Journal of Clinical Medicine

10 pages, 255 KiB

Open AccessArticle

Diabetes-Related Changes in Carotid Wall Properties: Role of Triglycerides

by Michaela Kozakova, Carmela Morizzo, Giuseppe Penno, Dante Chiappino and Carlo Palombo

J. Clin. Med. 2024, 13(18), 5654; https://doi.org/10.3390/jcm13185654 - 23 Sep 2024

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Background/Objectives: This study compares the power of the radiofrequency (RF) signal reflected from the media layer (media power) of the common carotid artery (CCA) and the CCA stiffness between individuals with and without type 2 diabetes mellitus (T2DM). It also evaluates the associations [...] Read more.

Background/Objectives: This study compares the power of the radiofrequency (RF) signal reflected from the media layer (media power) of the common carotid artery (CCA) and the CCA stiffness between individuals with and without type 2 diabetes mellitus (T2DM). It also evaluates the associations of CCA media power with plasma glucose and lipid levels, as well as carotid stiffness. Methods: A total of 540 individuals, 115 with and 425 without T2DM (273 males, mean age = 64 ± 8 years) were studied using RF-based tracking of the right CCA. The following parameters were measured: CCA media thickness, luminal diameter, wall tensile stress (WTS), local pulse wave velocity (PWV), and media power. Results: Compared to the non-diabetic individuals, the T2DM patients had significantly higher CCA media thickness (652 ± 122 vs. 721 ± 138 microns, p < 0.005), luminal diameter (6.12 ± 0.78 vs. 6.86 ± 0.96 mm, p < 0.0005), media power (36.1 ± 4.8 vs. 39.3 ± 4.6, p < 0.0001), and PWV (7.65 ± 1.32 vs. 8.40 ± 1.89 m/s; p < 0.01), but comparable WTS (32.7 ± 10.4 vs. 33.1 ± 10.7 kPa; p = 0.25). In the entire population, CCA media power was independently associated with male sex, pulse pressure, current smoking, and T2DM; when T2DM was not included in the model, triglycerides emerged as an independent determinant of media power. The CCA PWV was independently associated with age, pulse pressure, media power, and T2DM. Conclusions: Our findings suggest the presence of structural changes in the arterial media of T2DM patients, leading to carotid stiffening and remodeling, aiming to preserve WTS. T2DM-related changes in arterial wall composition may be driven by high plasma triglyceride levels, which have previously been associated with both arterial stiffening and the incidence of CV events. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

13 pages, 1296 KiB

Open AccessArticle

Treatment of Capsular Contracture in Previously Irradiated Breasts Implants and Expanders with the Use of Porcine Acellular Dermal Matrices: Outcomes and Complications

by Andrea Vittorio Emanuele Lisa, Riccardo Carbonaro, Manuela Bottoni, Giulia Colombo, Marika Gentilucci, Valeriano Vinci, Edvin Ostapenko, Luca Nicosia, Francesca De Lorenzi and Mario Rietjens

J. Clin. Med. 2024, 13(18), 5653; https://doi.org/10.3390/jcm13185653 - 23 Sep 2024

Viewed by 336

Abstract

Background: Radiation therapy is a crucial component of breast cancer treatment. However, it is well known to increase the risk of unsatisfactory cosmetic outcomes and higher complication rates. The aim of this study is to provide further insight into the use of [...] Read more.

Background: Radiation therapy is a crucial component of breast cancer treatment. However, it is well known to increase the risk of unsatisfactory cosmetic outcomes and higher complication rates. The aim of this study is to provide further insight into the use of acellular dermal matrices (ADMs) for the prevention of capsular contracture. Materials and Methods: This single-center, retrospective study analyzed irradiated patients who underwent post-mastectomy, ADM-assisted implant reconstructions. Of the 60 patients included, 26 underwent expander-to-implant substitution after radiotherapy (Group A), while 34 required implant replacement due to capsular contracture following radiotherapy (Group B). The primary objective was to evaluate the effectiveness of ADMs in reducing reconstructive failures, complications, and capsular contracture after breast irradiation. Results: We recorded a total of 15 complications and four implant losses. Reconstructive failures were attributed to implant exposure in two cases, full-thickness skin necrosis in one case, and severe Baker grade IV contracture in one case. Both Group A and Group B showed a significant decrease in postoperative Baker grades. US follow-up was used to demonstrate ADM integration with host tissues over time. Conclusions: Based on our findings, the use of ADM in selected cases appears to be a viable option for treating and preventing capsular contracture in irradiated breasts. This approach is associated with relatively low complication rates, a low rate of reconstructive failure, and satisfactory cosmetic outcomes and can be applied both in breast reconstructed with implants and with expanders. Full article

(This article belongs to the Special Issue Advances in Breast Imaging)

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17 pages, 5709 KiB

Open AccessReview

Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis

by Alaa Safia, Uday Abd Elhadi, Rawnk Bader, Ashraf Khater, Marwan Karam, Taiser Bishara, Saqr Massoud, Shlomo Merchavy and Raed Farhat

J. Clin. Med. 2024, 13(18), 5652; https://doi.org/10.3390/jcm13185652 - 23 Sep 2024

Viewed by 299

Abstract

The removal of foreign bodies (FBs) from the airways of children is a critical procedure that can avert serious complications. While both flexible and rigid bronchoscopy techniques are employed for this purpose, their comparative efficacy and safety remain subjects of debate. Therefore, we [...] Read more.

The removal of foreign bodies (FBs) from the airways of children is a critical procedure that can avert serious complications. While both flexible and rigid bronchoscopy techniques are employed for this purpose, their comparative efficacy and safety remain subjects of debate. Therefore, we conducted this investigation to compare between both procedures. Studies comparing flexible to rigid bronchoscopy (n = 14) were identified by searching PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. We performed comparative meta-analyses of reported presentation characteristics and clinical outcomes, using fixed- and random-effects models. A diverse range of FB types and locations were identified. No difference was observed in the success rate of FB removal between flexible and rigid bronchoscopy (logOR = 0.27; 95%CI: −1.91:2.45). The rate of negative first bronchoscopy was higher in the flexible compared to the rigid group (logOR = 2.68; 95%CI: 1.68:3.67). Conversion rates to the alternative method were higher in the flexible bronchoscopy group. The overall complication rates were similar between both methods; however, the risk of desaturation was significantly lower with flexible bronchoscopy (logOR = −2.22; 95%CI: −3.36:−1.08). Flexible bronchoscopy was associated with a shorter length of hospital stay. The choice of bronchoscopy technique should be tailored to individual case characteristics. Full article

(This article belongs to the Section Otolaryngology)

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11 pages, 788 KiB

Open AccessArticle

A French Preoperative Cholesteatoma Management: Current Preoperative Consultation and Tendencies

by Benjamin Reliquet, Mireille Folia, Paul Elhomsy, Serge Aho-Ludwig and Caroline Guigou

J. Clin. Med. 2024, 13(18), 5651; https://doi.org/10.3390/jcm13185651 - 23 Sep 2024

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Abstract

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended [...] Read more.

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended questions and 1 open-ended question. Seven questions concerned the participants’ characteristics and 2 questions concerned the physiopathology of cholesteatoma. Nine questions focused on surgical information, six questions focused on the procedure modalities and ten questions focused on the risks of complications from the intervention. Results: Eighty-two surgeons answered the survey. In 75% of the cases, an information form written by a professional society was provided. The risk of recurrence or residual post-operative cholesteatoma was systematically stated in 78% of cases (n = 64), while the risk of aesthetic sequelae was only stated in 1% (n = 1). Participants working in a university hospital were more likely to inform patients about the risks of vertigo (p = 0.04), aesthetic risks (p = 0.04), poor functional outcomes (p = 0.04), surgical revision (p = 0.05) and the risk of peripheral facial paralysis (p = 0.05). Surgeons who mainly practiced otology were more likely to inform patients about the risks of recurrence and/or residual cholesteatoma (p = 0.02) and taste disturbances (p = 0.02). Conclusions: Cholesteatoma surgery was well explained to patients during the preoperative consultation, mostly with written support, even if the information given was not the same for all complication risks. It could be useful to create an information form dedicated to cholesteatoma surgery to improve comprehensive information and maintain a trustworthy relationship with patients. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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15 pages, 1995 KiB

Open AccessArticle

Elevated Alanine Transaminase-to-Platelet Index (APRI) Is Associated with Obesity and Distinct Forms of Dyslipidemia: A Retrospective Cross-Sectional Study

by Yazeed Alshuweishi, Dalal Alfayez, Abdulmalik A. Almufarrih, Arwa Abudawood, Hanan Alyami, Faisal A. Alshuweishi, Yazeed A. Al-Sheikh and Mohammad A. Alfhili

J. Clin. Med. 2024, 13(18), 5650; https://doi.org/10.3390/jcm13185650 - 23 Sep 2024

Viewed by 465

Abstract

Background: Obesity is a pathological condition and a major risk factor for dyslipidemia, type 2 diabetes, and non-alcoholic fatty liver disease. Recent research highlighted the association of non-invasive serum markers with these conditions but the clinical utility of ALT APRI in obesity and [...] Read more.

Background: Obesity is a pathological condition and a major risk factor for dyslipidemia, type 2 diabetes, and non-alcoholic fatty liver disease. Recent research highlighted the association of non-invasive serum markers with these conditions but the clinical utility of ALT APRI in obesity and its relationship with dyslipidemia remain unexplored. Methods: We examined the association of ALT APRI in 165 non-diabetic adults stratified by BMI and serum lipid parameters. Results: Obese subjects had significantly higher APRI than lean subjects, with an area under the curve (AUC) of 0.65 (p = 0.019). Medians of APRI were significantly increased in subjects with high TG, TG/HDL, TC/HDL, and LDL/HDL and low HDL. Notably, all lipid parameters and ratios were significantly elevated in the highest APRI tertile, compared with patients in the lowest tertile. APRI was weakly yet significantly correlated with BMI (R² = 0.032, p = 0.022), HDL (R² = 0.071), TG/HDL (R² = 0.031), TC/HDL (R² = 0.063), LDL/HDL (R² = 0.072), and TyG index (R² = 0.081). While APRI only showed a discriminating capacity for HDL (AUC: 0.69, p = 0.003), TG/HDL (AUC: 0.63, p = 0.020), LDL/HDL (AUC: 0.68, p < 0.001), and TyG index (AUC: 0.65, p = 0.037), the highest diagnostic performance of APRI was observed with TC/HDL (AUC: 0.74, p < 0.001). Additionally, APRI was a risk factor for high TG (OR: 1.6, p = 0.028), low HDL (OR: 2.7, p = 0.0002), high TG/HDL (OR: 1.94, p = 0.0011), high TC/HDL (OR: 2.3, p < 0.0001), high LDL/HDL (OR: 2.2, p = 0.0001), and high TyG index (OR: 2.1, p = 0.008). Conclusions: Our findings argue for the role of APRI as a potential marker for obesity and dyslipidemia, which requires further confirmation in longitudinal studies. Full article

(This article belongs to the Special Issue Clinical Advances in Obesity and Bariatric Surgery)

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12 pages, 780 KiB

Open AccessArticle

The Hedonic Experience Associated with a Gentle Touch Is Preserved in Women with Fibromyalgia

by Sofia Tagini, Giorgia Varallo, Paolo Capodaglio, Alessandro Mauro and Federica Scarpina

J. Clin. Med. 2024, 13(18), 5649; https://doi.org/10.3390/jcm13185649 - 23 Sep 2024

Viewed by 309

Abstract

Background/Objectives: Although manual therapies can be used for pain alleviation in fibromyalgia, there is no clear evidence about the processing of gentle, affective touch in this clinical condition. In fact, persistent painful sensations and psychological factors may impact the hedonic experience of [...] Read more.

Background/Objectives: Although manual therapies can be used for pain alleviation in fibromyalgia, there is no clear evidence about the processing of gentle, affective touch in this clinical condition. In fact, persistent painful sensations and psychological factors may impact the hedonic experience of touch. Methods: This observational cross-sectional study compared the subjective experience of affective touch between 14 women with fibromyalgia (age range: 35–70; range of years of education: 5–13) and 14 pain-free women (age range: 18–30; range of years of education: 13–19). The participants rated the pleasantness of slow and fast touches delivered by a brush, the experimenter’s hand, and a plastic stick. Tactile stimuli were either imagined or real to disentangle the contribution of top-down and bottom-up sensory components. Additionally, a self-report questionnaire explored the lifetime experiences of affective touch. Results: Akin to healthy counterparts, individuals with fibromyalgia rated slow touches delivered by the experimenter’s hand or a brush as more pleasant than fast touches, regardless of whether they were imagined or real. However, the intensity of pain affects only the imagined pleasantness in our participants with fibromyalgia. Furthermore, despite the fibromyalgia patients reporting fewer experiences of affective touch in childhood and adolescence, this evidence was not associated with the experimental outcomes. Conclusions: The hedonic experience of affective touch seems preserved in fibromyalgia despite poor intimate bodily contact in youth. We confirmed that bottom-up and top-down factors contribute to the affective touch perception in fibromyalgia: bodily pain may impact even more the expected pleasure than the actual experience. Future investigations may introduce neurophysiological measures of the implicit autonomic responses to affective touch in fibromyalgia. To conclude, although preliminary, our evidence may be in favor of manual therapies for pain relief in fibromyalgia. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 911 KiB

Open AccessArticle

Association between Hip/Groin Pain and Hip ROM and Strength in Elite Female Soccer Players

by Eloy Jaenada-Carrilero, Luis Baraja-Vegas, Paula Blanco-Giménez, Raul Gallego-Estevez, Iker J. Bautista and Juan Vicente-Mampel

J. Clin. Med. 2024, 13(18), 5648; https://doi.org/10.3390/jcm13185648 - 23 Sep 2024

Viewed by 403

Abstract

Background/Objectives: Hip strength and range of motion have been compared in soccer players with and without hip and groin pain but only in male footballers or gender-combined samples. In female soccer players, the biomechanics contributing to this injury remain poorly understood compared [...] Read more.

Background/Objectives: Hip strength and range of motion have been compared in soccer players with and without hip and groin pain but only in male footballers or gender-combined samples. In female soccer players, the biomechanics contributing to this injury remain poorly understood compared to other sporting injuries. The aim of the present study is to investigate whether differences exist in adductor and abductor isometric test values and hip joint range of motion between elite female soccer players with longstanding groin pain and injury-free controls. Methods: Ten female elite soccer players with current longstanding hip and groin pain and twenty-five injury-free controls from the same teams were included in the study. Hip adductor and abductor isometric strength were evaluated with a hand-held dynamometer. A bent knee fall-out test was also utilized to examine the hip joint range of motion. Results: A significant difference in abductor isometric test values was observed between the control group (2.29 ± 0.53 N/Kg) and the hip and groin pain group (2.77 ± 0.48 N/Kg; p = 0.018). Furthermore, the injured group showed a decreased adductor/abductor ratio compared to the control group (1.00 ± 0.33 vs. 1.27 ± 0.26; p = 0.013). No differences were observed in the bent knee fall-out test (p = 0.285). Conclusions: Female elite soccer players with current longstanding hip and groin pain exhibited higher abductor isometric strength and lower adductor/abductor ratio compared to non-injured women players. There were no differences in the BKFO test between groups. Full article

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

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15 pages, 1298 KiB

Open AccessReview

Placental Gene Therapy for Fetal Growth Restriction and Preeclampsia: Preclinical Studies and Prospects for Clinical Application

by Sanjukta Majumder, Kristen Lee Moriarty, Youngmok Lee and Timothy M. Crombleholme

J. Clin. Med. 2024, 13(18), 5647; https://doi.org/10.3390/jcm13185647 - 23 Sep 2024

Viewed by 647

Abstract

In the last three decades, gene therapy has demonstrated significant progress. Over 700 active investigational new drug (IND) applications have been reported. Research on in utero gene therapy has advanced, but ethical and safety concerns persist. A novel approach under investigation is placental [...] Read more.

In the last three decades, gene therapy has demonstrated significant progress. Over 700 active investigational new drug (IND) applications have been reported. Research on in utero gene therapy has advanced, but ethical and safety concerns persist. A novel approach under investigation is placental gene therapy, which holds promise for targeting diseases associated with placental dysfunction, such as fetal growth restriction (FGR) and preeclampsia. One of the underlying causes of placental insufficiency in these conditions is reduced placental growth factor-driven angiogenesis and endothelial cell dysfunction during fetal development. Studies have explored the overexpression of growth factor transgenes like IGF-1 to address FGR, yielding promising outcomes in animal models. Furthermore, intra-placental gene transfer, instead of systemic delivery of gene therapy vectors, has the potential to treat and cure these disorders. However, challenges and limitations akin to in utero gene therapy persist, including the risk of in utero infection, potential impairment of the mother’s future fertility, the risk of germline integration, and possible off-target effects of gene transfer in the fetus or the mother. Consequently, additional research and deliberation within the scientific and medical communities are warranted to fully comprehend the potential benefits and risks of placental gene therapy. Full article

(This article belongs to the Special Issue State of the Art in Fetal Surgery: Past, Present and Future Perspectives)

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Graphical abstract

12 pages, 1064 KiB

Open AccessSystematic Review

The Influence of Obstructive Sleep Apnea on Post-Stroke Complications: A Systematic Review and Meta-Analysis

by Nithin Kurra, Nikhila Gandrakota, Manju Ramakrishnan, Kavya Sudireddy, Naga Vijaya Lakshmi Divya Boorle and Dinesh Jillella

J. Clin. Med. 2024, 13(18), 5646; https://doi.org/10.3390/jcm13185646 - 23 Sep 2024

Viewed by 520

Abstract

Objectives: Evidence shows that obstructive sleep apnea (OSA) is associated with the development of stroke. This study investigates the relationship between OSA and post-stroke complications, addressing the limited data on how OSA influences the severity and development of these complications through a systematic [...] Read more.

Objectives: Evidence shows that obstructive sleep apnea (OSA) is associated with the development of stroke. This study investigates the relationship between OSA and post-stroke complications, addressing the limited data on how OSA influences the severity and development of these complications through a systematic review of existing literature. Methods: Data was collected from PubMed, Web of Science, and Scopus databases up to December 2023. Studies meeting the inclusion criteria were selected, and statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used for pooling data with heterogeneity, and findings were presented using standard ratios with 95% confidence intervals. Results: The analysis included nine studies. Stroke patients with OSA did not show a significantly higher risk of post-stroke complications, which include mild cognitive impairment, dementia, insomnia, fatigue, reduced sleep quality, depression, anxiety, recurrent strokes, and death, compared with those without OSA (RR = 1.05, 95% CI 0.97 to 1.13). However, patients with high stroke severity and OSA had a slightly higher risk of post-stroke complications (RR = 1.06, 95% CI 1.01 to 1.12). Conclusions: This systematic review and meta-analysis suggests that OSA confers a higher risk of post-stroke complications in patients with high stroke severity. Further studies are required to explore the impact of OSA on post-stroke complications. Full article

(This article belongs to the Section Clinical Neurology)

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12 pages, 1151 KiB

Open AccessArticle

Long-Term Results and Quality of Life after Surgery for Acute Aortic Dissection Type A: Contemporary Single-Centre Experience

by Nora Goebel, Simone A. Holder, Franziska Huether, Eleanor Maw, Rafael Ayala, Yasemin Anguelov, Ulrich F. W. Franke and Dorothee Bail

J. Clin. Med. 2024, 13(18), 5645; https://doi.org/10.3390/jcm13185645 - 23 Sep 2024

Viewed by 381

Abstract

Background: Aortic dissection is still afflicted with significant morbidity and mortality. This research seeks to assess long-term outcomes and quality of life after emergency surgery for acute aortic dissection type A. Methods: A total of 413 patients were analysed, who had [...] Read more.

Background: Aortic dissection is still afflicted with significant morbidity and mortality. This research seeks to assess long-term outcomes and quality of life after emergency surgery for acute aortic dissection type A. Methods: A total of 413 patients were analysed, who had been operated upon between 2000 and 2016 at our centre. We compared our results of the early (2000–2007) versus late (2008–2016) period with regards to 30-day and follow-up mortality and need for reoperation, including risk factor analysis. Quality of life was assessed via the SF-36 survey. Results: Calculated perioperative risk by EuroSCORE increased significantly from early, 24.9%, to late, 38.0%, p < 0.001. Thirty-day rates of mortality decreased significantly from 26.7% to 17.4%, p = 0.03. Survival at 1-, 5-, and 10-years was 92.3% vs. 91.8% (p = 0.91), 75.2% vs. 81.0% (p = 0.29), and 53.4% vs. 69.7% (p = 0.04). Freedom from reoperation was comparable between groups at follow-up: 74.0% vs. 85.7%, p = 0.28. Quality of life was impaired. Conclusions: Despite more complex severity of disease and operative procedures, the results of surgery for type A aortic dissection improved significantly over time at 30-day and 10-year follow-up. Quality of life was significantly impaired compared to a healthy reference population. Full article

(This article belongs to the Section Cardiology)

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8 pages, 637 KiB

Open AccessArticle

Evaluation of Serum Calprotectin as an Alternative Diagnostic Marker for Intrahepatic Cholestasis of Pregnancy

by Harshita Katiyar, Sangeeta Yadav, Surender Singh, Ajay Kumar Mishra, Mandakini Pradhan, Raghavendra Lingaiah and Amit Goel

J. Clin. Med. 2024, 13(18), 5644; https://doi.org/10.3390/jcm13185644 - 23 Sep 2024

Viewed by 267

Abstract

Background/Objectives: Intrahepatic cholestasis of pregnancy (ICP) is characterised by unexplained intense pruritus during pregnancy. While serum bile acid (BA) is the standard diagnostic marker for ICP, we explored the potential of serum calprotectin as an alternative diagnostic marker for ICP. Methods: [...] Read more.

Background/Objectives: Intrahepatic cholestasis of pregnancy (ICP) is characterised by unexplained intense pruritus during pregnancy. While serum bile acid (BA) is the standard diagnostic marker for ICP, we explored the potential of serum calprotectin as an alternative diagnostic marker for ICP. Methods: Leftover serum specimens with known serum BA levels, collected from non-pregnant women and pregnant women with an ICP, were used to measure serum calprotectin levels using the Human calprotectin L1/S100-A8/A9 ELISA kit. Results: Serum calprotectin levels were measured in 79 pregnant women with ICP (median [interquartile range] 28 year; serum BA 20 [13.7–35.7] μMol/L; calprotectin159 pg/mL [122.2–212.3]); 43 pregnant women without ICP (age 28 years; serum BA 3.6 [2.1–5.8] μMol/L; calprotectin 146.5 pg/mL [75.8–194.8]), and 59 non-pregnant women (age 28 years; serum BA 3.5 [1.6–5.1 μMol/L; calprotectin 82.4 pg/mL [48.8–137.2]). Compared to non-pregnant women, calprotectin levels were significantly elevated among pregnant women with (p < 0.001) or without ICP (p = 0.01). Calprotectin levels were comparable between pregnant women with and without ICP (p = 0.15). The areas under the ROC curve, to differentiate the presence and absence of ICP, were 0.940 (0.903–0.977; p < 0.001) and 0.681 (0.604–0.759; p < 0.001) for BA and calprotectin, respectively. Conclusions: Serum calprotectin is raised in pregnant women regardless of the presence or absence of ICP and had an inferior diagnostic performance for ICP compared to BA. This information is crucial for understanding the challenges in ICP diagnosis and the limitations of serum calprotectin as an alternative marker. Full article

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

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8 pages, 711 KiB

Open AccessArticle

Association of Diagonal Earlobe Crease with Risk of Atrial Fibrillation in Stable Patients with Coronary Artery Disease

by Moo-Nyun Jin, Changho Song and Young Ju Kim

J. Clin. Med. 2024, 13(18), 5643; https://doi.org/10.3390/jcm13185643 - 23 Sep 2024

Viewed by 266

Abstract

Background: Diagonal earlobe crease (DELC) is a proposed visible predictor of coronary artery disease (CAD). However, studies on the association between atrial fibrillation (AF) and DELC are lacking. This study evaluated the association between DELC and the incidence of AF in patients [...] Read more.

Background: Diagonal earlobe crease (DELC) is a proposed visible predictor of coronary artery disease (CAD). However, studies on the association between atrial fibrillation (AF) and DELC are lacking. This study evaluated the association between DELC and the incidence of AF in patients with CAD. Methods: A total of 669 participants aged <65 years (mean, 53.8 ± 7.5 years) diagnosed with CAD and without AF were evaluated for the presence of DELC. The study outcome was the incidence of AF based on the presence of DELC. The study period was planned for 60 months with a minimum follow-up period of 12 months. Results: Herein, the incidence of DELC was 10.8%. During the follow-up period (44.6 ± 14.9 months), the incidences of AF development were 16.4% and 8.4% in DELC and non-DELC groups, respectively. Kaplan–Meier analysis revealed that the occurrence of AF was significantly higher in the DELC group than in the non-DELC group (log-rank test, p = 0.02). Compared with patients without DELC, patients with DELC had a high risk of AF development (adjusted hazard ratio = 1.88, 95% confidence interval = 1.01–3.53). Conclusions: DELC is associated with an increased risk of AF in patients with CAD. These findings may aid in the detection of AF in patients with CAD. Full article

(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Treatment of Atrial Fibrillation)

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18 pages, 2520 KiB

Open AccessCase Report

Acupuncture Effect on Reaction-Time Changes in Parkinson’s Disease Patients—Case Study Series

by Catarina Ramos Pereira, Henry J. Greten, Rubim Santos, Ana Mafalda Reis, Bruno Ramos, Maria João Santos, Jorge Machado and Maria Begoña Criado

J. Clin. Med. 2024, 13(18), 5642; https://doi.org/10.3390/jcm13185642 - 23 Sep 2024

Viewed by 424

Abstract

Background: Parkinson’s Disease (PD) is a progressive neurodegenerative condition associated with deficit in reaction time which can lead to falls, resulting in limited independence, diminished quality of life, heightened rates of institutionalization and increased healthcare costs. We aimed to examine the effects of [...] Read more.

Background: Parkinson’s Disease (PD) is a progressive neurodegenerative condition associated with deficit in reaction time which can lead to falls, resulting in limited independence, diminished quality of life, heightened rates of institutionalization and increased healthcare costs. We aimed to examine the effects of an acupuncture protocol in motor time response after an auditory stimulus. Methods: This study employed a case series design. Reaction time to exposed rhythmic and random auditory stimuli outcomes were evaluated at six different moments over a month-long acupuncture treatment protocol using the MP 36 system from Biopac Systems. Results: We observed a tendency to have more pronounced improvements in the time response in the more affected side of the body compared with the contralateral one. Patients tended to show better values of response to random auditory stimuli compared to rhythmic auditory ones. We also observed a tendency to obtain better results when considering the accumulative effects of the acupuncture protocol. Conclusions: Our findings indicated a possible role of reaction time as a sensitive and useful tool for motor function assessment in PD patients. Also, from our results, we concluded that the acupuncture protocol used may lead to an improvement in efficacy of motor response after aleatory and rhythmic stimulus; we also found a tendency for a higher efficacy of acupuncture in random stimuli responses in the first stages of the disease. However, further in-depth research, including a statistical evaluation with a larger participant pool, is necessary to validate and confirm these promising results. Full article

(This article belongs to the Special Issue Innovative Opportunities in Neurological Diseases Diagnosis, Management and Therapy)

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13 pages, 1986 KiB

Open AccessArticle

Long-Term Follow-Up of the Quality of Life of Endometriosis Patients after Surgery: A Comparative Study

by Alice Wenzl, Rene Wenzl, Manuela Gstoettner, Lorenz Kuessel, Heinrich Husslein, Jana Heine, Lejla Sandrieser, Christine Bekos and Alexandra Perricos-Hess

J. Clin. Med. 2024, 13(18), 5641; https://doi.org/10.3390/jcm13185641 - 23 Sep 2024

Viewed by 457

Abstract

Background/Objectives: This study investigated the long-term effects of the surgical removal of endometriotic lesions on quality of life in endometriosis patients. A sub-analysis explored different subtypes of endometriosis, hormonal influence, and the need for reoperation. Methods: The study was conducted at the Certified [...] Read more.

Background/Objectives: This study investigated the long-term effects of the surgical removal of endometriotic lesions on quality of life in endometriosis patients. A sub-analysis explored different subtypes of endometriosis, hormonal influence, and the need for reoperation. Methods: The study was conducted at the Certified Endometriosis Center of the Medical University of Vienna. Included in the study were patients who had undergone the complete surgical removal of endometriotic lesions between 2014 and 2018. Patients were asked to complete the Endometriosis Health Profile-30 preoperatively, at the short-term follow-up (six to ten weeks postoperatively), and at the long-term follow-up (median of 48 months postoperatively). Results: A total of 87 patients completed the Endometriosis Health Profile-30 at the three time points. At the long-term follow-up, the reoperation rate was 8.0%. Significant improvements in the overall quality of life (p < 0.001; median decrease from 45.0 to 11.7) and in the categories of “pain”, “control and powerlessness”, “social support”, “emotional well-being”, and “self-image” at the long-term follow-up compared to preoperative values were observed (p-values < 0.01). The sub-analysis showed that patients with deep-infiltrating endometriosis (p < 0.001; median decrease from 49.2 to 10.0) and adenomyosis (p < 0.02; median decrease from 37.5 to 0.0) had the most pronounced long-term postsurgical benefits in terms of quality of life. Patients with (p < 0.001; median decrease from 45.0 to 1.7) and without (p < 0.001; median decrease from 45.42 to 12.5) hormonal influence showed significant improvements in overall quality of life compared to preoperative values. Patients without reoperation demonstrated improved long-term quality of life compared to the preoperative (p < 0.001; median decrease from 45.8 to 9.6) and short-term follow-up results (p < 0.005; median decrease from 19.2 to 9.6). Participants who underwent reoperation showed no improvement in quality of life at the long-term follow-up. Conclusions: The surgical removal of endometriotic lesions has a positive long-term impact on the quality of life, as measured by Endometriosis Health Profile-30. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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9 pages, 1373 KiB

Open AccessCase Report

Flap-Free Tendon Coverage Using Autologous Fat Grafts Enhanced with Platelet-Rich Plasma and Growth Factors at a Secondary Level Hospital: A Case Report

by Guadalupe Santamaría Salvador, Esteban Acosta Muñoz, Juan Samaniego Rojas, Charles Hidalgo Quishpe, Juan S. Izquierdo-Condoy, Jorge Vasconez-Gonzalez and Esteban Ortiz-Prado

J. Clin. Med. 2024, 13(18), 5640; https://doi.org/10.3390/jcm13185640 - 23 Sep 2024

Viewed by 371

Abstract

Background: Autologous fat grafting, enriched with platelet-rich plasma (PRP), has been established as an effective and affordable treatment for various types of wound healing. However, its efficacy in managing wounds with tendon exposure has not been thoroughly investigated. Methods: We report the case [...] Read more.

Background: Autologous fat grafting, enriched with platelet-rich plasma (PRP), has been established as an effective and affordable treatment for various types of wound healing. However, its efficacy in managing wounds with tendon exposure has not been thoroughly investigated. Methods: We report the case of a 40-year-old male who sustained a severe friction burn on his hand and forearm from a car accident, resulting in significant tissue loss and exposed extensor tendons. Results: Traditional wound treatment strategies were not implemented due to specific patient circumstances. After initial surgical management failed to prevent necrosis and maintain coverage of the exposed tendons, the patient underwent a novel treatment involving autologous fat grafting combined with PRP and growth factors. The procedure was repeated twice within a month to promote granular tissue formation over that area and facilitate subsequent coverage with an epidermoreticular graft. By day 21 post-initial graft, the exposed tendons were 98% covered with granular tissue. Complete wound coverage was achieved by day 60, and by day 130 the patient had regained 90% functionality of the affected limbs. Conclusions: This case illustrates the potential of autologous fat grafting combined with PRP and growth factors as a viable, flap-free alternative for covering tendon exposures. This approach not only enhances wound healing but also supports functional recovery, underscoring the need for further research into its broader applicative potentials. Full article

(This article belongs to the Special Issue Advancements in Individualized Plastic and Reconstructive Surgery)

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8 pages, 662 KiB

Open AccessReview

Dry Eye Para-Inflammation Management: Preclinical and Clinical Evidence on a Novel 0.2% Hyaluronic Acid-Based Tear Substitute with 0.001% Hydrocortisone Sodium Phosphate

by Anna Rita Blanco and Giuseppe Zasa

J. Clin. Med. 2024, 13(18), 5639; https://doi.org/10.3390/jcm13185639 - 23 Sep 2024

Viewed by 257

Abstract

Purpose: An innovative eyedrop formulation based on a combination of 0.2% hyaluronic acid and 0.001% hydrocortisone sodium phosphate (Idroflog^®, Alfa Intes, Italy; HAC eyedrops) was granted a European Patent in 2016 and has been available on the market since 2019 in [...] Read more.

Purpose: An innovative eyedrop formulation based on a combination of 0.2% hyaluronic acid and 0.001% hydrocortisone sodium phosphate (Idroflog^®, Alfa Intes, Italy; HAC eyedrops) was granted a European Patent in 2016 and has been available on the market since 2019 in Europe and in other countries around the world. HAC eyedrops aim to synergize the moisturizing effects of hyaluronic acid with the mild anti-inflammatory properties of low-dose hydrocortisone, offering a more effective and safer alternative for treating dry eye disease (DED), targeting both tear film instability and dysfunctional para-inflammation. The activity of HAC eyedrops has been explored in different post-marketing clinical trials, in addition to preclinical studies. In this narrative review, we explored the available evidence on the use of HAC eyedrops for the management of para-inflammation in DED patients to provide a comprehensive overview of efficacy and safety data related to the use of this medical device in routine clinical practice. Methods: A literature search for preclinical and clinical data involving treatment with HAC eyedrops was conducted using PubMed/MEDLINE, considering only original research articles published in English, without time restrictions. Results: One preclinical and four clinical papers were retrieved. Preclinical evidence suggests that 0.001% hydrocortisone is able to control the expression of inflammatory markers, and this, together with the hydrating and lubricating properties of hyaluronic acid, leads to improvements in DED clinical signs, such as tear volume and the stability of the tear film. The results of clinical trials demonstrate that HAC eyedrops are able to improve the signs and symptoms of DED and that 0.001% low-dosage hydrocortisone can be helpful in preventing the progression to chronic stages of DED. Conclusions: HAC eyedrops represent a promising therapeutic strategy for the management of dysfunctional para-inflammation and offer a valuable addition to the armamentarium of treatments for DED. Full article

(This article belongs to the Section Ophthalmology)

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16 pages, 4791 KiB

Open AccessArticle

The Effect of Local Papaverine Use in an Experimental High-Risk Colonic Anastomosis Model: Reduced Inflammatory Findings and Less Necrosis

by Dursun Burak Ozdemir, Ahmet Karayigit, Emel Tekin, Evin Kocaturk, Cengiz Bal and Ilter Ozer

J. Clin. Med. 2024, 13(18), 5638; https://doi.org/10.3390/jcm13185638 - 23 Sep 2024

Viewed by 262

Abstract

Objectives: To assess the impact of topical papaverine administration in complete and incomplete colonic anastomosis, by examining bursting pressure, hydroxyproline concentration, collagen content, inflammation levels, inflammatory cell infiltration, neoangiogenesis, and necrosis grades. Methods: We performed an experimental study on rats, in which they [...] Read more.

Objectives: To assess the impact of topical papaverine administration in complete and incomplete colonic anastomosis, by examining bursting pressure, hydroxyproline concentration, collagen content, inflammation levels, inflammatory cell infiltration, neoangiogenesis, and necrosis grades. Methods: We performed an experimental study on rats, in which they were divided into the following 4 groups of 16 subjects each. Group 1 [complete anastomosis (CA) without papaverine (CA -P) group], Group 2 [CA with papaverine (CA +P) group], Group 3 [incomplete anastomosis (ICA) without papaverine (ICA -P) group], and Group 4 [ICA with papaverine (ICA +P) group]. Results: The lymphocyte infiltration score of the ICA +P3 (day 3) group was significantly higher compared to the ICA -P3 group (p = 0.018). The median Ehrlich–Hunt score (p = 0.012), inflammation score (p = 0.026), and neutrophil infiltration score (p = 0.041) of the CA +P7 (day 7) group were significantly lower than the corresponding data of the CA -P7 group. Additionally, the necrosis score of the ICA +P7 group was significantly lower than that of the ICA -P7 group (p = 0.014). Conclusions: Data from the current study reveal that, although topical papaverine seems to suppress inflammation in anastomosis tissue and reduce necrosis at 7 days, definite conclusions regarding its impact on anastomotic leak cannot be drawn without further studies investigating anastomotic wound healing and anastomotic leak, preferably with both shorter- and longer-term evaluations. Full article

(This article belongs to the Section General Surgery)

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26 pages, 399 KiB

Open AccessReview

Pharmacological Treatments of Negative Symptoms in Schizophrenia—An Update

by Evangelia Maria Tsapakis, Michael Treiber, Calypso Mitkani, Zoe Drakaki, Anastasios Cholevas, Cleanthe Spanaki and Konstantinos N. Fountoulakis

J. Clin. Med. 2024, 13(18), 5637; https://doi.org/10.3390/jcm13185637 - 23 Sep 2024

Viewed by 543

Abstract

Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little [...] Read more.

Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little improvement in the burden of negative symptoms. This article reviews current pharmacological strategies for treating negative symptoms. Dopaminergic, glutamatergic, serotonergic, noradrenergic, cholinergic, anti-inflammatory compounds, hormones, and psychostimulants are explored. Finally, we review pharmacological global treatment guidelines for negative symptoms. In general, switching to a second-generation antipsychotic seems to be most often recommended for patients with schizophrenia on first-generation antipsychotics, and an add-on antidepressant is considered when depression is also present. However, the treatment of negative symptoms remains an unmet need. Future, larger clinical studies and meta-analyses are needed to establish effective pharmacological agents for the effective treatment of negative symptoms. Full article

(This article belongs to the Section Mental Health)

11 pages, 2308 KiB

Open AccessArticle

Return to Work Following Anterior Lumbar Interbody Fusion with Percutaneous Posterior Pedicle Fixation: A Retrospective Analysis from Two Academic Centers in Germany

by Bedjan Behmanesh, Helen Wempe, Fatma Kilinc, Daniel Dubinski, Sae-Yeon Won, Marcus Czabanka, Matthias Setzer, Patrick Schuss, Matthias Schneider, Thomas Freiman and Florian Gessler

J. Clin. Med. 2024, 13(18), 5636; https://doi.org/10.3390/jcm13185636 - 23 Sep 2024

Viewed by 310

Abstract

Objective: Return to work after spinal surgery is a crucial factor in the recovery process. It can contribute not only to physical rehabilitation but also to psychological well-being. This study aims to evaluate the rate of return to work following elective lumbar spine [...] Read more.

Objective: Return to work after spinal surgery is a crucial factor in the recovery process. It can contribute not only to physical rehabilitation but also to psychological well-being. This study aims to evaluate the rate of return to work following elective lumbar spine surgery and identify predictors that predict failure of return to work. Methods: Adult patients who underwent anterior lumbar interbody fusion at two medical centers were retrospectively identified. A standardized telephone interview was conducted for the final analysis to assess the clinical outcomes of these patients. Results: Out of a total of 159 patients, 104 were of working age at the time of the elective surgery. Data were missing for 35 patients, who were thus excluded from the analysis. All patients had a minimum follow-up period of one year. After surgery, 75% of the patients returned to work within a median time of 3 months. Quality of life, back pain, leg pain, and ODI scores, as well as self-reported satisfaction, were significantly better in patients who returned to work (p < 0.05). Tobacco use and previous musculoskeletal surgery were significant predictive factors of failure to return to work. None of the patients who were unemployed prior to surgery returned to work. Conclusions: Our study reveals that 75% of patients returned to work within three months after surgery. The most significant predictor of failure to return to work is being unemployed before surgery. Additionally, preoperative education about postoperative behavior and physical activity could potentially increase the rate. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Clinical Updates and Perspective)

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10 pages, 915 KiB

Open AccessArticle

Temporal Pattern of Individual Neurological Function Recovery in Guillain–Barré Syndrome

by Roopali Mahajan, Jayantee Kalita, Vishal Jha, Nagendra B. Gutti, Prakash C. Pandey and Usha K. Misra

J. Clin. Med. 2024, 13(18), 5635; https://doi.org/10.3390/jcm13185635 - 23 Sep 2024

Viewed by 358

Abstract

Background: There is paucity of studies on the temporal pattern of recovery of facial, bulbar, sensory, motor, and autonomic dysfunction in Guillain–Barré syndrome (GBS), although many studies have reported short- and long-term functional outcomes. We report the temporal pattern of recovery of [...] Read more.

Background: There is paucity of studies on the temporal pattern of recovery of facial, bulbar, sensory, motor, and autonomic dysfunction in Guillain–Barré syndrome (GBS), although many studies have reported short- and long-term functional outcomes. We report the temporal pattern of recovery of various neurological functions in GBS, and compare the pattern of recovery between acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). Methods: Forty-two patients with GBS were prospectively included, and their clinical details, including peak disability on a 0–6 scale, were noted. The day of complete recovery in motor, sensory, facial, bulbar, and autonomic functions during 3 months of follow-up was recorded. Results: Complete recovery of autonomic function occurred in all (median, 12 days), bulbar weakness in 91.3% (median, 15 days), facial weakness in 86.2% (median, 19 days), and sensory functions in 82.1% (median, 20 days). Only 9.5% of patients achieved normal motor function within 3 months. The days of complete recovery of bulbar, facial, autonomic, and motor deficits were comparable between AIDP and AMAN. Demyelinating GBS had an earlier recovery of bulbar and sensory functions. Conclusions: The neurological recovery in GBS occurs first in the autonomic, followed by the bulbar, facial, sensory, and motor functions. The demyelinating type had an earlier recovery of bulbar and sensory functions. Full article

(This article belongs to the Section Clinical Neurology)

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12 pages, 450 KiB

Open AccessArticle

Common Cancer-Related Factors and the Risk of Developing Kaposi Sarcoma in Individuals without AIDS: Korea National Health Insurance Services Claims Database

by Ji Eun Shin, Kyungdo Han, Ho Jung An, Hyung Soon Park, Byoung Yong Shim and Hyunho Kim

J. Clin. Med. 2024, 13(18), 5634; https://doi.org/10.3390/jcm13185634 - 23 Sep 2024

Viewed by 314

Abstract

Backgrounds: Kaposi sarcoma (KS) is a unique form of cancer with epidemiological characteristics distinct from those of other solid cancers. While common risk factors including alcohol consumption, smoking, and metabolic disorders have been well studied in various cancers, their relationship with KS remains [...] Read more.

Backgrounds: Kaposi sarcoma (KS) is a unique form of cancer with epidemiological characteristics distinct from those of other solid cancers. While common risk factors including alcohol consumption, smoking, and metabolic disorders have been well studied in various cancers, their relationship with KS remains unclear. Methods: This study used a cohort approach with adults without AIDS, utilizing data from the National Health Insurance Service in South Korea. This study examined various conventional cancer-related risk factors related to the incidence of KS, including psoriasis. Results: Alcohol consumption, smoking, body mass index, diabetes mellitus, hypertension, hypercholesterolemia, and regular exercise were not significantly associated with the incidence of KS. Additionally, older age and male sex were associated with a higher incidence of KS. KS risk was increased in pathological conditions such as psoriasis and proteinuria, which require immunosuppressive medication. Conclusions: Our study suggests that traditional cancer-related risk factors may not play a significant role in the pathogenesis of KS, unlike other cancers. This, in turn, emphasizes the importance of immunosuppression and HHV-8 infection in the development of KS. Full article

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

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20 pages, 2044 KiB

Open AccessSystematic Review

The Efficacy of Eye Movement Desensitization and Reprocessing Treatment for Depression: A Meta-Analysis and Meta-Regression of Randomized Controlled Trials

by Ji-Woo Seok and Joong Il Kim

J. Clin. Med. 2024, 13(18), 5633; https://doi.org/10.3390/jcm13185633 - 23 Sep 2024

Viewed by 1154

Abstract

Background: Eye Movement Desensitization and Reprocessing (EMDR) therapy has gained attention for its potential effectiveness in treating depression beyond its initial use for PTSD. This systematic review and meta-analysis aims to evaluate the efficacy of EMDR in treating depression and to identify [...] Read more.

Background: Eye Movement Desensitization and Reprocessing (EMDR) therapy has gained attention for its potential effectiveness in treating depression beyond its initial use for PTSD. This systematic review and meta-analysis aims to evaluate the efficacy of EMDR in treating depression and to identify the variables influencing its effectiveness. Methods: A comprehensive search was conducted across databases, including MEDLINE, PubMed, and EMBASE, covering studies up to January 2023. A total of 521 studies were screened, and 25 studies with 1042 participants (522 EMDR, 520 control) met the inclusion criteria and were included in the meta-analysis. The inclusion criteria involved randomized controlled trials (RCTs) comparing EMDR to control conditions such as usual care or waitlist groups, with outcomes focused on changes in depression symptoms. Results: The results show that EMDR had a significant effect on reducing depression symptoms (Hedges’ g = 0.75), with moderate heterogeneity being observed. The meta-regression indicated that the severity of depression was a significant predictor of EMDR’s effectiveness, with greater effects in severe cases. Additionally, the systematic review analyzed and evaluated various theoretical models and related studies that explain how EMDR works for the treatment of depression, reporting on neurobiological models proposed in previous research. Conclusions: This study confirms that EMDR is effective in treating depression, particularly in severe cases, and highlights its potential as a non-pharmacological intervention. However, this study highlights the need for more standardized research and long-term evaluations to assess EMDR’s lasting impact. Integrating EMDR into multimodal treatment plans and primary care, especially for treatment-resistant depression, could significantly improve patient outcomes. Full article

(This article belongs to the Section Mental Health)

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10 pages, 4639 KiB

Open AccessArticle

Metformin Treatment Is Not Associated with Altered PD-L1 Expression in Diabetic Patients with Oral Squamous Cell Carcinoma

by Andreas Mamilos, Lina Winter, Alexander Lein, Steffen Spoerl, Nils Ludwig, Tobias Ettl, Julian Künzel, Torsten Reichert, Gerrit Spanier and Christoph Brochhausen

J. Clin. Med. 2024, 13(18), 5632; https://doi.org/10.3390/jcm13185632 - 23 Sep 2024

Viewed by 330

Abstract

Background: The anti-neoplastic activity of metformin is a subject of current debate. Preclinical data have suggested that metformin enhances PD-L1 anti-tumor effects in various cancer entities by decreasing insulin levels and inducing energetic stress. However, its impact on PD-L1 expression remains unclear [...] Read more.

Background: The anti-neoplastic activity of metformin is a subject of current debate. Preclinical data have suggested that metformin enhances PD-L1 anti-tumor effects in various cancer entities by decreasing insulin levels and inducing energetic stress. However, its impact on PD-L1 expression remains unclear in a clinical setting. Therefore, we aim to investigate the impact of metformin treatment in type 2 diabetes mellitus (DM) patients on PD-L1 expression in patients with oral squamous cell carcinoma (OSCC). Methods: We performed a retrospective analysis of patients with DM and OSCC treated at our tertiary referral center over a period of 12 years. The tumor proportion score (TPS), immune cell score (IC), and combined positive score (CPS) were used to quantify PD-L1 expression. PD-L1 expression of patients receiving metformin was compared to a control group without metformin prescription. Results: A total of 68 patients diagnosed with OSCC and DM were analyzed, with 24 receiving and 44 not receiving metformin therapy. No statistically significant differences were identified between the metformin and non-metformin groups for any of the scores (TPS: p = 0.818; IC: p = 0.748; CPS: p = 0.387). Conclusions: In contrast to previous studies, we could not find significant differences in PD-L1 expression between patients with and without metformin intake. Further research needs to shed light on the exact mechanism of metformin in different tumor entities. A comprehensive understanding of metformin’s role in cancer therapy could provide valuable insights for potential use of metformin as an adjuvant treatment to immune checkpoint therapy. Full article

(This article belongs to the Special Issue Precision Medicine in Head and Neck Squamous Cell Carcinoma (HNSCC))

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14 pages, 1330 KiB

Open AccessArticle

Parental Knowledge and Its Impact on Nutrition and Oral Health Habits in Children: A Cognitive Investigation

by Fabrizio Guerra, Giulia Zumbo, Lucia Straccamore, Laura Sansotta, Claudio Stamegna, Roberta Iacono, Denise Corridore and Iole Vozza

J. Clin. Med. 2024, 13(18), 5631; https://doi.org/10.3390/jcm13185631 - 23 Sep 2024

Viewed by 441

Abstract

Background: The correlation between the intake of certain nutrients and the development of oral pathologies has been demonstrated by several studies. The objective of this epidemiological investigation was to evaluate parents’ knowledge and awareness of children’s nutrition starting from the early stages [...] Read more.

Background: The correlation between the intake of certain nutrients and the development of oral pathologies has been demonstrated by several studies. The objective of this epidemiological investigation was to evaluate parents’ knowledge and awareness of children’s nutrition starting from the early stages of childhood. Methods: A questionnaire with 35 questions was handed over to 120 parents of infants aged 4 to 24 months. Among these, 20 questionnaires were excluded because they were incomplete; hence, the final sample analyzed consisted of 100 questionnaires. The outcome of this study revealed that the parents are well aware of many common topics, but their knowledge regarding specific prevention measures, i.e., the use of systemic fluoride as per the international guidelines, needs proper attention. Results: and Conclusions: After analyzing all the collected data, it is possible to conclude that prevention is the best investment to avoid the onset of the carious pathology, which can be possible through parental education, for example, by raising awareness among expectant mothers, through different actions in the territory. However, further research is needed as this study has some limitations and the convenience sample is hospital-based and not effectively representative of the whole population. Full article

(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations)

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11 pages, 254 KiB

Open AccessArticle

Acromegaly: The Relationship between Hemodynamic Profiles Assessed via Impedance Cardiography and Left Ventricular Systolic Function Assessed via Echocardiography

by Agnieszka Włochacz, Paweł Krzesiński, Beata Uziębło-Życzkowska, Przemysław Witek, Grzegorz Zieliński, Anna Kazimierczak, Robert Wierzbowski, Małgorzata Banak and Grzegorz Gielerak

J. Clin. Med. 2024, 13(18), 5630; https://doi.org/10.3390/jcm13185630 - 23 Sep 2024

Viewed by 276

Abstract

Background/Objectives: Acromegaly-induced prolonged exposure to growth hormone and insulin-like growth factor 1 may have significant cardiovascular effects. The purpose of this study was to assess the relationship between hemodynamic parameters measured via impedance cardiography (ICG) and parameters of systolic left ventricular function [...] Read more.

Background/Objectives: Acromegaly-induced prolonged exposure to growth hormone and insulin-like growth factor 1 may have significant cardiovascular effects. The purpose of this study was to assess the relationship between hemodynamic parameters measured via impedance cardiography (ICG) and parameters of systolic left ventricular function measured via echocardiography in patients with acromegaly. Methods: The observational cohort study included 33 patients with newly diagnosed acromegaly, with a mean age of 47 years and without significant comorbidities. Correlation analysis (Spearman’s rank correlation coefficient R) was performed on parameters obtained by ICG and left ventricular systolic function parameters obtained by echocardiography. ICG assessment included indices of (1) cardiac function as a pump: stroke volume index (SI), cardiac index (CI), Heather index (HI), velocity index (VI), and acceleration index (ACI); (2) afterload: systemic vascular resistance index (SVRI) and total arterial compliance index (TACI); and (3) thoracic fluid content (TFC). Echocardiographic examinations evaluated left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Results: A lower LVEF was associated with a lower SI (R = 0.38; p = 0.03) and a higher SVRI (R = −0.35; p = 0.046), whereas lower GLS was associated with lower SI (R = 0.43; p = 0.02), CI (R = 0.62; p < 0.001), VI (R = 0.59; p < 0.001), ACI (R = 0.38; p = 0.048), HI (R = 0.59; p < 0.001), and TACI (R = 0.50; p = 0.006) and a higher SVRI (R = −0.59; p < 0.001). No significant correlation was observed between either LVEF or GLS and TFC. Conclusions: In patients with acromegaly, poorer echocardiographic parameters of left ventricular systolic function are associated with impaired function of the heart as a pump and higher afterload as assessed via ICG. Full article

(This article belongs to the Special Issue Endocrine Tumors: Diagnosis, Treatment, and Management)

13 pages, 584 KiB

Open AccessFeature PaperReview

Harnessing the Power of Integrated Behavioral Health to Enhance Insomnia Intervention in Primary Care

by Rebecca L. Campbell and Ana J. Bridges

J. Clin. Med. 2024, 13(18), 5629; https://doi.org/10.3390/jcm13185629 - 23 Sep 2024

Viewed by 460

Abstract

Insomnia is prevalent in primary care and associated with co-morbid physical and mental health conditions and poor health outcomes. While there are effective treatments for insomnia in specialty mental health care, many patients have difficulty accessing these interventions. To begin, patients do not [...] Read more.

Insomnia is prevalent in primary care and associated with co-morbid physical and mental health conditions and poor health outcomes. While there are effective treatments for insomnia in specialty mental health care, many patients have difficulty accessing these interventions. To begin, patients do not always report their sleep challenges to physicians; meanwhile, primary care providers often do not screen for insomnia symptoms. Furthermore, patients may experience several barriers to accessing specialty care for insomnia treatment, such as a limited number of available providers, financial burden, lack of transportation, and low perceptions of treatment effectiveness. Primary care behavioral health (PCBH) is well-equipped to address the challenges of accessing evidence-based care for insomnia through (1) identifying sleep issues, (2) providing psychoeducation on the possible treatments for insomnia, (3) intervening with poor sleep habits and acute insomnia early to prevent chronic insomnia, and (4) delivering appropriate evidence-based interventions for chronic insomnia. Primary care clinics should leverage behavioral health providers to increase screening and embed interventions into routine care for the benefit of improved outcomes for patients with insomnia and other sleep challenges. Full article

(This article belongs to the Special Issue Sleep Disorders: Advances in the Diagnosis and Treatment)

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11 pages, 6619 KiB

Open AccessArticle

Allograft Screws as Fixation of the Scarf Osteotomy

by Kevin Döring, Sebastian Apprich, Markus Hanna, Reinhard Windhager and Stephan Puchner

J. Clin. Med. 2024, 13(18), 5628; https://doi.org/10.3390/jcm13185628 - 23 Sep 2024

Viewed by 274

Abstract

Background: In comparison to titanium screws, novel cortical bone allograft screws may come with advantages in osseointegration and with avoidance of potential material removal surgery after scarf osteotomy. Methods: A scarf osteotomy with allograft bone screws as fixation was performed in 21 patients [...] Read more.

Background: In comparison to titanium screws, novel cortical bone allograft screws may come with advantages in osseointegration and with avoidance of potential material removal surgery after scarf osteotomy. Methods: A scarf osteotomy with allograft bone screws as fixation was performed in 21 patients (30 feet). Clinical and radiological parameters were prospectively collected until one year after surgery. A retrospective control group, consisting of 75 patients (82 feet) after scarf osteotomy using headless compression screws, was used to compare clinical outcomes. Results: After fixation with allograft bone screws, the mean preoperative AOFAS score increased from 51.5 points preoperatively to 93.5 points one year after surgery. In radiological assessments, a continuous osseointegration with the remodeling of the bone screw was observed in all patients that finished follow-up. However, four metatarsal fractures occurred early postoperatively after fixation using allograft bone screws. There were only three material removal surgeries in patients treated with headless compression screws. Conclusions: Allograft bone screws display a safe fixation and are a biological alternative for scarf osteotomy. Enough distance between the screw and the proximal osteotomy should be ensured to avoid fractures. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 508 KiB

Open AccessReview

Impact of GLP-1 Receptor Agonists in Gastrointestinal Endoscopy: An Updated Review

by Sahib Singh, Saurabh Chandan, Dushyant Singh Dahiya, Ganesh Aswath, Daryl Ramai, Marcello Maida, Andrea Anderloni, Nicola Muscatiello and Antonio Facciorusso

J. Clin. Med. 2024, 13(18), 5627; https://doi.org/10.3390/jcm13185627 - 22 Sep 2024

Viewed by 756

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become one of the most popular medications for patients with diabetes and obesity. Due to their effects on gut motility via central or parasympathetic pathways, there have been concerns about an increased incidence of retained gastric [...] Read more.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become one of the most popular medications for patients with diabetes and obesity. Due to their effects on gut motility via central or parasympathetic pathways, there have been concerns about an increased incidence of retained gastric contents and risk of aspiration in the perioperative period. Hence, the American Society of Anesthesiologists (ASA) recommends holding GLP-1 RAs on the procedure day or a week before the elective procedure based on the respective daily or weekly formulations, regardless of the dose, indication (obesity or diabetes), or procedure type. On the contrary, the American Gastroenterological Association (AGA) advises an individualized approach, stating that more data are needed to decide if and when the GLP-1 RAs should be held prior to elective endoscopy. Several retrospective and prospective studies, along with meta-analyses, have been published since then evaluating the role of GLP-1 RAs in patients scheduled for endoscopic procedures. In this review, we discuss the current clinical guidelines and available studies regarding the effect of GLP-1 RAs on GI endoscopies. Full article

(This article belongs to the Special Issue Clinical Advances in Endoscopic Ultrasound-Guided Diagnosis and Treatment)

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21 pages, 309 KiB

Open AccessReview

Advancements in Artificial Intelligence for Fetal Neurosonography: A Comprehensive Review

by Jan Weichert and Jann Lennard Scharf

J. Clin. Med. 2024, 13(18), 5626; https://doi.org/10.3390/jcm13185626 - 22 Sep 2024

Viewed by 540

Abstract

The detailed sonographic assessment of the fetal neuroanatomy plays a crucial role in prenatal diagnosis, providing valuable insights into timely, well-coordinated fetal brain development and detecting even subtle anomalies that may impact neurodevelopmental outcomes. With recent advancements in artificial intelligence (AI) in general [...] Read more.

The detailed sonographic assessment of the fetal neuroanatomy plays a crucial role in prenatal diagnosis, providing valuable insights into timely, well-coordinated fetal brain development and detecting even subtle anomalies that may impact neurodevelopmental outcomes. With recent advancements in artificial intelligence (AI) in general and medical imaging in particular, there has been growing interest in leveraging AI techniques to enhance the accuracy, efficiency, and clinical utility of fetal neurosonography. The paramount objective of this focusing review is to discuss the latest developments in AI applications in this field, focusing on image analysis, the automation of measurements, prediction models of neurodevelopmental outcomes, visualization techniques, and their integration into clinical routine. Full article

(This article belongs to the Special Issue Update on Prenatal Diagnosis and Maternal Fetal Medicine: 2nd Edition)

11 pages, 582 KiB

Open AccessArticle

Thoracic Fluid Content as an Indicator of High Intravenous Diuretic Requirements in Hospitalized Patients with Decompensated Heart Failure

by Agata Galas, Paweł Krzesiński, Małgorzata Banak and Grzegorz Gielerak

J. Clin. Med. 2024, 13(18), 5625; https://doi.org/10.3390/jcm13185625 - 22 Sep 2024

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Abstract

Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to [...] Read more.

Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to diuretic treatment, which may be due to diuretic resistance (DR). Such cases require high doses of diuretic medications and combination therapy with diuretics of different mechanisms of action. Although certain predisposing factors for diuretic resistance have been identified (such as hypotension, type 2 diabetes, impaired renal function, and hyponatremia), further research is needed to identify other pathophysiological markers of DR. Objective: This study aims to identify admission markers that can predict a high requirement for intravenous diuretics in hospitalized patients with decompensated heart failure. Methods: This study included 102 adult patients hospitalized for ADHF. At admission, patients underwent clinical assessment, laboratory parameter evaluation (including the N-terminal prohormone of brain natriuretic peptide [NT-proBNP] levels), and hemodynamic assessment using impedance cardiography (ICG). Hemodynamic profiles were based on the use of parameters such as heart rate (HR), blood pressure (BP), and thoracic fluid content (TFC) as markers of volume status. The analysis included 97 patients with documented doses of intravenous diuretic use. Patients were stratified into two groups based on median diuretic consumption (equivalent to 540 mg of intravenous furosemide): the high-loop diuretic utilization (LDU) group (n = 49) and the low-LDU group (n = 48). Results: Compared to low-LDU patients, high-LDU patients had greater thoracic fluid content at admission, both quantitatively (37.4 ± 8.1 vs. 34.1 ± 6.9 kOhm-1; p = 0.024) and qualitatively (TFC ≥ 35 kOhm-1: 59.2% vs. 33.3%; p = 0.011). Anemia was more common in the high-LDU group (67.4% vs. 43.8%; p = 0.019), as was elevated NT-proBNP (≥median of 3952 pg/mL: 60.4% vs. 37.5%; p = 0.024). High LDU was associated with a significantly longer hospitalization duration (12.9 ± 6.4 vs. 7.0 ± 2.6 days; p < 0.001). Logistic regression analysis identified anemia, elevated NT-proBNP, and high TFC as predictors of high LDU (HR: 2.65, 2.54, and 2.90, respectively). In a multifactorial model, only high TFC remained an independent predictor (HR: 2.60, 95% CI 1.04–6.49; p = 0.038). Conclusions: TFC was the sole independent admission marker of a high requirement for intravenous diuretics in patients hospitalized for decompensated heart failure. An objective assessment of volume status by impedance cardiography may support intensive personalized decongestion therapy. Full article

(This article belongs to the Special Issue Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations)

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J. Clin. Med., Volume 13, Issue 18 (September-2 2024) – 311 articles

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