addressing a variety of clinical needs and challenges. By providing this comprehensive narrative, a detailed, up-to-date account of resorbable scaffolds’ role in bone tissue engineering and their transformative potential is offered. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery in 2023 and Beyond)

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33 pages, 5438 KiB

Open AccessEditor’s ChoiceReview

Autoimmune Heparin-Induced Thrombocytopenia

by Theodore E. Warkentin

J. Clin. Med. 2023, 12(21), 6921; https://doi.org/10.3390/jcm12216921 - 03 Nov 2023

Cited by 4 | Viewed by 4445

Abstract

Autoimmune thrombocytopenia (aHIT) is a severe subtype of heparin-induced thrombocytopenia (HIT) with atypical clinical features caused by highly pathological IgG antibodies (“aHIT antibodies”) that activate platelets even in the absence of heparin. The clinical features of aHIT include: the onset or worsening of [...] Read more.

Autoimmune thrombocytopenia (aHIT) is a severe subtype of heparin-induced thrombocytopenia (HIT) with atypical clinical features caused by highly pathological IgG antibodies (“aHIT antibodies”) that activate platelets even in the absence of heparin. The clinical features of aHIT include: the onset or worsening of thrombocytopenia despite stopping heparin (“delayed-onset HIT”), thrombocytopenia persistence despite stopping heparin (“persisting” or “refractory HIT”), or triggered by small amounts of heparin (heparin “flush” HIT), most cases of fondaparinux-induced HIT, and patients with unusually severe HIT (e.g., multi-site or microvascular thrombosis, overt disseminated intravascular coagulation [DIC]). Special treatment approaches are required. For example, unlike classic HIT, heparin cessation does not result in de-escalation of antibody-induced hemostasis activation, and thus high-dose intravenous immunoglobulin (IVIG) may be indicated to interrupt aHIT-induced platelet activation; therapeutic plasma exchange may be required if high-dose IVIG is ineffective. Also, aHIT patients are at risk for treatment failure with (activated partial thromboplastin time [APTT]-adjusted) direct thrombin inhibitor (DTI) therapy (argatroban, bivalirudin), either because of APTT confounding (where aHIT-associated DIC and resulting APTT prolongation lead to systematic underdosing/interruption of DTI therapy) or because DTI inhibits thrombin-induced protein C activation. Most HIT laboratories do not test for aHIT antibodies, contributing to aHIT under-recognition. Full article

(This article belongs to the Special Issue Antibody-Mediated Thrombotic Diseases)

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31 pages, 3442 KiB

Open AccessEditor’s ChoiceSystematic Review

Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology

by Elena Jost, Philipp Kosian, Jorge Jimenez Cruz, Shadi Albarqouni, Ulrich Gembruch, Brigitte Strizek and Florian Recker

J. Clin. Med. 2023, 12(21), 6833; https://doi.org/10.3390/jcm12216833 - 29 Oct 2023

Cited by 4 | Viewed by 1827

Abstract

Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To [...] Read more.

Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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12 pages, 1503 KiB

Open AccessEditor’s ChoiceReview

Janus Kinase Inhibitors in Rheumatoid Arthritis: An Update on the Efficacy and Safety of Tofacitinib, Baricitinib and Upadacitinib

by Robert Harrington, Patricia Harkins and Richard Conway

J. Clin. Med. 2023, 12(20), 6690; https://doi.org/10.3390/jcm12206690 - 23 Oct 2023

Cited by 4 | Viewed by 2026

Abstract

Janus kinase inhibitors (JAKis) are the most recent new drug class to arrive to the market for rheumatoid arthritis (RA) treatment. While they have proven to be a very effective treatment option, there remains significant concern regarding the risk of cardiovascular events, thrombosis [...] Read more.

Janus kinase inhibitors (JAKis) are the most recent new drug class to arrive to the market for rheumatoid arthritis (RA) treatment. While they have proven to be a very effective treatment option, there remains significant concern regarding the risk of cardiovascular events, thrombosis and malignancy, particularly given the findings of the post-marketing ORAL Surveillance study and FDA black box warnings. This article reviews the key findings of the most impactful cohort of studies and registry data since ORAL Surveillance. It also evaluates the role of JAKis in practice and offers guidance on risk stratifying patients and determining their suitability for a JAKi. Full article

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

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13 pages, 2217 KiB

Open AccessEditor’s ChoiceArticle

Personalized Risk Assessment of Hepatic Fibrosis after Cholecystectomy in Metabolic-Associated Steatotic Liver Disease: A Machine Learning Approach

by Miguel Suárez, Raquel Martínez, Ana María Torres, Antonio Ramón, Pilar Blasco and Jorge Mateo

J. Clin. Med. 2023, 12(20), 6489; https://doi.org/10.3390/jcm12206489 - 12 Oct 2023

Cited by 4 | Viewed by 960

Abstract

Metabolic Associated Fatty Liver Disease (MASLD) is a condition that is often present in patients with a history of cholecystectomy. This is because both situations share interconnected metabolic pathways. This study aimed to establish a predictive model that allows for the identification of [...] Read more.

Metabolic Associated Fatty Liver Disease (MASLD) is a condition that is often present in patients with a history of cholecystectomy. This is because both situations share interconnected metabolic pathways. This study aimed to establish a predictive model that allows for the identification of patients at risk of developing hepatic fibrosis following this surgery, with potential implications for surgical decision-making. A retrospective cross-sectional analysis was conducted in four hospitals using a database of 211 patients with MASLD who underwent cholecystectomy. MASLD diagnosis was established through liver biopsy or FibroScan, and non-invasive test scores were included for analysis. Various Machine Learning (ML) methods were employed, with the Adaptive Boosting (Adaboost) system selected to build the predictive model. Platelet level emerged as the most crucial variable in the predictive model, followed by dyslipidemia and type-2 diabetes mellitus. FIB-4 score proved to be the most reliable non-invasive test. The Adaboost algorithm improved the results compared to the other methods, excelling in both accuracy and area under the curve (AUC). Moreover, this system holds promise for implementation in hospitals as a valuable diagnostic support tool. In conclusion, platelet level (<150,000/dL), dyslipidemia, and type-2 diabetes mellitus were identified as primary risk factors for liver fibrosis in MASLD patients following cholecystectomy. FIB-4 score is recommended for decision-making, particularly when the indication for surgery is uncertain. This predictive model offers valuable insights into risk stratification and personalized patient management in post-cholecystectomy MASLD cases. Full article

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

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14 pages, 1432 KiB

Open AccessEditor’s ChoiceArticle

Perioperative Analgesia and Patients’ Satisfaction in Spinal Anesthesia for Cesarean Section: Fentanyl Versus Morphine

by Mihai O. Botea, Diana Lungeanu, Alina Petrica, Mircea I. Sandor, Anca C. Huniadi, Claudiu Barsac, Adina M. Marza, Ramona C. Moisa, Laura Maghiar, Raluca M. Botea, Codruta I. Macovei and Erika Bimbo-Szuhai

J. Clin. Med. 2023, 12(19), 6346; https://doi.org/10.3390/jcm12196346 - 03 Oct 2023

Cited by 4 | Viewed by 1811

Abstract

Perioperative analgesia for cesarean section aims to ensure the mother’s comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence [...] Read more.

Perioperative analgesia for cesarean section aims to ensure the mother’s comfort, facilitate a smooth surgical experience, and promote a successful recovery. One-hundred-ninety patients were enrolled in a randomized double-blind study designed to assess the quality of perioperative analgesia, level of satisfaction, and incidence of adverse reactions in elective cesarean section under spinal anesthesia when fentanyl or morphine was added to bupivacaine. Two treatment groups comprising 173 subjects were compared in the per-protocol analysis: F (fentanyl, standard dose 25 μg) and M (morphine, standard dose 100 μg). Numerical pain scores were recorded perioperatively for 72 h (both at rest and on mobilization), with overall postoperative satisfaction and analgesic-related side effects. The patients in the morphine group had significantly better pain management (Mann–Whitney U test, p < 0.001) and higher level of satisfaction (Mann–Whitney U test, p < 0.001). The latter was related to the greater need for rescue medication in the fentanyl group (OR = 4.396; p = 0.019). On the other hand, fentanyl had significantly fewer non-life-threatening side effects, such as high-intensity pruritus (Mann–Whitney U test, p < 0.001), nausea (OR = 0.324; p = 0.019), vomiting and dizziness upon first mobilization (OR = 0.256; p < 0.001). It remains for future clinical trials to help establish doses that will tilt the scale to one side or the other. Full article

(This article belongs to the Special Issue Anesthesia and Pain Management for Women)

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18 pages, 3012 KiB

Open AccessEditor’s ChoiceArticle

Left Atrial Posterior Wall Isolation with Pulsed Field Ablation in Persistent Atrial Fibrillation

by Melanie A. Gunawardene, Gerrit Frommeyer, Christian Ellermann, Mario Jularic, Patrick Leitz, Jens Hartmann, Philipp Sebastian Lange, Omar Anwar, Benjamin Rath, Rahin Wahedi, Lars Eckardt and Stephan Willems

J. Clin. Med. 2023, 12(19), 6304; https://doi.org/10.3390/jcm12196304 - 29 Sep 2023

Cited by 6 | Viewed by 1592

Abstract

Background: Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. Objective: This study aimed to [...] Read more.

Background: Left atrial posterior wall isolation (LAPWI) may improve rhythm control in addition to pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) patients undergoing catheter ablation (CA). However, LAPWI may be challenging when using thermal energy sources. Objective: This study aimed to investigate the efficacy and safety of LAPWI performed by non-thermal pulsed field ablation (PFA) in CA for persAF. Methods: Consecutive persAF patients from two German centers were prospectively enrolled. There were two study cohorts: (1) the LAPWI cohort, which included PFA-guided (re-)PVI with LAPWI for first-time and/or repeat ablation procedures; and (2) a comparative persAF cohort with a PFA PVI-only approach without LAPWI for first-time ablation within the same timeframe. Patients were followed up by routine Holter ECGs. Results: In total, 79 persistent AF patients were included in the study: 59/79 patients were enrolled in the LAPWI cohort, including 16/59 index (27%) and 43/59 repeat ablation procedures (73%). Sixteen patients (16/79; 21%) were in the PVI-only cohort without LAPWI. Of the patients treated with LAPWI, procedure time and fluoroscopy time was 91 ± 30 min and 15 ± 7 min, respectively. The acute PVI rate was 100% in all first-time ablation patients (32 patients (16 PVI only, 16 PVI plus LAPWI), 196/196 PVs). Of the 43 re-do patients in the LAPWI cohort, re-PVI was necessary in 33% (14/43) of patients (27 PVs; 1.9 PV per-patient); in 67% (29/43), all PVs were isolated, and antral ablation of the PV ostia was performed in 48% (14/29). LAPWI was performed successfully in all 59 (100%) patients of the LAPWI cohort. Two minor complications occurred. No esophageal lesion was detected in the LAPWI cohort (n = 33/59 (56%) patients underwent endoscopy). After 354 ± 197 days of follow-up, freedom from atrial arrhythmias was 79.3% (95-CI: 62–95%) in the complete LAPWI cohort (n = 14/59 (24%) on AAD: class Ic n = 9, class III n = 5). There was no difference regarding acute procedural and clinical outcome compared to the PVI-only cohort. Conclusion: LAPWI guided by PFA is feasible and safe in patients undergoing CA for persAF and shows favorable outcomes. In the context of durable PVI, PFA-guided LAPWI may be an effective adjunctive treatment option. Full article

(This article belongs to the Special Issue New Ablation Techniques for Atrial Fibrillation)

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26 pages, 2206 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Decoding Sepsis-Induced Disseminated Intravascular Coagulation: A Comprehensive Review of Existing and Emerging Therapies

by Ahsanullah Unar, Lorenzo Bertolino, Fabian Patauner, Raffaella Gallo and Emanuele Durante-Mangoni

J. Clin. Med. 2023, 12(19), 6128; https://doi.org/10.3390/jcm12196128 - 22 Sep 2023

Cited by 4 | Viewed by 1980

Abstract

Disseminated intravascular coagulation (DIC) is a recurrent complication of sepsis. Since DIC not only promotes organ dysfunction but also represents a strong prognostic factor, it is important to diagnose DIC as early as possible. When coagulation is activated, fibrinolysis is inhibited, blood thinners [...] Read more.

Disseminated intravascular coagulation (DIC) is a recurrent complication of sepsis. Since DIC not only promotes organ dysfunction but also represents a strong prognostic factor, it is important to diagnose DIC as early as possible. When coagulation is activated, fibrinolysis is inhibited, blood thinners are consumed, and a condition is created that promotes blood clotting, making it more difficult for the body to remove fibrin or prevent it from being deposited in the blood vessels. This leads to microvascular thrombosis, which plays a role in organ dysfunction. Despite efforts to understand the underlying mechanisms of sepsis-induced DIC, healthcare providers worldwide still face challenges in effectively treating this condition. In this review, we provide an in-depth analysis of the available strategies for sepsis-induced DIC, considering their effectiveness, limitations, and potential for future advances. Corticosteroids (CS), recombinant thrombomodulin (rTM), vitamin C, fibrinolytic therapy, and platelet transfusion are among the treatments discussed in the review. In addition, we are specifically addressing immunomodulatory therapy (IMT) by investigating treatments such as granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon gamma (IFN-γ), and mesenchymal stem cell therapy (MSC). Finally, we also examined how these therapies might affect COVID-19 cases, which often present with sepsis-induced DIC. The review suggests that targeted experiments with randomization are needed to verify the effectiveness of these treatments and to discover novel approaches to treat sepsis-induced DIC. By increasing our knowledge of sepsis-induced DIC, we can develop targeted treatments that have the potential to save lives and improve outcomes. Full article

(This article belongs to the Section Infectious Diseases)

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32 pages, 1759 KiB

Open AccessEditor’s ChoiceReview

Severe Asthma and Biological Therapies: Now and the Future

by Olaia Sardon-Prado, Carolina Diaz-Garcia, Paula Corcuera-Elosegui, Javier Korta-Murua, Jose Valverde-Molina and Manuel Sanchez-Solis

J. Clin. Med. 2023, 12(18), 5846; https://doi.org/10.3390/jcm12185846 - 08 Sep 2023

Cited by 5 | Viewed by 3699

Abstract

Recognition of phenotypic variability in pediatric asthma allows for a more personalized therapeutic approach. Knowledge of the underlying pathophysiological and molecular mechanisms (endotypes) of corresponding biomarkers and new treatments enables this strategy to progress. Biologic therapies for children with severe asthma are becoming [...] Read more.

Recognition of phenotypic variability in pediatric asthma allows for a more personalized therapeutic approach. Knowledge of the underlying pathophysiological and molecular mechanisms (endotypes) of corresponding biomarkers and new treatments enables this strategy to progress. Biologic therapies for children with severe asthma are becoming more relevant in this sense. The T2 phenotype is the most prevalent in childhood and adolescence, and non-T2 phenotypes are usually rare. This document aims to review the mechanism of action, efficacy, and potential predictive and monitoring biomarkers of biological drugs, focusing on the pediatric population. The drugs currently available are omalizumab, mepolizumab, benralizumab, dupilumab, and 1ezepelumab, with some differences in administrative approval prescription criteria between the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). Previously, we described the characteristics of severe asthma in children and its diagnostic and therapeutic management. Full article

(This article belongs to the Section Immunology)

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12 pages, 256 KiB

Open AccessEditor’s ChoiceReview

TAVI after More Than 20 Years

by Adriana Postolache, Simona Sperlongano and Patrizio Lancellotti

J. Clin. Med. 2023, 12(17), 5645; https://doi.org/10.3390/jcm12175645 - 30 Aug 2023

Cited by 5 | Viewed by 1221

Abstract

It has been more than 20 years since the first in man transcatheter aortic valve intervention (TAVI), and during this period we have witnessed an impressive evolution of this technique, with an extension of its use from non-operable patients to high-, intermediate- and [...] Read more.

It has been more than 20 years since the first in man transcatheter aortic valve intervention (TAVI), and during this period we have witnessed an impressive evolution of this technique, with an extension of its use from non-operable patients to high-, intermediate- and even low-risk patients with aortic stenosis, and with a decrease in the incidence of complications. In this review, we discuss the evaluation of patients before TAVI, the procedure and the changes it has seen over time, and we present the current main complications and challenges of TAVI. Full article

(This article belongs to the Special Issue Structural Heart Diseases: State of the Art from Diagnosis to Treatment)

16 pages, 903 KiB

Open AccessEditor’s ChoiceReview

Nonalcoholic Fatty Liver Disease in Patients with Type 2 Diabetes: Screening, Diagnosis, and Treatment

by Stefano Ciardullo, Michela Vergani and Gianluca Perseghin

J. Clin. Med. 2023, 12(17), 5597; https://doi.org/10.3390/jcm12175597 - 27 Aug 2023

Cited by 5 | Viewed by 2703

Abstract

Nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD) affects ~70% of patients with type 2 diabetes (T2D), with ~20% showing signs of advanced liver fibrosis. Patients with T2D are at an increased risk of developing cirrhosis, liver failure, [...] Read more.

Nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic dysfunction-associated steatotic liver disease (MASLD) affects ~70% of patients with type 2 diabetes (T2D), with ~20% showing signs of advanced liver fibrosis. Patients with T2D are at an increased risk of developing cirrhosis, liver failure, and hepatocellular carcinoma and their liver-related mortality is doubled compared with non-diabetic individuals. Nonetheless, the condition is frequently overlooked and disease awareness is limited both among patients and among physicians. Given recent epidemiological evidence, clinical practice guidelines recommend screening for NAFLD/MASLD and advanced liver fibrosis in patients with T2D. While many drugs are currently being tested for the treatment of NAFLD/MASLD, none of them have yet received formal approval from regulatory agencies. However, several classes of antidiabetic drugs (namely pioglitazone, sodium-glucose transporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and multi-agonists) have shown favorable effects in terms of liver enzymes, liver fat content and, in some occasions, on histologic features such as inflammation and fibrosis. Therefore, diabetologists have the opportunity to actively treat NAFLD/MASLD, with a concrete possibility of changing the natural history of the disease. In the present narrative review, we summarize evidence and clinical recommendations for NAFLD/MAFLD screening in the setting of T2D, as well as on the effect of currently available glucose-lowering drugs on hepatic endpoints. Full article

(This article belongs to the Special Issue (Expert Views) Nonalcoholic Fatty Liver Disease: Pathogenesis, Clinical Diagnosis, and Treatment)

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19 pages, 2919 KiB

Open AccessEditor’s ChoiceReview

Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions

by Francesco Perone, Marco Bernardi, Alban Redheuil, Dario Mafrica, Edoardo Conte, Luigi Spadafora, Fiona Ecarnot, Lale Tokgozoglu, Carlos G. Santos-Gallego, Sergio Emanuel Kaiser, Federica Fogacci, Annabelle Sabouret, Deepak L. Bhatt, Francesco Paneni, Maciej Banach, Raul Santos, Giuseppe Biondi Zoccai, Kausik K. Ray and Pierre Sabouret

J. Clin. Med. 2023, 12(17), 5563; https://doi.org/10.3390/jcm12175563 - 26 Aug 2023

Cited by 9 | Viewed by 3787

Abstract

Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who [...] Read more.

Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging. Full article

(This article belongs to the Topic Cardiac Imaging: State of the Art)

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20 pages, 1498 KiB

Open AccessEditor’s ChoiceArticle

The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications

by Thomas Matheve, Paul Hodges and Lieven Danneels

J. Clin. Med. 2023, 12(17), 5510; https://doi.org/10.3390/jcm12175510 - 24 Aug 2023

Cited by 6 | Viewed by 4189

Abstract

Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of [...] Read more.

Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of low back pain differs between individuals. Consequently, interventions should be tailored to the individual patient and be based on a thorough clinical examination taking into account the multidimensional nature of CLBP. Considering the complexity of this process, we will provide a state-of-the-art update on back muscle dysfunctions in patients with CLBP and their implications for treatment. To this end, we will first give an overview of (1) dysfunctions in back muscle structure and function, (2) the potential of exercise therapy to address these dysfunctions, and (3) the relationship between changes in back muscle dysfunctions and clinical parameters. In a second part, we will describe a framework for an individualised approach for back muscle training in patients with CLBP. Full article

(This article belongs to the Special Issue The Biology of Chronic Pain: Applications in Clinical Practice)

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20 pages, 957 KiB

Open AccessEditor’s ChoiceReview

The Impact of Microbiota on the Gut–Brain Axis: Examining the Complex Interplay and Implications

by Tuba Shahid Chaudhry, Sidhartha Gautam Senapati, Srikanth Gadam, Hari Priya Sri Sai Mannam, Hima Varsha Voruganti, Zainab Abbasi, Tushar Abhinav, Apurva Bhavana Challa, Namratha Pallipamu, Niharika Bheemisetty and Shivaram P. Arunachalam

J. Clin. Med. 2023, 12(16), 5231; https://doi.org/10.3390/jcm12165231 - 11 Aug 2023

Cited by 6 | Viewed by 2137

Abstract

The association and interaction between the central nervous system (CNS) and enteric nervous system (ENS) is well established. Essentially ENS is the second brain, as we call it. We tried to understand the structure and function, to throw light on the functional aspect [...] Read more.

The association and interaction between the central nervous system (CNS) and enteric nervous system (ENS) is well established. Essentially ENS is the second brain, as we call it. We tried to understand the structure and function, to throw light on the functional aspect of neurons, and address various disease manifestations. We summarized how various neurological disorders influence the gut via the enteric nervous system and/or bring anatomical or physiological changes in the enteric nervous system or the gut and vice versa. It is known that stress has an effect on Gastrointestinal (GI) motility and causes mucosal erosions. In our literature review, we found that stress can also affect sensory perception in the central nervous system. Interestingly, we found that mutations in the neurohormone, serotonin (5-HT), would result in dysfunctional organ development and further affect mood and behavior. We focused on the developmental aspects of neurons and cognition and their relation to nutritional absorption via the gastrointestinal tract, the development of neurodegenerative disorders in relation to the alteration in gut microbiota, and contrariwise associations between CNS disorders and ENS. This paper further summarizes the synergetic relation between gastrointestinal and neuropsychological manifestations and emphasizes the need to include behavioral therapies in management plans. Full article

(This article belongs to the Special Issue Biomarkers in the Clinical Diagnostic of Central Nervous System Diseases)

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19 pages, 1334 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence

by Stefano Cacciatore, Luigi Spadafora, Marco Bernardi, Mattia Galli, Matteo Betti, Francesco Perone, Giulia Nicolaio, Emanuele Marzetti, Anna Maria Martone, Francesco Landi, Elad Asher, Maciej Banach, Olivier Hanon, Giuseppe Biondi-Zoccai and Pierre Sabouret

J. Clin. Med. 2023, 12(16), 5233; https://doi.org/10.3390/jcm12165233 - 11 Aug 2023

Cited by 15 | Viewed by 7018

Abstract

Coronary artery disease (CAD) is highly prevalent in older adults, yet its management remains challenging. Treatment choices are made complex by the frailty burden of older patients, a high prevalence of comorbidities and body composition abnormalities (e.g., sarcopenia), the complexity of coronary anatomy, [...] Read more.

Coronary artery disease (CAD) is highly prevalent in older adults, yet its management remains challenging. Treatment choices are made complex by the frailty burden of older patients, a high prevalence of comorbidities and body composition abnormalities (e.g., sarcopenia), the complexity of coronary anatomy, and the frequent presence of multivessel disease, as well as the coexistence of major ischemic and bleeding risk factors. Recent randomized clinical trials and epidemiological studies have provided new data on optimal management of complex patients with CAD. However, frail older adults are still underrepresented in the literature. This narrative review aims to highlight the importance of assessing frailty as an aid to guide therapeutic decision-making and tailor CAD management to the specific needs of older adults, taking into account age-related pharmacokinetic and pharmacodynamic changes, polypharmacy, and potential drug interactions. We also discuss gaps in the evidence and offer perspectives on how best in the future to optimize the global strategy of CAD management in older adults. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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11 pages, 1397 KiB

Open AccessEditor’s ChoiceArticle

Acute Kidney Injury and Sepsis after Cardiac Surgery: The Roles of Tissue Inhibitor Metalloproteinase-2, Insulin-like Growth Factor Binding Protein-7, and Mid-Regional Pro-Adrenomedullin

by Antonio Lacquaniti, Fabrizio Ceresa, Susanna Campo, Giovanna Barbera, Daniele Caruso, Elenia Palazzo, Francesco Patanè and Paolo Monardo

J. Clin. Med. 2023, 12(16), 5193; https://doi.org/10.3390/jcm12165193 - 09 Aug 2023

Cited by 9 | Viewed by 887

Abstract

Background: Identifying a panel of markers detecting kidney injury before the glomerular filtration rate reduction is a challenge to improving the diagnosis and management of acute kidney injury (AKI) in septic patients. This study evaluated the roles of tissue inhibitor metal proteinase-2, insulin [...] Read more.

Background: Identifying a panel of markers detecting kidney injury before the glomerular filtration rate reduction is a challenge to improving the diagnosis and management of acute kidney injury (AKI) in septic patients. This study evaluated the roles of tissue inhibitor metal proteinase-2, insulin growth factor binding protein-7 (TIMP2*IGFBP7), and mid-regional pro-adrenomedullin (MR-proADM) in patients with AKI. Patients and Methods: This study was prospectively conducted in an intensive care unit (ICU) enrolling 230 patients who underwent cardiac surgery. Biomarkers were evaluated before and after 4 h of the cardiac surgery. Results: Whereas urine and creatinine alterations appeared at 23.2 (12.7–36.5) hours after cardiac surgery, urinary TIMP2*IGBP7 levels were higher at 4 h in AKI patients (1.1 ± 0.4 mg/L vs. 0.08 ± 0.02 mg/L; p < 0.001). Its concentration > 2 mg/L increases AKI risk within the following 24 h, clearly identifying the population at high risk of renal replacement therapy (RRT). In patients with sepsis, MR-proADM levels were 2.3 nmol/L (0.7–7.8 nmol/L), with the highest values observed in septic shock patients (5.6 nmol/L (3.2–18 nmol/L)) and a better diagnostic profile than procalcitonin and C-reactive protein to identify septic patients. MR-proADM values > 5.1 nmol/L and urine TIMP2*IGBP7 levels > 2 mg/L showed a significantly faster progression to RRT, with a mean follow-up time of 1.1 days. Conclusions: TIMP2*IGBP7 and MR-proADM precociously diagnose AKI in septic patients after cardiac surgery, giving prognostic information for RRT requirement. Full article

(This article belongs to the Special Issue Acute Kidney Injury: Advances in Clinical Management)

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16 pages, 318 KiB

Open AccessEditor’s ChoiceReview

Endocrine Side Effects in Patients Treated with Immune Checkpoint Inhibitors: A Narrative Review

by Nicia I. Profili, Roberto Castelli, Antonio Gidaro, Alessandro Merella, Roberto Manetti, Giuseppe Palmieri, Margherita Maioli and Alessandro P. Delitala

J. Clin. Med. 2023, 12(15), 5161; https://doi.org/10.3390/jcm12155161 - 07 Aug 2023

Cited by 5 | Viewed by 1485

Abstract

Checkpoint inhibitors are monoclonal antibodies that elicit an anti-tumor response by stimulating immune system. Their use has improved the treatment of different types of cancer such as melanoma, breast carcinoma, lung, stomach, colon, liver, renal cell carcinoma, and Hodgkin’s lymphoma, but several adverse [...] Read more.

Checkpoint inhibitors are monoclonal antibodies that elicit an anti-tumor response by stimulating immune system. Their use has improved the treatment of different types of cancer such as melanoma, breast carcinoma, lung, stomach, colon, liver, renal cell carcinoma, and Hodgkin’s lymphoma, but several adverse events have been reported. Although the etiology of these effects is not completely understood, an uncontrolled activation of the immune system has been postulated. Indeed, some studies showed a cross reactivity of T cells, which acted against tumor antigens as well as antigens in the tissues of patients who developed immune-related adverse events. Despite the known possibility of developing immune-related adverse events, early diagnosis, monitoring during therapy, and treatment are fundamental for the best supportive care and administration of immune checkpoint inhibitors. The aim of this review is to guide the clinician in early diagnosis, management, and treatment of the endocrinological adverse effects in the major endocrine glands (thyroid, pituitary, adrenal, endocrine pancreas, and parathyroid). Full article

(This article belongs to the Section Cardiology)

17 pages, 1155 KiB

Open AccessEditor’s ChoiceArticle

Development and Initial Validation of the in-Session Patient Affective Reactions Questionnaire (SPARQ) and the Rift In-Session Questionnaire (RISQ)

by Alberto Stefana, Joshua A. Langfus, Eduard Vieta, Paolo Fusar-Poli and Eric A. Youngstrom

J. Clin. Med. 2023, 12(15), 5156; https://doi.org/10.3390/jcm12155156 - 07 Aug 2023

Cited by 5 | Viewed by 1227

Abstract

This article discusses the development and preliminary validation of a self-report inventory of the patient’s perception of, and affective reaction to, their therapist during a psychotherapy session. First, we wrote a pool of 131 items, reviewed them based on subject matter experts’ review, [...] Read more.

This article discusses the development and preliminary validation of a self-report inventory of the patient’s perception of, and affective reaction to, their therapist during a psychotherapy session. First, we wrote a pool of 131 items, reviewed them based on subject matter experts’ review, and then collected validation data from a clinical sample of adult patients in individual therapy (N = 701). We used exploratory factor analysis and item response theory graded response models to select items, confirmatory factor analysis (CFA) to test the factor structure, and k-fold cross-validation to verify model robustness. Multi-group CFA examined measurement invariance across patients with different diagnoses (unipolar depression, bipolar disorder, and neither of these). Three factors produced short scales retaining the strongest items. The in-Session Patient Affective Reactions Questionnaire (SPARQ) has a two-factor structure, yielding a four-item Negative affect scale and a four-item Positive affect scale. The Relationship In-Session Questionnaire (RISQ) is composed of four items from the third factor with dichotomized responses. Both scales showed excellent psychometric properties and evidence of metric invariance across the three diagnostic groups: unipolar depression, bipolar disorder, and neither of these. The SPARQ and the RISQ scale can be used in clinical or research settings, with particular value for capturing the patient’s perspectives about their therapist and session-level emotional processes. Full article

(This article belongs to the Special Issue Evidence-Based Relationship Factors in the Diagnosis & Treatment of Mood and Psychotic Disorders)

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12 pages, 1291 KiB

Open AccessEditor’s ChoiceArticle

Correlation between Inflammatory Systemic Biomarkers and Surgical Trauma in Elderly Patients with Hip Fractures

by Flaviu Moldovan, Adrian Dumitru Ivanescu, Pal Fodor, Liviu Moldovan and Tiberiu Bataga

J. Clin. Med. 2023, 12(15), 5147; https://doi.org/10.3390/jcm12155147 - 06 Aug 2023

Cited by 13 | Viewed by 1749

Abstract

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the [...] Read more.

The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty in Elderly)

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21 pages, 2985 KiB

Open AccessEditor’s ChoiceArticle

Measuring Quality of Life in Adults with Scoliosis: A Cross-Sectional Study Comparing SRS-22 and ISYQOL Questionnaires

by Fabio Zaina, Irene Ferrario, Antonio Caronni, Stefano Scarano, Sabrina Donzelli and Stefano Negrini

J. Clin. Med. 2023, 12(15), 5071; https://doi.org/10.3390/jcm12155071 - 01 Aug 2023

Cited by 5 | Viewed by 1473

Abstract

Idiopathic scoliosis is common in adulthood and can impact patients’ physical and psychological health. The Scoliosis Research Society-22 Questionnaire (SRS-22) has been designed to assess health-related quality of life (HRQOL) in idiopathic scoliosis, and it is the most used disease-specific outcome tool from [...] Read more.

Idiopathic scoliosis is common in adulthood and can impact patients’ physical and psychological health. The Scoliosis Research Society-22 Questionnaire (SRS-22) has been designed to assess health-related quality of life (HRQOL) in idiopathic scoliosis, and it is the most used disease-specific outcome tool from adolescence to adulthood. More recently, the Italian Spine Youth Quality of Life (ISYQOL) international questionnaire was developed, which performs better than SRS-22 in adolescent spinal deformities. However, the ISYQOL questionnaire has never been tested in adults. This study compares the construct validity of ISYQOL and SRS-22 with the Rasch analysis (partial credit model). We recruited 150 adults and 50 adolescents with scoliosis (≥30° Cobb). SRS-22, but not ISQYOL, showed disordered categories and one item not fitting the Rasch model. A 21-item SRS-22 version with revised categories was arranged and further compared to ISYQOL. Both questionnaires showed multidimensionality, and some items (SRS-22 in a greater number) functioned differently in persons of different ages. However, the artefacts caused by multidimensionality and differential functioning had a low impact on the questionnaires’ measures. The construct validity of ISYQOL International and the revised SRS-22 are comparable. Both questionnaires (but not the original SRS-22) can return measures of disease burden in adults with scoliosis. Full article

(This article belongs to the Special Issue Spine Rehabilitation in 2022 and Beyond)

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17 pages, 2178 KiB

Open AccessEditor’s ChoiceReview

Reversing the Inflammatory Process—25 Years of Tumor Necrosis Factor-α Inhibitors

by Katharina N. Muth, Juergen Rech, Florian O. Losch and André Hoerning

J. Clin. Med. 2023, 12(15), 5039; https://doi.org/10.3390/jcm12155039 - 31 Jul 2023

Cited by 7 | Viewed by 1274

Abstract

Immune-mediated inflammatory diseases, such as rheumatoid arthritis, psoriatic arthritis, peripheral and/or axial spondyloarthritis, Crohn’s disease, and ulcerative colitis, are characterized by molecular and cellular changes in the immune system. Due to the systemic nature of these diseases, organs such as the liver or [...] Read more.

Immune-mediated inflammatory diseases, such as rheumatoid arthritis, psoriatic arthritis, peripheral and/or axial spondyloarthritis, Crohn’s disease, and ulcerative colitis, are characterized by molecular and cellular changes in the immune system. Due to the systemic nature of these diseases, organs such as the liver or cardiovascular system are often affected by the inflammatory process. Tumor necrosis factor-α inhibitor therapy reduces the activation of pro-inflammatory signaling cascades, mitigates the chronic inflammatory process by restoring cellular balance, and alleviates clinical consequences, such as pain and tissue damage. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Current Treatment and Future Options)

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12 pages, 264 KiB

Open AccessEditor’s ChoiceArticle

Cough Hypersensitivity Syndrome: Why Its Use Is Inappropriate in Children

by Anne B. Chang, Richard S. Irwin, Hannah E. O’Farrell, Peter V. Dicpinigaitis, Suhani Goel, Ahmad Kantar and Julie M. Marchant

J. Clin. Med. 2023, 12(15), 4879; https://doi.org/10.3390/jcm12154879 - 25 Jul 2023

Cited by 6 | Viewed by 1683

Abstract

In children and adults, chronic cough is a common symptom presenting to health professionals worldwide. It is internationally accepted that children with chronic cough should be managed with pediatric specific management guidelines. The newly proposed clinical entity of ‘cough hypersensitivity syndrome’ has gained [...] Read more.

In children and adults, chronic cough is a common symptom presenting to health professionals worldwide. It is internationally accepted that children with chronic cough should be managed with pediatric specific management guidelines. The newly proposed clinical entity of ‘cough hypersensitivity syndrome’ has gained significant attention in adult literature. Given the significant differences between childhood and adult chronic cough, including in respiratory physiology and anatomy, and cough sensitivity, we address the suitability of the use of cough hypersensitivity syndrome in children. We explore these differences between childhood and adult chronic cough, explain what cough hypersensitivity is and highlight why the term cough hypersensitivity syndrome should not be used in children. Full article

(This article belongs to the Special Issue Novel Insight into Cough: Seed of Respiratory Disease with a Focus on Children)

29 pages, 2292 KiB

Open AccessEditor’s ChoiceReview

A JAK Inhibitor for Treatment of Rheumatoid Arthritis: The Baricitinib Experience

by Peter C. Taylor, Cedric Laedermann, Rieke Alten, Eugen Feist, Ernest Choy, Ewa Haladyj, Inmaculada De La Torre, Pascal Richette, Axel Finckh and Yoshiya Tanaka

J. Clin. Med. 2023, 12(13), 4527; https://doi.org/10.3390/jcm12134527 - 06 Jul 2023

Cited by 7 | Viewed by 5043

Abstract

Baricitinib, an oral selective Janus kinase (JAK)1/JAK2 inhibitor, is approved as monotherapy or in combination with methotrexate for treating adults with moderate-to-severe active rheumatoid arthritis (RA) and provides improvements in clinical signs, symptoms and patient-reported outcomes. Currently, baricitinib is approved for treating RA [...] Read more.

Baricitinib, an oral selective Janus kinase (JAK)1/JAK2 inhibitor, is approved as monotherapy or in combination with methotrexate for treating adults with moderate-to-severe active rheumatoid arthritis (RA) and provides improvements in clinical signs, symptoms and patient-reported outcomes. Currently, baricitinib is approved for treating RA in more than 75 countries. In several pivotal Phase II and III RA trials (RA-BALANCE, RA-BEGIN, RA-BEAM, RA-BUILD, RA-BEACON, RA-BEYOND), up to seven years of baricitinib treatment was well tolerated and provided rapid and sustained efficacy, which was confirmed in real-world settings. Safety signals for another JAK inhibitor, tofacitinib, have emerged, as observed in the post-marketing Phase IIIb/IV trial Oral Rheumatoid Arthritis Trial (ORAL) Surveillance; safety signals were subsequently highlighted in a retrospective study of baricitinib and consequently new recommendations and warnings and precautions for all JAK inhibitors have been issued. Ongoing studies to further characterise and clarify the benefit:risk of JAK inhibitors include registries and controlled trials. This capstone review summarises clinical and real-world data outlining the benefit:risk profile of baricitinib, confirming that the improved disease activity and physical function of patients with RA treated with this JAK inhibitor observed in clinical trials is translated into effectiveness in clinical practice, with a low rate of discontinuations. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Current Treatment and Future Options)

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13 pages, 353 KiB

Open AccessEditor’s ChoiceReview

Congenital Cytomegalovirus and Hearing Loss: The State of the Art

by Mirko Aldè, Sandro Binda, Valeria Primache, Laura Pellegrinelli, Elena Pariani, Fabrizio Pregliasco, Federica Di Berardino, Giovanna Cantarella and Umberto Ambrosetti

J. Clin. Med. 2023, 12(13), 4465; https://doi.org/10.3390/jcm12134465 - 03 Jul 2023

Cited by 6 | Viewed by 1890

Abstract

In developed countries, congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, representing the leading non-genetic cause of sensorineural hearing loss (HL). Diagnosis of cCMV infection can be performed by detection of CMV DNA in urine or saliva within 2–3 weeks [...] Read more.

In developed countries, congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, representing the leading non-genetic cause of sensorineural hearing loss (HL). Diagnosis of cCMV infection can be performed by detection of CMV DNA in urine or saliva within 2–3 weeks after birth, or later in dried blood samples on the Guthrie card. Currently, there are many controversies regarding the preventive, diagnostic, and therapeutic approaches to cCMV infection. HL secondary to cCMV is highly variable in onset, side, degree, audiometric configuration, and threshold changes over time. Therefore, it is of paramount importance to perform a long and thorough audiological follow-up in children with cCMV infection to ensure early identification and prompt treatment of progressive and/or late-onset HL. Early cochlear implantation appears to be a valid solution not only for children with bilateral profound HL, but also for those with single-sided deafness, improving localization ability and understanding speech in noisy environments. Moreover, the decision to apply a unilateral cochlear implant in children with cCMV is strengthened by the non-negligible possibility of hearing deterioration of the contralateral ear over time. Full article

(This article belongs to the Special Issue Syndromic and Non-syndromic Hearing Loss: From Diagnosis to Treatment)

32 pages, 3208 KiB

Open AccessEditor’s ChoiceReview

Levodopa-Induced Dyskinesias in Parkinson’s Disease: An Overview on Pathophysiology, Clinical Manifestations, Therapy Management Strategies and Future Directions

by Lazzaro di Biase, Pasquale Maria Pecoraro, Simona Paola Carbone, Maria Letizia Caminiti and Vincenzo Di Lazzaro

J. Clin. Med. 2023, 12(13), 4427; https://doi.org/10.3390/jcm12134427 - 30 Jun 2023

Cited by 8 | Viewed by 2240

Abstract

Since its first introduction, levodopa has become the cornerstone for the treatment of Parkinson’s disease and remains the leading therapeutic choice for motor control therapy so far. Unfortunately, the subsequent appearance of abnormal involuntary movements, known as dyskinesias, is a frequent drawback. Despite [...] Read more.

Since its first introduction, levodopa has become the cornerstone for the treatment of Parkinson’s disease and remains the leading therapeutic choice for motor control therapy so far. Unfortunately, the subsequent appearance of abnormal involuntary movements, known as dyskinesias, is a frequent drawback. Despite the deep knowledge of this complication, in terms of clinical phenomenology and the temporal relationship during a levodopa regimen, less is clear about the pathophysiological mechanisms underpinning it. As the disease progresses, specific oscillatory activities of both motor cortical and basal ganglia neurons and variation in levodopa metabolism, in terms of the dopamine receptor stimulation pattern and turnover rate, underlie dyskinesia onset. This review aims to provide a global overview on levodopa-induced dyskinesias, focusing on pathophysiology, clinical manifestations, therapy management strategies and future directions. Full article

(This article belongs to the Section Clinical Neurology)

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25 pages, 12037 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Triglyceride-Rich Lipoprotein Metabolism: Key Regulators of Their Flux

by Alejandro Gugliucci

J. Clin. Med. 2023, 12(13), 4399; https://doi.org/10.3390/jcm12134399 - 29 Jun 2023

Cited by 7 | Viewed by 3456

Abstract

The residual risk for arteriosclerotic cardiovascular disease after optimal statin treatment may amount to 50% and is the consequence of both immunological and lipid disturbances. Regarding the lipid disturbances, the role of triglyceride-rich lipoproteins (TRLs) and their remnants has come to the forefront [...] Read more.

The residual risk for arteriosclerotic cardiovascular disease after optimal statin treatment may amount to 50% and is the consequence of both immunological and lipid disturbances. Regarding the lipid disturbances, the role of triglyceride-rich lipoproteins (TRLs) and their remnants has come to the forefront in the past decade. Triglycerides (TGs) stand as markers of the remnants of the catabolism of TRLs that tend to contain twice as much cholesterol as compared to LDL. The accumulation of circulating TRLs and their partially lipolyzed derivatives, known as “remnants”, is caused mainly by ineffective triglyceride catabolism. These cholesterol-enriched remnant particles are hypothesized to contribute to atherogenesis. The aim of the present narrative review is to briefly summarize the main pathways of TRL metabolism, bringing to the forefront the newly discovered role of apolipoproteins, the key physiological function of lipoprotein lipase and its main regulators, the importance of the fluxes of these particles in the post-prandial period, their catabolic rates and the role of apo CIII and angiopoietin-like proteins in the partition of TRLs during the fast-fed cycle. Finally, we provide a succinct summary of the new and old therapeutic armamentarium and the outcomes of key current trials with a final outlook on the different methodological approaches to measuring TRL remnants, still in search of the gold standard. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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19 pages, 512 KiB

Open AccessEditor’s ChoiceReview

The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women’s Lifespan: An Updated Review

by Valentina Bucciarelli, Anna Vittoria Mattioli, Susanna Sciomer, Federica Moscucci, Giulia Renda and Sabina Gallina

J. Clin. Med. 2023, 12(13), 4347; https://doi.org/10.3390/jcm12134347 - 28 Jun 2023

Cited by 12 | Viewed by 1886

Abstract

Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects [...] Read more.

Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women’s lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations. Full article

(This article belongs to the Special Issue New Perspectives on Cardiovascular Disease: Women's Treatment and Management)

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14 pages, 331 KiB

Open AccessEditor’s ChoiceReview

Understanding Psychological Symptoms of Endometriosis from a Research Domain Criteria Perspective

by Katharina van Stein, Kathrin Schubert, Beate Ditzen and Cornelia Weise

J. Clin. Med. 2023, 12(12), 4056; https://doi.org/10.3390/jcm12124056 - 15 Jun 2023

Cited by 7 | Viewed by 5714

Abstract

Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria [...] Read more.

Endometriosis is currently the second most common gynecological disease and is associated with severe pain, vegetative impairment, and infertility. In association, there are considerable psychological symptoms that limit the quality of life of those affected. In this narrative review, the Research Domain Criteria (RDoC) framework was utilized to display the different transdiagnostic processes involved in disease progression and maintenance in regard to psychosocial functioning. Using the RDoC framework, it becomes clear that immune/endocrinological dysregulation is interlocked with (pelvic) pain chronification processes and psychological symptoms such as depressive mood, loss of control, higher vigilance toward the onset or worsening of symptoms, social isolation, and catastrophizing. This paper will discuss and identify promising treatment approaches, in addition to medical care, as well as further research implications. Endometriosis can come with substantial psychosomatic and social burden, requiring more research to understand the interdependence of different factors involved in its chronic development pathway. However, it is already clear that standard care should be extended with multifaceted treatments addressing pain, as well as the psychological and social burden, in order to halt the cycle of aggravation of symptoms and to improve quality of life for patients. Full article

(This article belongs to the Special Issue Endometriosis: Clinical Advances and Challenges)

20 pages, 2435 KiB

Open AccessEditor’s ChoiceReview

Finerenone: Questions and Answers—The Four Fundamental Arguments on the New-Born Promising Non-Steroidal Mineralocorticoid Receptor Antagonist

by Luca Di Lullo, Carlo Lavalle, Alessia Scatena, Marco Valerio Mariani, Claudio Ronco and Antonio Bellasi

J. Clin. Med. 2023, 12(12), 3992; https://doi.org/10.3390/jcm12123992 - 12 Jun 2023

Cited by 7 | Viewed by 8292

Abstract

Chronic kidney disease (CKD) is one of the most common complications of diabetes mellitus and an independent risk factor for cardiovascular disease. Despite guideline-directed therapy of CKD in patients with type 2 diabetes, the risk of renal failure and cardiovascular events still remains [...] Read more.

Chronic kidney disease (CKD) is one of the most common complications of diabetes mellitus and an independent risk factor for cardiovascular disease. Despite guideline-directed therapy of CKD in patients with type 2 diabetes, the risk of renal failure and cardiovascular events still remains high, and diabetes remains the leading cause of end-stage kidney disease in affected patients. To date, current medications for CKD and type 2 diabetes mellitus have not reset residual risk in patients due to a high grade of inflammation and fibrosis contributing to kidney and heart disease. This question-and-answer-based review will discuss the pharmacological and clinical differences between finerenone and other mineralocorticoid receptor antagonists and then move on to the main evidence in the cardiovascular and renal fields, closing, finally, on the potential role of therapeutic combination with sodium-glucose cotransporter 2 inhibitors (SGLT2is). Full article

(This article belongs to the Section Cardiovascular Medicine)

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17 pages, 2365 KiB

Open AccessEditor’s ChoiceArticle

Benralizumab Effectiveness in Severe Eosinophilic Asthma with Co-Presence of Bronchiectasis: A Real-World Multicentre Observational Study

by Raffaele Campisi, Santi Nolasco, Corrado Pelaia, Pietro Impellizzeri, Maria D’Amato, Andrea Portacci, Luisa Ricciardi, Giulia Scioscia, Nunzio Crimi, Nicola Scichilone, Maria Pia Foschino Barbaro, Girolamo Pelaia, Giovanna Elisiana Carpagnano, Alessandro Vatrella and Claudia Crimi

J. Clin. Med. 2023, 12(12), 3953; https://doi.org/10.3390/jcm12123953 - 09 Jun 2023

Cited by 8 | Viewed by 1919

Abstract

Introduction: The co-presence of bronchiectasis (BE) in severe eosinophilic asthma (SEA) is common. Data about the effectiveness of benralizumab in patients with SEA and BE (SEA + BE) are lacking. Aim: The aim of this study was to evaluate the effectiveness [...] Read more.

Introduction: The co-presence of bronchiectasis (BE) in severe eosinophilic asthma (SEA) is common. Data about the effectiveness of benralizumab in patients with SEA and BE (SEA + BE) are lacking. Aim: The aim of this study was to evaluate the effectiveness of benralizumab and remission rates in patients with SEA compared to SEA + BE, also according to BE severity. Methods: We conducted a multicentre observational study, including patients with SEA who underwent chest high-resolution computed tomography at baseline. The Bronchiectasis Severity Index (BSI) was used to assess BE severity. Clinical and functional characteristics were collected at baseline and after 6 and 12 months of treatment. Results: We included 74 patients with SEA treated with benralizumab, of which 35 (47.2%) showed the co-presence of bronchiectasis (SEA + BE) with a median BSI of 9 (7–11). Overall, benralizumab significantly improved the annual exacerbation rate (p < 0.0001), oral corticosteroids (OCS) consumption (p < 0.0001) and lung function (p < 0.01). After 12 months, significant differences were found between SEA and SEA + BE cohorts in the number of exacerbation-free patients [64.1% vs. 20%, OR 0.14 (95% CI 0.05–0.40), p < 0.0001], the proportion of OCS withdrawal [−92.6% vs. −48.6, p = 0.0003], and the daily dose of OCS [−5 mg (0 to −12.5) vs. −12.5 mg (−7.5 to −20), p = 0.0112]. Remission (zero exacerbations + zero OCS) was achieved more frequently in the SEA cohort [66.7% vs. 14.3%, OR 0.08 (95% CI 0.03–0.27), p < 0.0001]. Changes in FEV₁% and FEF_25–75% were inversely correlated with BSI (r = −0.36, p = 0.0448 and r = −0.41, p = 0.0191, respectively). Conclusions: These data suggest that benralizumab exerts beneficial effects in SEA with or without BE, although the former achieved less OCS sparing and fewer respiratory-function improvements. Full article

(This article belongs to the Special Issue Clinical Application of Biological Therapies in Severe Asthma)

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18 pages, 11244 KiB

Open AccessEditor’s ChoiceReview

Dual-Source Photon-Counting Computed Tomography—Part I: Clinical Overview of Cardiac CT and Coronary CT Angiography Applications

by Filippo Cademartiri, Antonella Meloni, Laura Pistoia, Giulia Degiorgi, Alberto Clemente, Carmelo De Gori, Vincenzo Positano, Simona Celi, Sergio Berti, Michele Emdin, Daniele Panetta, Luca Menichetti, Bruna Punzo, Carlo Cavaliere, Eduardo Bossone, Luca Saba, Riccardo Cau, Ludovico La Grutta and Erica Maffei

J. Clin. Med. 2023, 12(11), 3627; https://doi.org/10.3390/jcm12113627 - 23 May 2023

Cited by 11 | Viewed by 2945

Abstract

The photon-counting detector (PCD) is a new computed tomography detector technology (photon-counting computed tomography, PCCT) that provides substantial benefits for cardiac and coronary artery imaging. Compared with conventional CT, PCCT has multi-energy capability, increased spatial resolution and soft tissue contrast with near-null electronic [...] Read more.

The photon-counting detector (PCD) is a new computed tomography detector technology (photon-counting computed tomography, PCCT) that provides substantial benefits for cardiac and coronary artery imaging. Compared with conventional CT, PCCT has multi-energy capability, increased spatial resolution and soft tissue contrast with near-null electronic noise, reduced radiation exposure, and optimization of the use of contrast agents. This new technology promises to overcome several limitations of traditional cardiac and coronary CT angiography (CCT/CCTA) including reduction in blooming artifacts in heavy calcified coronary plaques or beam-hardening artifacts in patients with coronary stents, and a more precise assessment of the degree of stenosis and plaque characteristic thanks to its better spatial resolution. Another potential application of PCCT is the use of a double-contrast agent to characterize myocardial tissue. In this current overview of the existing PCCT literature, we describe the strengths, limitations, recent applications, and promising developments of employing PCCT technology in CCT. Full article

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17 pages, 994 KiB

Open AccessEditor’s ChoiceReview

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

by Paolo Severino, Andrea D’Amato, Silvia Prosperi, Vincenzo Myftari, Lorenzo Colombo, Elisa Tomarelli, Alice Piccialuti, Gianluca Di Pietro, Lucia Ilaria Birtolo, Viviana Maestrini, Roberto Badagliacca, Gennaro Sardella, Francesco Fedele, Carmine Dario Vizza and Massimo Mancone

J. Clin. Med. 2023, 12(10), 3586; https://doi.org/10.3390/jcm12103586 - 21 May 2023

Cited by 7 | Viewed by 2268

Abstract

Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease [...] Read more.

Among the most common causes of death worldwide, ischemic heart disease (IHD) is recognized to rank first. Even if atherosclerotic disease of the epicardial arteries is known as the leading cause of IHD, the presence of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasingly recognized. Notwithstanding the increasing interest, MINOCA remains a puzzling clinical entity that can be classified by distinguishing different underlying mechanisms, which can be divided into atherosclerotic and non-atherosclerotic. In particular, coronary microvascular dysfunction (CMD), classifiable in non-atherosclerotic mechanisms, is a leading factor for the pathophysiology and prognosis of patients with MINOCA. Genetic susceptibility may have a role in primum movens in CMD. However, few results have been obtained for understanding the genetic mechanisms underlying CMD. Future studies are essential in order to find a deeper understanding of the role of multiple genetic variants in the genesis of microcirculation dysfunction. Progress in research would allow early identification of high-risk patients and the development of pharmacological, patient-tailored strategies. The aim of this review is to revise the pathophysiology and underlying mechanisms of MINOCA, focusing on CMD and actual knowledge about genetic predisposition to it. Full article

(This article belongs to the Special Issue Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): Current Status, Challenges and Future Directions)

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13 pages, 774 KiB

Open AccessEditor’s ChoiceArticle

Concomitant Autoimmunity in Endometriosis Impairs Endometrium–Embryo Crosstalk at the Implantation Site: A Multicenter Case-Control Study

by Noemi Salmeri, Gianluca Gennarelli, Valeria Stella Vanni, Stefano Ferrari, Alessandro Ruffa, Patrizia Rovere-Querini, Luca Pagliardini, Massimo Candiani and Enrico Papaleo

J. Clin. Med. 2023, 12(10), 3557; https://doi.org/10.3390/jcm12103557 - 19 May 2023

Cited by 8 | Viewed by 1278

Abstract

Endometriosis and autoimmune diseases share a hyper-inflammatory state that might negatively impact the embryo–endometrium crosstalk. Inflammatory and immune deregulatory mechanisms have been shown to impair both endometrial receptivity and embryo competence at the implantation site. The aim of this study was to investigate [...] Read more.

Endometriosis and autoimmune diseases share a hyper-inflammatory state that might negatively impact the embryo–endometrium crosstalk. Inflammatory and immune deregulatory mechanisms have been shown to impair both endometrial receptivity and embryo competence at the implantation site. The aim of this study was to investigate the potential additional impact of co-existing autoimmunity in women affected by endometriosis on the early stages of reproduction. This was a retrospective, multicenter case-control study enrolling N = 600 women with endometriosis who underwent in vitro fertilization–embryo transfer cycles between 2007 and 2021. Cases were women with endometriosis and concomitant autoimmunity matched based on age and body mass index to controls with endometriosis only in a 1:3 ratio. The primary outcome was the cumulative clinical pregnancy rate (cCPR). The study found significantly lower cleavage (p = 0.042) and implantation (p = 0.029) rates among cases. Autoimmunity (p = 0.018), age (p = 0.007), and expected poor response (p = 0.014) were significant negative predictors of cCPR, with an adjusted odds ratio of 0.54 (95% CI, 0.33–0.90) for autoimmunity. These results suggest that the presence of concomitant autoimmunity in endometriosis has a significant additive negative impact on embryo implantation. This effect might be due to several immunological and inflammatory mechanisms that interfere with both endometrial receptivity and embryo development and deserves further consideration. Full article

(This article belongs to the Special Issue Current Trends in Reproductive Endocrinology)

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16 pages, 489 KiB

Open AccessEditor’s ChoiceReview

Nephroprotective Properties of Antidiabetic Drugs

by Christian Gerdes, Nicolle Müller, Gunter Wolf and Martin Busch

J. Clin. Med. 2023, 12(10), 3377; https://doi.org/10.3390/jcm12103377 - 10 May 2023

Cited by 7 | Viewed by 3157

Abstract

Chronic kidney disease (CKD) is associated with increased morbidity and mortality, especially from cardiovascular (CV) causes, and especially in people with diabetes mellitus (DM). Already the presence of DM increases CV risk and potentiates the risk of CKD. Therefore, besides glycemic control, prevention [...] Read more.

Chronic kidney disease (CKD) is associated with increased morbidity and mortality, especially from cardiovascular (CV) causes, and especially in people with diabetes mellitus (DM). Already the presence of DM increases CV risk and potentiates the risk of CKD. Therefore, besides glycemic control, prevention and treatment of CKD to slow its progression are of clinical importance. A significant nephroprotective effect of novel antidiabetic drugs, namely sodium-glucose cotransporter 2 inhibitors (SGLT2-I) and glucagon-like peptide 1 receptor agonists (GLP1-RA), has been shown on top of their glucose-lowering effects and was confirmed in cardiovascular outcome trials. GLP1-RA mainly reduced the risk of macroalbuminuria, whereas SGLT2-I were also associated with a lower risk of declining glomerular filtration rate (GFR) over time. The nephroprotective effects of SGLT2-I are also evident in people without DM. According to current guidelines, SGLT2-I and/or GLP1-RA are recommended for people with DM who have chronic kidney disease and/or increased cardiovascular risk. However, other antidiabetic drugs offer nephroprotective properties, which will also be discussed in this review. Full article

(This article belongs to the Special Issue Diabetic Kidney Disease: Epidemiology, Risk Factors for Disease Progression and Cardiovascular Complications, Novel Diagnostics and Treatments)

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16 pages, 1149 KiB

Open AccessEditor’s ChoiceReview

Pathobiology of Type 2 Inflammation in Asthma and Nasal Polyposis

by Corrado Pelaia, Giulia Pelaia, Angelantonio Maglio, Caterina Tinello, Luca Gallelli, Nicola Lombardo, Rosa Terracciano and Alessandro Vatrella

J. Clin. Med. 2023, 12(10), 3371; https://doi.org/10.3390/jcm12103371 - 09 May 2023

Cited by 9 | Viewed by 3955

Abstract

Asthma and nasal polyposis often coexist and are frequently intertwined by tight pathogenic links, mainly consisting of the cellular and molecular pathways underpinning type 2 airway inflammation. The latter is characterized by a structural and functional impairment of the epithelial barrier, associated with [...] Read more.

Asthma and nasal polyposis often coexist and are frequently intertwined by tight pathogenic links, mainly consisting of the cellular and molecular pathways underpinning type 2 airway inflammation. The latter is characterized by a structural and functional impairment of the epithelial barrier, associated with the eosinophilic infiltration of both the lower and upper airways, which can be driven by either allergic or non-allergic mechanisms. Type 2 inflammatory changes are predominantly due to the biological actions exerted by interleukins 4 (IL-4), 13 (IL-13), and 5 (IL-5), produced by T helper 2 (Th2) lymphocytes and group 2 innate lymphoid cells (ILC2). In addition to the above cytokines, other proinflammatory mediators involved in the pathobiology of asthma and nasal polyposis include prostaglandin D₂ and cysteinyl leukotrienes. Within this context of ‘united airway diseases’, nasal polyposis encompasses several nosological entities such as chronic rhinosinusitis with nasal polyps (CRSwNP) and aspirin-exacerbated respiratory disease (AERD). Because of the common pathogenic origins of asthma and nasal polyposis, it is not surprising that the more severe forms of both these disorders can be successfully treated by the same biologic drugs, targeting many molecular components (IgE, IL-5 and its receptor, IL-4/IL-13 receptors) of the type 2 inflammatory trait. Full article

(This article belongs to the Special Issue Advances in Asthma)

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10 pages, 1284 KiB

Open AccessEditor’s ChoiceArticle

The Epidemiology of Spondylodiscitis in Germany: A Descriptive Report of Incidence Rates, Pathogens, In-Hospital Mortality, and Hospital Stays between 2010 and 2020

by Siegmund Lang, Nike Walter, Melanie Schindler, Susanne Baertl, Dominik Szymski, Markus Loibl, Volker Alt and Markus Rupp

J. Clin. Med. 2023, 12(10), 3373; https://doi.org/10.3390/jcm12103373 - 09 May 2023

Cited by 8 | Viewed by 1467

Abstract

Background: Spondylodiscitis can lead to significant morbidity and mortality. Understanding its up-to-date epidemiological characteristics and trends is important to improve patient care. Methods: This study analyzed trends in the incidence rate of spondylodiscitis cases in Germany between 2010 and 2020, as well as [...] Read more.

Background: Spondylodiscitis can lead to significant morbidity and mortality. Understanding its up-to-date epidemiological characteristics and trends is important to improve patient care. Methods: This study analyzed trends in the incidence rate of spondylodiscitis cases in Germany between 2010 and 2020, as well as the pathogens, in-hospital mortality rate, and length of hospital stay. Data were obtained from the Federal Statistical Office and the Institute for the Hospital Remuneration System database. The ICD-10 codes “M46.2-”, “M46.3-” and “M46.4-” were evaluated. Results: The incidence rate of spondylodiscitis increased to 14.4/100,000 inhabitants, with 59.6% cases occurring in patients 70 years or older and affecting mainly the lumbar spine (56.2%). Absolute case numbers increased from 6886 by 41.6% to 9753 in 2020 (IIR = 1.39, 95% CI 0.62–3.08). Staphylococci and Escherichia coli were the most coded pathogens. The proportion of resistant pathogens was 12.9%. In-hospital mortality rates increased to a maximum of 64.7/1000 patients in 2020, intensive care unit treatment was documented in 2697 (27.7%) cases, and the length of stay per case was 22.3 days. Conclusion: The sharply increasing incidence and in-hospital mortality rate of spondylodiscitis highlights the need for patient-centered therapy to improve patient outcomes, especially in the geriatric, frail population, which is prone to infectious diseases. Full article

(This article belongs to the Special Issue Spinal Infections: Pathogenesis, Diagnosis, Management and Outcomes)

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19 pages, 4282 KiB

Open AccessEditor’s ChoiceReview

Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy

by Ali Fahim Khan, Grace Haynes, Esmaeil Mohammadi, Fauziyya Muhammad, Sanaa Hameed and Zachary A. Smith

J. Clin. Med. 2023, 12(9), 3337; https://doi.org/10.3390/jcm12093337 - 08 May 2023

Cited by 7 | Viewed by 2265

Abstract

Cervical spondylotic myelopathy (CSM) is a progressive disease that worsens over time if untreated. However, the rate of progression can vary among individuals and may be influenced by various factors, such as the age of the patients, underlying conditions, and the severity and [...] Read more.

Cervical spondylotic myelopathy (CSM) is a progressive disease that worsens over time if untreated. However, the rate of progression can vary among individuals and may be influenced by various factors, such as the age of the patients, underlying conditions, and the severity and location of the spinal cord compression. Early diagnosis and prompt treatment can help slow the progression of CSM and improve symptoms. There has been an increased use of magnetic resonance imaging (MRI) methods in diagnosing and managing CSM. MRI methods provide detailed images and quantitative structural and functional data of the cervical spinal cord and brain, allowing for an accurate evaluation of the extent and location of tissue injury. This review aims to provide an understanding of the use of MRI methods in interrogating functional and structural changes in the central nervous system in CSM. Further, we identified several challenges hindering the clinical utility of these neuroimaging methods. Full article

(This article belongs to the Special Issue Latest Developments in Minimally Invasive Spinal Treatment)

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19 pages, 2766 KiB

Open AccessEditor’s ChoiceArticle

Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants

by Jan-Henrik Rieck, Annika Beyer, Alexander Mewes, Amke Caliebe and Matthias Hey

J. Clin. Med. 2023, 12(9), 3262; https://doi.org/10.3390/jcm12093262 - 03 May 2023

Cited by 9 | Viewed by 1544

Abstract

Background: The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study [...] Read more.

Background: The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients. Methods: A retrospective study with 664 ears of 530 adult patients was conducted. Correlations between the target variable postoperative word comprehension with the preoperative speech and sound comprehension as well as aetiology were investigated. Significant correlations were inserted into multivariate models. Speech comprehension measured as word recognition score at 70 dB with CI was analyzed as (i) a continuous and (ii) a dichotomous variable. Results: All variables that tested preoperative hearing were significantly correlated with the dichotomous target; with the continuous target, all except word comprehension at 65 dB with hearing aid. The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. The preoperative maximum word comprehension was reached or surpassed by 97.3% of CI patients. Meningitis and congenital diseases were strongly negatively associated with postoperative word comprehension. The multivariate model was able to explain 40% of postoperative variability. Conclusion: Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling. Full article

(This article belongs to the Special Issue Hearing Disorders: Diagnosis, Management, and Future Opportunities: Part II)

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19 pages, 515 KiB

Open AccessEditor’s ChoiceReview

Oral Cavity Squamous Cell Carcinoma Risk Factors: State of the Art

by Lara Nokovitch, Charles Maquet, Frédéric Crampon, Ihsène Taihi, Lise-Marie Roussel, Rais Obongo, François Virard, Béatrice Fervers and Sophie Deneuve

J. Clin. Med. 2023, 12(9), 3264; https://doi.org/10.3390/jcm12093264 - 03 May 2023

Cited by 10 | Viewed by 2546

Abstract

Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol [...] Read more.

Head and neck (HN) squamous cell carcinomas (SCCs) originate from the epithelial cells of the mucosal linings of the upper aerodigestive tract, which includes the oral cavity, the pharynx, the larynx, and the sinonasal cavities. There are many associated risk factors, including alcohol drinking coupled with tobacco use, which accounts for 70% to 80% of HNSCCs. Human papilloma virus (HPV) is another independent risk factor for oropharyngeal SCC, but it is only a minor contributor to oral cavity SCC (OSCC). Betel quid chewing is also an established risk factor in southeast Asian countries. However, OSCC, and especially oral tongue cancer, incidence has been reported to be increasing in several countries, suggesting risk factors that have not been identified yet. This review summarizes the established risk factors for oral cavity squamous cell carcinomas and examines other undemonstrated risk factors for HNSCC. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

14 pages, 1613 KiB

Open AccessEditor’s ChoiceArticle

Impact of Pretreatment Systemic Inflammatory Markers on Treatment Persistence with Biologics and Conventional Systemic Therapy: A Retrospective Study of Patients with Psoriasis Vulgaris and Psoriatic Arthritis

by Eiki Sugimoto, Hiroki Matsuda, Sayaka Shibata, Yuka Mizuno, Asumi Koyama, Lixin Li, Haruka Taira, Yukiko Ito, Kentaro Awaji, Takashi Yamashita and Shinichi Sato

J. Clin. Med. 2023, 12(8), 3046; https://doi.org/10.3390/jcm12083046 - 21 Apr 2023

Cited by 9 | Viewed by 1833

Abstract

Systemic inflammation plays a central role in the pathophysiology of psoriasis. This study examined accessible systemic inflammatory markers in patients with psoriasis vulgaris and psoriatic arthritis. We aimed to evaluate their association with psoriasis severity, the presence of arthritis, and drug continuation rates. [...] Read more.

Systemic inflammation plays a central role in the pathophysiology of psoriasis. This study examined accessible systemic inflammatory markers in patients with psoriasis vulgaris and psoriatic arthritis. We aimed to evaluate their association with psoriasis severity, the presence of arthritis, and drug continuation rates. The findings revealed that neutrophil, monocyte, and platelet count, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, systemic inflammation response index, systemic immune/inflammation index (SII), and CRP were positively correlated with Psoriasis Area and Severity Index scores. Patients presenting with higher platelet/lymphocyte ratio (PLR) or CRP values were more likely to be diagnosed with psoriatic arthritis than with psoriasis vulgaris in the multivariate regression analysis. Importantly, patients with higher pretreatment neutrophil or platelet count, PLR, and SII were associated with lower treatment continuation rates of conventional systemic agents. Higher pretreatment scores of systemic inflammatory markers did not affect treatment retention rates of biologics. These findings suggest that several accessible systemic inflammatory markers may effectively assess underlying systemic inflammation and may provide an indication for a therapeutic approach in patients with psoriasis vulgaris and psoriatic arthritis. Full article

(This article belongs to the Special Issue Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors—Volume 2)

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12 pages, 1314 KiB

Open AccessEditor’s ChoiceArticle

A Real-World Study of Achievement Rate and Predictive Factors of Clinical and Deep Remission to Biologics in Patients with Severe Asthma

by Keiji Oishi, Kazuki Hamada, Yoriyuki Murata, Kazuki Matsuda, Syuichiro Ohata, Yoshikazu Yamaji, Maki Asami-Noyama, Nobutaka Edakuni, Tomoyuki Kakugawa, Tsunahiko Hirano and Kazuto Matsunaga

J. Clin. Med. 2023, 12(8), 2900; https://doi.org/10.3390/jcm12082900 - 16 Apr 2023

Cited by 13 | Viewed by 3300

Abstract

Background: Recent advances in biologics have provided new insights into the clinical course of asthma, including disease modification, clinical remission (CR), and deep remission (DR). However, the extent to which biologics achieve CR and DR in severe asthma patients is poorly understood. Methods: [...] Read more.

Background: Recent advances in biologics have provided new insights into the clinical course of asthma, including disease modification, clinical remission (CR), and deep remission (DR). However, the extent to which biologics achieve CR and DR in severe asthma patients is poorly understood. Methods: To assess the achievement rate and predictors of CR and DR using long-term biologics, we retrospectively evaluated 54 severe asthma patients recently started on biologics. “CR” denotes the achievement of all three criteria: (1) absence of asthma symptoms, (2) no asthma exacerbations, and (3) no use of oral corticosteroids. DR denoted CR plus (4) normalized pulmonary function and (5) suppressed type 2 inflammation. Results: CR and DR achievement rates were 68.5% and 31.5%, respectively. Compared with the non-deep remission group, the DR group had higher adult-onset asthma rates (94.1% vs. 70.3%, p = 0.078), shorter asthma duration (5 vs. 19 years, p = 0.006), and higher FEV₁ (91.5% vs. 71.5%, p < 0.001). There were no significant differences in the Asthma Control Questionnaire scores, exacerbation frequency, or type 2 inflammation at baseline between groups. Asthma duration combined with FEV₁ can stratify the achievement rates of CR and DR. Conclusions: the early introduction of biologics in severe asthma patients may help achieve CR and DR. Full article

(This article belongs to the Special Issue Clinical Application of Biological Therapies in Severe Asthma)

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16 pages, 2711 KiB

Open AccessEditor’s ChoiceArticle

A No-History Multi-Formula Approach to Improve the IOL Power Calculation after Laser Refractive Surgery: Preliminary Results

by Ferdinando Cione, Maddalena De Bernardo, Marco Gioia, Marianunzia Oliviero, Andrea Giuseppe Santoro, Alessandro Caputo, Luigi Capasso, Sergio Pagliarulo and Nicola Rosa

J. Clin. Med. 2023, 12(8), 2890; https://doi.org/10.3390/jcm12082890 - 15 Apr 2023

Cited by 12 | Viewed by 1391

Abstract

This retrospective comparative study proposes a multi-formula approach by comparing no-history IOL power calculation methods after myopic laser-refractive-surgery (LRS). One-hundred-thirty-two eyes of 132 patients who had myopic-LRS and cataract surgery were examined. ALMA, Barrett True-K (TK), Ferrara, Jin, Kim, Latkany and Shammas methods [...] Read more.

This retrospective comparative study proposes a multi-formula approach by comparing no-history IOL power calculation methods after myopic laser-refractive-surgery (LRS). One-hundred-thirty-two eyes of 132 patients who had myopic-LRS and cataract surgery were examined. ALMA, Barrett True-K (TK), Ferrara, Jin, Kim, Latkany and Shammas methods were evaluated in order to back-calculate refractive prediction error (PE). To eliminate any systematic error, constant optimization through zeroing-out the mean error (ME) was performed for each formula. Median absolute error (MedAE) and percentage of eyes within ±0.50 and ±1.00 diopters (D) of PE were analyzed. PEs were plotted with corresponding mean keratometry (K), axial length (AL), and AL/K ratio; then, different ranges were evaluated. With optimized constants through zeroing-out ME (90 eyes), ALMA was better when K ≤ 38.00 D-AL > 28.00 mm and when 38.00 D < K ≤ 40.00 D-26.50 mm < AL ≤ 29.50 mm; Barrett-TK was better when K ≤ 38.00 D-AL ≤ 26.50 mm and when K > 40.00 D-AL ≤ 28.00 mm or AL > 29.50 mm; and both ALMA and Barrett-TK were better in other ranges. (p < 0.05) Without modified constants (132 eyes), ALMA was better when K > 38.00 D-AL ≤ 29.50 mm and when 36.00 < K ≤ 38.00 D-AL ≤ 26.50 mm; Barrett-TK was better when K ≤ 36.00 D and when K ≤ 38.00 D with AL > 29.50 mm; and both ALMA and Barrett-TK were better in other ranges (p < 0.05). A multi-formula approach, according to different ranges of K and AL, could improve refractive outcomes in post-myopic-LRS eyes. Full article

(This article belongs to the Section Ophthalmology)

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23 pages, 417 KiB

Open AccessEditor’s ChoiceReview

Treatment Advances in Sepsis and Septic Shock: Modulating Pro- and Anti-Inflammatory Mechanisms

by Adriana Marques, Carla Torre, Rui Pinto, Bruno Sepodes and João Rocha

J. Clin. Med. 2023, 12(8), 2892; https://doi.org/10.3390/jcm12082892 - 15 Apr 2023

Cited by 10 | Viewed by 3017

Abstract

Sepsis is currently defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and it affects over 25 million people every year. Even more severe, septic shock is a subset of sepsis defined by persistent hypotension, and hospital mortality [...] Read more.

Sepsis is currently defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and it affects over 25 million people every year. Even more severe, septic shock is a subset of sepsis defined by persistent hypotension, and hospital mortality rates are higher than 40%. Although early sepsis mortality has greatly improved in the past few years, sepsis patients who survive the hyperinflammation and subsequent organ damage often die from long-term complications, such as secondary infection, and despite decades of clinical trials targeting this stage of the disease, currently, no sepsis-specific therapies exist. As new pathophysiological mechanisms have been uncovered, immunostimulatory therapy has emerged as a promising path forward. Highly investigated treatment strategies include cytokines and growth factors, immune checkpoint inhibitors, and even cellular therapies. There is much to be learned from related illnesses, and immunotherapy trials in oncology, as well as the recent COVID-19 pandemic, have greatly informed sepsis research. Although the journey ahead is a long one, the stratification of patients according to their immune status and the employment of combination therapies represent a hopeful way forward. Full article

(This article belongs to the Special Issue SIRS and Sepsis: Novel Aspects of Modern Research on Hyperinflammation)

35 pages, 2812 KiB

Open AccessEditor’s ChoiceReview

Bruch’s Membrane: A Key Consideration with Complement-Based Therapies for Age-Related Macular Degeneration

by Sarah Hammadi, Nikolaos Tzoumas, Mariantonia Ferrara, Ingrid Porpino Meschede, Katharina Lo, Claire Harris, Majlinda Lako and David H. Steel

J. Clin. Med. 2023, 12(8), 2870; https://doi.org/10.3390/jcm12082870 - 14 Apr 2023

Cited by 8 | Viewed by 5162

Abstract

The complement system is crucial for immune surveillance, providing the body’s first line of defence against pathogens. However, an imbalance in its regulators can lead to inappropriate overactivation, resulting in diseases such as age-related macular degeneration (AMD), a leading cause of irreversible blindness [...] Read more.

The complement system is crucial for immune surveillance, providing the body’s first line of defence against pathogens. However, an imbalance in its regulators can lead to inappropriate overactivation, resulting in diseases such as age-related macular degeneration (AMD), a leading cause of irreversible blindness globally affecting around 200 million people. Complement activation in AMD is believed to begin in the choriocapillaris, but it also plays a critical role in the subretinal and retinal pigment epithelium (RPE) spaces. Bruch’s membrane (BrM) acts as a barrier between the retina/RPE and choroid, hindering complement protein diffusion. This impediment increases with age and AMD, leading to compartmentalisation of complement activation. In this review, we comprehensively examine the structure and function of BrM, including its age-related changes visible through in vivo imaging, and the consequences of complement dysfunction on AMD pathogenesis. We also explore the potential and limitations of various delivery routes (systemic, intravitreal, subretinal, and suprachoroidal) for safe and effective delivery of conventional and gene therapy-based complement inhibitors to treat AMD. Further research is needed to understand the diffusion of complement proteins across BrM and optimise therapeutic delivery to the retina. Full article

(This article belongs to the Special Issue Imaging in Ophthalmology—Volume I)

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12 pages, 295 KiB

Open AccessEditor’s ChoiceReview

Optimizing Outcomes in Flexible Ureteroscopy: A Narrative Review of Suction Techniques

by Catalina Solano, Marie Chicaud, Stessy Kutchukian, Luigi Candela, Mariela Corrales, Frédéric Panthier, Steeve Doizi and Olivier Traxer

J. Clin. Med. 2023, 12(8), 2815; https://doi.org/10.3390/jcm12082815 - 11 Apr 2023

Cited by 7 | Viewed by 1705

Abstract

Objective: The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. Methods: A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we [...] Read more.

Objective: The aim of this review is to summarize the existing suction systems in flexible ureteroscopy (fURS) and to evaluate their effectiveness and safety. Methods: A narrative review was performed using the Pubmed and Web of Science Core Collection (WoSCC) databases. Additionally, we conducted a search on the Twitter platform. Studies including suctions systems in fURS were included. Editorials, letters and studies reporting intervention with semirigid ureteroscopy, PCNL and mPCNL were excluded. Results: A total of 12 studies were included in this review. These studies comprised one in vitro study, one ex vivo study, one experimental study and eight cohort studies. The Pubmed and WoSCC searches identified three suction techniques (Irrigation/Suctioning system with control of pressure, suction ureteral access sheath (sUAS) and direct in scope suction (DISS)), and the Twitter search identified four of them. The overall results showed that suction is an effective and safe technique that improves stone-free rates, reduces operative time and limits complication rates after fURS. Conclusions: The use of suctioning during common endourological procedures has been shown to improve safety and efficacy in several indications. However, randomized controlled trials are needed to confirm this. Full article

(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)

16 pages, 343 KiB

Open AccessEditor’s ChoiceReview

Current Trends in Volume and Surgical Outcomes in Gastric Cancer

by Luigi Marano, Luigi Verre, Ludovico Carbone, Gianmario Edoardo Poto, Daniele Fusario, Dario Francesco Venezia, Natale Calomino, Karolina Kaźmierczak-Siedlecka, Karol Polom, Daniele Marrelli, Franco Roviello, Johnn Henry Herrera Kok and Yogesh Vashist

J. Clin. Med. 2023, 12(7), 2708; https://doi.org/10.3390/jcm12072708 - 04 Apr 2023

Cited by 9 | Viewed by 2434

Abstract

Gastric cancer is ranked as the fifth most frequently diagnosed type of cancer. Complete resection with adequate lymphadenectomy represents the goal of treatment with curative intent. Quality assurance is a crucial factor in the evaluation of oncological surgical care, and centralization of healthcare [...] Read more.

Gastric cancer is ranked as the fifth most frequently diagnosed type of cancer. Complete resection with adequate lymphadenectomy represents the goal of treatment with curative intent. Quality assurance is a crucial factor in the evaluation of oncological surgical care, and centralization of healthcare in referral hospitals has been proposed in several countries. However, an international agreement about the setting of “high-volume hospitals” as well as “minimum volume standards” has not yet been clearly established. Despite the clear postoperative mortality benefits that have been described for gastric cancer surgery conducted by high-volume surgeons in high-volume hospitals, many authors have highlighted the limitations of a non-composite variable to define the ideal postoperative period. The textbook outcome represents a multidimensional measure assessing the quality of care for cancer patients. Transparent and easily available hospital data will increase patients’ awareness, providing suitable elements for a more informed hospital choice. Full article

(This article belongs to the Special Issue Preventive, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

22 pages, 677 KiB

Open AccessEditor’s ChoiceReview

Irritable Bowel Syndrome and the Gut Microbiome: A Comprehensive Review

by Sofia D. Shaikh, Natalie Sun, Andrew Canakis, William Y. Park and Horst Christian Weber

J. Clin. Med. 2023, 12(7), 2558; https://doi.org/10.3390/jcm12072558 - 28 Mar 2023

Cited by 17 | Viewed by 8525

Abstract

Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits. It has a prevalence of 10 to 25% in the United States and has a high disease burden, as evidenced by reduced quality [...] Read more.

Irritable Bowel Syndrome (IBS) is a functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits. It has a prevalence of 10 to 25% in the United States and has a high disease burden, as evidenced by reduced quality of life, decreased work productivity and increased healthcare utilization and costs. IBS has been associated with several intra-intestinal and extra-intestinal conditions, including psychiatric comorbidities. Although the pathophysiology of IBS has not been fully elucidated, it involves dysregulation of communication between the brain and gut (brain–gut axis) which is associated with alterations in intestinal motility, gut permeability, visceral hypersensitivity and gut microbiota composition. The purpose of this article is to review the role the gut microbiota plays in the pathophysiology of IBS, understand factors that affect the gut microbiome and explore the microbiome as a target of treatment. Full article

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

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