Journal of Clinical Medicine

31 pages, 1298 KiB

Open AccessSystematic Review

Impulsivity in ADHD and Borderline Personality Disorder: A Systematic Review of Gray and White Matter Variations

by Łukasz Franczak, Piotr Podwalski, Patryk Wysocki, Bartosz Dawidowski, Adam Jędrzejewski, Marcin Jabłoński and Jerzy Samochowiec

J. Clin. Med. 2024, 13(22), 6906; https://doi.org/10.3390/jcm13226906 (registering DOI) - 16 Nov 2024

Abstract

Introduction: Impulsivity is one of the overlapping symptoms common to borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD), but the neurobiological basis of these disorders remains uncertain. This systematic review aims to identify abnormalities in the gray and white matter [...] Read more.

Introduction: Impulsivity is one of the overlapping symptoms common to borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD), but the neurobiological basis of these disorders remains uncertain. This systematic review aims to identify abnormalities in the gray and white matter associated with impulsivity in BPD and ADHD. Methods: We conducted a systematic search of the PubMed, Embase, and SCOPUS databases, adhering to PRISMA guidelines. Studies that investigated gray and white matter alterations in BPD or ADHD populations and their relationship with impulsivity were included. We reviewed information from 23 studies involving 992 participants, which included findings from structural MRI and DTI. Results: The review identified various nonhomogeneous changes associated with impulsivity in BPD and ADHD. BPD was mainly associated with abnormalities in the prefrontal cortex (PFC) and limbic areas, which correlated negatively with impulsivity. In contrast, impulsivity associated with ADHD was associated with structural changes in the caudate nucleus and frontal–striatal pathways. Despite the overlapping symptoms of impulsivity, the neurobiological mechanisms appeared to differ between the two disorders. Conclusions: These findings emphasize the distinct neurostructural correlates of impulsivity in BPD and ADHD. While both disorders show impulsivity as one of their main symptoms, the fundamental brain structures associated with this trait are different. BPD is primarily associated with abnormalities in the prefrontal cortex and limbic system, whereas the alterations seen in ADHD tend to focus on the caudate nucleus and frontostriatal pathways. Further research is needed to clarify these differences and their implications for treatment. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

15 pages, 812 KiB

Open AccessSystematic Review

Pandoraea Infections in Humans—A Systematic Review

by Afroditi Ziogou, Alexios Giannakodimos, Ilias Giannakodimos, Andreas G. Tsantes and Petros Ioannou

J. Clin. Med. 2024, 13(22), 6905; https://doi.org/10.3390/jcm13226905 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: Pandoraea species are Gram-negative, aerobic, rod-shaped bacteria that belong to the Burkholderiaceae family and the Betaproteobacteria class. Despite their rare occurrence in the general population, they have been increasingly observed as the causes of infection in immunocompromised individuals or patients with [...] Read more.

Background/Objectives: Pandoraea species are Gram-negative, aerobic, rod-shaped bacteria that belong to the Burkholderiaceae family and the Betaproteobacteria class. Despite their rare occurrence in the general population, they have been increasingly observed as the causes of infection in immunocompromised individuals or patients with severe comorbidities. The present review seeks to examine all documented cases of Pandoraea spp. infections in humans, focusing on data related to epidemiology, microbiology, antimicrobial susceptibility, treatment options, and mortality rates. Methods: A systematic review was conducted through a literature search of the PubMed/MedLine and Scopus databases. This review is subjected to certain limitations regarding the data accuracy or pathogen identification molecular techniques applied in the studies. Results: In total, 29 studies provided information on 43 patients with Pandoraea spp. infections. The mean age of the patients was 42 years, and 58% were male. Cystic fibrosis was these patients’ most prevalent risk factor (39.5%). The most frequently reported types of infection were lower respiratory tract infections (74.41%) and bacteremia (30.23%), followed by infective endocarditis, pancreatitis, upper respiratory tract infection, and osteomyelitis (4.65%). P. apista was the most regularly isolated species (37.2%), while antimicrobial resistance was lower for carbapenems, especially for imipenem (17.14%). The most commonly administered antibiotics included carbapenems (82%), cephalosporins, and trimethoprim/sulfamethoxazole (35.89%). The infection outcome primarily depended on the type of infection; mortality rates were high (30.23%) and particularly elevated for bloodstream infections. The protocol for this review was registered in Prospero (ID: CRD42024579385). Conclusions: Due to Pandoraea’s unique antimicrobial resistance pattern and capacity to induce severe infection, clinicians should include it when making a differential diagnosis, especially in patients with severe comorbidities and immunodeficiency. Full article

(This article belongs to the Section Infectious Diseases)

► Show Figures

Figure 1

12 pages, 1443 KiB

Open AccessArticle

Cervical Open-Door Laminoplasty for Myelopathy Caused by Ossification of the Posterior Longitudinal Ligament: Correlation Between Spinal Canal Expansion and Clinical Outcomes

by Young-Il Ko, Young-Hoon Kim, Jorge Barraza, Myung-Sup Ko, Chungwon Bang, Byung Jun Hwang, Sang-Il Kim and Hyung-Youl Park

J. Clin. Med. 2024, 13(22), 6904; https://doi.org/10.3390/jcm13226904 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: This study investigated the relationship between spinal canal expansion and clinical outcomes in patients with myelopathy due to ossification of the posterior longitudinal ligament (OPLL) who underwent cervical open-door laminoplasty. Methods: A retrospective study was conducted on 36 OPLL patients [...] Read more.

Background/Objectives: This study investigated the relationship between spinal canal expansion and clinical outcomes in patients with myelopathy due to ossification of the posterior longitudinal ligament (OPLL) who underwent cervical open-door laminoplasty. Methods: A retrospective study was conducted on 36 OPLL patients who underwent open-door laminoplasty between 2009 and 2021. Preoperative and two-year postoperative radiologic parameters, including bony canal area (BCA) and spinal canal area (SCA), were measured. Clinical outcomes were assessed using the Numerical Rating Scale (NRS) for neck pain and radicular pain, the Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Results: The mean expansion of BCA was 112.1 mm² (47%) and SCA was 100.5 mm² (64%). All clinical outcomes improved after surgery, although not statistically significant. JOA scores improved significantly in the severe group, while NDI and NRS-neck scores improved in the mild to moderate group. Significant correlations were found between improvements in NRS-neck and expansions of BCA (r = 0.533, p = 0.001) and SCA (r = 0.537, p = 0.001). NDI improvement was also associated with BCA expansion. No significant correlations were found between canal expansion and NRS-R, NRS-L, or JOA scores. Conclusions: Cervical open-door laminoplasty effectively increased the bony and spinal canal areas in patients with OPLL and myelopathy. In addition to improving myelopathy symptoms, this procedure may also improve neck pain and disability. Further research is needed to assess the long-term outcomes and to better understand these clinical improvements. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

16 pages, 931 KiB

Open AccessReview

Ophthalmic Formulations for the Treatment of Allergic Conjunctivitis and Their Effect on the Ocular Surface: A Review of Safety and Tolerability Assessments in Clinical Trials

by Tatiana Suárez-Cortés, Ana Gonzalo, Eider Arana, Virginia Guillén and Noelia Andollo

J. Clin. Med. 2024, 13(22), 6903; https://doi.org/10.3390/jcm13226903 (registering DOI) - 16 Nov 2024

Abstract

Allergic conjunctivitis (AC) is the most common allergic eye disorder. Antiallergic eyedrops are the first line of pharmacological treatment. However, the application of antiallergic eyedrops can potentially alter tear homeostasis and affect the ocular surface, which may result in iatrogenic diseases such as [...] Read more.

Allergic conjunctivitis (AC) is the most common allergic eye disorder. Antiallergic eyedrops are the first line of pharmacological treatment. However, the application of antiallergic eyedrops can potentially alter tear homeostasis and affect the ocular surface, which may result in iatrogenic diseases such as dye eye disease (DED). Long-term treatment of AC with eyedrops containing preservatives and other components may increase the risk of DED and ocular surface damage. Here, we examined 20 clinical trials published during the past ten years with antihistamine ophthalmic formulations in the treatment of AC, to evaluate the extent of evidence about their safety and tolerability. Remarkably, we find that most trials lack an evaluation of the critical ocular surface parameters, such as tear film break-up time, tear volume, corneal and conjunctival damage, and inflammation, to properly assess the state of the ocular surface state after prolonged treatment. There is a need to increase awareness of the use of specific formulations that do not increase the risk of iatrogenic DED. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

12 pages, 690 KiB

Open AccessArticle

A Six-Year Examination of the Influence of Surgical Technique and Intraoperative Intraglandular Clostridium Botulinum Toxin Application in Salivary Gland Tumor Operations

by Felix Johnson, Nora-Maria Burian, Matthias Santer, Verena Strasser, Teresa Steinbichler, Benedikt Hofauer, Anna Stenzl, Johanna Klarer, Robin Lochbaum, Haochen Lei, Hongyuan Cao, Gabriel Hillebrand and Amir Bolooki

J. Clin. Med. 2024, 13(22), 6902; https://doi.org/10.3390/jcm13226902 (registering DOI) - 16 Nov 2024

Abstract

Introduction: Salivary gland tumor operations are associated with complications including facial nerve dysfunction (FND) and salivary fistula. The objective of this study was to investigate the effect of extracapsular dissection (ECD) and the application of Clostridium botulinum toxin (CBT) in contrast to partial [...] Read more.

Introduction: Salivary gland tumor operations are associated with complications including facial nerve dysfunction (FND) and salivary fistula. The objective of this study was to investigate the effect of extracapsular dissection (ECD) and the application of Clostridium botulinum toxin (CBT) in contrast to partial and lateral parotidectomy on complications. Methods: All salivary gland tumor operations performed within the last 6 years were retrospectively examined. Data were collected from electronic patient files from our otorhinolaryngology clinic. Total parotidectomies and submandibulectomies were not included in the analysis of CBT application. Results: In total, 418 cases were examined, including 84 (20%) malignant tumors. In total, 18 patients underwent ECD, 93 partial parotidectomy, 199 lateral parotidectomy, 76 total parotidectomy, and 32 submandibulectomy. The most common complication was transient FND (49%; n = 205; data available for 415 patients), which was measured at four days. Additional complications included salivary fistula (n = 56), infection (n = 49), bleeding or hematoma (n = 21). Preoperative facial nerve paralysis (p < 0.0001), pain (p < 0.0001), and a history of squamous cell skin carcinoma (SCC) (p < 0.001) were predictive of malignancy. The application of CBT did not reduce the risk of salivary fistula (p-value: 0.0182) and was associated with a higher combined complication rate (p-value: 0.0199). ECD was not associated with a lower likelihood for FND (p = 0.350). Conclusions: Preoperative pain, facial paralysis, or a history of SCC are predictors of malignancy. Use of CBT was not associated with a reduced risk of salivary fistula, but rather a higher complication rate. Full article

(This article belongs to the Special Issue Current and Future Trends in Otorhinolaryngology–Head and Neck Surgery)

► Show Figures

Figure 1

15 pages, 3218 KiB

Open AccessArticle

Relationship Between Ultrasound Diagnosis, Symptoms and Pain Scale Score on Examination in Patients with Uterosacral Ligament Endometriosis

by Shae Maple, Eva Bezak, K. Jane Chalmers and Nayana Parange

J. Clin. Med. 2024, 13(22), 6901; https://doi.org/10.3390/jcm13226901 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: This study investigated patient pain descriptors for transvaginal ultrasound (TVS) diagnostic evaluation of endometriosis for uterosacral ligaments (USLs), including correlation between USL thickness and site-specific tenderness (SST). It further investigated if SST could positively assist diagnosing endometriosis on TVS. Methods: TVS images [...] Read more.

Background/Objectives: This study investigated patient pain descriptors for transvaginal ultrasound (TVS) diagnostic evaluation of endometriosis for uterosacral ligaments (USLs), including correlation between USL thickness and site-specific tenderness (SST). It further investigated if SST could positively assist diagnosing endometriosis on TVS. Methods: TVS images and SST pain descriptors were collected from 42 patients. SST was evaluated by applying sonopalpation during TVS. The images were presented to six observers for diagnosis based on established USL criteria. Following this, they were given the SST pain scores and asked to reevaluate their diagnosis to assess if the pain scores impacted their decision. Results: An independent t-test showed that the patients with an endometriosis history had higher pain scores overall (7.2 ± 0.59) compared to the patients with no history (0.34 ± 0.12), t (40) = 8.8673. Spearman’s correlation showed a strong correlation to the pain scale score for clinical symptoms (r = 0.74), endometriosis diagnosis (r = 0.78), USL thickness (r = 0.74), and when USL nodules were identified (r = 0.70). Paired t-tests showed that the observers demonstrated a higher ability to correctly identify endometriosis with the pain scale information (33 ± 8.83) as opposed to not having this information (29.67 ± 6.31), which was a statistically significant change of 3.33, t (5) = 2.7735. Conclusions: Patients with an endometriosis history have significantly higher pain scores on TVS compared to patients with no endometriosis history. A strong correlation was shown between SST pain scores and patient symptoms, USL thickness, and USL nodules. Inclusion of SST alongside TVS imaging shows promise, with these results demonstrating a higher ability to diagnose endometriosis with additional SST pain scale information. Full article

(This article belongs to the Special Issue Endometriosis and Adenomyosis: Modern Concepts on Clinical Outcomes, Treatment and Management)

► Show Figures

Figure 1

15 pages, 2691 KiB

Open AccessArticle

Aetiology, Treatment and Outcomes of Pericarditis: Long-Term Data from a Longitudinal Retrospective Single-Centre Cohort

by Andrea Silvio Giordani, Iris Bocaj, Cristina Vicenzetto, Anna Baritussio, Dario Gregori, Federico Scognamiglio, Honoria Ocagli, Renzo Marcolongo and Alida Linda Patrizia Caforio

J. Clin. Med. 2024, 13(22), 6900; https://doi.org/10.3390/jcm13226900 (registering DOI) - 16 Nov 2024

Abstract

Background. Pericarditis has a heterogeneous clinical spectrum and rate of relapse. Data on aetiology, real-life treatment strategies, and long-term course from contemporary pericarditis cohorts are lacking. Methods. Pericarditis patients referred to the Cardioimmunology Outpatient Clinic at Padua University Hospital in 2001–2020 [...] Read more.

Background. Pericarditis has a heterogeneous clinical spectrum and rate of relapse. Data on aetiology, real-life treatment strategies, and long-term course from contemporary pericarditis cohorts are lacking. Methods. Pericarditis patients referred to the Cardioimmunology Outpatient Clinic at Padua University Hospital in 2001–2020 were retrospectively included. Kaplan–Meier method was used for recurrence-free survival probability estimation. The appropriateness of treatment was assessed based on the European Society of Cardiology guidelines. Results. One-hundred forty-four patients (57% males, mean age 50 years) followed up for 18 months (IQR 7–45) were included; of those, 52% had acute, 35% recurrent, 8% incessant, and 5% chronic pericarditis; 9% had cardiac tamponade at diagnosis. Time to pericardial effusion resolution was 53 days (IQR 16–124); median medical treatment duration was 87 days (IQR 48–148). Treatment was readjusted following the ESC guidelines for nonsteroidal anti-inflammatory drugs in 29% of the cases, steroids in 12%, and colchicine in 25%. Eleven (8%) patients were treated with anti-IL1 agents. Recurrence-free survival probability was 86% at 1st-year follow-up, and 23 patients (16%) had at least one recurrence, with a mean of two relapses per patient. Compared to patients without recurrences, they had a higher frequency of cardiac tamponade (27% vs. 6%, p = 0.006) and left bundle branch block (14% vs. 1%, p = 0.034). Out of the 144 patients, 5 (3%) were diagnosed as having constrictive pericarditis at first evaluation at our clinic, underwent successful pericardiectomy, and are currently alive and asymptomatic. Conclusions. When treated following a guideline-based approach, pericarditis has a favourable evolution. A relevant quote of cases benefits from the treatment readjustment of previously prescribed medical therapy when not in line with ESC recommendations. Cases relapsing despite treatment readjustment should receive anti-IL1 therapies. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pericardial Diseases)

► Show Figures

Figure 1

24 pages, 21479 KiB

Open AccessReview

Advancements in 3D Transoesophageal Echocardiography (TOE) and Computed Tomography (CT) for Stroke Prevention in Left Atrial Appendage Occlusion Interventions

by Reza Hajhosseiny, Ben Ariff, Graham Cole, Michael Koa-Wing, Punam Pabari, Nilesh Sutaria, Norman Qureshi, Prapa Kanagaratnam and Bushra Rana

J. Clin. Med. 2024, 13(22), 6899; https://doi.org/10.3390/jcm13226899 (registering DOI) - 16 Nov 2024

Abstract

Left atrial appendage occlusion (LAAO) has emerged as a highly effective alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation. Precise pre-procedural planning and meticulous post-procedural follow-up are essential for achieving successful LAAO outcomes. This review explores the latest [...] Read more.

Left atrial appendage occlusion (LAAO) has emerged as a highly effective alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation. Precise pre-procedural planning and meticulous post-procedural follow-up are essential for achieving successful LAAO outcomes. This review explores the latest advancements in three-dimensional (3D) transoesophageal echocardiography (TOE) and computed tomography (CT) imaging modalities, which have considerably improved the planning, intra-procedural guidance, and follow-up processes for LAAO interventions. Innovations in 3D TOE and CT imaging have transformed the approach to LAAO by providing a more detailed and accurate assessment of the left atrial appendage, enabling clinicians to acquire comprehensive anatomical and morphological information, crucial for optimising device selection and positioning, thus reducing the risk of complications and enhancing the overall safety and efficacy of the procedure. Post-procedurally, CT and TOE imaging are invaluable in the monitoring of patients, ensuring that the device is correctly positioned and functioning as intended. Early detection of any complications (e.g., device-related thrombus and peri-device leaks) can help to risk-stratify patient at increased risk of stroke and initiate timely interventions, thereby improving long-term outcomes for patients. Full article

(This article belongs to the Special Issue Acute Ischemic Stroke: Current Status and Future Challenges)

► Show Figures

Figure 1

9 pages, 787 KiB

Open AccessArticle

Risk Factors for Developmental Dysplasia of the Hip: A Critical Analysis About an Unclear Relationship

by Tamir Dib, Matteo Nanni, Ilaria Sanzarello, Giada Salvatori, Daniela Alessia Marletta, Biagio Zampogna and Danilo Leonetti

J. Clin. Med. 2024, 13(22), 6898; https://doi.org/10.3390/jcm13226898 (registering DOI) - 16 Nov 2024

Abstract

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was [...] Read more.

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was conducted. The participants were selected on the basis of a DDH diagnosis using sonography. A total of 181 hips of patients with DDH were considered in our study group (Graf types IIa to IV), and the normal hips of those affected unilaterally were excluded from the analyses (43 participants were affected unilaterally). The risk factors considered included female sex, breech presentation, firstborn status, familiarity, association with other orthopedic abnormalities, and uterine packing, which includes factors such as twin pregnancy, macrosomia, and oligohydramnios. Binary logistic regression was used to analyze the relationship between these variables and the Graf type of DDH at presentation, which was defined using two groups: Graf types IIc–IV, which include unstable or decentered hips, and Graf types IIa and IIb, which encompass stable and centered hips. Results: The analyses revealed a significant protective role of the presence of other lower limb congenital malformations such as clubfoot, which was more closely associated with a stable form of DDH (OR = 0.26, p = 0.017), a significant association between the presence of mechanical risk factors in females with an unstable form of DDH (OR = 5.00, p = 0.042), a borderline significant protective role of breech presentation in females, which was more closely associated with a stable form of DDH (OR = 0.25, p = 0.054), and a borderline significant association between the presence of mechanical risk factors and an unstable form of DDH (OR = 4.28, p = 0.054). Conclusions: Prenatal risk factors may have a complex effect on the Graf grade in DDH. The protective effects of some factors in contrast with the increased risk associated with other factors suggest a possible relationship, with some prenatal risk factors affecting the severity of DDH. These findings may have implications for the early identification and management of DDH. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

► Show Figures

Figure 1

9 pages, 554 KiB

Open AccessArticle

Role of Preoperative Multiple-Drug-Resistant Bacteria Intestinal Colonization in Cardiac Surgery: A Retrospective Study

by Alessia Mattei, Martina Cuccarelli, Lorenzo Schiavoni, Antonio Nenna, Giuseppe Pascarella, Alessandro Ruggiero, Lelio Carpinteri, Fabio Costa, Mario Lusini, Ciro Mastroianni, Raffaele Barbato, Massimo Chello, Massimiliano Carassiti, Rita Cataldo, Felice Eugenio Agrò and Alessandro Strumia

J. Clin. Med. 2024, 13(22), 6897; https://doi.org/10.3390/jcm13226897 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use [...] Read more.

Background/Objectives: Multiple-drug-resistant (MDR) bacteria are pathogens resistant to three or more antibiotic classes, and infection with these bacteria is associated with increased mortality, morbidity, and hospital management costs. Given the rise in antibiotic resistance, selecting appropriate antimicrobial drugs and avoiding the unnecessary use of new antibiotics are crucial. Due to their nosocomial nature, monitoring and preventing MDR infections are essential. Methods: This study enrolled patients who underwent cardiac surgery from January 2020 to May 2022. The patients included were those 18 years or older who tested positive for MDR intestinal colonization before surgery. Excluded were patients who tested positive after surgery, or were younger than 18, pregnant, or lactating. For each positive patient, the National Surgical Quality Improvement Program (NSQIP) score was calculated. The data collected included age, gender, body mass index (BMI), the type of surgery, the intensive care unit (ICU) length of stay, ICU readmission, mortality, and other infections (pneumonia, bacteremia, or surgical site infection) to establish a control group and postoperative outcome measures. Results: No statistically significant differences were found between the groups regarding the ICU length of stay, new ICU admissions, or mortality. Additionally, there were no differences in the infection rates, such as bacteremia, wound infections, and pneumonia. Conclusions: Preoperative rectal colonization by MDR bacteria does not appear to worsen postoperative outcomes for cardiac surgery patients. These findings suggest that patients with a preoperative MDR-positive rectal sample might undergo cardiac surgery without significantly increased risk. Besides the limitations of this study, pre-surgical antibiotic prophylaxis may not need to be adjusted for patients with preoperative MDR positivity. Full article

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

10 pages, 3879 KiB

Open AccessArticle

Upper Mediastinal Lymphadenectomy Utilizing Prone-Position Thoracoscopy for Esophageal and Gastroesophageal Junction Cancers

by Spyridon Davakis, Dimitrios Ziogas, Pavlos Papadakis, Stratigoula Sakellariou, Athanasia Mitsala, Christos Tsalikidis and Alexandros Charalabopoulos

J. Clin. Med. 2024, 13(22), 6896; https://doi.org/10.3390/jcm13226896 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: Esophagectomy is the mainstay of treatment in esophageal cancer. Minimally invasive esophagectomy (MIE) remains a challenging procedure and has been associated with a high rate of complications and mortality. Routine lymphadenectomy includes two-field lymphadenectomy for distal-esophageal or gastroesophageal junction Siewert I–II tumors. [...] Read more.

Background/Objectives: Esophagectomy is the mainstay of treatment in esophageal cancer. Minimally invasive esophagectomy (MIE) remains a challenging procedure and has been associated with a high rate of complications and mortality. Routine lymphadenectomy includes two-field lymphadenectomy for distal-esophageal or gastroesophageal junction Siewert I–II tumors. Superior mediastinal lymphadenectomy (SML) refers to an extended two-field lymphadenectomy or total mediastinal lymphadenectomy during MIE for cancer. The exact benefits of SML have been the subject of prolonged debate, with no conclusive evidence indicating improved clinical and oncological results. Herein, we aim to present our surgical technique of thoracoscopic SML during MIE in the prone position, with short-term clinical and oncological outcomes. Methods: About 150 consecutive patients underwent totally MIE within 3 years period (2016–2019). SML included right-paratracheal nodes and nodes along the right-recurrent laryngeal nerve throughout its mediastinal route in cases of extended two-field lymphadenectomy, as well as left-paratracheal nodes and nodes along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy. Eligible patients underwent SML during two-stage or three-stage MIE. Results: Twenty consecutive patients underwent SML during the study period. The 30- and 90-day mortality rates were 0. Pulmonary complications were observed in 16.5% of the patients. There was 1 right recurrent laryngeal nerve palsy noted. The median length of stay was 9 days. The median number of resected lymph nodes was 45, with the median SML nodes count being 8. The median follow-up was 24 months. Conclusions: SML during prone position thoracoscopy for esophageal cancer is safe and feasible, although technically demanding. Minimally invasive esophagectomy with SML may offer meaningful benefits in oncological outcomes without introducing additional significant morbidity. Further comparative studies are needed to better elucidate our results. Full article

(This article belongs to the Special Issue Minimally Invasive Surgical Procedures: Challenges, Advancements and New Directions)

► Show Figures

Figure 1

14 pages, 442 KiB

Open AccessArticle

Quantitative Approach to Quality Review of Prenatal Ultrasound Examinations: Estimated Fetal Weight and Fetal Sex

by C. Andrew Combs, Ryan C. Lee, Sarah Y. Lee, Sushma Amara and Olaide Ashimi Balogun

J. Clin. Med. 2024, 13(22), 6895; https://doi.org/10.3390/jcm13226895 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: Systematic quality review of ultrasound exams is recommended to ensure accurate diagnosis. Our primary objectives were to develop a quantitative method for quality review of estimated fetal weight (EFW) and to assess the accuracy of EFW for an entire practice and [...] Read more.

Background/Objectives: Systematic quality review of ultrasound exams is recommended to ensure accurate diagnosis. Our primary objectives were to develop a quantitative method for quality review of estimated fetal weight (EFW) and to assess the accuracy of EFW for an entire practice and for individual personnel. A secondary objective was to evaluate the accuracy of fetal sex determination. Methods: This is a retrospective cohort study. Eligible ultrasound exams included singleton pregnancies with live birth and known birth weight (BW). A published method was used to predict BW from EFW for exams with ultrasound-to-delivery intervals of up to 12 weeks. Mean error and median absolute error (AE) were compared between different personnel. Image audits were performed for exams with AE > 30% and exams with reported fetal sex different than newborn sex. Results: We analyzed 1938 exams from 890 patients. In the last exam before birth, the median AE was 5.9%, and the predicted BW was within ±20% of the actual BW in 97.2% of patients. AE was >30% in 28 exams (1.4%); image audit found correct caliper placement in all 28. Only two patients (0.2%) had AE > 30% on the last exam before birth. One sonographer systematically over-measured head and abdominal circumferences, leading to EFWs that were overestimated. Reported fetal sex differed from newborn sex in seven exams (0.4%) and five patients (0.6%). Images in four of these patients were annotated with the correct fetal sex, but a clerical error was made in the report. In one patient, an unclear image was labeled “probably female”, but the newborn was male. Conclusions: The accuracy of EFW in this practice was similar to literature reports. The quantitative analysis identified a sonographer with outlier measurements. Time-consuming image audits could be focused on a small number of exams with large errors. We suggest some enhancements to ultrasound reporting software that may help to reduce clerical errors. We provide tools to help other practices perform similar quality reviews. Full article

(This article belongs to the Special Issue Progress in Patient Safety and Quality in Maternal–Fetal Medicine)

► Show Figures

Figure 1

12 pages, 1861 KiB

Open AccessArticle

The Influence of Kinematic Alignment on Patellofemoral Joint Biomechanics in Total Knee Arthroplasty

by Johanna-Maria Simon, Leandra Bauer, Christoph Thorwächter, Matthias Woiczinski, Florian Simon, Peter E. Müller, Boris M. Holzapfel and Thomas R. Niethammer

J. Clin. Med. 2024, 13(22), 6894; https://doi.org/10.3390/jcm13226894 (registering DOI) - 16 Nov 2024

Abstract

Background: Anterior knee pain is a prevalent issue post total knee arthroplasty, often necessitating revision surgery. Various factors contribute to this complication, including patellar maltracking and excessive patellofemoral load. Kinematic alignment has emerged as an alternative, showing promising outcomes in clinical studies. [...] Read more.

Background: Anterior knee pain is a prevalent issue post total knee arthroplasty, often necessitating revision surgery. Various factors contribute to this complication, including patellar maltracking and excessive patellofemoral load. Kinematic alignment has emerged as an alternative, showing promising outcomes in clinical studies. However, its impact on patellofemoral biomechanics needs to be more adequately understood. This study compared the effects of kinematically versus mechanically aligned total knee arthroplasty on patellofemoral joint biomechanics. Methods: Eight fresh-frozen human knee specimens underwent biomechanical testing in a knee rig setup, performing an active weight-loaded knee joint flexion of 30–130°. After the testing of native kinematics, kinematically and mechanically aligned total knee arthroplasty was performed using a medial pivot implant design without patellar resurfacing. Quadriceps force, retropatellar peak pressure and the retropatellar contact area were measured during knee flexion using a patellar pressure-sensitive film. Patella kinematics (shift and tilt) was tracked using an optoelectrical measurement system. Functional regressions were used to determine the influence of the alignment on the kinematics and loading of the knee joint. Results: Kinematically aligned total knee arthroplasty resulted in reduced quadriceps force during knee flexion compared to mechanically aligned total knee arthroplasty. Retropatellar peak pressure, retropatellar contact area and patella kinematics did not vary between the alignments. Conclusions: Kinematic alignment offers potential benefits in reducing quadriceps force during knee flexion, which may mitigate anterior knee pain risk. Further research is needed to elucidate its effects in varying anatomical conditions and alignment strategies. Full article

(This article belongs to the Special Issue Advancements in Total Joint Arthroplasty: Innovations, Outcomes and Challenges)

► Show Figures

Figure 1

9 pages, 1061 KiB

Open AccessBrief Report

Glypican-3 and Cytokeratin-19 Expression in Pancreatic Cancer in a Canadian Population

by Carley Bekkers, Ravi Ramjeesingh and Thomas Arnason

J. Clin. Med. 2024, 13(22), 6893; https://doi.org/10.3390/jcm13226893 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: One study of pancreatic ductal adenocarcinoma has found expression of glypican-3 (GPC3) and cytokeratin-19 (CK19) determined by immunohistochemistry to be associated with higher stage and grade disease, with a more adverse prognosis. The reported 44% rate of GPC3 expression in pancreatic cancer [...] Read more.

Background/Objectives: One study of pancreatic ductal adenocarcinoma has found expression of glypican-3 (GPC3) and cytokeratin-19 (CK19) determined by immunohistochemistry to be associated with higher stage and grade disease, with a more adverse prognosis. The reported 44% rate of GPC3 expression in pancreatic cancer raises the important possibility that targeted immunotherapies currently in development for hepatocellular carcinoma may also prove useful for GPC3-expressing pancreatic cancers. The present study aims to determine if a similar expression pattern of these markers and stage/grade/prognostic associations is present in our Canadian patient population. Methods: Patients with a pancreatic surgical resection for adenocarcinoma or neuroendocrine tumor (NET) were identified from pathology records over a 5-year period. Immunohistochemistry for GPC3 and CK19 was performed on archived tumor tissue and the proportion of positive cells and intensity of staining were recorded. Grade, stage, and overall survival were compared in patients with NETs that were CK19-positive versus -negative. Results: All 72 pancreatic adenocarcinomas and 20 NETs tested were negative for GPC3, apart from a single case of pancreatic adenocarcinoma. All 72 adenocarcinomas were positive for CK19 expression. Half of the NETs were positive for CK19. There was no correlation between CK19 expression in NETs and tumor grade, lymph node metastasis, distant metastasis, or overall survival. Conclusions: We are skeptical of the reported prognostic value of GPC3 and CK19 in pancreatic adenocarcinomas. CK19 as a prognostic marker in NETs has potential for further study. The results with our protocol for GPC3 immunohistochemistry suggest that pancreatic cancer may be a less promising target for GPC3-targeted immunotherapies than previously thought. Full article

(This article belongs to the Special Issue Pancreatic Cancer: Current and Emerging Treatment Options)

► Show Figures

Figure 1

15 pages, 695 KiB

Open AccessArticle

Sleep Problems and Quality of Life in Children with Epilepsy Without Neurodevelopmental Disorders

by Kotaro Yazaki, Satoru Sakuma, Yuuto Shirokihara, Kayo Inutsuka, Takuji Imamura, Takenao Mihara, Naoko Tachibana, Kyoko Kondo, Wakaba Fukushima and Takashi Hamazaki

J. Clin. Med. 2024, 13(22), 6892; https://doi.org/10.3390/jcm13226892 (registering DOI) - 16 Nov 2024

Abstract

Background/Objectives: Sleep problems affect the quality of life (QoL) and treatment prognosis of children with epilepsy (CWE). We analyzed sleep problems and QoL in CWE but without neurodevelopmental disorders, which affect sleep and QoL. We also examined discrepancies between child self-reports and [...] Read more.

Background/Objectives: Sleep problems affect the quality of life (QoL) and treatment prognosis of children with epilepsy (CWE). We analyzed sleep problems and QoL in CWE but without neurodevelopmental disorders, which affect sleep and QoL. We also examined discrepancies between child self-reports and parent proxy reports in QoL assessments. Methods: Thirty-two CWE in grades 2–6 (aged 7–12 years) in regular classes who attended Osaka Metropolitan University Hospital and PL General Hospital between January 2022 and August 2023 were compared with 21 children who had attended the hospitals for acute non-neurological disorders and had recovered (control group). Children with neurodevelopmental disorders, those unable to answer questionnaires, and those taking sleeping pills were excluded. Children in both groups completed the Kinder Lebensqualität Fragebogen (KINDL-R); their parents completed the KINDL-R and Japanese Sleep Questionnaire for Elementary Schoolers (JSQ-ES). Results: There were no significant differences in mean (±SD) JSQ-ES total scores between the epilepsy and control groups (71.6 ± 21.4 vs. 63.2 ± 15.2, respectively; p = 0.16). In the epilepsy group, there were no significant differences in total or subscale KINDL-R scores between children with (JSQ-ES ≥ 80) and without (JSQ-ES < 80) sleep problems. Correlation coefficients between child self-reports and parent proxy reports for KINDL-R total scores were 0.171 (p = 0.348) and 0.656 (p = 0.001) for the epilepsy and control groups, respectively. There was a significant difference between the total scores of children’s self-reports and parents’ proxy reports in the control (p = 0.008) group, but not in the epilepsy group (p = 0.837). Conclusions: Sleep problems may not have significant impacts on the QoL of CWE without neurodevelopmental disorders. Parents of CWE do not always correctly assess their children’s QoL, so it is important to ask both children and their parents to obtain a comprehensive picture of their QoL. Full article

(This article belongs to the Special Issue Clinical Therapeutic and Management Strategies for Epilepsy)

► Show Figures

Figure 1

12 pages, 2323 KiB

Open AccessArticle

7-Year Follow-Up of Maxillary Overdentures Supported by Mini-Dental Implants

by Luc Van Doorne, Laure Demeulenaere, Marie Dejans and Hugo De Bruyn

J. Clin. Med. 2024, 13(22), 6891; https://doi.org/10.3390/jcm13226891 (registering DOI) - 15 Nov 2024

Abstract

Background: Mini dental implants (MDIs) are alternatives to support an overdenture when a standard diameter implant cannot be placed due to lack of bone volume. They reduce the need for invasive bone grafting and lower the barrier for treatment. Aim: This prospective study [...] Read more.

Background: Mini dental implants (MDIs) are alternatives to support an overdenture when a standard diameter implant cannot be placed due to lack of bone volume. They reduce the need for invasive bone grafting and lower the barrier for treatment. Aim: This prospective study reports on implant and patient-centered outcomes of flaplessly placed, early loaded MDIs supporting horseshoe-shaped maxillary overdentures after 7 years of function. Materials and Methods: Patients with a CBCT-confirmed thin alveolar crest received 5–6 one-piece MDIs using mentally guided flapless surgery. The conventional denture was relined and MDIs were provisionally loaded within one week. After 6 months the non-splinted MDIs were actively loaded with a horseshoe overdenture. Implant and prosthetic survival, peri-implant health (PPD and BoP) and patient-related outcomes using OHIP-14 and Subjective Masticatory Evaluation were assessed after 7 years. Results: 185 MDIs were placed in 14 females and 17 males. During provisional loading, 32 MDIs were lost, and 17 replacements were required in 16 patients. In total, 170 out of 202 totally placed MDIs were supporting 29 overdentures after 6 months. Cumulative implant failure increased from 15.8% at the moment of active loading to 34.7% at 7 years. After 7 years, 76% of the initially placed overdentures remained functional, mean PPD was 3.48 (SD 0.86), BoP was 0.20 (SD 0.40) and peri-implantitis incidence was 0.9%. The total OHIP-14 was reduced from 21.3/56 (SD: 13.1) preoperatively to 15.6/56 (SD 12.8) at provisional loading (p > 0.1) and 7.3/56 (SD 6.7) at final loading (p = 0.006), and it remained unchanged up to 7 years at 6.57/56 (SD: 8.92) (p > 0.5). Conclusions: Maxillary MDIs provide an acceptable treatment option in patients with deficient bone volume that cannot or refuse to be treated with bone grafting. Despite one third of the MDIs being lost, remaining MDIs had good peri-implant health, prosthetic success was 71% and Oral Health Related Quality of Life was beyond expectations. Full article

(This article belongs to the Special Issue Research Progress in Osseointegrated Oral Implants)

► Show Figures

Figure 1

12 pages, 1092 KiB

Open AccessArticle

Clinical Efficacy of Two Different Low-Level Laser Therapies for the Treatment of Trigeminal Neuralgia: A Randomized, Placebo-Controlled Trial

by İrem Karagözoğlu, Nermin Demirkol, Özge Parlar Öz, Gökçe Keçeci, Beste Çetin and Mutlu Özcan

J. Clin. Med. 2024, 13(22), 6890; https://doi.org/10.3390/jcm13226890 (registering DOI) - 15 Nov 2024

Abstract

Background: Trigeminal neuralgia (TN) is a disease that causes severe pain that can seriously affect the quality of life. This study aimed to compare the effectiveness of two different low-level laser therapies (LLLT) as alternatives to medical treatment to reduce pain and improve [...] Read more.

Background: Trigeminal neuralgia (TN) is a disease that causes severe pain that can seriously affect the quality of life. This study aimed to compare the effectiveness of two different low-level laser therapies (LLLT) as alternatives to medical treatment to reduce pain and improve the quality of life in patients with TN. Methods: A total of 45 patients were randomly divided into 3 groups. In the first group, a new-generation diode laser (GRR laser) was applied at predetermined points in the trigeminal nerve line. In the second group, a low-level neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was applied along the affected nerve line. The placebo group received the same protocol with a Nd:YAG laser without the device switched on. The scores were recorded pre- and post-treatment using the Brief Pain Inventory-Facial (BPI-facial) scale. Results: A statistically significant difference was found between the pre- and post-treatment values of all four variables in the GRR laser, Nd:YAG laser, and placebo groups. When the post-treatment values were compared, statistically significant differences were found between the groups in pain frequency, pain intensity, and interference in facial-specific activities, but no differences were found in general activities. Conclusions: Both LLLTs can be considered alternative treatment modalities for TN, but the GRR laser treatment was more effective than the Nd:YAG laser treatment in reducing pain and improving the quality of life in patients with TN. Full article

(This article belongs to the Topic Advances in Dental Health)

► Show Figures

Graphical abstract

21 pages, 549 KiB

Open AccessArticle

Understanding Surgeons’ Reluctance to Adopt Intraoperative Coronary Graft Verification Procedures: A Literature Review Combined to AI-Driven Insights Under Human Supervision

by Gabriele Di Giammarco, Federico Cammertoni, Nicola Testa and Massimo Massetti

J. Clin. Med. 2024, 13(22), 6889; https://doi.org/10.3390/jcm13226889 (registering DOI) - 15 Nov 2024

Abstract

Background: Intraoperative graft verification in coronary surgery is accepted worldwidand equally discussed. In spite of multiple sources of evidence published up to now in favor of clinical benefits following the use of the procedure, there is a persistent skepticism in adopting the available [...] Read more.

Background: Intraoperative graft verification in coronary surgery is accepted worldwidand equally discussed. In spite of multiple sources of evidence published up to now in favor of clinical benefits following the use of the procedure, there is a persistent skepticism in adopting the available technologies. The object of the present review is to analyze the reluctance of surgeons toward the adoption of assessment methods. Materials and Method: A thorough literature review was carried out on Google Scholar based on the results obtained from AI’s answer to the question about the reasons for that reluctance. We took advantage of using ChatGPT-4 since the research based on PubMed Central alone was not able to return a detailed response, maybe because the reasons for the reluctance are veiled in the text of the published papers. Through the items suggested by AI and taken from the literature, we deepened the research, pointing attention to the issues published so far about the various technologies. Results: There are many convincing pieces of evidence about the utility of intraoperative graft control in coronary surgery, involving improved clinical outcome, efficacy and safety, and social cost saving. The opinion that arose through this analysis is that, beyond the objective difficulties in utilizing some technologies and the equally objective limitations of an economic and organizational nature, the reluctance is the result of a real unwillingness based on the various implications that the discovery of the technical error entails. Conclusions: This negative attitude, in light of the convincing scientific and clinical evidence published up to now, appears to overwhelm the benefits for patients. Full article

(This article belongs to the Section General Surgery)

9 pages, 550 KiB

Open AccessArticle

Minimally Invasive Repair of Pectus Excavatum: A Lifeline to Quality of Life

by Mostafa Higaze, Mohamed Anwar Haj Khalaf, Chirag Parjiea and Horia Sirbu

J. Clin. Med. 2024, 13(22), 6888; https://doi.org/10.3390/jcm13226888 (registering DOI) - 15 Nov 2024

Abstract

Background: Pectus excavatum, a deformity of the chest wall, can lead to significant emotional and social challenges, adversely affecting an individual’s overall well-being. While the Nuss procedure is a well-established treatment, this study evaluates the impact of a modified, minimally invasive approach [...] Read more.

Background: Pectus excavatum, a deformity of the chest wall, can lead to significant emotional and social challenges, adversely affecting an individual’s overall well-being. While the Nuss procedure is a well-established treatment, this study evaluates the impact of a modified, minimally invasive approach on patients’ quality of life. Methods: This retrospective study analyzed patients who underwent minimally invasive pectus excavatum repair (MIRPE) from 1 January 2010 to 31 January 2024. Collected data included demographics, operative details, and patient outcomes. Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire, administered preoperatively and at least four weeks post-surgery. Results: Two hundred thirty-four patients (195 male, mean age 20.5 ± 6 years) underwent MIRPE. Postoperative results showed statistically significant improvements in all dimensions of HRQoL (Physical Component Summary Score (PCS) p = 0.007; Mental Component Summary Score (MCS) p < 0.001). Importantly, postoperative HRQoL scores were not just improved but comparable to those of the general German population, providing reassurance and confidence in the effectiveness of MIRPE. Conclusions: This study demonstrates that MIRPE significantly enhances patients’ quality of life (HRQoL). The improvements observed post-surgery bring HRQoL to levels akin to healthy individuals in the German population. These findings underscore the profound positive impact of MIRPE on patients’ well-being, offering hope and optimism for the future of pectus excavatum treatment. Full article

(This article belongs to the Section General Surgery)

Journal Description

Journal of Clinical Medicine

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI