Journal Description
Journal of Clinical Medicine
Journal of Clinical Medicine
is an international, peer-reviewed, open access journal of clinical medicine, published semimonthly online by MDPI. The International Bone Research Association (IBRA), Italian Resuscitation Council (IRC), Spanish Society of Hematology and Hemotherapy (SEHH), Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) and others are all affiliated with JCM, and their members receive a discount on article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q2 (Medicine, General & Internal) / CiteScore - Q1 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.9 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2023).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Companion journals for JCM include: Epidemiologia, Transplantology, Uro, Sinusitis, Rheumato, Journal of Clinical & Translational Ophthalmology, Journal of Vascular Diseases, Osteology, Complications, and Sclerosis.
Impact Factor:
3.9 (2022);
5-Year Impact Factor:
4.1 (2022)
Latest Articles
Public Attitude towards Implementing DNAR and a Stance on Pediatric DNAR in Poland—A Prospective Survey Study
J. Clin. Med. 2024, 13(6), 1755; https://doi.org/10.3390/jcm13061755 (registering DOI) - 18 Mar 2024
Abstract
Background: Do not attempt resuscitation (DNAR) is a document signed by a patient, which states that they do not want to be resuscitated. In Poland, DNAR is not regulated by law. We aimed to assess people’s perceptions on DNAR and pediatric DNAR in
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Background: Do not attempt resuscitation (DNAR) is a document signed by a patient, which states that they do not want to be resuscitated. In Poland, DNAR is not regulated by law. We aimed to assess people’s perceptions on DNAR and pediatric DNAR in Poland. Methods: An anonymous survey was distributed via the snowball sampling method in different voivodeships in Poland in the years 2014–2018. The survey consisted of questions regarding knowledge and attitudes towards DNAR and pediatric DNAR. Results: A total of 1049 responses were collected. Moreover, 82% support introducing DNAR in Poland, but 78% believe that this is not a pressing issue. In a general question, 46% of respondents believe that DNAR should be obtainable only for adults. However, in a specific question, this number drops to 17%, with people agreeing for pediatric DNAR if it contains a boundary—23% agree if both parents agree to the solution and 45% if both parents and the child’s doctor agree to it. Conclusions: Even though someone supports DNAR, it does not mean that they support pediatric DNAR. People outside the medical community are more likely to be against DNAR. Giving a boundary in using pediatric DNAR may lead to the ease of its implementation in a legislative manner.
Full article
(This article belongs to the Section Epidemiology & Public Health)
Open AccessReview
The Efficacy and Effectiveness of the Biological Treatment of Pruritus in the Course of Atopic Dermatitis
by
Agnieszka Marta Hołdrowicz and Anna Woźniacka
J. Clin. Med. 2024, 13(6), 1754; https://doi.org/10.3390/jcm13061754 (registering DOI) - 18 Mar 2024
Abstract
Atopic dermatitis is a heterogenous inflammatory disease with high variety in terms of clinical symptoms and etiopathogenesis, occurring both in pediatric and adult populations. The clinical manifestation of atopic dermatitis varies depending on the age of patients, but all age groups share certain
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Atopic dermatitis is a heterogenous inflammatory disease with high variety in terms of clinical symptoms and etiopathogenesis, occurring both in pediatric and adult populations. The clinical manifestation of atopic dermatitis varies depending on the age of patients, but all age groups share certain common features, such as a chronic and recurrent course of disease, pruritus, and a co-occurrence of atopic diseases in personal or family medical history. Treating pruritus is a high priority due to its incidence rate in atopic dermatitis and substantial impact on quality of life. In recent years, treatments with biological drugs have increased the range of therapeutic possibilities in atopic dermatitis. The aim of the study is to present the safety profile, efficacy, and effectiveness of various biological treatment methods for the therapy of pruritus in the course of atopic dermatitis.
Full article
(This article belongs to the Section Dermatology)
Open AccessArticle
The Moderating Role of Anxiety and Depressive Symptoms in Protective Effects of Health Behaviors among Clients Using Mental Health Services
by
Yusen Zhai, Mahmood Almaawali and Xue Du
J. Clin. Med. 2024, 13(6), 1753; https://doi.org/10.3390/jcm13061753 (registering DOI) - 18 Mar 2024
Abstract
College-student clients using mental health services contend with increased anxiety and depressive symptoms, and their vulnerability to infectious respiratory diseases and severe clinical outcomes rises. To mitigate severe outcomes, health behaviors serve as essential protective tools to reduce the risk of infectious diseases,
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College-student clients using mental health services contend with increased anxiety and depressive symptoms, and their vulnerability to infectious respiratory diseases and severe clinical outcomes rises. To mitigate severe outcomes, health behaviors serve as essential protective tools to reduce the risk of infectious diseases, including COVID-19. Considering the escalating prevalence of anxiety and depression among college-student clients, little is known about how anxiety and depressive symptoms could potentially attenuate the protective effects of COVID-19 health behaviors (i.e., masking, social distancing, and hygiene practice). This study aims to examine the interactive effects of anxiety/depression and health behaviors in predicting COVID-19 infection. Methods: We analyzed data from the 2020–2021 Healthy Mind Study including a random sample of 9884 college-student clients in mental health services across 140 higher education institutions in the United States. We performed multivariable logistic regression to assess whether and to what extent the associations between COVID-19 health behaviors and infection depended on severity of anxiety or depressive symptoms. Results: Anxiety symptom severity negatively moderated the protective effects of social distancing against infection after adjusting for demographic characteristics and pre-existing chronic health conditions. Depressive symptom severity negatively moderated the protective effects of masking, social distancing, or hygiene practices against infection. Conclusion: The associations between certain COVID-19 health behaviors and infection were conditional on anxiety and depressive symptom severity. Findings suggest a potential public health benefit of mental health clinicians’ efforts in assessing and treating clients’ anxiety and depressive symptoms, namely reducing their vulnerability to COVID-19 infection and perhaps other infectious respiratory diseases.
Full article
(This article belongs to the Section Mental Health)
Open AccessArticle
A Matter of Trust: Confidentiality in Therapeutic Relationships during Psychological and Medical Treatment in Children and Adolescents with Mental Disorders
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Johanna Xenia Kafka, Oswald David Kothgassner and Anna Felnhofer
J. Clin. Med. 2024, 13(6), 1752; https://doi.org/10.3390/jcm13061752 - 18 Mar 2024
Abstract
Background: Confidentiality is a crucial ethical principle in therapy, particularly for children and adolescents, yet their perception of it remains understudied. We aimed to explore minors’ perspectives and attributions on confidentiality in psychological and medical treatment. Methods: We interviewed 11 pediatric patients aged
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Background: Confidentiality is a crucial ethical principle in therapy, particularly for children and adolescents, yet their perception of it remains understudied. We aimed to explore minors’ perspectives and attributions on confidentiality in psychological and medical treatment. Methods: We interviewed 11 pediatric patients aged 7 to 15 and used reflexive thematic analysis to analyze their responses. Results: Four main themes were extracted from the data: (1) confidentiality and uncertainty regarding what information will be shared with clinicians and parents; (2) consequences of breaching confidentiality, encompassing breaches of confidentiality in the past and their negative effects on interactions with parents and health professionals; (3) exceptions to confidentiality, including understanding the limits of confidentiality; and (4) autonomy and self-determination, reflecting the desire for involvement in medical decisions. Conclusion: Explanations about confidentiality rules and limits, especially with younger children, are crucial. This is particularly important because it is fundamental to promote children’s development and self-determination through increasing autonomy, as well as to provide a sense of security and respect through transparent rules. A single educational session on confidentiality at the outset of therapy is insufficient; ongoing conversations are needed to reinforce understanding and promote autonomy.
Full article
(This article belongs to the Section Mental Health)
Open AccessArticle
Clinical Utility of Genetic Testing with Geographical Locations in ADPKD: Describing New Variants
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Carmen García Rabaneda, María Luz Bellido Díaz, Ana Isabel Morales García, Antonio Miguel Poyatos Andújar, Juan Bravo Soto, Anita Dayaldasani Khialani, Margarita Martínez Atienza and Rafael Jose Esteban de la Rosa
J. Clin. Med. 2024, 13(6), 1751; https://doi.org/10.3390/jcm13061751 - 18 Mar 2024
Abstract
Background: Our study aims to comment on all ADPKD variants identified in our health area and explain how they are distributed geographically, to identify new variants, and relate the more frequent variants with their renal phenotype in terms of kidney survival. Materials and
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Background: Our study aims to comment on all ADPKD variants identified in our health area and explain how they are distributed geographically, to identify new variants, and relate the more frequent variants with their renal phenotype in terms of kidney survival. Materials and Methods: We identified patients suffering from ADPKD in a specialized consultation unit; genealogical trees were constructed from the proband. According to the ultrasound-defined modified Ravine–Pei criteria, relatives classified as at risk were offered participation in the genetic study. Socio-demographic, clinical, and genetic factors related to the impact of the variant on the survival of the kidney and the patient, such as age at RRT beginning and age of death, were recorded. Results: In 37 families, 33 new variants of the PKD1 gene were identified, which probably produce a truncated protein. These variants included 2 large deletions, 19 frameshifts, and 12 stop-codons, all of which had not been previously described in the databases. In 10 families, six new probably pathogenic variants in the PKD2 gene were identified. These included three substitutions; two deletions, one of which was intronic and not associated with any family; and one duplication. A total of 11 missense variants in the PKD1 gene were grouped in 14 families and classified as probably pathogenic. We found that 33 VUS were grouped into 18 families and were not described in the databases, while another 15 were without grouping, and there was only 1 in the PKD2 gene. Some of these variants were present in patients with a different pathogenic variant (described or not), and the variant was probably benign. Renal survival curves were compared to nonsense versus missense variants on the PKD1 gene to check if there were any differences. A group of 328 patients with a nonsense variant was compared with a group of 264 with a missense variant; mean renal survival for truncated variants was lower (53.1 ± 0.46 years versus non-truncated variant 59.1 ± 1.36 years; Log Rank, Breslow, and Tarone Ware, p < 0.05). Conclusions: To learn more about ADPKD, it is necessary to understand genetics. By describing new genetic variants, we are approaching creation of an accurate genetic map of the disease in our country, which could have prognostic and therapeutic implications in the future.
Full article
(This article belongs to the Section Nephrology & Urology)
Open AccessArticle
A RAND/UCLA-Modified VASStudy on Telemedicine, Telehealth, and Virtual Care in Daily Clinical Practice of Vascular Medicine
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Sergio Pillon, Georgia Gomatou, Evangelos Dimakakos, Agata Stanek, Zsolt Pecsvarady, Matija Kozak, Jean-Claude Wautrecht, Katalin Farkas, Gerit-Holger Schernthaner, Mariella Catalano, Aleš Blinc, Grigorios Gerotziafas, Pavel Poredoš, Sergio De Marchi, Michael E. Gschwandtner, Endre Kolossváry, Muriel Sprynger, Bahar Fazeli, Aaron Liew, Peter Marschang, Andrzej Szuba, Dusan Suput, Michael Edmonds, Chris Manu, Christian Alexander Schaefer, George Marakomichelakis, Majda Vrkić Kirhmajer, Jonas Spaak, Elias Kotteas, Gianfranco Lessiani, Mary Paola Colgan, Marc Righini, Michael Lichtenberg, Oliver Schlager, Caitriona Canning, Antonella Marcoccia, Anastasios Kollias and Alberta Spreaficoadd
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J. Clin. Med. 2024, 13(6), 1750; https://doi.org/10.3390/jcm13061750 - 18 Mar 2024
Abstract
Telemedicine is increasingly used in several fields of healthcare, including vascular medicine. This study aimed to investigate the views of experts and propose clinical practice recommendations on the possible applications of telemedicine in vascular medicine. Methods: A clinical guidance group proposed a set
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Telemedicine is increasingly used in several fields of healthcare, including vascular medicine. This study aimed to investigate the views of experts and propose clinical practice recommendations on the possible applications of telemedicine in vascular medicine. Methods: A clinical guidance group proposed a set of 67 clinical practice recommendations based on the synthesis of current evidence and expert opinion. The Telemedicine Vascular Medicine Working Group included 32 experts from Europe evaluating the appropriateness of each clinical practice recommendation based on published RAND/UCLA methodology in two rounds. Results: In the first round, 60.9% of clinical practice recommendations were rated as appropriate, 35.9% as uncertain, and 3.1% as inappropriate. The strongest agreement (a median value of 10) was reached on statements regarding the usefulness of telemedicine during the 2019 coronavirus disease (COVID-19) pandemic, its usefulness for geographical areas that are difficult to access, and the superiority of video calls compared to phone calls only. The lowest degree of agreement (a median value of 2) was reported on statements regarding the utility of telemedicine being limited to the COVID-19 pandemic and regarding the applicability of teleconsultation in the diagnosis and management of abdominal aortic aneurysm. In the second round, 11 statements were re-evaluated to reduce variability. Conclusions: This study highlights the levels of agreement and the points that raise concern on the use of telemedicine in vascular medicine. It emphasizes the need for further clarification on various issues, including infrastructure, logistics, and legislation.
Full article
(This article belongs to the Special Issue European Independent Foundation in Angiology/Vascular Medicine (VAS) Collection on Vascular Medicine)
Open AccessReview
Efficacy of Topical Application of a Skin Moisturizer Containing Pseudo-Ceramide and a Eucalyptus Leaf Extract on Atopic Dermatitis: A Review
by
Yutaka Takagi
J. Clin. Med. 2024, 13(6), 1749; https://doi.org/10.3390/jcm13061749 - 18 Mar 2024
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with pruritus, an impaired cutaneous barrier function and a disrupted water holding capacity. Levels of ceramides, which are major components of intercellular lipids and are crucial for their functions, are decreased in the
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Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with pruritus, an impaired cutaneous barrier function and a disrupted water holding capacity. Levels of ceramides, which are major components of intercellular lipids and are crucial for their functions, are decreased in the stratum corneum of patients with AD. Treatments to increase ceramide levels are effective for AD care. Synthetic pseudo-ceramide (cetyl PG hydroxyethyl palmitamide (SLE66)), which has a structure developed via molecular designs, and a eucalyptus leaf extract (ELE) enhance ceramide synthesis in the epidermis. The topical application of a skin moisturizer containing SLE66 and ELE improves the barrier functions and water holding capacity of AD skin accompanied by an improvement in skin symptoms. This is a multifaceted review that summarizes the efficacy of the topical application of a skin moisturizer containing SLE66 and ELE on atopic dermatitis.
Full article
(This article belongs to the Special Issue Clinical Updates on Atopic Dermatitis Treatment)
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Open AccessSystematic Review
Risk of Diabetic Ketoacidosis Associated with Sodium Glucose Cotransporter-2 Inhibitors: A Network Meta-Analysis and Meta-Regression
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Kannan Sridharan and Gowri Sivaramakrishnan
J. Clin. Med. 2024, 13(6), 1748; https://doi.org/10.3390/jcm13061748 - 18 Mar 2024
Abstract
Background: Sodium glucose cotransporter-2 inhibitors (SGLT2is) represent an emerging class of drugs with diverse indications. Despite their therapeutic potential, concerns regarding safety, particularly diabetic ketoacidosis (DKA), remain contentious, with uncertainty regarding differences among various SGLT2is. This study aimed to conduct a network meta-analysis
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Background: Sodium glucose cotransporter-2 inhibitors (SGLT2is) represent an emerging class of drugs with diverse indications. Despite their therapeutic potential, concerns regarding safety, particularly diabetic ketoacidosis (DKA), remain contentious, with uncertainty regarding differences among various SGLT2is. This study aimed to conduct a network meta-analysis and meta-regression to evaluate the risk of SGLT2i-induced DKA and associated factors. Methods: We systematically searched electronic databases for randomized clinical trials assessing SGLT2is across indications, reporting incidences of DKA. Mixed treatment comparison pooled estimates (MTCPEs) were calculated, and odds ratios (OR) with 95% confidence intervals (95% CI) served as effect estimates. We analyzed differences across dose categories (low, medium, and high) and conducted a meta-regression analysis to identify risk factors. The strength of evidence for key comparisons was determined. Results: Our analysis included 73 articles encompassing 85,997 participants assessing the risk of DKA. SGLT2is were associated with a heightened risk of DKA compared to placebo/control interventions (OR: 1.83; 95% CI: 1.35, 2.46), a finding confirmed by bootstrap analysis. Among SGLT2is, dapagliflozin (OR: 1.9; 95% CI: 1.17, 3.08), sotagliflozin (OR: 1.93; 95% CI: 1.14, 3.25), canagliflozin (OR: 1.11; 95% CI: 1.11, 12.45), and ertugliflozin (OR: 3.92; 95% CI: 1.04, 14.77) exhibited increased DKA risk. No significant differences were observed among specific SGLT2is. Sub-group analyses revealed a high risk of DKA with low (OR: 1.98; 95% CI: 1.3, 2.95) and high doses (OR: 2.4; 95% CI: 1.7, 3.3), type 1 diabetes (OR: 3.6; 95% CI: 1.6, 8.1), type 2 diabetes (OR: 1.6; 95% CI: 1.3, 2.4), as well as a diabetes duration exceeding 10 years (OR: 3.4; 95% CI: 1.1, 10.8). The evidence of certainty for most comparisons was moderate. Conclusions: SGLT2 inhibitors (SGLT2is) have been found to elevate the risk of DKA. The key factors that significantly predict the likelihood of DKA include the presence of diabetes (whether T1D or T2D) and the duration of diabetes. Based on these findings, standard treatment guidelines should advise taking specific precautions against DKA in patients identified as high-risk.
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(This article belongs to the Section Endocrinology & Metabolism)
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Open AccessSystematic Review
Efficacy and Safety of Rho Kinase Inhibitors vs. Beta-Blockers in Primary Open-Angle Glaucoma: A Systematic Review with Meta-Analysis
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Brenda Nana Wandji, Noélie Bacq and Adèle Ehongo
J. Clin. Med. 2024, 13(6), 1747; https://doi.org/10.3390/jcm13061747 - 18 Mar 2024
Abstract
Background: In order to support the positioning of Rho kinase inhibitors (Rhokis) in the European market for the treatment of glaucoma, scientific evidence comparing the efficacy and safety of Rhokis and beta-blockers (β-βs) in the treatment of open-angle glaucoma after 3 months was
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Background: In order to support the positioning of Rho kinase inhibitors (Rhokis) in the European market for the treatment of glaucoma, scientific evidence comparing the efficacy and safety of Rhokis and beta-blockers (β-βs) in the treatment of open-angle glaucoma after 3 months was assembled through a systematic review and meta-analysis (meta-A) of randomized controlled trials (RCTs). Methods: Relevant articles were searched for on PubMed, EMBASE, and the Cochrane Library. Of the 251 articles found, three met all eligibility criteria. These three articles were assessed for risk of bias. Data were extracted and a random effects meta-A was performed. The studies’ methods were homogeneous but there was great heterogeneity within the data (I2 = 92–93%; p < 0.001). Results: All studies had low risk of bias. The meta-A showed statistically better efficacy of β-βs, resulting in an intraocular pressure (IOP) reduction mean difference of 1.73 (1.19–2.27) at 8 a.m., 0.66 (0.19–1.15) at 10 a.m. and 0.49 mmHg (0.001–0.98) at 4 p.m., compared to Rhokis. This difference is not clinically significant as intra-operator variability of IOP measurements varies from ±2 to ±3 mmHg The adverse effects of Rhokis were essentially topical, whereas β-βs mainly caused systemic side effects. Conclusions: This Meta-A showed that Rhokis are clinically non-inferior to beta-blockers in reducing IOP. Rhokis have a better safety profile.
Full article
(This article belongs to the Special Issue Advances in Glaucoma Management and Intraocular Pressure Physiology)
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Open AccessReview
Mechanical Circulatory Support Systems in the Management of Ventricular Arrhythmias: A Contemporary Overview
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Marco Valerio Mariani, Nicola Pierucci, Pietro Cipollone, Walter Vignaroli, Agostino Piro, Paolo Compagnucci, Andrea Matteucci, Cristina Chimenti, Claudio Pandozi, Antonio Dello Russo, Fabio Miraldi, Carmine Dario Vizza and Carlo Lavalle
J. Clin. Med. 2024, 13(6), 1746; https://doi.org/10.3390/jcm13061746 - 18 Mar 2024
Abstract
Ventricular tachycardias (VTs) and electrical storms (ES) are life-threatening conditions mostly seen in the setting of structural heart disease (SHD). Traditional management strategies, predominantly centered around pharmacological interventions with antiarrhythmic drugs, have demonstrated limited efficacy in these cases, whereas catheter ablation is related
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Ventricular tachycardias (VTs) and electrical storms (ES) are life-threatening conditions mostly seen in the setting of structural heart disease (SHD). Traditional management strategies, predominantly centered around pharmacological interventions with antiarrhythmic drugs, have demonstrated limited efficacy in these cases, whereas catheter ablation is related with more favorable outcomes. However, patients with hemodynamically unstable, recurrent VT or ES may present cardiogenic shock (CS) that precludes the procedure, and catheter ablation in patients with SHD portends a multifactorial intrinsic risk of acute hemodynamic decompensation (AHD), that is associated with increased mortality. In this setting, the use of mechanical circulatory support (MCS) systems allow the maintenance of end-organ perfusion and cardiac output, improving coronary flow and myocardial mechanics, and minimizing the effect of cardiac stunning after multiple VT inductions or cardioversion. Although ablation success and VT recurrence are not influenced by hemodynamic support devices, MCS promotes diuresis and reduces the incidence of post-procedural kidney injury. In addition, MCS has a role in post-procedural mortality reduction at long-term follow-up. The current review aims to provide a deep overview of the rationale and modality of MCS in patients with refractory arrhythmias and/or undergoing VT catheter ablation, underlining the importance of patient selection and timing for MCS and summarizing reported clinical experiences in this field.
Full article
(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
Open AccessArticle
Comparison of Cylindrical and Tapered Stem Designs for Femoral Revision Hip Arthroplasty
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José María Hernández-Mateo, Javier Orozco-Martínez, José Antonio Matas-Díaz, Francisco Javier Vaquero and Pablo Sanz-Ruiz
J. Clin. Med. 2024, 13(6), 1745; https://doi.org/10.3390/jcm13061745 - 18 Mar 2024
Abstract
Background: Cylindrical fully-coated cobalt-chromium stems (CCS) have been widely used in femoral revisions. However, monoblock fluted conical tapered stems (FCTS) are growing in popularity. The present study seeks to determine whether there are any long-term differences between the two designs. Material and methods:
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Background: Cylindrical fully-coated cobalt-chromium stems (CCS) have been widely used in femoral revisions. However, monoblock fluted conical tapered stems (FCTS) are growing in popularity. The present study seeks to determine whether there are any long-term differences between the two designs. Material and methods: A retrospective study of 38 CCS versus 40 FCTS was carried out. Demographic data, clinical variables and radiographic parameters were recorded. Results: Demographic data were comparable. A greater proportion of septic revisions, periprosthetic fractures and previous osteosynthesis failures was observed with FCTS versus CCS (p = 0.012). A greater use of FCTS was recorded in cases with bone defects of type IIIA and higher (p = 0.025). There were no significant differences in terms of in-hospital complications (p = 0.815), postoperative surgical complications or need for reoperation (p = 0.156). The CCS group presented a higher percentage of clinical thigh pain at the end of follow-up (p = 0.006). Additionally, a greater presence of radiolucencies was observed with CCS, especially in proximal zones (1, 7, 10 and 14). More subsidence, tip cortical hypertrophy and stress shielding were recorded in the CCS group. The overall survival at 120 months was 84.2% in the CCS group and 85% in the FCTS group (p = 0.520). When analyzing isolated aseptic loosening as the cause of failure, the survival rate was 94.7% in the CCS group and 95% in the FCTS group (p = 0.506). Conclusions: Both FCTS and CCS with diaphyseal anchorage afford excellent long-term survival rates, with no differences between the two designs. However, a higher incidence of stress shielding, radiolucencies and thigh pain with CCS seems to favor the use of FCTS.
Full article
(This article belongs to the Special Issue State of the Art in Hip Replacement Surgery)
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Open AccessReview
Renal AL Amyloidosis: Updates on Diagnosis, Staging, and Management
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Areez Shafqat, Hassan Elmaleh, Ali Mushtaq, Zaina Firdous, Omer Ashruf, Debduti Mukhopadhyay, Maheen Ahmad, Mahnoor Ahmad, Shahzad Raza and Faiz Anwer
J. Clin. Med. 2024, 13(6), 1744; https://doi.org/10.3390/jcm13061744 - 18 Mar 2024
Abstract
AL amyloidosis is caused by the excessive production of nonfunctional immunoglobulins, leading to the formation of amyloid fibrils that damage vital organs, especially the heart and kidneys. AL amyloidosis presents with non-specific symptoms such as fatigue, weight loss, numbness, pain, and nephrotic syndrome.
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AL amyloidosis is caused by the excessive production of nonfunctional immunoglobulins, leading to the formation of amyloid fibrils that damage vital organs, especially the heart and kidneys. AL amyloidosis presents with non-specific symptoms such as fatigue, weight loss, numbness, pain, and nephrotic syndrome. Consequently, diagnosis is often delayed, and patients typically present with advanced disease at diagnosis. The Pavia renal staging model stratifies patients based on their likelihood of progressing to dialysis. Treatment with daratumumab plus cyclophosphamide, bortezomib, and dexamethasone (i.e., Dara-CyBorD) was effective in inducing renal response in the landmark phase III ANDROMEDA trial and reducing early mortality. However, determining the most appropriate treatment regimen for relapsed or refractory cases remains a challenge due to various patient- and disease-related factors. Encouragingly, t(11:14) may be a positive indicator of therapy responses to the anti-BCL2 therapy venetoclax. Moreover, it is increasingly possible—for the first time—to clear AL amyloid fibrils from peripheral organs by leveraging novel anti-fibril immunotherapeutic approaches, although these medications are still under investigation in clinical trials. Given these advancements, this review provides a comprehensive overview of the current strategies for diagnosing, staging, treating, and monitoring AL amyloidosis, emphasizing renal involvement.
Full article
(This article belongs to the Special Issue Clinical Management of AL Amyloidosis)
Open AccessRetraction
RETRACTED: De Vecchis et al. Vasopressin Receptor Antagonists for the Correction of Hyponatremia in Chronic Heart Failure: An Underutilized Therapeutic Option in Current Clinical Practice? J. Clin. Med. 2016, 5, 86
by
Renato De Vecchis, Claudio Cantatrione, Damiana Mazzei and Cesare Baldi
J. Clin. Med. 2024, 13(6), 1743; https://doi.org/10.3390/jcm13061743 - 18 Mar 2024
Abstract
The Journal of Clinical Medicine retracts the article “Vasopressin Receptor Antagonists for the Correction of Hyponatremia in Chronic Heart Failure: An Underutilized Therapeutic Option in Current Clinical Practice [...]
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Open AccessArticle
An Evaluation of Plasma TNF, VEGF-A, and IL-6 Determination as a Risk Marker of Atherosclerotic Vascular Damage in Early-Onset CAD Patients
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Marta Bialecka, Michał Rac, Violetta Dziedziejko, Krzysztof Safranow, Dariusz Chlubek and Monika Ewa Rać
J. Clin. Med. 2024, 13(6), 1742; https://doi.org/10.3390/jcm13061742 - 18 Mar 2024
Abstract
Background: The pathogenesis of atherosclerosis is multifactorial and diverse. Pro-inflammatory cytokines are involved in these processes. It is suggested that inflammation may represent a novel and modifiable risk factor for cardiovascular disease. Therefore, this study aimed to gain insight into the relationship
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Background: The pathogenesis of atherosclerosis is multifactorial and diverse. Pro-inflammatory cytokines are involved in these processes. It is suggested that inflammation may represent a novel and modifiable risk factor for cardiovascular disease. Therefore, this study aimed to gain insight into the relationship between plasma concentrations of TNF, VEGF, IL-6, and radiological parameters of atherosclerosis progression in patients with early-onset coronary artery disease (CAD). Methods: Seventy clinically stable patients were included in the study group. The age range for men was no more than 50 years, while for women, it was no more than 55 years. Fasting blood samples were obtained for plasma TNF, VEGF, and IL-6 protein measurements. Plasma cytokine concentrations were measured via ELISA. Doppler ultrasound of the carotid and peripheral arteries was performed in all patients. Results: After Bonferroni correction, there were no significant correlations between any cytokine and radiological parameters of atherosclerosis progression in our patients. Conclusions: The determination of plasma TNF, IL-6, and VEGF levels may not be a reliable marker for the vascular condition, and the measurement of these cytokines in plasma cannot replace the classical radiological examination of the vessels.
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(This article belongs to the Special Issue Current Challenges and Advances in Atherosclerosis)
Open AccessArticle
Evaluation of Serum Myostatin Concentration in Chronic Heart Failure with Preserved and Impaired Left Ventricular Ejection Fraction
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Jan Bączek, Mirosław Charkiewicz, Agnieszka Kasiukiewicz, Anna Maria Witkowska, Łukasz Magnuszewski, Marta Bączek and Zyta Beata Wojszel
J. Clin. Med. 2024, 13(6), 1741; https://doi.org/10.3390/jcm13061741 - 18 Mar 2024
Abstract
Background: Chronic heart failure (CHF) is a complex clinical syndrome associated with muscle wasting, which can progress to cardiac cachexia. Myostatin, a negative regulator of muscle growth, has been implicated in the pathophysiology of muscle wasting in CHF patients and suggested as a
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Background: Chronic heart failure (CHF) is a complex clinical syndrome associated with muscle wasting, which can progress to cardiac cachexia. Myostatin, a negative regulator of muscle growth, has been implicated in the pathophysiology of muscle wasting in CHF patients and suggested as a potential biomarker. The objective of this study was to investigate serum myostatin concentration in patients with CHF with preserved and reduced ejection fraction. Methods: The authors conducted a single-centre study comparing serum myostatin levels, functional and echocardiographic parameters, muscle mass, strength and function in patients with CHF to a control group without CHF. The study group was further divided into sub-groups with preserved and reduced or mildly reduced ejection fraction. Results: Results showed no significant differences in myostatin concentration between CHF patients and controls, and no correlation with sarcopenia or dynapenia. However, a higher myostatin concentration was found in patients with impaired systolic function (Me = 1675 pg/mL vs. Me—884.5 pg/mL; p = 0.007). A positive correlation between myostatin concentration and muscle mass (r = 0.27; p = 0.04), and functional parameters such as Norton (r = 0.35; p < 0.01), I-ADL (r = 0.28; p = 0.02) and Barthel scale (r = 0.27; p = 0.03) scores, was also observed. Conclusions: Myostatin appears to play a role in muscle wasting and its progression to cardiac cachexia in patients with impaired ejection fraction. Further research is needed to confirm these findings and explore myostatin’s potential as a biomarker for muscle loss and a target for pharmacotherapeutic agents in this population of patients.
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(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty and Sarcopenia in Elderly)
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Open AccessReview
Reports of Gastric Banding and Bowel Obstruction: A Narrative Review of the Literature
by
Antonio Vitiello, Alessandro Matarese, Giulia Sansone, Emanuela Cappiello, Giovanna Berardi, Pietro Calabrese, Roberto Peltrini and Vincenzo Pilone
J. Clin. Med. 2024, 13(6), 1740; https://doi.org/10.3390/jcm13061740 - 18 Mar 2024
Abstract
The utilization rates of laparoscopic gastric banding (LAGB) declined worldwide from 42.3% in 2008 to 1.8% in 2018. Rates of complications requiring removal may reach 40–50% in the medium to long term. Bowel obstruction is a rare but severe complication that occurs after
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The utilization rates of laparoscopic gastric banding (LAGB) declined worldwide from 42.3% in 2008 to 1.8% in 2018. Rates of complications requiring removal may reach 40–50% in the medium to long term. Bowel obstruction is a rare but severe complication that occurs after LAGB. A comprehensive literature search in PubMed was carried out to identify all available case reports of intestinal obstruction after gastric banding. The search terms were as follows: “intestinal obstruction”, “small bowel obstruction”, “gastric band”, “gastric banding”, “gastric band complications”, and “laparoscopic gastric band obstruction”. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flowchart was used. Forty-three case reports were included in our review. Laparotomy was necessary in 18/43 (41%) of patients. Vomit was not always reported, while abdominal pain was constantly present. A CT scan was the preferred diagnostic tool. The main causes of occlusion were found to be the erosion of the gastrointestinal tract or internal hernia due to a loose tube loop. Forty-six percent of cases occurred within 5 years from insertion. Even if rare, small bowel obstruction after LAGB requires surgical intervention often with an open approach. The absence of vomit masks symptoms, but an obstruction must be always suspected in the case of severe colicky abdominal pain. A CT scan is recommended for making diagnoses.
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(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)
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Open AccessSystematic Review
Waist Circumference and Body Mass Index as Predictors of Disability Progression in Multiple Sclerosis: A Systematic Review and Meta-Analysis
by
Vasileios Giannopapas, Maria-Ioanna Stefanou, Vassiliki Smyrni, Dimitrios K. Kitsos, Maria Kosmidou, Sophia Stasi, Athanasios K. Chasiotis, Konstantina Stavrogianni, Georgia Papagiannopoulou, John S. Tzartos, George P. Paraskevas, Georgios Tsivgoulis and Sotirios Giannopoulos
J. Clin. Med. 2024, 13(6), 1739; https://doi.org/10.3390/jcm13061739 - 18 Mar 2024
Abstract
Background: While obesity has been shown to elevate the risk of developing multiple sclerosis (MS), there is a lack of strong evidence regarding its role in the disability progression and status of MS patients. Methods: This systematic review and meta-analysis aimed to provide
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Background: While obesity has been shown to elevate the risk of developing multiple sclerosis (MS), there is a lack of strong evidence regarding its role in the disability progression and status of MS patients. Methods: This systematic review and meta-analysis aimed to provide comparative estimates of WC and BMI in patients with MS (PwMS) and to investigate potential associations between the waist circumference (WC) and body mass index (BMI) and demographic and specific MS characteristics. Adhering to PRISMA guidelines, a detailed search of the MEDLINE PubMed, Cochrane Library, and Scopus databases was conducted. Results: A total of 16 studies were included. The pooled mean WC and BMI among PwMS was estimated to be 87.27 cm (95%CI [84.07; 90.47]) and 25.73 (95%CI [25.15; 26.31]), respectively. Meta-regression models established a significant bidirectional relationship between WC and the Expanded Disability Scale (EDSS) (p < 0.001) but not between BMI and EDSS (p = 0.45). Sensitivity analyses showed no association between WC and age (p = 0.48) and a tendency between WC and disease duration (p = 0.08). Conclusions: Although WC measurements classify PwMS as normal weight, BMI measurements classify them as overweight. Therefore, WC should complement BMI evaluations in clinical practice. Additionally, our findings highlight the significant association between abdominal fat, as indicated by WC, and disease progression. Considering the heightened risk of cardiovascular comorbidity and mortality among PwMS, we recommend integrating both WC and BMI as standard anthropometric measurements in routine clinical examinations and targeted prevention strategies for PwMS.
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(This article belongs to the Section Clinical Neurology)
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Open AccessReview
New Public Health and Sport Medicine Institutions Guidelines of Physical Activity Intensity for Pregnancy—A Scoping Review
by
Aneta Worska, Ida Laudańska-Krzemińska, Julia Ciążyńska, Beata Jóźwiak and Janusz Maciaszek
J. Clin. Med. 2024, 13(6), 1738; https://doi.org/10.3390/jcm13061738 - 18 Mar 2024
Abstract
Background: Before starting PA, pregnant women should select the appropriate type of training and adjust its components to the development of pregnancy and her capabilities. This review aimed to analyze current recommendations for pregnant women on methods for determining and assessing PA intensity
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Background: Before starting PA, pregnant women should select the appropriate type of training and adjust its components to the development of pregnancy and her capabilities. This review aimed to analyze current recommendations for pregnant women on methods for determining and assessing PA intensity levels and characterize the extent and nature of the information provided to pregnant women in official documents published by public health and sports medicine institutions. Methods: The review was conducted as per the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched scientific databases (PubMed, ScienceDirect, Web of Science, Academic Search Complete, and SPORTDiscus with Full Text via EBSCO) and the Internet to identify papers regarding recommendations for the PA intensity level for pregnant women. We analyzed 22 eligible guidelines, published over the last 10 years in English, from nine countries and three international organizations. Results: The PA of pregnant women should be at a moderate level. As for higher levels, the analyzed recommendations are contradictory. Methods for assessing PA intensity levels are often not included. The most frequently recommended methods for determining and assessing the PA intensity level for pregnant women are the rating of perceived exertion, the Talk Test, and heart rate measurements. Few guidelines offer specific advice for highly active women (e.g., elite athletes) or trimester-specific considerations. Conclusions: The number of published recommendations regarding PA during pregnancy has increased over the last decade. The amount of information on PA intensity levels is still insufficient. There is a need to update them, based on high-quality scientific work.
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(This article belongs to the Section Epidemiology & Public Health)
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Open AccessArticle
The Influence of Arrhythmias and Metabolic Profile on Inpatient Mortality in Patients with Left Ventricular Assist Devices
by
Daniel Antwi-Amoabeng, Bryce David Beutler and Tokunbo David Gbadebo
J. Clin. Med. 2024, 13(6), 1737; https://doi.org/10.3390/jcm13061737 - 17 Mar 2024
Abstract
Background: In patients with end-stage heart failure, durable Left Ventricular Assist Devices (LVADs) can be used as a bridge to transplant or destination therapy. LVADs have been shown to improve survival for patients with heart failure (HF). HF is associated with electrolyte abnormalities
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Background: In patients with end-stage heart failure, durable Left Ventricular Assist Devices (LVADs) can be used as a bridge to transplant or destination therapy. LVADs have been shown to improve survival for patients with heart failure (HF). HF is associated with electrolyte abnormalities and the development of sustained arrhythmias. However, data on the influence of arrhythmias and electrolyte imbalances on inpatient outcomes in LVAD patients are lacking. Furthermore, previous works assessing inpatient outcomes focused mainly on the role of chronic comorbidities in those outcomes. Methods: In this cross-sectional study, we used discharge data from the National Inpatient Sample from 2019 to 2020 to assess the influence of acute arrhythmias on inpatient mortality in patients with LVADs. We also investigated the relationship between acute medical conditions and mortality. Results: There were 9418 (not survey-adjusted) hospitalizations with LVAD, among which 2539 (27%) died during the hospitalization. Univariate analysis of arrhythmias showed that ventricular arrhythmias (VAs)—ventricular fibrillation/flutter and ventricular tachycardia—as well as complete heart block were associated with significantly higher odds of mortality. Follow-up multivariable logistic analysis showed that these arrhythmias retain their increased association with death. Hyperkalemia and acidosis had increased adjusted odds of death (1.54 (95% confidence interval: 1.28–1.85) (p < 0.001) and 2.44 (CI: 2.14–2.77) (p < 0.001), respectively). Conclusions: VAs, complete heart block, hyperkalemia, and acidosis were associated with increased odds of all-cause mortality. Females had higher odds of inpatient mortality. These findings suggest that electrolyte management, maintenance of optimal acid–base balance, and interventions to treat sustained ventricular arrhythmias may be suitable therapeutic targets to reduce mortality in hospitalized patients with LVADs.
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(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)
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Open AccessSystematic Review
Oral Findings in Male Prisoners: A Systematic Review
by
Rafał Korkosz, Agata Trzcionka, Tomasz Hildebrandt, Maksymilian Kiełbratowski, Anna Kuśka-Kiełbratowska, Mansur Rahnama and Marta Tanasiewicz
J. Clin. Med. 2024, 13(6), 1736; https://doi.org/10.3390/jcm13061736 - 17 Mar 2024
Abstract
Background: Modern penitentiary systems attach great importance, at least in the area of formal and codified arrangements, to providing inmates with access to health care and rehabilitation. The aim of our study was to analyze the Web of Science (WoS) and SCOPUS medical
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Background: Modern penitentiary systems attach great importance, at least in the area of formal and codified arrangements, to providing inmates with access to health care and rehabilitation. The aim of our study was to analyze the Web of Science (WoS) and SCOPUS medical databases in order to search for and evaluate the available literature discussing the oral status and dental treatment needs of adult male prisoners. Methods: The following terms were used: prisoners or inmates; oral health, oral status; periodontal status, periodontal disease; oral hygiene; caries; mucosa; and saliva. The studies were screened based on their title and abstract according to the PICO (population, intervention, control, and outcome) criteria. The research protocol was prepared on the basis of the 2020 PRISMA guidelines and was not registered. The available literature discussing the oral status and dental treatment needs of adult imprisoned patients was analyzed. The inclusion criteria were as follows: articles published in English between 1 January 2012 and 2022; articles discussing the oral cavity status of adult inmates over 18 years old (hard tissues, periodontal status, saliva, mucosa condition, or oral hygiene); articles with a full text available; and articles that were assessed as satisfactory according to the Newcastle–Ottawa Scale. Results: A total of 934 articles were identified, out of which 9 were included in the systematic review. Two articles discussed the oral condition of prisoners in Europe (Russia and Finland), four examined prisoners in Asia (three in India and one in Saudi Arabia), two examined prisoners in Africa (Nigeria), and one examined prisoners in the Americas (Brazil). Conclusions: The oral status of prisoners has been widely discussed in the available literature. Among inmates, a higher frequency of both caries and periodontal disease along with poorer oral hygiene were observed. It can be concluded that inmates should have access to specialized treatment from periodontists and endodontists.
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(This article belongs to the Special Issue Clinical Management of Oral Healthcare in Diverse Patient Populations)
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