June-2 2022 - Browse Articles
Journal of Clinical Medicine, an international, peer-reviewed Open Access journal.
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11 pages, 421 KiB

Open AccessArticle

Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

by Sanae Hosomi, Tetsuhisa Kitamura, Tomotaka Sobue, Ling Zha, Kosuke Kiyohara, Tasuku Matsuyama and Jun Oda

J. Clin. Med. 2022, 11(12), 3564; https://doi.org/10.3390/jcm11123564 - 20 Jun 2022

Cited by 4 | Viewed by 2245

Abstract

The effects of epinephrine administration timing on patients with out-of-hospital cardiac arrest (OHCA) following traffic collisions are unknown. We analyzed the 2013–2019 All-Japan Utstein Registry data of 2024 such patients aged ≥18 years who were resuscitated by emergency medical service (EMS) personnel or [...] Read more.

The effects of epinephrine administration timing on patients with out-of-hospital cardiac arrest (OHCA) following traffic collisions are unknown. We analyzed the 2013–2019 All-Japan Utstein Registry data of 2024 such patients aged ≥18 years who were resuscitated by emergency medical service (EMS) personnel or bystanders and then transported to medical institutions. Time from 119 call to epinephrine administration was classified into quartiles: Q1 (6–21 min), Q2 (22–26 min), Q3 (27–34 min), and Q4 (35–60 min). Multivariable logistic regression analysis was used to assess the effects of epinephrine administration timing on one-month survival after OHCA. Overall, the one-month survival rates were 3.2% (15/466) in Q1, 1.1% (5/472) in Q2, 1.9% (11/577) in Q3, and 0.2% (1/509) in Q4. Additionally, the one-month survival rate decreased significantly in the Q4 group (adjusted odds ratio, 0.07; 95% confidence interval, 0.01–0.57) compared with the Q1 group, and the probability of one-month survival decreased as the time from the EMS call to epinephrine administration increased (p-value for trend = 0.009). Only four patients (0.9% [4/466]) with the earliest epinephrine administration showed a good neurological outcome. Full article

(This article belongs to the Section Cardiology)

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9 pages, 936 KiB

Open AccessReview

Admission Severity of Atrial-Fibrillation-Related Acute Ischemic Stroke in Patients under Anticoagulation Treatment: A Systematic Review and Meta-Analysis

by Catarina Garcia, Marcelo Silva, Mariana Araújo, Mariana Henriques, Marta Margarido, Patrícia Vicente, Hipólito Nzwalo and Ana Macedo

J. Clin. Med. 2022, 11(12), 3563; https://doi.org/10.3390/jcm11123563 - 20 Jun 2022

Cited by 8 | Viewed by 1818

Abstract

Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission [...] Read more.

Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS). We sought to analyze the literature to assess the association between pre-admission anticoagulation (VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001 and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC. Full article

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

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10 pages, 13611 KiB

Open AccessArticle

Endoscopic Management of Adenomas in the Ileal Pouch and the Rectal Remnant after Surgical Treatment in Familial Adenomatous Polyposis

by Masahiro Tajika, Tsutomu Tanaka, Sachiyo Oonishi, Keisaku Yamada, Tomoyasu Kamiya, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Shin Haba, Yasuhiro Kuraishi, Akira Ouchi, Yusuke Sato, Takashi Kinoshita, Koji Komori, Kazuo Hara, Waki Hosoda and Yasumasa Niwa

J. Clin. Med. 2022, 11(12), 3562; https://doi.org/10.3390/jcm11123562 - 20 Jun 2022

Cited by 5 | Viewed by 2502

Abstract

In patients with familial adenomatous polyposis (FAP), adenomas and even carcinomas may develop in the rectal remnant and the ileal pouch after surgical treatment. The aim of this study was to evaluate the outcome of endoscopic management in patients with FAP. The main [...] Read more.

In patients with familial adenomatous polyposis (FAP), adenomas and even carcinomas may develop in the rectal remnant and the ileal pouch after surgical treatment. The aim of this study was to evaluate the outcome of endoscopic management in patients with FAP. The main outcome measurements were the appearance of secondary cancer, complications, and the need for additional surgery. Thirty-four FAP patients with Kock’s continent ileostomy (Kock) (n = 3), ileorectal anastomosis (IRA) (n = 12), and ileal pouch-anal anastomosis (IPAA) (n = 19) were identified. The median follow-up period of endoscopic surveillance was 11.5 years for pouch patients (Kock + IPAA) and 21.7 years for IRA. Metachronous adenomas appeared in 32 patients (94.1%). In pouch patients, a total of 120 treatments were given to 20 patients, and 12 sessions of delayed bleeding (10%) occurred, which was significantly higher compared to IRA patients, with 0 sessions (p < 0.001). In IRA patients, a total of 169 treatments were given to 11 patients, with one case of perforation. No adenocarcinoma has developed since the start of endoscopic surveillance. Regular endoscopic surveillance and treatment are feasible and safe. However, in pouch patients, one must be cautious about delayed bleeding in the treatment of adenomas. Full article

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

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9 pages, 422 KiB

Open AccessReview

Functional Magnetic Resonance Imaging and Obesity—Novel Ways to Seen the Unseen

by Anna Drelich-Zbroja, Małgorzata Matuszek, Michał Kaczor and Maryla Kuczyńska

J. Clin. Med. 2022, 11(12), 3561; https://doi.org/10.3390/jcm11123561 - 20 Jun 2022

Cited by 4 | Viewed by 1746

Abstract

Obesity remains a pandemic of the 21st century. While there are many causes of obesity and potential treatments that are currently known, source data indicate that the number of patients is constantly increasing. Neural mechanisms have become the subject of research and there [...] Read more.

Obesity remains a pandemic of the 21st century. While there are many causes of obesity and potential treatments that are currently known, source data indicate that the number of patients is constantly increasing. Neural mechanisms have become the subject of research and there has been an introduction of functional magnetic resonance imaging in obesity-associated altered neural signaling. Functional magnetic resonance imaging has been established as the gold standard in the assessment of neuronal functions related to nutrition. Thanks to this, it has become possible to delineate those regions of the brain that show altered activity in obese individuals. An integrative review of the literature was conducted using the keywords ““functional neuroimaging” OR “functional magnetic resonance “OR “fmri” and “obesity” and “reward circuit and obesity” in PubMed and Google Scholar databases from 2017 through May 2022. Results in English and using functional magnetic resonance imaging to evaluate brain response to diet and food images were identified. The results from functional magnetic resonance imaging may help to identify relationships between neuronal mechanisms and causes of obesity. Furthermore, they may provide a substrate for etiology-based treatment and provide new opportunities for the development of obesity pharmacotherapy. Full article

(This article belongs to the Collection Obesity: From Diagnosis to Treatment)

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14 pages, 1771 KiB

Open AccessArticle

Integrated Cognitive Rehabilitation Home-Based Protocol to Improve Cognitive Functions in Multiple Sclerosis Patients: A Randomized Controlled Study

by Minoo Sharbafshaaer, Francesca Trojsi, Simona Bonavita and Amirreza Azimi

J. Clin. Med. 2022, 11(12), 3560; https://doi.org/10.3390/jcm11123560 - 20 Jun 2022

Cited by 1 | Viewed by 2136

Abstract

Cognitive impairment (CI) occurs in about 40–65% of people with multiple sclerosis (MS) during the disease course. Cognitive rehabilitation has produced non-univocal results in MS patients. Objective: The present study aimed to evaluate whether an Integrated Cognitive Rehabilitation Program (ICRP) in MS patients [...] Read more.

Cognitive impairment (CI) occurs in about 40–65% of people with multiple sclerosis (MS) during the disease course. Cognitive rehabilitation has produced non-univocal results in MS patients. Objective: The present study aimed to evaluate whether an Integrated Cognitive Rehabilitation Program (ICRP) in MS patients might significantly improve CI. Methods: Forty patients with three phenotypes of MS were randomly assigned into two groups: the experimental group (EG, n = 20), which participated in the ICRP for 10 weeks of training; and the control group (CG, n = 20). All participants’ cognitive functions were assessed at three timepoints (baseline, post-treatment, and 3-month follow-up) with the California Verbal Learning (CVLT), Brief Visuospatial Memory (BVMTR), Numerical Stroop, and Wisconsin tests. Results: When compared to CG patients, EG patients showed significant improvements in several measures of cognitive performance after ICRP, including verbal learning, visuospatial memory, attention, and executive functions. Conclusions: Home-based ICRP can improve cognitive functions and prevent the deterioration of patients’ cognitive deficits. As an integrated cognitive rehabilitation program aimed at potentiation of restorative and compensatory mechanisms, this approach might suggest an effective role in preserving neuronal flexibility as well as limiting the progression of cognitive dysfunction in MS. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 401 KiB

Open AccessArticle

Single versus Double Stenting in NSTEMI Patients with Complex Left Main Bifurcation Disease

by Gianluca Rigatelli, Marco Zuin, Filippo Gianese, Dario Adami, Mauro Carraro and Loris Roncon

J. Clin. Med. 2022, 11(12), 3559; https://doi.org/10.3390/jcm11123559 - 20 Jun 2022

Cited by 3 | Viewed by 1700

Abstract

Background: Among patients with non-ST-segment elevation myocardial infarction (NSTEMI) the presence of a bifurcation left main (LM) disease represents a particular subset graved by both clinical and technical challenges. We sought to assess the long-term outcomes of patients with NSTEMI treated either by [...] Read more.

Background: Among patients with non-ST-segment elevation myocardial infarction (NSTEMI) the presence of a bifurcation left main (LM) disease represents a particular subset graved by both clinical and technical challenges. We sought to assess the long-term outcomes of patients with NSTEMI treated either by single or double stent strategy, having an LM bifurcation culprit lesion. Methods: We retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for NSTEMI due to complex LM bifurcation disease as the culprit lesion, treated using either single or dual stenting (provisional stenting, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT)) techniques between January 2008 and May 2018. Target lesion failure (TLF) was defined as the composite of cardiovascular death, target-vessel myocardial infarction (MI), and clinically driven target lesion revascularization (TLR). Results: Four hundred and forty-five patients (54.1% males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3) were evaluated. Of these, 155 patients (34.8%) were treated using a single stent while the remaining were treated with a double stent strategy. After a mean follow-up of 37.1 months (IQR 22.1-39.3), TLF rate was 8.7% (n = 39): 5/155 (3.2%) in the crossover group; 10/53 (18.8%) in T/TAP group, 14/89 (15.7%) in the culotte group, and 10/148 (6.7%) in the NIT group of patients. Cardiovascular mortality rate was 2.9% (n = 13) while stent thrombosis was 0.89% (n = 4). On multivariate analysis dyslipidemia, Syntax score > 25, triple vessel disease, additional LM ostial, or LM body lesions and the use of Rotablator, were independent predictors of TLF. Conclusions: Either a single or double stent strategy resulted in low rates of TLF, cardiovascular death, and stent thrombosis in the long-term period in NSTEMI LM patients with contraindications or refusal of surgery. A single stent strategy appeared to have a slightly better outcome compared to a 2-stent strategy. Full article

(This article belongs to the Section Cardiology)

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11 pages, 851 KiB

Open AccessArticle

Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes

by María José Martínez, Ferran Rueda, Carlos Labata, Teresa Oliveras, Santiago Montero, Marc Ferrer, Nabil El Ouaddi, Jordi Serra, Josep Lupón, Antoni Bayés-Genís and Cosme García-García

J. Clin. Med. 2022, 11(12), 3558; https://doi.org/10.3390/jcm11123558 - 20 Jun 2022

Cited by 10 | Viewed by 3223

Abstract

Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term [...] Read more.

Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16–3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock: New Perspectives)

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22 pages, 1116 KiB

Open AccessReview

The Gut Microbiota and Vascular Aging: A State-of-the-Art and Systematic Review of the Literature

by Davide Agnoletti, Federica Piani, Arrigo F. G. Cicero and Claudio Borghi

J. Clin. Med. 2022, 11(12), 3557; https://doi.org/10.3390/jcm11123557 - 20 Jun 2022

Cited by 13 | Viewed by 3676

Abstract

The gut microbiota is a critical regulator of human physiology, deleterious changes to its composition and function (dysbiosis) have been linked to the development and progression of cardiovascular diseases. Vascular ageing (VA) is a process of progressive stiffening of the arterial tree associated [...] Read more.

The gut microbiota is a critical regulator of human physiology, deleterious changes to its composition and function (dysbiosis) have been linked to the development and progression of cardiovascular diseases. Vascular ageing (VA) is a process of progressive stiffening of the arterial tree associated with arterial wall remodeling, which can precede hypertension and organ damage, and is associated with cardiovascular risk. Arterial stiffness has become the preferred marker of VA. In our systematic review, we found an association between gut microbiota composition and arterial stiffness, with two patterns, in most animal and human studies: a direct correlation between arterial stiffness and abundances of bacteria associated with altered gut permeability and inflammation; an inverse relationship between arterial stiffness, microbiota diversity, and abundances of bacteria associated with most fit microbiota composition. Interventional studies were able to show a stable link between microbiota modification and arterial stiffness only in animals. None of the human interventional trials was able to demonstrate this relationship, and very few adjusted the analyses for determinants of arterial stiffness. We observed a lack of large randomized interventional trials in humans that test the role of gut microbiota modifications on arterial stiffness, and take into account BP and hemodynamic alterations. Full article

(This article belongs to the Special Issue Frontiers in Vascular Stiffness)

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18 pages, 892 KiB

Open AccessSystematic Review

The Effect of Endurance Training on Serum BDNF Levels in the Chronic Post-Stroke Phase: Current Evidence and Qualitative Systematic Review

by Sara Górna and Katarzyna Domaszewska

J. Clin. Med. 2022, 11(12), 3556; https://doi.org/10.3390/jcm11123556 - 20 Jun 2022

Cited by 2 | Viewed by 2405

Abstract

Research in modern neurorehabilitation focusses on cognitive and motor recovery programmes tailored to each stroke patient, with particular emphasis on physiological parameters. The objectives of this review were to determine whether a single bout of endurance activity or long-term endurance activity regulates exercise-dependent [...] Read more.

Research in modern neurorehabilitation focusses on cognitive and motor recovery programmes tailored to each stroke patient, with particular emphasis on physiological parameters. The objectives of this review were to determine whether a single bout of endurance activity or long-term endurance activity regulates exercise-dependent serum brain-derived neurotrophic factor (BDNF) levels and to evaluate the methodological quality of the studies. To assess the effectiveness of endurance exercise among patients in the chronic post-stroke phase, a systematic review was performed, including searching EBSCOhost, PEDro, PubMed, and Scopus for articles published up to the end of October 2021. The PRISMA 2020 outline was used, and this review was registered on PROSPERO. Of the 180 papers identified, seven intervention studies (comprising 200 patients) met the inclusion criteria. The methodological quality of these studies was evaluated by using the Physiotherapy Evidence Database (PEDro) criteria. The effect of exercise was evaluated in four studies with a single bout of endurance activity, two studies with long-term endurance activity, and one study with a single bout of endurance activity as well as long-term endurance activity. The results of our systematic review provide evidence that endurance exercise might augment the peripheral BDNF concentration in post-stroke individuals. Full article

(This article belongs to the Special Issue Clinical Application of Physical Therapy in Neurorehabilitation)

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15 pages, 6783 KiB

Open AccessArticle

The Assessment of COVID-19 Pneumonia in Neonates: Observed by Lung Ultrasound Technique and Correlated with Biomarkers and Symptoms

by Emil Robert Stoicescu, Diana Luminita Manolescu, Roxana Iacob, Simona Cerbu, Mirabela Dima, Emil Radu Iacob, Ioana Mihaiela Ciuca, Cristian Oancea and Daniela Iacob

J. Clin. Med. 2022, 11(12), 3555; https://doi.org/10.3390/jcm11123555 - 20 Jun 2022

Cited by 9 | Viewed by 1878

Abstract

Newborns infected with SARS-CoV2 infection develop different symptoms in comparison with adults, but one thing is clear: some of the most common manifestations include cough and other respiratory symptoms that need to be evaluated. In these cases, lung ultrasound is a useful imaging [...] Read more.

Newborns infected with SARS-CoV2 infection develop different symptoms in comparison with adults, but one thing is clear: some of the most common manifestations include cough and other respiratory symptoms that need to be evaluated. In these cases, lung ultrasound is a useful imaging technique that can evaluate the newborns’ lung damage caused by COVID-19 pneumonia and can be used for the surveillance of the patients as well, being non-irradiating and easy to use. Nineteen neonates who were confirmed as having SARS-CoV2 infection were investigated using this imaging tool, and the results were compared and correlated with their symptoms and biomarkers. The mean of LUSS was 12.21 ± 3.56 (S.D), while the 95% CI for the arithmetic mean was 10.49–13.93. The difference of an independent t-test between the LUSS for the patient who presented cough and the LUSS for the patient without cough was −4.48 with an associated p-value of p = 0.02. The Pearson’s correlation coefficient r = 0.89 (p = 0.03, 95% CI 0.0642 to 0.993) between the LUSS and IL-6 level showed a positive strong correlation. This reliable correlation between lung ultrasound score and inflammatory markers suggests that LUS could be used for monitoring inflammatory lung diseases in the future. Full article

(This article belongs to the Special Issue Current Advances in Lung Ultrasound for COVID-19)

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14 pages, 423 KiB

Open AccessArticle

Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study

by Vivencio Barrios, Carlos Escobar, Carmen Suarez, Xavier Garcia-Moll and Francisco Lozano

J. Clin. Med. 2022, 11(12), 3554; https://doi.org/10.3390/jcm11123554 - 20 Jun 2022

Cited by 4 | Viewed by 2605

Abstract

This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were [...] Read more.

This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted. Full article

(This article belongs to the Section Cardiology)

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13 pages, 978 KiB

Open AccessArticle

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study

by Salvatore D’Angelo, Carlo Salvarani, Francesca Marando, Giuliana Gualberti, Lucia Novelli, Giacomo Curradi, Giovanni Tripepi, Annalisa Pitino, Roberta Ramonda and Antonio Marchesoni

J. Clin. Med. 2022, 11(12), 3553; https://doi.org/10.3390/jcm11123553 - 20 Jun 2022

Cited by 4 | Viewed by 1522

Abstract

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to [...] Read more.

In this study, we evaluated the presence of residual disease in patients with axial spondyloarthritis (axSpA) in remission/low disease activity (LDA) status. This cross-sectional post-hoc analysis of the QUASAR study involving 23 rheumatology centres across Italy included adults with axSpA classified according to the Assessment of SpondyloArthritis International Society criteria. Patients with inactive disease (score < 1.3) or at least LDA status (score < 2.1) at baseline visit according to Ankylosing Spondylitis Disease Activity Score were investigated to evaluate how residual disease activity impacts patients’ quality of life. They were assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) and EuroQoL 5-Dimension 5-Level (EQ-5D-5L) questionnaires. This study included 480 patients with axSpA (mean age, 47.5 ± 12.9 years, 64% male). In total, 123 patients (25.6%) had inactive disease and 262 (54.6%) had at least LDA. Using the ASQoL, ranges of 10–25% and 20–40% of patients with inactive disease and with LDA status, respectively, experienced tiredness/fatigue. Despite being classified with inactive disease, 48.8% of patients reported light pain/discomfort according to the EQ-5D-5L, with 4.1% reporting moderate pain/discomfort, whereas 55.7% of patients with LDA reported light pain/discomfort and 13% had moderate pain/discomfort. Using the ASQoL questionnaire, in patients with at least LDA, a higher proportion of women compared with males and a higher proportion of patients > 48 years of age (vs. patients ≤ 48 years) experienced tiredness. In this post-hoc analysis, ≥25% of axSpA patients in remission/LDA status were still burdened by residual disease, mainly characterised by pain and fatigue. Full article

(This article belongs to the Special Issue Ankylosing Spondylitis and Psoriatic Arthritis, Pathogenesis, Diagnosis, and Therapies)

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6 pages, 237 KiB

Open AccessEditorial

Pharmacovigilance and Pharmacoepidemiology as a Guarantee of Patient Safety: The Role of the Clinical Pharmacologist

by Giada Crescioli, Roberto Bonaiuti, Renato Corradetti, Guido Mannaioni, Alfredo Vannacci and Niccolò Lombardi

J. Clin. Med. 2022, 11(12), 3552; https://doi.org/10.3390/jcm11123552 - 20 Jun 2022

Cited by 8 | Viewed by 2516

Abstract

Recent years, particularly the COVID-19 pandemic, can be considered a turning point for pharmacovigilance and pharmacoepidemiology in terms of their role in drug safety and drug utilisation monitoring in clinical practice [...] Full article

(This article belongs to the Special Issue Medication Safety and Pharmacovigilance in Clinical: From the Researcher Bench to the Patient Bedside)

9 pages, 770 KiB

Open AccessReview

Sjögren’s Syndrome-Related Organs Fibrosis: Hypotheses and Realities

by Margherita Sisto, Domenico Ribatti and Sabrina Lisi

J. Clin. Med. 2022, 11(12), 3551; https://doi.org/10.3390/jcm11123551 - 20 Jun 2022

Cited by 7 | Viewed by 1914

Abstract

Sjögren’s syndrome (SS) is a systemic chronic autoimmune disorder characterized by lymphoplasmacytic infiltration of salivary glands (SGs) and lacrimal glands, causing glandular damage. The disease shows a combination of dryness symptoms found in the oral cavity, pharynx, larynx, and vagina, representing a systemic [...] Read more.

Sjögren’s syndrome (SS) is a systemic chronic autoimmune disorder characterized by lymphoplasmacytic infiltration of salivary glands (SGs) and lacrimal glands, causing glandular damage. The disease shows a combination of dryness symptoms found in the oral cavity, pharynx, larynx, and vagina, representing a systemic disease. Recent advances link chronic inflammation with SG fibrosis, based on a molecular mechanism pointing to the epithelial to mesenchymal transition (EMT). The continued activation of inflammatory-dependent fibrosis is highly detrimental and a common final pathway of numerous disease states. The important question of whether and how fibrosis contributes to SS pathogenesis is currently intensely debated. Here, we collect the recent findings on EMT-dependent fibrosis in SS SGs and explore clinical evidence of multi-organ fibrosis in SS to highlight potential avenues for therapeutic investigation. Full article

(This article belongs to the Special Issue Diseases of the Salivary Glands—Part II)

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9 pages, 760 KiB

Open AccessArticle

High Expression of Claudin-4 Is Associated with Synchronous Tumors in Patients with Early Gastric Cancer

by Won Shik Kim, Hayeon Kim, Moon Kyung Joo, Byung Il Choi, Ah Young Yoo, Jong-Jae Park, Beom Jae Lee, Seung Han Kim and Hoon Jai Chun

J. Clin. Med. 2022, 11(12), 3550; https://doi.org/10.3390/jcm11123550 - 20 Jun 2022

Cited by 3 | Viewed by 1828

Abstract

Claudin (CLDN) is a tight junction protein found in human epithelial cells and its altered expression is known to be associated with the progression of gastric cancer. We aimed to investigate the differential expression of CLDN-4 in early gastric cancer (EGC) according to [...] Read more.

Claudin (CLDN) is a tight junction protein found in human epithelial cells and its altered expression is known to be associated with the progression of gastric cancer. We aimed to investigate the differential expression of CLDN-4 in early gastric cancer (EGC) according to its clinicopathological characteristics. We enrolled 53 patients with EGC who underwent surgical gastric resection from January 2007 to December 2018. The staining intensity of the tumor cells was scored as 0–3, and the percentage of staining was scored as 0–5; high expression was defined if the intensity plus percentage score was 7 or 8, and low expression was defined if the score was 0–6. Among the 53 patients, 16 (30.2%) showed low CLDN-4 expression, while 37 (69.8%) had high CLDN-4 expression. High CLDN-4 expression was significantly associated with intestinal-type EGC (low: 12.5% vs. high: 56.8%, p = 0.003), open-type atrophic change (low: 60.0% vs. high: 90.9%, p = 0.011), and the presence of synchronous tumors (0 vs. 32.4%, p = 0.010), and all 12 EGCs with synchronous tumors showed high CLDN-4 expression. However, expression of CLDN-3, a typical intestinal phenotype CLDN, was neither correlated with CLDN-4 expression nor associated with synchronous tumors. Taken together, high CLDN-4 expression may be considered as an auxiliary tool for screening synchronous tumors in patients with EGC. Full article

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

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10 pages, 263 KiB

Open AccessReview

Stereotactic Radiotherapy: An Alternative Option for Refractory Ventricular Tachycardia to Drug and Ablation Therapy

by Wenfeng Shangguan, Gang Xu, Xin Wang, Nan Zhang, Xingpeng Liu, Guangping Li, Gary Tse and Tong Liu

J. Clin. Med. 2022, 11(12), 3549; https://doi.org/10.3390/jcm11123549 - 20 Jun 2022

Cited by 5 | Viewed by 1881

Abstract

Refractory ventricular tachycardia (VT) often occurs in the context of organic heart disease. It is associated with significantly high mortality and morbidity rates. Antiarrhythmic drugs and catheter ablation represent the two main treatment options for refractory VT, but their use can be associated [...] Read more.

Refractory ventricular tachycardia (VT) often occurs in the context of organic heart disease. It is associated with significantly high mortality and morbidity rates. Antiarrhythmic drugs and catheter ablation represent the two main treatment options for refractory VT, but their use can be associated with inadequate therapeutic responses and procedure-related complications. Stereotactic body radiotherapy (SBRT) is extensively applied in the precision treatment of solid tumors, with excellent therapeutic responses. Recently, this highly precise technology has been applied for radioablation of VT, and its early results demonstrate a favorable safety profile. This review presents the potential value of SBRT in refractory VT. Full article

(This article belongs to the Special Issue Current Updates on Interventional Cardiac Electrophysiology)

13 pages, 1986 KiB

Open AccessArticle

Usefulness of Hospital Admission Chest X-ray Score for Predicting Mortality and ICU Admission in COVID-19 Patients

by Trieu-Nghi Hoang-Thi, Duc-Tuan Tran, Hai-Dang Tran, Manh-Cuong Tran, Tra-My Ton-Nu, Hong-Minh Trinh-Le, Hanh-Nhi Le-Huu, Nga-My Le-Thi, Cong-Trinh Tran, Nhat-Nam Le-Dong and Anh-Tuan Dinh-Xuan

J. Clin. Med. 2022, 11(12), 3548; https://doi.org/10.3390/jcm11123548 - 20 Jun 2022

Cited by 2 | Viewed by 1944

Abstract

We aimed to investigate the performance of a chest X-ray (CXR) scoring scale of lung injury in prediction of death and ICU admission among patients with COVID-19 during the 2021 peak pandemic in HCM City, Vietnam. CXR and clinical data were collected from [...] Read more.

We aimed to investigate the performance of a chest X-ray (CXR) scoring scale of lung injury in prediction of death and ICU admission among patients with COVID-19 during the 2021 peak pandemic in HCM City, Vietnam. CXR and clinical data were collected from Vinmec Central Park-hospitalized patients from July to September 2021. Three radiologists independently assessed the day-one CXR score consisting of both severity and extent of lung lesions (maximum score = 24). Among 219 included patients, 28 died and 34 were admitted to the ICU. There was a high consensus for CXR scoring among radiologists (κ = 0.90; CI95%: 0.89–0.92). CXR score was the strongest predictor of mortality (tdAUC 0.85 CI95% 0.69–1) within the first 3 weeks after admission. A multivariate model confirmed a significant effect of an increased CXR score on mortality risk (HR = 1.33, CI95%: 1.10 to 1.62). At a threshold of 16 points, the CXR score allowed for predicting in-hospital mortality and ICU admission with good sensitivity (0.82 (CI95%: 0.78 to 0.87) and 0.86 (CI95%: 0.81 to 0.90)) and specificity (0.89 (CI95%: 0.88 to 0.90) and 0.87 (CI95%: 0.86 to 0.89)), respectively, and can be used to identify high-risk patients in needy countries such as Vietnam. Full article

(This article belongs to the Topic Fighting against COVID-19: Latest Advances, Challenges and Methodologies)

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18 pages, 3597 KiB

Open AccessArticle

Upregulation of Endothelin-1 May Predict Chemotherapy-Induced Cardiotoxicity in Women with Breast Cancer

by Krithika Krishnarao, Katelyn A. Bruno, Damian N. Di Florio, Brandy H. Edenfield, Emily R. Whelan, Logan P. Macomb, Molly M. McGuire, Anneliese R. Hill, Jordan C. Ray, Lauren F. Cornell, Winston Tan, Xochiquetzal J. Geiger, Gary R. Salomon, Erika J. Douglass, DeLisa Fairweather and Mohamad H. Yamani

J. Clin. Med. 2022, 11(12), 3547; https://doi.org/10.3390/jcm11123547 - 20 Jun 2022

Cited by 5 | Viewed by 2184

Abstract

As survival in breast cancer patients from newer therapies increases, concerns for chemotherapy-induced cardiotoxicity (CIC) have offset some of these benefits, manifesting as a decline in left ventricular ejection fraction (LVEF). Patients receiving anthracycline-based chemotherapy followed by trastuzumab are at risk for CIC. [...] Read more.

As survival in breast cancer patients from newer therapies increases, concerns for chemotherapy-induced cardiotoxicity (CIC) have offset some of these benefits, manifesting as a decline in left ventricular ejection fraction (LVEF). Patients receiving anthracycline-based chemotherapy followed by trastuzumab are at risk for CIC. Previous research evaluating whether clinical biomarkers predict cardiotoxicity has been inconsistent. Recently, angiotensin II type 1 receptor (ATR1) and endothelin 1 (ET1) have been shown to play a role in breast tumor growth. We evaluated ATR1 and ET1 expression in breast cancer tissue and its association with CIC. A total of 33 paraffin-embedded breast tissue specimens from women with breast cancer treated with anthracycline-based chemotherapy and trastuzumab were analyzed by immunohistochemistry (IHC) and qRT-PCR. We found that ET1 expression was increased in patients with an LVEF ≤ 50% (p = 0.032) with a lower LVEF correlating with higher ET1 expression (r = 0.377, p = 0.031). In patients with a change in LVEF of greater than 10%, greater ET1 expression was noted compared to those without a change in LVEF (p = 0.017). Increased ET1 expression in breast tumor tissue is associated with reduced LVEF. Future studies need to examine whether ET1 may be a tissue biomarker that helps predict the risk of developing CIC in women with breast cancer. Full article

(This article belongs to the Special Issue Side Effects of Cancer Therapeutics in Clinical Practice)

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10 pages, 866 KiB

Open AccessArticle

Association Analysis of the Cerebral Fractional Tissue Oxygen Extraction (cFTOE) and the Cerebral Oxygen Saturation (crSaO2) with Perinatal Factors in Preterm Neonates: A Single Centre Study

by Melinda Matyas, Mihaela Iancu, Monica Hasmasanu, Anca Man and Gabriela Zaharie

J. Clin. Med. 2022, 11(12), 3546; https://doi.org/10.3390/jcm11123546 - 20 Jun 2022

Viewed by 1809

Abstract

(1) Background: Near-infrared spectroscopy (NIRS) is a non-invasive, easily performed method of monitoring brain oxygenation. The regional cerebral oxygen saturation (crSaO2) and the cerebral fractional tissue oxygen extraction (cFTOE) evaluated by NIRS provide more accurate information on brain oxygenation than the [...] Read more.

(1) Background: Near-infrared spectroscopy (NIRS) is a non-invasive, easily performed method of monitoring brain oxygenation. The regional cerebral oxygen saturation (crSaO2) and the cerebral fractional tissue oxygen extraction (cFTOE) evaluated by NIRS provide more accurate information on brain oxygenation than the blood oxygen saturation. We investigated the effect of perinatal factors on cerebral oxygenation of preterm newborns. (2) Methods: We conducted a longitudinal study with 48 preterm newborns <34 weeks of gestation who underwent NIRS registration during the first 72 h of life. crSaO2 was measured and cFTOE was calculated foreach patient. (3) Results: One-way ANOVA showed no significant main effect of IVH severity on crSaO2 and cFTOE (p > 0.05); there was a tendency toward statistical significance concerning the difference between the means of crSaO2 (p = 0.083) and cFTOE (p = 0.098). Patients with intraventricular haemorrhage (IVH) had a lower mean of crSaO2 and a higher mean of cFTOE (59.67 ± 10.37% vs. 64.92 ± 10.16% for crSaO2; 0.37 ± 0.11 vs. 0.32 ± 0.11 for cFTOE) compared to those with no IVH. Significantly lower values of crSaO2 and higher values of cFTOE were found in neonates receiving inotropic treatment (p < 0.0001). Episodes of apnoea also proved to influence the cerebral oxygen saturation of the study group (p = 0.0026). No significant association between the maternal hypertension treatment and the cerebral oxygenation of preterms was found. (4) Conclusions: This study showed a decreased cerebral oxygen saturation of preterms with IVH, inotrope support and apnoea episodes. Full article

(This article belongs to the Special Issue Preterm Newborn at the Border between Obstetrics and Neonatology: Advances in the Interdisciplinary Management)

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15 pages, 2140 KiB

Open AccessArticle

What Does Bone Corticalization around Dental Implants Mean in Light of Ten Years of Follow-Up?

by Marcin Kozakiewicz, Małgorzata Skorupska and Tomasz Wach

J. Clin. Med. 2022, 11(12), 3545; https://doi.org/10.3390/jcm11123545 - 20 Jun 2022

Cited by 8 | Viewed by 2599

Abstract

The phenomenon of peri-implant bone corticalization after functional loading does not yet have a definite clinical significance and impact on prognosis. An attempt was made to assess the clinical significance of this phenomenon. This prospective study included 554 patients. Standardized intraoral radiographs documenting [...] Read more.

The phenomenon of peri-implant bone corticalization after functional loading does not yet have a definite clinical significance and impact on prognosis. An attempt was made to assess the clinical significance of this phenomenon. This prospective study included 554 patients. Standardized intraoral radiographs documenting the jawbone environment of 1556 implants were collected. The follow-up period was 10 years of functional loading. Marginal alveolar bone loss (MBL) and radiographic bone structure (bone index, BI) were evaluated in relation to intraosseous implant design features and prosthetic work performed. After five years, bone structure abnormalities expressed by a reduction of BI to 0.47 ± 0.21 and MBL = 0.88 ± 1.27 mm were observed. Both values had an inverse relationship with each other (p < 0.0001). Reference cancellous bone showed BI = 0.85 ± 0.18. The same relationship was observed after ten years of functional loading: BI = 0.48 ± 0.21, MBL = 1.49 ± 1.94 mm, and again an inverse relationship (p < 0.0001). Increasing corticalization (lower BI) is strongly associated with increasing marginal bone loss and increasing corticalization precedes future marginal bone loss. Marginal bone loss will increase as corticalization progresses. Full article

(This article belongs to the Special Issue Recent Advances in Dental Implantology)

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11 pages, 554 KiB

Open AccessArticle

Effectiveness and Safety of High-Dose Dual Therapy: Results of the European Registry on the Management of Helicobacterpylori Infection (Hp-EuReg)

by Luis Fernández-Salazar, Ana Campillo, Luis Rodrigo, Ángeles Pérez-Aisa, Jesús M. González-Santiago, Xavier Segarra Ortega, Maja Denkovski, Natasa Brglez Jurecic, Luis Bujanda, Blas José Gómez Rodríguez, Juan Ortuño, Sotirios Georgopoulos, Laimas Jonaitis, Ignasi Puig, Olga P. Nyssen, Francis Megraud, Colm O’Morain and Javier P. Gisbert

J. Clin. Med. 2022, 11(12), 3544; https://doi.org/10.3390/jcm11123544 - 20 Jun 2022

Cited by 12 | Viewed by 2728

Abstract

Background: Randomized clinical trials and meta-analyses, primarily from Asian countries, have reported good effectiveness with high-dose dual therapy (HDDT) including a proton pump inhibitor (PPI) and amoxicillin when prescribed as H. pylori first-line or rescue treatment. However, combining amoxicillin with PPIs in the [...] Read more.

Background: Randomized clinical trials and meta-analyses, primarily from Asian countries, have reported good effectiveness with high-dose dual therapy (HDDT) including a proton pump inhibitor (PPI) and amoxicillin when prescribed as H. pylori first-line or rescue treatment. However, combining amoxicillin with PPIs in the 1990s in several European countries yielded suboptimal results. Methods: An international, multicenter, prospective non-interventional Registry (Hp-EuReg) aimed to evaluate the decisions and outcomes of H. pylori management by European gastroenterologists. All infected adult cases treated with HDDT were registered at e-CRF AEG-REDCap platform until June 2021. Sixty patients were prescribed with HDDT (98% compliance), 19 of them received a first-line therapy and 41 a rescue treatment (second- to sixth-line). Results: Overall HDDT effectiveness was 52% (per-protocol) and 51% (modified intention-to-treat). First-line and rescue treatment lines were equally effective, but the effectiveness was worse when patients had previously received metronidazole, tetracycline, or rifabutin. Adding bismuth to HDDT in rescue treatment did not yield better results. The incidence of adverse events was 30%, diarrhea being the most common (20% of patients); no serious adverse events were reported. Conclusion: Although HDDT is safe and has good compliance, it is not a good option in European first-line or rescue H. pylori treatment, even when adding bismuth. Full article

(This article belongs to the Topic Infectious Diseases)

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15 pages, 1039 KiB

Open AccessReview

The Use of Intravenous Lidocaine in Perioperative Medicine: Anaesthetic, Analgesic and Immune-Modulatory Aspects

by Ingrid Wing-Sum Lee and Stefan Schraag

J. Clin. Med. 2022, 11(12), 3543; https://doi.org/10.3390/jcm11123543 - 20 Jun 2022

Cited by 20 | Viewed by 5253

Abstract

This narrative review provides an update on the applied pharmacology of lidocaine, its clinical scope in anaesthesia, novel concepts of analgesic and immune-modulatory effects as well as the current controversy around its use in perioperative opioid-sparing multi-modal strategies. Potential benefits of intravenous lidocaine [...] Read more.

This narrative review provides an update on the applied pharmacology of lidocaine, its clinical scope in anaesthesia, novel concepts of analgesic and immune-modulatory effects as well as the current controversy around its use in perioperative opioid-sparing multi-modal strategies. Potential benefits of intravenous lidocaine in the context of cancer, inflammation and chronic pain are discussed against concerns of safety, toxicity and medico-legal constraints. Full article

(This article belongs to the Special Issue New Approaches in Intravenous Anesthesia and Anesthetics—Part II)

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26 pages, 1681 KiB

Open AccessReview

LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement

by Christos P. Kyriakopoulos, Chris J. Kapelios, Elizabeth L. Stauder, Iosif Taleb, Rana Hamouche, Konstantinos Sideris, Antigone G. Koliopoulou, Michael J. Bonios and Stavros G. Drakos

J. Clin. Med. 2022, 11(12), 3542; https://doi.org/10.3390/jcm11123542 - 20 Jun 2022

Cited by 9 | Viewed by 2621

Abstract

Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of [...] Read more.

Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population. Full article

(This article belongs to the Special Issue State of the Art: Clinical Use of Durable Left Ventricular Assist Devices)

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10 pages, 1043 KiB

Open AccessArticle

Complications of Autologous Stem Cell Transplantation in Multiple Myeloma: Results from the CALM Study

by Anna Waszczuk-Gajda, Olaf Penack, Giulia Sbianchi, Linda Koster, Didier Blaise, Péter Reményi, Nigel Russell, Per Ljungman, Marek Trneny, Jiri Mayer, Simona Iacobelli, Guido Kobbe, Christof Scheid, Jane Apperley, Cyrille Touzeau, Stig Lenhoff, Esa Jantunen, Achilles Anagnostopoulos, Laura Paris, Paul Browne, Catherine Thieblemont, Nicolaas Schaap, Jorge Sierra, Ibrahim Yakoub-Agha, Laurent Garderet, Jan Styczynski, Helene Schoemans, Ivan Moiseev, Rafael F. Duarte, Zinaida Peric, Silvia Montoto, Anja van Biezen, Malgorzata Mikulska, Mahmoud Aljurf, Tapani Ruutu, Nicolaus Kröger, Curly Morris, Christian Koenecke, Stefan Schoenland and Grzegorz W. Basakadd Show full author list remove Hide full author list

J. Clin. Med. 2022, 11(12), 3541; https://doi.org/10.3390/jcm11123541 - 20 Jun 2022

Cited by 5 | Viewed by 2778

Abstract

Background: The main goal of this post hoc analysis of the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study was to evaluate the rate of short- and long-term infectious and non-infectious complications occurring after ASCT in patients with multiple [...] Read more.

Background: The main goal of this post hoc analysis of the Collaboration to Collect Autologous Transplant Outcomes in Lymphoma and Myeloma (CALM) study was to evaluate the rate of short- and long-term infectious and non-infectious complications occurring after ASCT in patients with multiple myeloma (MM). Methods: The analysis included all patients with MM from the CALM study who underwent ≥1 ASCT. The primary endpoint of the analysis was to determine the rate of infectious and non-infectious complications after ASCT and to compare them in three time periods: 0–100 days, 101 days–1 year, and >1 year after the first transplant. Results: The analysis included a total of 3552 patients followed up for a median of 56.7 months (range 0.4–108.1). Complication rates decreased with the time from ASCT with 24.85 cases per 100 patient-years from day 0 to 100 days after the transplant, and <2.31 cases per 100 patient-years from the 101st day. At 100 days after ASC T, 45.7% of patients had complications, with infectious events being twice as frequent as non-infectious complications. Bacterial infections (6.5 cases per 100 patient-years, 95% CI: 6.1–7.0) and gastrointestinal complications (4.7 cases per 100 patient-years, 95% CI: 4.3–5.1) were the most common early events. The pattern of complications changed with time from ASCT. The presence of complications after ASCT was not associated with overall survival. Conclusions: Our data provide a solid basis for comparing ASCT-related complications to those caused by emerging treatments in multiple myeloma, such as CAR T-cell therapy and other immunotherapies. Full article

(This article belongs to the Special Issue Plasma Cell Dyscrasias–Laboratory and Clinical Insights)

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10 pages, 20100 KiB

Open AccessArticle

Foveal Intraretinal Fluid Localization Affects the Visual Prognosis of Branch Retinal Vein Occlusion

by Hirofumi Sasajima, Masahiro Zako, Rio Maeda, Kenta Murotani, Hidetoshi Ishida and Yoshiki Ueta

J. Clin. Med. 2022, 11(12), 3540; https://doi.org/10.3390/jcm11123540 - 20 Jun 2022

Cited by 3 | Viewed by 1730

Abstract

We investigated whether baseline foveal intraretinal fluid (IRF) localization affects the visual prognosis of branch retinal vein occlusion (BRVO). Fifty eyes from 50 patients were included in this retrospective study. We classified the eyes with IRF involving and not involving the central foveola [...] Read more.

We investigated whether baseline foveal intraretinal fluid (IRF) localization affects the visual prognosis of branch retinal vein occlusion (BRVO). Fifty eyes from 50 patients were included in this retrospective study. We classified the eyes with IRF involving and not involving the central foveola on the vertical optical coherence tomography (OCT) image at the initial visit into both-sides (n = 17) and one-side IRF (n = 33) groups, respectively. Multiple regression analyses demonstrated that not only the baseline logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) but also the IRF localization significantly correlated with the 12-month logMAR BCVA (p = 0.04 and p = 0.001, respectively), indicating that eyes with better baseline logMAR BCVA and one-side IRF have a significantly better visual prognosis in BRVO. The foveal ellipsoid zone band was significantly more disrupted (p < 0.001) in the both-sides IRF (47.1%) group than in the one-side IRF (3.0%) group. No eyes with decimal BCVA less than 0.5 were detected in the one-side IRF group at 12 months. Thus, baseline foveal IRF localization on vertical OCT images can be considered a novel biomarker for the visual prognosis of BRVO. Full article

(This article belongs to the Collection Recent Advances of Examination and Treatment for Retinal and Choroidal Diseases)

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14 pages, 1499 KiB

Open AccessArticle

Use of Inhaled Corticosteroids and Risk of Acquiring Haemophilus influenzae in Patients with Chronic Obstructive Pulmonary Disease

by Raza Ul Mohsin, Christian Kjer Heerfordt, Josefin Eklöf, Pradeesh Sivapalan, Mohamad Isam Saeed, Truls Sylvan Ingebrigtsen, Susanne Dam Nielsen, Zitta Barrella Harboe, Kasper Karmark Iversen, Jette Bangsborg, Jens Otto Jarløv, Jonas Bredtoft Boel, Christian Østergaard Andersen, Henrik Pierre Calum, Ram B. Dessau and Jens-Ulrik Stæhr Jensen

J. Clin. Med. 2022, 11(12), 3539; https://doi.org/10.3390/jcm11123539 - 20 Jun 2022

Cited by 6 | Viewed by 2038

Abstract

Background: Inhaled corticosteroids (ICS) are widely used in chronic obstructive pulmonary disease (COPD), despite the known risk of severe adverse effects including pulmonary infections. Research Question: Our study investigates the risk of acquiring a positive Haemophilus influenzae airway culture with use of ICS [...] Read more.

Background: Inhaled corticosteroids (ICS) are widely used in chronic obstructive pulmonary disease (COPD), despite the known risk of severe adverse effects including pulmonary infections. Research Question: Our study investigates the risk of acquiring a positive Haemophilus influenzae airway culture with use of ICS in outpatients with COPD. Study Design and Methods: We conducted an epidemiological cohort study using data from 1 January 2010 to 19 February 2018, including 21,218 outpatients with COPD in Denmark. ICS use 365 days prior to cohort entry was categorised into low, moderate, and high, based on cumulated ICS dose extracted from a national registry on reimbursed prescriptions. A Cox proportional hazards regression model was used to assess the future risk of acquiring H. Influenzae within 365 days from cohort entry, and sensitivity analyses were performed using propensity score matched models. Results: In total, 801 (3.8%) patients acquired H. Influenzae during follow-up. Use of ICS was associated with a dose-dependent increased risk of acquiring H. Influenzae with hazard ratio (HR) 1.2 (95% confidence interval (CI) 0.9–1.5, p value = 0.1) for low-dose ICS; HR 1.7 (95% CI 1.3–2.1, p value < 0.0001) for moderate dose; and HR 1.9 (95% CI 1.5–2.4, p value < 0.0001) for high-dose ICS compared to no ICS use. Results were confirmed in the propensity-matched model using the same categories. Conclusions: ICS use in outpatients with COPD was associated with a dose-dependent increase in risk of isolating H. Influenzae. This observation supports that high dose ICS should be used with caution. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease: New Treatments and Future Directions)

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10 pages, 669 KiB

Open AccessArticle

Serum IgG4 Concentration Is a Potential Predictive Biomarker in Glucocorticoid Treatment for Idiopathic Retroperitoneal Fibrosis

by Shoichiro Mukai, Naotaka Sakamoto, Hiroaki Kakinoki, Tadamasa Shibuya, Ryosuke Moriya, Kiyoaki Nishihara, Mitsuru Noguchi, Toshitaka Shin, Naohiro Fujimoto, Tsukasa Igawa, Tatsu Ishii, Nobuhiro Haga, Hideki Enokida, Masatoshi Eto, Tomomi Kamba, Hideki Sakai, Seiichi Saito, Naoki Terada and Toshiyuki Kamoto

J. Clin. Med. 2022, 11(12), 3538; https://doi.org/10.3390/jcm11123538 - 20 Jun 2022

Cited by 1 | Viewed by 2188

Abstract

Objectives: To evaluate the management and outcome of idiopathic retroperitoneal fibrosis (iRPF) in Japan, and to identify its clinical biomarker. Methods: We retrospectively analyzed 129 patients with iRPF treated between January 2008 and May 2018 at 12 university and related hospitals. Patients treated [...] Read more.

Objectives: To evaluate the management and outcome of idiopathic retroperitoneal fibrosis (iRPF) in Japan, and to identify its clinical biomarker. Methods: We retrospectively analyzed 129 patients with iRPF treated between January 2008 and May 2018 at 12 university and related hospitals. Patients treated with glucocorticoid were analyzed to identify a predictive biomarker. These patients were classified into three groups according to overall effectiveness (no change: NC, complete response: CR, and partial response groups: PR), and each parameter was compared statistically. Results: Male–female ratio was 5:1, and median age at diagnosis was 69 (33–86) years. Smoking history was reported in 59.6% of the patients. As treatment, 95 patients received glucocorticoid therapy with an overall response rate of 84%. As a result, serum concentration of IgG4 was significantly decreased in NC group compared with the other two groups (56.6 mg/dL vs. 255 mg/dL, 206 mg/dL, p = 0.0059 and 0.0078). ROC analysis was performed between the nonresponder (NC) and responder groups (CR + PR) to identify the cut-off value of serum IgG4 as a predictive marker. As a result, AUC of 0.793 was confirmed. Conclusions: Pre-treatment serum IgG4 concentration may have potential as a predictive biomarker of steroid treatment. Full article

(This article belongs to the Section Nephrology & Urology)

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11 pages, 265 KiB

Open AccessArticle

Association of the CYP19A1 rs700518 Polymorphism with Selected Markers of Bone Metabolism in Women with Hyperandrogenism

by Izabela Uzar, Anna Bogacz, Elżbieta Sowińska-Przepiera, Krzysztof Piątek, Filip Przerwa, Marlena Wolek and Bogusław Czerny

J. Clin. Med. 2022, 11(12), 3537; https://doi.org/10.3390/jcm11123537 - 20 Jun 2022

Cited by 1 | Viewed by 1588

Abstract

Hyperandrogenism is the most common endocrine disorder in women, characterized by an imbalance of normal estrogen and androgen levels in the blood. Androgens play an important role in the female body because they influence bone mineral density (BMD), body mass composition, muscle mass, [...] Read more.

Hyperandrogenism is the most common endocrine disorder in women, characterized by an imbalance of normal estrogen and androgen levels in the blood. Androgens play an important role in the female body because they influence bone mineral density (BMD), body mass composition, muscle mass, mental state, and the regulation of sexual function. The reduced activity of aromatase, due to mutations in the CYP19A1 gene, reduces the estrogen pool in favor of androgens. Clinically, aromatase deficiency causes hyperandrogenism in women. Therefore, the aim of the study was to assess the effect of the CYP19A1 gene polymorphism on selected markers of bone metabolism and hormonal parameters in women with hyperandrogenism. The study group was comprised of 80 young women with hyperandrogenism who underwent measurements of bone mineral density (BMD), and determination of hormonal and metabolic parameters. Enzyme immunoassays were used to measure leptin, total sRANKL (free and bound RANKL), osteoprotegerin, and total 25-OH Vitamin D. An analysis of the CYP19A1 gene polymorphisms was performed using the real-time PCR method. The GG genotype of the CYP19A1 rs700518 polymorphism turned out to be associated with: FEI (Free Estradiol Index), SHGB concentration, estradiol concentration, and insulin concentration determined in the glucose tolerance test 60’ compared to AG and AA genotypes. Patients with the AG genotype had a higher ratio of android to gynoid fat and a greater content of visceral adipose tissue. Higher visceral tissue content may reduce BMD. In conclusion, the study showed that the CYP19A1 rs700518 polymorphism may be associated with the distribution of adipose tissue in young women with hyperandrogenism. These results suggest that patients with the AG genotype may develop osteoporosis. Full article

(This article belongs to the Section Orthopedics)

14 pages, 4416 KiB

Open AccessArticle

Novel Anterior Cranial Base Area for Voxel-Based Superimposition of Craniofacial CBCTs

by Georgios Kanavakis, Mohammed Ghamri and Nikolaos Gkantidis

J. Clin. Med. 2022, 11(12), 3536; https://doi.org/10.3390/jcm11123536 - 20 Jun 2022

Cited by 6 | Viewed by 1779

Abstract

A standard method to assess changes in craniofacial morphology over time is through the superimposition of serial patient images. This study evaluated the reliability of a novel anterior cranial base reference area, principally including stable midline structures (EMACB) after an early age, and [...] Read more.

A standard method to assess changes in craniofacial morphology over time is through the superimposition of serial patient images. This study evaluated the reliability of a novel anterior cranial base reference area, principally including stable midline structures (EMACB) after an early age, and compared it to the total anterior cranial base (TACB) and an area including only midline structures (MACB). Fifteen pairs of pre-existing serial CBCT images acquired from growing patients were superimposed with all techniques by applying a best-fit registration algorithm of corresponding voxel intensities (Dolphin 3D software). The research outcomes were the reproducibility of each technique and the agreement between them in skeletal change detection, as well as their validity. The TACB and EMACB methods were valid, since the superimposed midline ACB structures consistently showed adequate overlap. They also presented perfect overall reproducibility (median error < 0.01 mm) and agreement (median difference < 0.01 mm). MACB showed reduced validity, higher errors, and a moderate agreement to the TACB. Thus, the EMACB method performed efficiently and mainly included the stable midline ACB structures during growth. Based on the technical, anatomical, and biological principles applied when superimposing serial 3D data to assess craniofacial changes, we recommend the EMACB method as the method of choice to fulfil this purpose. Full article

(This article belongs to the Topic Diagnosis of Craniofacial Changes: Conventional Approaches and Novel Methodologies)

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