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J. Clin. Med., Volume 7, Issue 5 (May 2018)

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Open AccessArticle Individualised Multimodal Treatment Strategies for Anaplastic and Poorly Differentiated Thyroid Cancer
J. Clin. Med. 2018, 7(5), 115; https://doi.org/10.3390/jcm7050115
Received: 16 April 2018 / Revised: 8 May 2018 / Accepted: 9 May 2018 / Published: 15 May 2018
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Abstract
The prognosis of anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC) is poor, due to their radioiodine refractoriness (RAI-R), high metastatic potential and current lack of effective treatment strategies. We aimed to examine the efficacy of the tyrosine kinase inhibitors (TKIs) sorafenib and
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The prognosis of anaplastic (ATC) and poorly differentiated thyroid cancer (PDTC) is poor, due to their radioiodine refractoriness (RAI-R), high metastatic potential and current lack of effective treatment strategies. We aimed to examine the efficacy of the tyrosine kinase inhibitors (TKIs) sorafenib and selumetinib and the histone deacetylase inhibitor (HDACI) panobinostat in patient-derived tumor tissue (PDTT) of ATCs/PDTCs, the expression of sodium iodide symporter (NIS) and radioiodine up-take (RAI-U). High Mobility Group AT-Hook 2 (HMGA2) and associated miRNAs expression was correlated with the clinical course of the patients. Inhibitory effects of panobinostat, sorafenib and selumetinib were measured by real time cell analyser xCELLigence in five PDTTs and human foreskin fibroblasts (HF) used as control. Expression of NIS, HMGA2 and associated miRNAs hsa-let-7f-5p, hsa-let-7b-5p, hsa-miR-146b-5p and hsa-miR-146b-3p was performed by RT-qPCR and Western blot. RAI-U was performed by Gamma Counter with I-131. Panobinostat showed the strongest cytotoxic effect (10 nM) in all PDTTs and HF and caused a significant over-expression of NIS transcript. TKIs were able to up-regulate NIS transcript in patient 5 and in HF. RAI-U was up-regulated after 24 h of treatment with TKIs and panobinostat in all PDTT and HF, except in patient 5. Selumetinib caused a significant suppression of HMGA2 in PDTT 1, 2, 4, 5 and HF; whereas sorafenib caused no change of HMGA2 expression. Panobinostat suppressed significantly HMGA2 in PDTT 2, 4 and HF. The expression of miRNAs hsa-let-7f-5p, has-let-7b-5p hsa-miR-146b-5p and hsa-miR-146b-3p was modulated heterogeneously. NIS protein level was over-expressed in three PDTTs (patients 1, 3 and 4) after 24 h of treatment with selumetinib, sorafenib and in particular with panobinostat. HF showed a stable NIS protein level after treatment. Panobinostat showed the strongest cytotoxicity in all treated PDTTs at the lowest dosage in comparison with TKI. All three compounds were able to modulate differently NIS, HMGA2 and related miRNAs. These factors represent valuable markers in PDTT for new treatment strategies for patients suffering from ATC/PDTC. Thus, the establishment of PDTT could be a useful tool to test the efficacy of compounds and to develop new and individualised multimodal treatment options for PDTCs and ATCs. Full article
(This article belongs to the Special Issue Histone Deacetylase Inhibitor in Cancer Therapy)
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Open AccessReview Role of Venous Sampling in the Diagnosis of Endocrine Disorders
J. Clin. Med. 2018, 7(5), 114; https://doi.org/10.3390/jcm7050114
Received: 30 March 2018 / Revised: 8 May 2018 / Accepted: 9 May 2018 / Published: 14 May 2018
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Abstract
Venous sampling is the gold standard for localizing abnormal hormone secretion in several endocrine disorders. The most common indication for venous sampling is in the workup of primary aldosteronism, adrenocorticotropic hormone-dependent Cushing’s syndrome, and hyperparathyroidism. In experienced hands, venous sampling is safe and
[...] Read more.
Venous sampling is the gold standard for localizing abnormal hormone secretion in several endocrine disorders. The most common indication for venous sampling is in the workup of primary aldosteronism, adrenocorticotropic hormone-dependent Cushing’s syndrome, and hyperparathyroidism. In experienced hands, venous sampling is safe and accurate. This review discusses the role of venous sampling in the workup of endocrine disease, describing the underlying anatomy and pathophysiology, as an understanding of these concepts is essential for technical and clinical success. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Association of Cardiovascular Health with Epicardial Adipose Tissue and Intima Media Thickness: The Kardiovize Study
J. Clin. Med. 2018, 7(5), 113; https://doi.org/10.3390/jcm7050113
Received: 14 April 2018 / Revised: 8 May 2018 / Accepted: 10 May 2018 / Published: 13 May 2018
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Abstract
Background: Intima-media thickness (IMT) has been proposed as a measurement of subclinical atherosclerosis and has been associated with cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is a fat depot between the pericardium and myocardium and has been associated with coronary atherosclerosis. The relationship
[...] Read more.
Background: Intima-media thickness (IMT) has been proposed as a measurement of subclinical atherosclerosis and has been associated with cardiovascular disease (CVD). Epicardial adipose tissue (EAT) is a fat depot between the pericardium and myocardium and has been associated with coronary atherosclerosis. The relationship between IMT and EAT thickness has not been reported before. We investigated the relationship between EAT thickness, IMT, CVD risk factors, and ideal cardiovascular health (CVH) metrics using subjects from the Kardiovize Brno 2030 cohort study, a random urban sample population in Central Europe. Methods: We studied 102 individuals (65 males) aged 25–64 years (median = 37 years) with no current or past CVD history. We measured IMT using a vascular ultrasound and EAT thickness using transthoracic echocardiography, and collected data on anthropometric factors, CVD risk factors, and CVH score. Correlation tests and multiple linear regression models were applied. Results: In the age- and gender-adjusted model, we demonstrated that, among CVD risk factors, only BMI was significantly and positively associated with EAT thickness (β = 0.182, SE = 0.082, p = 0.030), while no significant associations with IMT were evident. Although both EAT thickness and IMT were negatively correlated with CVH score (r = −0.45, p < 0.001, and r = −0.38, p < 0.001, respectively), we demonstrated that overall CVH score (β = −0.262; SE = 0.077; p = 0.001), as well as BMI (β = −1.305; SE = 0.194; p < 0.001) and blood pressure CVH metrics (β = −0.607; SE = 0.206; p = 0.004) were significantly associated with EAT thickness but not with IMT. Conclusions: Our study is important as it demonstrated for the first time that CVH is associated with EAT thickness. Interestingly, this relationship seems to be dependent on BMI and blood pressure rather than on the other CVH metrics. However, outcome-driven studies are required to confirm these findings. Full article
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Open AccessArticle Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness
J. Clin. Med. 2018, 7(5), 112; https://doi.org/10.3390/jcm7050112
Received: 14 April 2018 / Revised: 6 May 2018 / Accepted: 8 May 2018 / Published: 10 May 2018
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Abstract
Background: Psychosomatic patients often complain of a variety of somatic symptoms. We sought to clarify the role of clinical predictors of complaints of somatic symptoms. Methods: We enrolled 604 patients visiting a psychosomatic outpatient clinic. The outcome was the total number of somatic
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Background: Psychosomatic patients often complain of a variety of somatic symptoms. We sought to clarify the role of clinical predictors of complaints of somatic symptoms. Methods: We enrolled 604 patients visiting a psychosomatic outpatient clinic. The outcome was the total number of somatic symptoms, and the candidate clinical predictors were perceived psychosocial stress, alexithymia, somatosensory amplification, adaptation, anxiety, and depression. All participants completed questionnaires assessing the outcome and the predictors. Results: The average number of reported somatic symptoms was 4.8; the most frequent was fatigue (75.3%), followed by insomnia (56.1%), low-back pain (49.5%), headache (44.7%), and palpitations (43.1%). Multiple regression analysis showed that the total number of somatic symptoms was significantly associated with the degree of perceived psychosocial stress, alexithymia, somatosensory amplification, and depression. Also, structural equation models indicated links between excessive adaptation (via perceived psychosocial stress, alexithymia, and somatosensory amplification) and the total number of somatic symptoms. Conclusion: The results suggested that the association between psychosocial stress and reported somatic symptoms is mediated by alexithymia and somatosensory amplification in psychosomatic patients. Full article
(This article belongs to the Special Issue Psychosomatic Medicine)
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Open AccessArticle Practice Trends of Fibrinogen Monitoring in Thrombolysis
J. Clin. Med. 2018, 7(5), 111; https://doi.org/10.3390/jcm7050111
Received: 29 March 2018 / Revised: 30 April 2018 / Accepted: 8 May 2018 / Published: 10 May 2018
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Abstract
There is a lack of evidence or societal guidelines regarding the utility of fibrinogen monitoring during thrombolysis. The purpose of our study was to investigate the current use of monitoring fibrinogen levels during thrombolysis. A voluntary, anonymous online survey was sent to all
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There is a lack of evidence or societal guidelines regarding the utility of fibrinogen monitoring during thrombolysis. The purpose of our study was to investigate the current use of monitoring fibrinogen levels during thrombolysis. A voluntary, anonymous online survey was sent to all physician members of the Society of Interventional Radiology, consisting of 23 questions related to practitioner demographics, thrombolysis protocol, and fibrinogen monitoring. There were 455 physician responses; 82% of respondents monitored fibrinogen levels during thrombolysis, of which 97% decreased or stopped tissue plasminogen activator based on the level. Self-reported estimates of significant bleeding events during thrombolysis were 1.86% in those who monitored fibrinogen and 1.93% in those who did not. Only 34% of all respondents report, in their clinical experience, having found low fibrinogen level to be correlated with bleeding events. There was no significant difference in self-reported major bleeding rates between practitioners who monitor and those who do not monitor fibrinogen. This high variability of clinical use of fibrinogen monitoring during catheter-directed thrombolysis is secondary to the paucity of scientific studies demonstrating its utility; further scientific investigation is needed to define the true utility of fibrinogen monitoring. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Factors Affecting Pregnancy Rate Following Fallopian Tube Recanalization in Women with Proximal Fallopian Tube Obstruction
J. Clin. Med. 2018, 7(5), 110; https://doi.org/10.3390/jcm7050110
Received: 19 April 2018 / Revised: 8 May 2018 / Accepted: 9 May 2018 / Published: 10 May 2018
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Abstract
Fallopian tube obstruction is a major cause of female infertility. We aimed to evaluate the factors potentially affecting pregnancy rate following fallopian tube recanalization (FTR) in infertile women with proximal fallopian tube obstruction. Data was retrospectively collected for 61 women (25, primary infertility;
[...] Read more.
Fallopian tube obstruction is a major cause of female infertility. We aimed to evaluate the factors potentially affecting pregnancy rate following fallopian tube recanalization (FTR) in infertile women with proximal fallopian tube obstruction. Data was retrospectively collected for 61 women (25, primary infertility; 36, secondary infertility) who underwent FTR at our institution. Bivariable and multivariable analyses of clinical pregnancy rates in relation to the following factors were performed: primary vs. secondary infertility, duration of infertility, age at the time of FTR, unilateral vs. bilateral obstruction, and previous pelvic interventions. All women who underwent fluoroscopically guided transcervical FTR of one or both proximally obstructed tubes were successfully recanalized (technical success rate, 100%). Within a year after FTR, 41% of women had conceived. None of the studied variables was significantly associated with pregnancy rate on bivariable analysis. Nevertheless, on multivariable analysis, the type and duration of infertility were significantly associated with pregnancy among women aged <35 years at the time of FTR. Our findings regarding pregnancy rates following FTR reflect the diversity of the patient population and suggest the presence of multiple contributing factors. Younger women with secondary infertility for <5 years are highly likely to achieve conception following FTR. Full article
Open AccessReview The Use of Transarterial Approaches in Peripheral Arteriovenous Malformations (AVMs)
J. Clin. Med. 2018, 7(5), 109; https://doi.org/10.3390/jcm7050109
Received: 31 March 2018 / Revised: 1 May 2018 / Accepted: 7 May 2018 / Published: 9 May 2018
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Abstract
Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various
[...] Read more.
Arteriovenous malformations (AVMs) are a subset of congenital vascular malformations (CVMs). They comprise abnormal connections between arterial and venous circulation; treatment approaches are dependent on the angioarchitecture of the AVM, specifically the number and arrangement of the feeder arteries and outflow veins. Various imaging modalities can be used to diagnose and plan treatment. Here we will review the use of transarterial approaches to treat AVMs. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Preschoolers’ Technology-Assessed Physical Activity and Cognitive Function: A Cross-Sectional Study
J. Clin. Med. 2018, 7(5), 108; https://doi.org/10.3390/jcm7050108
Received: 19 April 2018 / Revised: 4 May 2018 / Accepted: 7 May 2018 / Published: 8 May 2018
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Abstract
Early childhood is a critical period for development of cognitive function, but research on the association between physical activity and cognitive function in preschool children is limited and inconclusive. This study aimed to examine the association between technology-assessed physical activity and cognitive function
[...] Read more.
Early childhood is a critical period for development of cognitive function, but research on the association between physical activity and cognitive function in preschool children is limited and inconclusive. This study aimed to examine the association between technology-assessed physical activity and cognitive function in preschool children. A cross-sectional analysis of baseline data from the Physical Activity and Cognitive Development Study was conducted in Shanghai, China. Physical activity was measured with accelerometers for 7 consecutive days, and cognitive functions were assessed using the Chinese version of Wechsler Young Children Scale of Intelligence (C-WYCSI). Linear regression analyses were used to assess the association between physical activity and cognitive function. A total of 260 preschool children (boys, 144; girls, 116; mean age: 57.2 ± 5.4 months) were included in analyses for this study. After adjusting for confounding factors, we found that Verbal Intelligence Quotient, Performance Intelligence Quotient, and Full Intelligence Quotient were significantly correlated with light physical activity, not moderate to vigorous physical activity, in boys. Standardized coefficients were 0.211, 0.218, and 0.242 (all p < 0.05) in three different models, respectively. However, the correlation between physical activity and cognitive functions were not significant in girls (p > 0.05). These findings suggest that cognitive function is apparently associated with light physical activity in boys. Further studies are required to clarify the sex-specific effect on physical activity and cognitive functions. Full article
Open AccessArticle Degree of Left Renal Vein Compression Predicts Nutcracker Syndrome
J. Clin. Med. 2018, 7(5), 107; https://doi.org/10.3390/jcm7050107
Received: 31 March 2018 / Revised: 2 May 2018 / Accepted: 3 May 2018 / Published: 8 May 2018
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Abstract
Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment.
[...] Read more.
Nutcracker syndrome (NS) refers to symptomatic compression of the left renal vein (LRV) between the abdominal aorta and superior mesenteric artery with potential symptoms including hematuria, proteinuria, left flank pain, and renal venous hypertension. No consensus diagnostic criteria exist to guide endovascular treatment. We aimed to evaluate the specificity of LRV compression to NS symptoms through a retrospective study including 33 NS and 103 control patients. The size of the patent lumen at point of compression and normal portions of the LRV were measured for all patients. Multiple logistic regression analyses (MLR) assessing impact of compression, body mass index (BMI), age, and gender on the likelihood of each symptom with NS were obtained. NS patients presented most commonly with abdominal pain (72.7%), followed by hematuria (57.6%), proteinuria (39.4%), and left flank pain (30.3%). These symptoms were more commonly seen than in the control group at 10.6, 11.7, 6.8, and 1.9%, respectively. The degree of LRV compression for NS was 74.5% and 25.2% for controls (p < 0.0001). Higher compression led to more hematuria (p < 0.0013), abdominal pain (p < 0.006), and more proteinuria (p < 0.002). Furthermore, the average BMI of NS patients was 21.4 and 27.2 for controls (p < 0.001) and a low BMI led to more abdominal pain (p < 0.005). These results demonstrate a strong correlation between the degree of LRV compression on imaging in diagnosing NS. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Influence of the Self-Perception of Old Age on the Effect of a Healthy Aging Program
J. Clin. Med. 2018, 7(5), 106; https://doi.org/10.3390/jcm7050106
Received: 27 March 2018 / Revised: 29 April 2018 / Accepted: 2 May 2018 / Published: 7 May 2018
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Abstract
It has been shown that health programs are useful for the prevention and control of chronic diseases in community-dwelling older people; however, a negative self-perception of old age could have an effect on the results. Therefore, our aim was to evaluate the effect
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It has been shown that health programs are useful for the prevention and control of chronic diseases in community-dwelling older people; however, a negative self-perception of old age could have an effect on the results. Therefore, our aim was to evaluate the effect of a healthy aging program linked to self-perception of old age in Mexican community-dwelling older people. A pre-test/post-test single-group design study was conducted in a convenience sample of 64 older people who undertook the entire healthy aging program workshop (five months’ duration). We measured self-perception of old age, efficacy of self-care, blood glucose concentration, anthropometric measures, and blood pressure before and after the workshop. A statistically significant decrease in blood glucose concentration was observed (baseline 136 ± 50 vs. post-intervention, 124 ± 45 ± 29 mg/dL, p < 0.01), LDL (baseline 153 ± 47 vs. post-intervention, 130 ± 36 mg/dL, p < 0.01), systolic blood pressure (130 ± 20 vs. 119 ± 11 mm/Hg, p < 0.001), and diastolic blood pressure (75 ± 9 vs. 72 ± 7 mm/Hg, p < 0.05) after community intervention. However, when we analyzed the data regarding self-perception, we found that this difference was only maintained in the subgroup of older adults with a positive self-perception of old age. Our findings suggest that the self-perception of old age influences the effect of healthy aging programs on the health of community-dwelling older people. Full article
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Open AccessArticle The Frequency of MEFV Gene Mutations and Genotypes in Sanliurfa Province, South-Eastern Region of Turkey, after the Syrian Civil War by Using Next Generation Sequencing and Report of a Novel Exon 4 Mutation (I423T)
J. Clin. Med. 2018, 7(5), 105; https://doi.org/10.3390/jcm7050105
Received: 17 April 2018 / Revised: 30 April 2018 / Accepted: 4 May 2018 / Published: 7 May 2018
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Abstract
Background: Familial Mediterranean Fever (FMF) is a genetic disorder characterized by recurrent episodes of fever and abdominal pain. Mutations in the Mediterranean fever (MEFV) gene are localized on the p arm of chromosome 16. Over 333 MEFV sequence variants have been identified so
[...] Read more.
Background: Familial Mediterranean Fever (FMF) is a genetic disorder characterized by recurrent episodes of fever and abdominal pain. Mutations in the Mediterranean fever (MEFV) gene are localized on the p arm of chromosome 16. Over 333 MEFV sequence variants have been identified so far in FMF patients, which occur mostly in the 2nd and 10th exons of the gene. Methods: In this study, 296 unrelated patients with clinical suspicion of FMF, which were admitted during January–December 2017, were retrospectively reviewed to identify the frequency of MEFV gene mutations by using next generation sequencing. Results: Eighteen different mutations, 45 different genotypes and a novel exon 4 (I423T) mutation were identified in this study. This mutation is the fourth mutation identified in exon 4.The most frequent mutation was R202Q, followed by M694V, E148Q, M680I, R761H, V726A and R354W. Conclusions: One of the most important aims of this study is to investigate the MEFV mutation type and genotype of migrants coming to Sanliurfa after the civil war of Syria. This study also examines the effect of the condition on the region’s gene pool and the distribution of different types of mutations. Our results indicated that MEFV mutations are highly heterogeneous in our patient population, which is consistent with the findings of other studies in our region. Previously used methods, such as Restriction Fragment Length Polymorphism (RFLP), do not define uncommon or especially novel mutations. Therefore, Next Generation Sequencing (NGS) analysis of the MEFV gene could be useful for finding novel mutations, except for those located on exon 2 and 10. Full article
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Open AccessArticle Evaluation of the Effect of Oral Pyridostigmine on the Ileus after Abdominal Surgery: A Blinded Randomized Clinical Trial
J. Clin. Med. 2018, 7(5), 104; https://doi.org/10.3390/jcm7050104
Received: 17 April 2018 / Revised: 29 April 2018 / Accepted: 4 May 2018 / Published: 6 May 2018
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Abstract
Postoperative ileus is one of the most important and common complications after abdominal surgery. This single-blind randomized clinical trial study was conducted with the aim of evaluating the effect of oral pyridostigmine (60 mg) on the duration and frequency of response to the
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Postoperative ileus is one of the most important and common complications after abdominal surgery. This single-blind randomized clinical trial study was conducted with the aim of evaluating the effect of oral pyridostigmine (60 mg) on the duration and frequency of response to the treatment of ileus after abdominal surgery on 40 patients in two 20-subject groups of oral pyridostigmine (interventional) and starch (control) in 2015. All 40 people completed the study process and entered the final analysis. In the oral Pyridostigmin group (60 mg) the mean response time for the disposal of gas and stool were 5.4 ± 4.7 h and 4.9 ± 3.4 h, respectively. Most of the participants 10 (50%) (Disposal of stool) responded to treatment 4 h after the administration of oral pyridostigmine. In the starch group, the mean response time for the disposal of gas and stool were 32.4 ± 9.9 h and 36.2 ± 10.3 h, respectively. The mean treatment response time in two groups showed a significant difference between both groups (p = 0.001). Regarding the frequency of response to treatment (disposal of gas or stool) in the 24-h period after the initiation of treatment in the oral pyridostigmine group, 95% (n = 19) of the subjects responded to the treatment in the first 24 h. However, in the starch group, only 50% (n = 10) responded to treatment in the first 24 h, the results showed a significant difference between the two groups (p = 0.001). The results indicate that oral pyridostigmine can be used as a simple and effective treatment for gastrointestinal ileus. Full article
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Open AccessArticle The Gender Impact on Morphogenetic Variability in Coronary Artery Disease: A Preliminary Study
J. Clin. Med. 2018, 7(5), 103; https://doi.org/10.3390/jcm7050103
Received: 16 April 2018 / Revised: 27 April 2018 / Accepted: 30 April 2018 / Published: 3 May 2018
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Abstract
We analyzed morphogenetic variability and degree of genetic homozygosity in male and female individuals with coronary artery disease (CAD) versus unaffected controls. We have tested 235 CAD patients; 109 were diagnosed also with diabetes mellitus (DM) and 126 with hypertension (HTN). We additionally
[...] Read more.
We analyzed morphogenetic variability and degree of genetic homozygosity in male and female individuals with coronary artery disease (CAD) versus unaffected controls. We have tested 235 CAD patients; 109 were diagnosed also with diabetes mellitus (DM) and 126 with hypertension (HTN). We additionally evaluated 152 healthy individuals without manifested CAD. For the evaluation of the degree of recessive homozygosity, we have performed the homozygously recessive characteristics (HRC) test and tested 19 HRCs. In controls, the frequency of HRC for males was 2.88 ± 1.89, while for females, it was 3.65 ± 1.60. In the CAD group, the frequency of HRC for males was 4.21 ± 1.47, while for females, it was 4.73 ± 1.60. There is significant difference in HRC frequencies between controls and CAD separately for males (p < 0.001) and females (p < 0.001). The same applies between controls and CAD with DM (males: p < 0.001 and females: p = 0.004), and controls and CAD with HTN (males: p < 0.001 and females: p < 0.001). There is no significant difference in HRC frequencies between the group of CAD with DM and the group of CAD with HTN (males: p = 0.952 and females: p = 0.529). Our findings point to the increased degree of recessive homozygosity and decreased variability in both genders of CAD patients versus controls, indicating the potential genetic predisposition for CAD. Full article
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Open AccessFeature PaperReview The Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities
J. Clin. Med. 2018, 7(5), 102; https://doi.org/10.3390/jcm7050102
Received: 29 March 2018 / Revised: 25 April 2018 / Accepted: 30 April 2018 / Published: 3 May 2018
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Abstract
Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have
[...] Read more.
Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described. Full article
(This article belongs to the Special Issue Diagnosis and Treatment for Autism Spectrum Disorders)
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Open AccessReview Gastrodoudenal Embolization: Indications, Technical Pearls, and Outcomes
J. Clin. Med. 2018, 7(5), 101; https://doi.org/10.3390/jcm7050101
Received: 1 April 2018 / Revised: 25 April 2018 / Accepted: 27 April 2018 / Published: 2 May 2018
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Abstract
The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will
[...] Read more.
The gastroduodenal artery (GDA) is frequently embolized in cases of upper GI bleed that has failed endoscopic therapy. Additionally, it may be done for GDA pseudoaneurysms or as an adjunctive procedure prior to Yttrim-90 (Y90) treatment of hepatic tumors. This clinical review will summarize anatomy and embryology of the GDA, indications, outcomes and complications of GDA embolization. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Reliability of Using Motion Sensors to Measure Children’s Physical Activity Levels in Exergaming
J. Clin. Med. 2018, 7(5), 100; https://doi.org/10.3390/jcm7050100
Received: 2 April 2018 / Revised: 27 April 2018 / Accepted: 30 April 2018 / Published: 2 May 2018
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Abstract
Objectives: This study examined the reliability of two objective measurement tools in assessing children’s physical activity (PA) levels in an exergaming setting. Methods: A total of 377 children (190 girls, Mage = 8.39, SD = 1.55) attended the 30-min exergaming class every
[...] Read more.
Objectives: This study examined the reliability of two objective measurement tools in assessing children’s physical activity (PA) levels in an exergaming setting. Methods: A total of 377 children (190 girls, Mage = 8.39, SD = 1.55) attended the 30-min exergaming class every other day for 18 weeks. Children’s PA levels were concurrently measured by NL-1000 pedometer and ActiGraph GT3X accelerometer, while children’s steps per min and time engaged in sedentary, light, and moderate-to-vigorous PA were estimated, respectively. Results: The results of intraclass correlation coefficient (ICC) indicated a low degree of reliability (single measures ICC = 0.03) in accelerometers. ANOVA did detect a possible learning effect for 27 classes (p < 0.01), and the single measures ICC was 0.20 for pedometers. Moreover, there was no significant positive relationship between steps per min and time spent in moderate-to-vigorous physical activity (MVPA). Finally, only 1.3% variance was explained by pedometer as a predictor using Hierarchical Linear Modeling to further explore the relationship between pedometer and accelerometer data. Conclusions: The NL-1000 pedometers and ActiGraph GT3X accelerometers have low reliability in assessing elementary school children’s PA levels during exergaming. More research is warranted in determining the reliable and accurate measurement information regarding the use of modern devices in exergaming setting. Full article
Open AccessArticle Lower Limb Function in Elderly Korean Adults Is Related to Cognitive Function
J. Clin. Med. 2018, 7(5), 99; https://doi.org/10.3390/jcm7050099
Received: 6 April 2018 / Revised: 23 April 2018 / Accepted: 26 April 2018 / Published: 1 May 2018
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Abstract
Patients with cognitive impairment have decreased lower limb function. Therefore, we aimed to investigate the relationship between lower limb function and cognitive disorders to determine whether lower limb function can be screened to identify cognitive decline. Using Korean National Health Insurance Service-National Sample
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Patients with cognitive impairment have decreased lower limb function. Therefore, we aimed to investigate the relationship between lower limb function and cognitive disorders to determine whether lower limb function can be screened to identify cognitive decline. Using Korean National Health Insurance Service-National Sample Cohort database data, we assessed the cognitive and lower limb functioning of 66-year-olds who underwent national health screening between 2010 and 2014. Cognitive function was assessed via a questionnaire. Timed Up-and-Go (TUG) and one-leg-standing (OLS) tests were performed to evaluate lower limb function. Associations between cognitive and lower limb functions were analyzed, and optimal cut-off points for these tests to screen for cognitive decline, were determined. Cognitive function was significantly correlated with TUG interval (r = 0.414, p < 0.001) and OLS duration (r = −0.237, p < 0.001). Optimal cut-off points for screening cognitive disorders were >11 s and ≤12 s for TUG interval and OLS duration, respectively. Among 66-year-olds who underwent national health screening, a significant correlation between lower limb and cognitive function was demonstrated. The TUG and OLS tests are useful screening tools for cognitive disorders in elderly patients. A large-scale prospective cohort study should be conducted to investigate the causal relationship between cognitive and lower limb function. Full article
(This article belongs to the Special Issue Mild Cognitive Impairment)
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Open AccessReview MicroRNAs in Smoking-Related Carcinogenesis: Biomarkers, Functions, and Therapy
J. Clin. Med. 2018, 7(5), 98; https://doi.org/10.3390/jcm7050098
Received: 5 April 2018 / Revised: 21 April 2018 / Accepted: 25 April 2018 / Published: 1 May 2018
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Abstract
Long-term heavy cigarette smoking is a well-known high-risk factor for carcinogenesis in various organs such as the head and neck, lungs, and urinary bladder. Furthermore, cigarette smoking can systemically accelerate aging, and as the result, promoting carcinogenesis via changing the host microenvironment. Various
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Long-term heavy cigarette smoking is a well-known high-risk factor for carcinogenesis in various organs such as the head and neck, lungs, and urinary bladder. Furthermore, cigarette smoking can systemically accelerate aging, and as the result, promoting carcinogenesis via changing the host microenvironment. Various inflammatory factors, hormones, and chemical mediators induced by smoking mediate carcinoma-related molecules and induce carcinogenesis. MicroRNAs (miRNAs) are a family of short noncoding RNA molecules that bind to mRNAs and inhibit their expression. Cigarette smoke induces the expression of various miRNAs, many of which are known to function in the post-transcriptional silencing of anticancer molecules, thereby leading to smoking-induced carcinogenesis. Analysis of expression profiles of smoking-induced miRNAs can help identify biomarkers for the diagnosis and prognosis of smoking-related cancers and prediction of therapeutic responses, as well as revealing promising therapeutic targets. Here, we introduce the most recent and useful findings of miRNA analyses focused on lung cancer and urinary bladder cancer, which are strongly associated with cigarette smoking, and discuss the utility of miRNAs as clinical biomarkers. Full article
(This article belongs to the Special Issue MicroRNA biomarkers in Aging Society)
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Open AccessArticle Long-Term Statin Administration Does Not Affect Warfarin Time in Therapeutic Range in Australia or Singapore
J. Clin. Med. 2018, 7(5), 97; https://doi.org/10.3390/jcm7050097
Received: 19 April 2018 / Revised: 24 April 2018 / Accepted: 26 April 2018 / Published: 1 May 2018
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Abstract
Background: Warfarin requires ongoing monitoring of the International Normalised Ratio (INR). This is because numerous factors influence the response, including drug interactions with commonly-prescribed medications, such as statins. The administration of statins with warfarin may change INR; however, there is limited information regarding
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Background: Warfarin requires ongoing monitoring of the International Normalised Ratio (INR). This is because numerous factors influence the response, including drug interactions with commonly-prescribed medications, such as statins. The administration of statins with warfarin may change INR; however, there is limited information regarding the effects on warfarin control as measured by time in therapeutic range (TTR). Statins may also alter bleeds with warfarin, but there are conflicting reports demonstrating both increased and decreased bleeds, and limited data on diverse ethnic populations. Therefore, the aim of this study was to determine the effect of statin administration on warfarin control and bleeds in patients in Australia and Singapore. Methods: Retrospective data were collected for patients on warfarin between January and June 2014 in Australia and Singapore. Patient data were used to calculate TTR and bleed events. Concurrent statin therapy was assessed and comparisons of TTR and bleed incidence were made across patient subgroups. Results: Warfarin control in Australia and Singapore was not significantly affected by statins, as measured by TTR (83% and 58%, respectively), frequency of testing, and warfarin doses. In Australia, statin use did not significantly affect bleeds, whilst in Singapore the bleed incidence was significantly lower for patients on statins. Conclusions: Chronic concurrent administration of statins with warfarin does not adversely affect warfarin TTR in Australia or Singapore. In Singapore, patients on statins, compared to no statins, had a lower bleed incidence and this requires further investigation, especially given the potential genetic influences of ethnicity on both statin and warfarin metabolism. Full article
(This article belongs to the Special Issue Pharmacoepidemiology)
Open AccessArticle Body Mass, Total Body Fat Percentage, and Visceral Fat Level Predict Insulin Resistance Better Than Waist Circumference and Body Mass Index in Healthy Young Male Adults in Indonesia
J. Clin. Med. 2018, 7(5), 96; https://doi.org/10.3390/jcm7050096
Received: 13 April 2018 / Revised: 17 April 2018 / Accepted: 20 April 2018 / Published: 1 May 2018
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Abstract
The incidence of obesity which leads to insulin resistance (IR) and metabolic disorder is increasing in developing countries, including Indonesia. Male adults have a higher risk of abdominal obesity than females. This is associated with cardiometabolic disorders. Several anthropometric measurements have been proposed
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The incidence of obesity which leads to insulin resistance (IR) and metabolic disorder is increasing in developing countries, including Indonesia. Male adults have a higher risk of abdominal obesity than females. This is associated with cardiometabolic disorders. Several anthropometric measurements have been proposed to predict IR. The aim of this study was to investigate whether body mass, body mass index (BMI), waist circumference (WC), body fat percentage (BF) or visceral fat level (VF) could become a better predictor of IR in healthy young male adults. A total of 140 healthy young male adults ranging from 18–25 years were recruited in the study. Insulin resistance was measured by calculating their Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Subjects with a HOMA-IR value ≥75th percentile, with cut off 3.75, were defined as IR. Anthropometric measurements including body weight, BMI, and WC were performed, whereas BF and VC were measured using bioelectrical impedance analysis (BIA). IR had a strong correlation with body weight, BMI, WC, BF, and VF. In the area under the curve of body mass, BF and VF were slightly greater than WC and BMI. Anthropometric measurements correlated strongly with IR but body weight, BF, VF had a stronger correlation than WC and BMI in healthy young male adults. Full article
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Open AccessArticle Multimodal Assessment of Recurrent mTBI across the Lifespan
J. Clin. Med. 2018, 7(5), 95; https://doi.org/10.3390/jcm7050095
Received: 29 March 2018 / Revised: 18 April 2018 / Accepted: 22 April 2018 / Published: 1 May 2018
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Abstract
Recurrent mild traumatic brain injuries (mTBI) and its neurological sequelae have been the focus of a large number of studies, indicating cognitive, structural, and functional brain alterations. However, studies often focused on single outcome measures in small cohorts of specific populations only. We
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Recurrent mild traumatic brain injuries (mTBI) and its neurological sequelae have been the focus of a large number of studies, indicating cognitive, structural, and functional brain alterations. However, studies often focused on single outcome measures in small cohorts of specific populations only. We conducted a multimodal evaluation of the impact of recurrent mTBI on a broad range of cognitive functions, regional brain volume, white matter integrity, and resting state functional connectivity (RSFC) in young and older adults in the chronic stage (>6 months after the last mTBI). Seventeen young participants with mTBI (age: 24.2 ± 2.8 (mean ± SD)) and 21 group-wise matched healthy controls (age: 25.8 ± 5.4 (mean ± SD)), as well as 17 older participants with mTBI (age: 62.7 ± 7.7 (mean ± SD)) and 16 group-wise matched healthy controls (age: 61.7 ± 5.9 (mean ± SD)) were evaluated. We found significant differences in the verbal fluency between young participants with mTBI and young healthy controls. Furthermore, differences in the regional volume of precuneus and medial orbitofrontal gyrus between participants with mTBI and controls for both age groups were seen. A significant age by group interaction for the right hippocampal volume was noted, indicating an accelerated hippocampal volume loss in older participants with mTBI. Other cognitive parameters, white matter integrity, and RSFC showed no significant differences. We confirmed some of the previously reported detrimental effects of recurrent mTBI, but also demonstrated inconspicuous findings for the majority of parameters. Full article
(This article belongs to the Special Issue Novel Strategies for the Chronic Traumatic Encephalopathy)
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Open AccessReview Bleeding after Percutaneous Transhepatic Biliary Drainage: Incidence, Causes and Treatments
J. Clin. Med. 2018, 7(5), 94; https://doi.org/10.3390/jcm7050094
Received: 30 March 2018 / Revised: 19 April 2018 / Accepted: 23 April 2018 / Published: 1 May 2018
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Abstract
Of all procedures in interventional radiology, percutaneous transhepatic biliary drainage (PTBD) is amongst the most technically challenging. Successful placement requires a high level of assorted skills. While this procedure can be life-saving, it can also lead to significant iatrogenic harm, often manifesting as
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Of all procedures in interventional radiology, percutaneous transhepatic biliary drainage (PTBD) is amongst the most technically challenging. Successful placement requires a high level of assorted skills. While this procedure can be life-saving, it can also lead to significant iatrogenic harm, often manifesting as bleeding. Readers of this article will come to understand the pathophysiology and anatomy underlying post-PTBD bleeding, its incidence, its varied clinical manifestations and its initial management. Additionally, a structured approach to its treatment emphasizing endovascular and percutaneous methods is given. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Maternal Educational Attainment at Birth Promotes Future Self-Rated Health of White but Not Black Youth: A 15-Year Cohort of a National Sample
J. Clin. Med. 2018, 7(5), 93; https://doi.org/10.3390/jcm7050093
Received: 8 April 2018 / Revised: 25 April 2018 / Accepted: 26 April 2018 / Published: 1 May 2018
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Abstract
Background: Socioeconomic status (SES) is essential for maintaining health, and self-rated health (SRH) is not an exception to this rule. This study explored racial differences in the protective effects of maternal educational attainment at birth against poor SRH of the youth 15 years
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Background: Socioeconomic status (SES) is essential for maintaining health, and self-rated health (SRH) is not an exception to this rule. This study explored racial differences in the protective effects of maternal educational attainment at birth against poor SRH of the youth 15 years later. Methods: Using data from the Fragile Families and Child Wellbeing Study (FFCWS), this 15-year longitudinal study followed 1934 youths from birth to age 15. This sample was composed of White (n = 497, 25.7%), and Black (n = 1437, 74.3%) youths. The independent variable was maternal educational attainment at birth. SRH at age 15 was the dependent variable. Family structure was the covariate. Race was the focal moderator. We ran logistic regression models in the pooled sample, as well as stratified models based on race. Results: In the pooled sample, maternal educational attainment and family structure were not predictive of SRH for the youths at age 15. Race interacted with maternal educational attainment, indicating a stronger association between maternal educational attainment at birth on youth SRH for Whites compared to Blacks. In race stratified models, maternal educational attainment at birth was protective against poor SRH for White but not Black youths. Conclusion: White but not Black youths gain less SRH from their maternal educational attainment. Enhancing education attainment may not have identical effects across racial groups. The health status of Blacks may be less responsive to improvements in maternal educational attainment. Policies should go beyond investing in educational attainment by empowering Black families to better use the educational attainment that they gain. Policies and programs should reduce the costs of upward social mobility for minority families. Full article
Open AccessFeature PaperReview Endovascular Interventions for the Morbidly Adherent Placenta
J. Clin. Med. 2018, 7(5), 92; https://doi.org/10.3390/jcm7050092
Received: 31 March 2018 / Revised: 20 April 2018 / Accepted: 23 April 2018 / Published: 1 May 2018
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Abstract
Morbidly adherent placentas are a spectrum of abnormalities ranging from placental invasion of the myometrium to invasion past the myometrium and muscular layers into adjacent structures. This entity is becoming more prevalent recently with increased number of cesarean deliveries. Given the high risk
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Morbidly adherent placentas are a spectrum of abnormalities ranging from placental invasion of the myometrium to invasion past the myometrium and muscular layers into adjacent structures. This entity is becoming more prevalent recently with increased number of cesarean deliveries. Given the high risk of morbidity and mortality, this was traditionally treated with pre-term planned cesarean hysterectomy. However, recently, uterine preservation techniques have been implemented for those women wishing to preserve future fertility or their uterus. Early identification is crucial as studies have shown better outcomes for women treated at tertiary care facilities by a dedicated multidisciplinary team. Interventional radiologists are frequently included in the care of these patients as there are several different endovascular techniques which can be implemented to decrease morbidity in these patients both in conjunction with cesarean hysterectomy and in the setting of uterine preservation. This article will review the spectrum of morbidly adherent placentas, imaging, as well as the surgical and endovascular interventions implemented in the care of these complex patients. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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Open AccessArticle Diagnostic Accuracy of a 64-Slice Multi-Detector CT Scan in the Preoperative Evaluation of Periampullary Neoplasms
J. Clin. Med. 2018, 7(5), 91; https://doi.org/10.3390/jcm7050091
Received: 4 April 2018 / Revised: 21 April 2018 / Accepted: 23 April 2018 / Published: 27 April 2018
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Abstract
Periampullary tumors are highly malignant masses with poor prognosis. Surgical resection is the only treatment for patients with this disease. The preoperative evaluation of masses is essential to determine the tumor resectability and vascular invasion. The aim of this study was to determine
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Periampullary tumors are highly malignant masses with poor prognosis. Surgical resection is the only treatment for patients with this disease. The preoperative evaluation of masses is essential to determine the tumor resectability and vascular invasion. The aim of this study was to determine the diagnostic accuracy of 64-slice multi-detector computed tomography (MDCT) in detecting the resectability of periampullary masses. A cross-sectional study was conducted on patients with a definite diagnosis of periampullary cancer. All the participants underwent an MDCT scan before the surgical pancreaticoduodenectomy. The preoperative results were compared to the intraoperative findings and the diagnostic accuracy was determined based on the sensitivity and specificity of the MDCT. From June 2015 until June 2016, 32 patients with periampullary carcinoma were enrolled in the study. Of 32 masses, one of them considered nonresectable because of the gross vascular invasion in th CT images. After the operation, the overall resectability rate was 81.3%. The sensitivity and specificity of MDCT for tumor resectability was 100% and 16.7%, respectively, with an overall accuracy of 84.4%. To sum up, MDCT had high sensitivity but low specificity in the preoperative evaluation of preampullary carcinomas. The low specificity resulted from the low accuracy of the CT scan in detecting vascular involvement. Full article
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Open AccessArticle Evaluation of Oral Mucositis Occurrence in Oncologic Patients under Antineoplastic Therapy Submitted to the Low-Level Laser Coadjuvant Therapy
J. Clin. Med. 2018, 7(5), 90; https://doi.org/10.3390/jcm7050090
Received: 31 March 2018 / Revised: 5 April 2018 / Accepted: 10 April 2018 / Published: 24 April 2018
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Abstract
Low-level laser therapy has been widely used in treating many conditions, including oral mucositis. The purpose of this study was to evaluate the occurrence of oral mucositis in patients undergoing antineoplastic therapy submitted to preventive and therapeutic treatment with low-level laser therapy. This
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Low-level laser therapy has been widely used in treating many conditions, including oral mucositis. The purpose of this study was to evaluate the occurrence of oral mucositis in patients undergoing antineoplastic therapy submitted to preventive and therapeutic treatment with low-level laser therapy. This cross-sectional study was carried out with 51 children and adolescents of both sexes with malignant neoplasias who developed oral mucositis and underwent low-level laser therapy. Data were collected on sex, age, type and degree of neoplasia, region affected, and remission time. 64.7% of the patients were male and were between 3 and 6 years of age (39.2%). Acute lymphoid leukemia was the most frequent neoplasm (37.3%). Regarding the maximum oral mucositis, grade 2 (41.2%) was predominant, with jugal mucosa (29.9%) and tongue (17.7%) being the most affected regions. The majority of cases presented lesion remission time between 4 and 7 days (44.0%). Most patients were young, male, and diagnosed with acute lymphoid leukemia. Predominance of grade 2 oral mucositis was observed, with jugal mucosa and tongue being the most affected regions, with the majority of cases presenting lesion remission time between 4 and 7 days. Low-level laser therapy has been shown to be an essential therapy in the prevention and treatment of these lesions, since it is a non-invasive and low-cost method. Full article
Open AccessArticle Perceived Discrimination and Binge Eating Disorder; Gender Difference in African Americans
J. Clin. Med. 2018, 7(5), 89; https://doi.org/10.3390/jcm7050089
Received: 10 March 2018 / Revised: 7 April 2018 / Accepted: 9 April 2018 / Published: 24 April 2018
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Abstract
Environmental stressors, such as perceived discrimination (PD), are linked to Binge Eating Disorder (BED). The current study investigated the association between PD and BED among African Americans, and the variation in such an association based on gender. Data of the National Survey of
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Environmental stressors, such as perceived discrimination (PD), are linked to Binge Eating Disorder (BED). The current study investigated the association between PD and BED among African Americans, and the variation in such an association based on gender. Data of the National Survey of American Life (NSAL), 2001–2003, with a nationally-representative sample of African American adults, were used (n = 3516). The independent variable in the study was PD. The dependent variable was BED, measured using the Composite International Diagnostic Interview (CIDI). Socio-demographics (age, education, employment, and marital status) were covariates, and gender was the moderator variable. Survey logistic regressions with and without gender × PD interaction terms were used for data analysis. In the pooled sample, PD was associated with higher odds of BED, net of socio-demographic factors. Models also showed a significant gender × PD interaction term suggesting a stronger association between PD and BED for women, compared to men. Gender specific models showed an association between PD and BED among female, but not male, African Americans. Although a link may exist between PD and BED among African Americans, the magnitude of this association depends on gender, with a stronger association among females than males. This finding is in line with the literature that has shown gender-specific consequences of environmental stress for African Americans. Full article
(This article belongs to the Special Issue Psychosomatic Medicine)
Open AccessReview Multi-Detector Computed Tomography Imaging Techniques in Arterial Injuries
J. Clin. Med. 2018, 7(5), 88; https://doi.org/10.3390/jcm7050088
Received: 1 April 2018 / Revised: 17 April 2018 / Accepted: 18 April 2018 / Published: 24 April 2018
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Abstract
Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various
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Cross-sectional imaging has become a critical aspect in the evaluation of arterial injuries. In particular, angiography using computed tomography (CT) is the imaging of choice. A variety of techniques and options are available when evaluating for arterial injuries. Techniques involve contrast bolus, various phases of contrast enhancement, multiplanar reconstruction, volume rendering, and maximum intensity projection. After the images are rendered, a variety of features may be seen that diagnose the injury. This article provides a general overview of the techniques, important findings, and pitfalls in cross sectional imaging of arterial imaging, particularly in relation to computed tomography. In addition, the future directions of computed tomography, including a few techniques in the process of development, is also discussed. Full article
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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