Journal of Clinical Medicine

25 pages, 2439 KiB

Open AccessReview

Sleep Disordered Breathing and Neurocognitive Disorders

by Ikechukwu Ogbu, Tushar Menon, Vipanpreet Chahil, Amrit Kahlon, Dakshinkumaar Devanand and Dinesh K. Kalra

J. Clin. Med. 2024, 13(17), 5001; https://doi.org/10.3390/jcm13175001 (registering DOI) - 23 Aug 2024

Abstract

Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure [...] Read more.

Sleep-disordered breathing (SDB), which includes conditions such as obstructive sleep apnea (OSA) and central sleep apnea (CSA), is an independent risk factor for cerebral small vessel disease (CSVD), stroke, heart failure, arrhythmias, and other cardiovascular disorders. The influence of OSA on brain structure and cognitive function has become an essential focus in the heart-brain axis, given its potential role in developing neurocognitive abnormalities. In this review, we found that OSA plays a significant role in the cardio-neural pathway that leads to the development of cerebral small vessel disease and neurocognitive decline. Although data is still limited on this topic, understanding the critical role of OSA in the heart-brain axis could lead to the utilization of imaging modalities to simultaneously identify early signs of pathology in both organ systems based on the known OSA-driven pathological pathways that result in a disease state in both the cardiovascular and cerebrovascular systems. This narrative review aims to summarize the current link between OSA and neurocognitive disorders, cardio-neural pathophysiology, and the treatment options available for patients with OSA-related neurocognitive disorders. Full article

(This article belongs to the Section Cardiovascular Medicine)

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13 pages, 740 KiB

Open AccessReview

Screening and Perioperative Management of Obesity Hypoventilation Syndrome

by Roop Kaw, Kara Dupuy-McCauley and Jean Wong

J. Clin. Med. 2024, 13(17), 5000; https://doi.org/10.3390/jcm13175000 (registering DOI) - 23 Aug 2024

Abstract

Obesity hypoventilation syndrome (OHS) can often be underdiagnosed or misdiagnosed and has been shown to pose significant risks in perioperative situations. Patients with OHS have a higher prevalence of baseline morbid conditions like hypertension, congestive heart failure (CHF), diabetes mellitus, atrial fibrillation, and [...] Read more.

Obesity hypoventilation syndrome (OHS) can often be underdiagnosed or misdiagnosed and has been shown to pose significant risks in perioperative situations. Patients with OHS have a higher prevalence of baseline morbid conditions like hypertension, congestive heart failure (CHF), diabetes mellitus, atrial fibrillation, and pulmonary hypertension (PH), which contribute to adverse postoperative outcomes. The potential challenges include difficult intubation and loss of airway, postoperative respiratory failure, worsening heart failure, pulmonary hypertensive crisis, and opioid-induced respiratory depression (OIRD). It is, therefore, important to screen all obese patients for obstructive sleep apnea (OSA) and OHS before elective surgical procedures. The aim of this review is to discuss the preoperative screening and evaluation and safe anesthetic and up-to-date ventilatory management of this complex group of patients. This review also intends to increase the awareness of OHS in the adult population among hospitalists, surgeons, and cardiologists who may find themselves taking care of these patients in complex multidisciplinary settings. Full article

(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)

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13 pages, 4809 KiB

Open AccessReview

The Use of 3D Printing in Fetal Surgery for Surgical Planning: A Scoping Review

by Aaron J. Fils, Julia Kasmirski, Oluwateniayo Okpaise, John M. Reynolds, Gabriele Tonni, Heron Werner and Rodrigo Ruano

J. Clin. Med. 2024, 13(17), 4999; https://doi.org/10.3390/jcm13174999 (registering DOI) - 23 Aug 2024

Abstract

Objectives: We sought to identify in which clinical scenarios 3D printed models are used to plan for fetal surgeries as well as the main purpose and the imaging method utilized for the models. In addition, we describe benefits and shortcomings of the [...] Read more.

Objectives: We sought to identify in which clinical scenarios 3D printed models are used to plan for fetal surgeries as well as the main purpose and the imaging method utilized for the models. In addition, we describe benefits and shortcomings of the models, as well as potential future improvements. Methods: In this scoping review, data were collected retrospectively from scientific databases (PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, and the Web of Science platform) and screened by title, abstract, and full text against strict criteria. The inclusion criteria required the study be performed on a live fetus and involve 3D models used for fetal surgery. The models must have been designed from diagnostic imaging modalities such as CT, MRI, or ultrasound. The articles considered include clinical trials, review articles, cohort studies, case series, case reports, and conference abstracts. Results: Of the initial 742 articles collected, six met the inclusion criteria. Spina bifida and EXIT procedures were the most frequent use cases that inspired surgeons to print models for surgical planning. The ability to view patient-specific anatomy in a 3D handheld model was often touted as providing a great benefit to the surgical team’s ability to anticipate intraoperative challenges. Conclusions: Three-dimensional printing models have been applied to plan for fetal surgeries, more specifically, for EXIT procedures and fetoscopic surgical repair of spina bifida. The potential benefits of 3D printing in fetal surgery are enormous. Full article

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

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11 pages, 4658 KiB

Open AccessArticle

A Preliminary Study of a Prototype Cryoablation Needle on Porcine Livers for Pancreatic Cancer Treatment

by Hyunjoon Son, Tae In Kim, Jonghyun Lee, Sung Yong Han, Dong Uk Kim, Daejin Kim and Gun-Ho Kim

J. Clin. Med. 2024, 13(17), 4998; https://doi.org/10.3390/jcm13174998 (registering DOI) - 23 Aug 2024

Abstract

Background and Aims: Despite its relatively low incidence rate compared to others, pancreatic cancer has a poor prognosis owing to its late detection and poor response to systemic chemotherapy. Because the effectiveness of chemotherapy is still restricted, the need for locoregional treatment is [...] Read more.

Background and Aims: Despite its relatively low incidence rate compared to others, pancreatic cancer has a poor prognosis owing to its late detection and poor response to systemic chemotherapy. Because the effectiveness of chemotherapy is still restricted, the need for locoregional treatment is increasing. Cryoablation is an effective and minimally invasive treatment for some cancers, but its efficiency in pancreatic cancer is limited. Despite recent reports about promising outcomes, the optimal method and conditions of treatment are not known. In this preliminary study, we aimed to develop a cryoablation needle which can control the ablated area considering application through endoscopic ultrasonography. Methods: Here, we used a novel cryoneedle cooling system which can adjust the ablation range based on a liquid carbon dioxide refrigerant. Applied to the livers of swine, the cryoablation needle rapidly reached −60 °C within 30 s and cryoablation was performed for approximately 240 s. Based on the distance and depth, we collected real-time temperature data during the procedure. To compare the extent of cell death over time, tissue samples were collected hourly from 3 to 6 h after the procedure. Results: Approximately 4–5 mm of tissue was ablated via cryoablation, and cell death progressed over time after cryoablation. Moreover, the ablated lesions could be regulated using an insulating agent on the needle. Conclusions: This preliminary study on a novel surgical cooling needle system compatible with endoscopic ultrasound for cryoablation-based pancreatic cancer treatment confirmed the efficacy of cryoablation and identified the conditions necessary to induce necrosis. Additionally, this study evaluated the effectiveness of the insulation component of the system in protecting normal cells and assessed the extent of necrosis over time after the procedure. Full article

(This article belongs to the Special Issue Advancements and Challenges in Managing Hepato-Pancreato-Biliary Cancers)

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21 pages, 822 KiB

Open AccessArticle

Automated Speech Analysis in Bipolar Disorder: The CALIBER Study Protocol and Preliminary Results

by Gerard Anmella, Michele De Prisco, Jeremiah B. Joyce, Claudia Valenzuela-Pascual, Ariadna Mas-Musons, Vincenzo Oliva, Giovanna Fico, George Chatzisofroniou, Sanjeev Mishra, Majd Al-Soleiti, Filippo Corponi, Anna Giménez-Palomo, Laura Montejo, Meritxell González-Campos, Dina Popovic, Isabella Pacchiarotti, Marc Valentí, Myriam Cavero, Lluc Colomer, Iria Grande, Antoni Benabarre, Cristian-Daniel Llach, Joaquim Raduà, Melvin McInnis, Diego Hidalgo-Mazzei, Mark A. Frye, Andrea Murru and Eduard Vieta Show full author list Hide full author list

J. Clin. Med. 2024, 13(17), 4997; https://doi.org/10.3390/jcm13174997 (registering DOI) - 23 Aug 2024

Abstract

Background: Bipolar disorder (BD) involves significant mood and energy shifts reflected in speech patterns. Detecting these patterns is crucial for diagnosis and monitoring, currently assessed subjectively. Advances in natural language processing offer opportunities to objectively analyze them. Aims: To (i) correlate [...] Read more.

Background: Bipolar disorder (BD) involves significant mood and energy shifts reflected in speech patterns. Detecting these patterns is crucial for diagnosis and monitoring, currently assessed subjectively. Advances in natural language processing offer opportunities to objectively analyze them. Aims: To (i) correlate speech features with manic-depressive symptom severity in BD, (ii) develop predictive models for diagnostic and treatment outcomes, and (iii) determine the most relevant speech features and tasks for these analyses. Methods: This naturalistic, observational study involved longitudinal audio recordings of BD patients at euthymia, during acute manic/depressive phases, and after-response. Patients participated in clinical evaluations, cognitive tasks, standard text readings, and storytelling. After automatic diarization and transcription, speech features, including acoustics, content, formal aspects, and emotionality, will be extracted. Statistical analyses will (i) correlate speech features with clinical scales, (ii) use lasso logistic regression to develop predictive models, and (iii) identify relevant speech features. Results: Audio recordings from 76 patients (24 manic, 21 depressed, 31 euthymic) were collected. The mean age was 46.0 ± 14.4 years, with 63.2% female. The mean YMRS score for manic patients was 22.9 ± 7.1, reducing to 5.3 ± 5.3 post-response. Depressed patients had a mean HDRS-17 score of 17.1 ± 4.4, decreasing to 3.3 ± 2.8 post-response. Euthymic patients had mean YMRS and HDRS-17 scores of 0.97 ± 1.4 and 3.9 ± 2.9, respectively. Following data pre-processing, including noise reduction and feature extraction, comprehensive statistical analyses will be conducted to explore correlations and develop predictive models. Conclusions: Automated speech analysis in BD could provide objective markers for psychopathological alterations, improving diagnosis, monitoring, and response prediction. This technology could identify subtle alterations, signaling early signs of relapse. Establishing standardized protocols is crucial for creating a global speech cohort, fostering collaboration, and advancing BD understanding. Full article

(This article belongs to the Special Issue Diagnosis and Management of Bipolar Disorder)

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16 pages, 3056 KiB

Open AccessArticle

Evaluating the Safety and Efficacy of a Novel Glaucoma Drainage Device in High-Risk Adult Glaucoma Patients: A One-Year Pilot Study

by Faisal Ahmed, Eduardo Normando, Syed Ahmed, Simrun Virdee and Ahmed Al-Nahrawy

J. Clin. Med. 2024, 13(17), 4996; https://doi.org/10.3390/jcm13174996 (registering DOI) - 23 Aug 2024

Abstract

Background: We report on the 12-month safety and efficacy outcomes of a new non-valved glaucoma drainage device, the eyePlate-300 (Rheon Medical, Lausanne, Switzerland), in managing refractory glaucoma. Methods: A retrospective review was conducted on consecutive patients over 18 who underwent glaucoma drainage device [...] Read more.

Background: We report on the 12-month safety and efficacy outcomes of a new non-valved glaucoma drainage device, the eyePlate-300 (Rheon Medical, Lausanne, Switzerland), in managing refractory glaucoma. Methods: A retrospective review was conducted on consecutive patients over 18 who underwent glaucoma drainage device (GDD) surgery with the eyePlate-300 after a single glaucoma consultation between February 2020 and April 2021, with at least 12 months of documented post-op follow-up. Results: A total of 16 eyes from 15 patients were included. Complete success was observed in 47% of patients and overall success in 83%. The mean IOP decreased from 31.5 mm Hg to 10.7 mm Hg (67% reduction from baseline), and the number of IOP-lowering drops was reduced from 3.1 to 0.7 at one year. The mean BCVA remained stable. No additional IOP-lowering surgeries were required, and no severe sight-threatening complications were noted. Conclusions: The initial one-year results suggest that the eyePlate could be a safe and effective device for reducing IOP in an ethnically diverse refractory glaucoma population. Further follow-up is necessary to determine the long-term safety and efficacy. Full article

(This article belongs to the Special Issue Clinical Advances in Glaucoma, 2nd Edition)

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35 pages, 958 KiB

Open AccessReview

Impact of Molecular Profiling on Therapy Management in Breast Cancer

by Flavia Ultimescu, Ariana Hudita, Daniela Elena Popa, Maria Olinca, Horatiu Alin Muresean, Mihail Ceausu, Diana Iuliana Stanciu, Octav Ginghina and Bianca Galateanu

J. Clin. Med. 2024, 13(17), 4995; https://doi.org/10.3390/jcm13174995 (registering DOI) - 23 Aug 2024

Abstract

Breast cancer (BC) remains the most prevalent cancer among women and the leading cause of cancer-related mortality worldwide. The heterogeneity of BC in terms of histopathological features, genetic polymorphisms, and response to therapies necessitates a personalized approach to treatment. This review focuses on [...] Read more.

Breast cancer (BC) remains the most prevalent cancer among women and the leading cause of cancer-related mortality worldwide. The heterogeneity of BC in terms of histopathological features, genetic polymorphisms, and response to therapies necessitates a personalized approach to treatment. This review focuses on the impact of molecular profiling on therapy management in breast cancer, emphasizing recent advancements in next-generation sequencing (NGS) and liquid biopsies. These technologies enable the identification of specific molecular subtypes and the detection of blood-based biomarkers such as circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and tumor-educated platelets (TEPs). The integration of molecular profiling with traditional clinical and pathological data allows for more tailored and effective treatment strategies, improving patient outcomes. This review also discusses the current challenges and prospects of implementing personalized cancer therapy, highlighting the potential of molecular profiling to revolutionize BC management through more precise prognostic and therapeutic interventions. Full article

(This article belongs to the Topic From Basic Research to a Clinical Perspective in Oncology)

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12 pages, 520 KiB

Open AccessViewpoint

The Impact of Infections in Patients Treated with Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma

by Abdullah Esmail, Jiaqiong Xu, Ethan A. Burns, Karen Abboud, Ali Sheikh, Godsfavour Umoru, Kelly Gee, Catherine Wiechmann, Yuqi Zhang and Maen Abdelrahim

J. Clin. Med. 2024, 13(17), 4994; https://doi.org/10.3390/jcm13174994 (registering DOI) - 23 Aug 2024

Abstract

Background: The therapeutic landscape of unresectable hepatocellular carcinoma (uHCC) continues to evolve. Atezolizumab, an anti-programmed cell death ligand 1 (PD-1) immune checkpoint inhibitor (ICI), in combination with bevacizumab, has substantially improved outcomes. This study aims to evaluate the incidence, risk factors, and [...] Read more.

Background: The therapeutic landscape of unresectable hepatocellular carcinoma (uHCC) continues to evolve. Atezolizumab, an anti-programmed cell death ligand 1 (PD-1) immune checkpoint inhibitor (ICI), in combination with bevacizumab, has substantially improved outcomes. This study aims to evaluate the incidence, risk factors, and outcomes in patients who develop infections while receiving atezolizumab and bevacizumab for uHCC. Methods: Patients who received atezolizumab and bevacizumab for uHCC at a single hospital network were included. Types and rates of infections were reported. Covariates compared among infected and non-infected cohorts included age, sex, race, comorbidities, Eastern Cooperative Oncology Group (ECOG) performance status, immunosuppressive use, chronic infections, number of cycles of ICIs given, antibiotic or antiviral therapies at ICI initiation, and line of therapy (first-line, second-line, greater than second-line). Results: Out of 810 evaluable patients, 34 uHCC patients were treated with atezolizumab plus bevacizumab. The mean ± SD age was 66.29 ± 9.39; 28 (82.35%) were males. There were 17 (50%) patients with reported infection, with bacterial infection occurring in 12 (70.59%) patients and COVID-19 in 4 (23.5%). Of the infected patients, eight (47.06%) had one infection, five (29.41%) had two infections, and two (11.76%) had three or more infections. Infected and non-infected patients received a median of 12 (IQR: 5–17) and 4 (IQR: 3–12) ICI cycles (p = 0.18), respectively. Infections did not negatively impact OS or PFS but resulted in treatment delays and discontinuation in 11 (64.71%) and 7 (41.18%) patients, respectively. At the last follow-up, 19 (55.88%) patients died, 9 (52.94%) in the non-infected group vs. 10 (58.82%) in the infected group (p = 1.0). Conclusions: While a broad array of infections occurred in 50% of the patients in this cohort, it did not negatively impact survival outcomes. However, it did impact morbidity, with more all-cause admissions and treatment delays. Full article

(This article belongs to the Section Oncology)

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15 pages, 1668 KiB

Open AccessArticle

Effect of Kinematic Chain Exercise Protocol on Throwing Performance and Shoulder Muscle Strength among University Shot Put Athletes—A Randomized Controlled Trial

by Vinod Kumar Kanakapura Chananke Gowda, Shenbaga Sundaram Subramanian, Riziq Allah Mustafa Gaowgzeh, Samira Ahmed Alsenany, Sally Mohammed Farghaly Abdelaliem, Amany Anwar Saeed Alabdullah and Alkhateeb M. Afnan

J. Clin. Med. 2024, 13(17), 4993; https://doi.org/10.3390/jcm13174993 (registering DOI) - 23 Aug 2024

Abstract

Background/Objectives: This study looks at how a kinematic chain exercise regimen that targets the lower, core, and upper body affects university shot put participants’ shoulder muscle strength and throwing efficiency. This study fills an apparent research void on shot put training approaches [...] Read more.

Background/Objectives: This study looks at how a kinematic chain exercise regimen that targets the lower, core, and upper body affects university shot put participants’ shoulder muscle strength and throwing efficiency. This study fills an apparent research void on shot put training approaches by presenting a comprehensive kinematic chain workout program. It was anticipated that this method would improve performance the most, considering the complex biomechanical requirements of the sport. Methods: Eighty athletes aged (19.87 ± 1.31 years), were assigned into two groups at random: experimental (n = 40) and control (n = 40). While the control group carried on with their usual training, the experimental group participated in an 8-week kinematic chain training program. Pre- and post-training evaluations were carried out to evaluate shot put-throwing ability, shoulder muscle strength, and participant satisfaction with the exercise regimen. Results: The analyses were performed to evaluate the between- and within-group effects in the 10-week intervention period using a two-way ANOVA. This study demonstrated that, when compared to the control group, the athletes in the kinematic chain program had significantly increased throwing distance (p = 0.01) and shoulder muscle strength (p = 0.01). Furthermore, there was a significant increase (p = 0.005) in the athletes’ satisfaction levels with the workout program among those in the experimental group. Conclusions: In shot put athletes, this study suggests that a kinematic chain-focused strategy can improve throwing performance and shoulder muscle strength. The findings suggest that incorporating kinematic chain workouts into shot put training programs could be beneficial. However, conclusions should be drawn with caution, and further research is necessary to confirm the effectiveness of kinematic chain-based approaches across various sports and to understand their broader implications in sports science. Full article

(This article belongs to the Section Sports Medicine)

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5 pages, 1031 KiB

Open AccessReply

Precision in Practice: Enhancing MI-E Therapy Evaluation for Improved Patient Outcomes, Excluding Speech and Swallowing. Reply to Allen, J. et al. Comment on “Chatwin et al. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J. Clin. Med. 2024, 13, 2643”

by Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck

J. Clin. Med. 2024, 13(17), 4992; https://doi.org/10.3390/jcm13174992 (registering DOI) - 23 Aug 2024

Abstract

We would like to thank Allen et al [...] Full article

(This article belongs to the Section Pulmonology)

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5 pages, 204 KiB

Open AccessComment

Comment on Chatwin et al. Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders. J. Clin. Med. 2024, 13, 2643

by Jodi Allen, Gemma Clunie, Helen Newman and Claire Slinger

J. Clin. Med. 2024, 13(17), 4991; https://doi.org/10.3390/jcm13174991 (registering DOI) - 23 Aug 2024

Abstract

We read with interest the paper published by Chatwin et al [...] Full article

(This article belongs to the Section Pulmonology)

12 pages, 1598 KiB

Open AccessArticle

Two-Decade Retrospective Analysis of Endogenous Endophthalmitis in Spain and Mexico: A Comprehensive Study

by Elia de Esteban Maciñeira, Manuel F. Bande, Jorge Ivan Soberanes-Pérez, Laura Paniagua, Maria F. Golzarri, Jans Fromow-Guerra, María José Blanco Teijeiro and Rosario Touriño Peralba

J. Clin. Med. 2024, 13(17), 4990; https://doi.org/10.3390/jcm13174990 (registering DOI) - 23 Aug 2024

Abstract

Objectives: The aim of this study was to investigate endogenous endophthalmitis (EE) in Spain and Mexico, focusing on microbial patterns, antibiotic resistance, infection sources, risk factors, and patient outcomes. Methods: Over 20 years, 705 endophthalmitis cases were reviewed, and we identified 78 cases [...] Read more.

Objectives: The aim of this study was to investigate endogenous endophthalmitis (EE) in Spain and Mexico, focusing on microbial patterns, antibiotic resistance, infection sources, risk factors, and patient outcomes. Methods: Over 20 years, 705 endophthalmitis cases were reviewed, and we identified 78 cases of EE in Santiago de Compostela, Spain, and Mexico City, Mexico. Microbial etiology, infection sources, antibiotic resistance, and treatment outcomes were compared between patients from Spain and Mexico. Results: Among the 78 EE cases, 47 (60.25%) were from Spain and primarily had bacterial infections (57.1%, mainly Staphylococcus and Streptococcus). In contrast, 31 cases (39.74%) were from Mexico and had a higher prevalence of fungal infections, particularly Candida (47.1%). Diabetes mellitus was a significant risk factor, and was more common in Mexico (61.3%) than in Spain (37.0%). The Spanish cohort exhibited notable antibiotic resistance, especially in Staphylococcus. Treatment typically involved systemic and intraocular antibiotics, with vitrectomy performed in 61.5% cases. Post-treatment, bacterial infections had higher success rates (approximately 50%) compared with fungal infections (approximately 30%). Evisceration was necessary in 9% cases, and the overall mortality rate was approximately 4.4%; it was slightly higher in Mexico than in Spain. Conclusions: The study highlights significant regional differences in EE between Spain and Mexico, particularly regarding microbial etiology and antibiotic resistance. The findings emphasize the need to adapt healthcare practices to specific regions to improve EE treatment outcomes, underscoring the importance of ongoing research and interregional collaboration to better understand and manage this complex condition. Full article

(This article belongs to the Special Issue Advancements and Challenges in Retina Surgery)

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13 pages, 1603 KiB

Open AccessArticle

Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses

by Dimitrios E. Magouliotis, Serge Sicouri, Massimo Baudo, Yoshiyuki Yamashita, Andrew Xanthopoulos, Arian Arjomandi Rad, Thanos Athanasiou and Basel Ramlawi

J. Clin. Med. 2024, 13(17), 4989; https://doi.org/10.3390/jcm13174989 (registering DOI) - 23 Aug 2024

Abstract

Abstract: Objective: We assessed the available literature regarding patients undergoing minimally invasive mitral valve surgery (MIMVS) with either transthoracic clamping (TTC) or endoaortic balloon occlusion (EABO). Methods: Original research studies that evaluated the perioperative outcomes of TTC versus EABO group were [...] Read more.

Abstract: Objective: We assessed the available literature regarding patients undergoing minimally invasive mitral valve surgery (MIMVS) with either transthoracic clamping (TTC) or endoaortic balloon occlusion (EABO). Methods: Original research studies that evaluated the perioperative outcomes of TTC versus EABO group were identified from 2000 to 2024. The incidence of all-cause mortality, cerebrovascular accidents (CVA), and aortic dissections were the primary endpoints. The cardiopulmonary bypass (CPB), cross-clamp, and ventilation time, along with the incidence of conversion to sternotomy, re-exploration, new-onset atrial fibrillation (AF), postoperative acute kidney injury (AKI), ICU stay, and LOS were the secondary endpoints. Subgroup analyses were performed regarding the EABO cannulation approach (femoral and aortic) and MIMVS approach (video-assisted and robotic-assisted). Sensitivity analyses were performed with the leave-one-out method and by including risk-adjusted populations. Results: Sixteen studies were included in both the qualitative and quantitative syntheses. After pooling data from 6335 patients, both groups demonstrated similar outcomes on all primary and secondary endpoints in the non-adjusted and adjusted total cohort analyses. These outcomes were further validated by the leave-one-out sensitivity analysis. In addition, the aortic cannulation EABO was associated with a lower cross-clamp time, followed by TTC and the femoral cannulation EABO approach. Furthermore, in the video-assisted subgroup analysis, the EABO approach was associated with a higher incidence of CVA, conversion to sternotomy, and longer ICU stay compared to the TTC group. Conclusions: The present meta-analysis indicates that both aortic occlusion techniques are safe and feasible in the context of MIMVS. A future well-designed randomized-control trial should further validate the current outcomes. Full article

(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: Volume II)

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13 pages, 1269 KiB

Open AccessArticle

Comparing Sarcopenia Definitions and Muscle Power Reduction: Associations with Health Outcomes in Spanish Community-Dwelling Older Adults

by Juan Diego Ruiz-Cárdenas, Juan José Rodríguez-Juan, María del Mar Martínez-García and Alessio Montemurro

J. Clin. Med. 2024, 13(17), 4988; https://doi.org/10.3390/jcm13174988 (registering DOI) - 23 Aug 2024

Abstract

Objectives: To analyze the associations between the different operational definitions of sarcopenia published in the last decade and reduced muscle power with a set of adverse health-related outcomes, such as comorbidities, depression, polypharmacy, self-perceived health, educational attainment, socioeconomic status, falls, and hospitalizations [...] Read more.

Objectives: To analyze the associations between the different operational definitions of sarcopenia published in the last decade and reduced muscle power with a set of adverse health-related outcomes, such as comorbidities, depression, polypharmacy, self-perceived health, educational attainment, socioeconomic status, falls, and hospitalizations in Spanish community-dwelling older adults. Methods: A total of 686 community-dwelling older adults (median age: 72; women: 59.2%; physically active: 84%) were included in this cross-sectional analysis (ClinicalTrials.gov: NCT05148351). Sarcopenia was assessed using the FNIH, EWGSOP2, AWGS, and SDOC algorithms. Reduced muscle power was defined as the lowest sex-specific tertile and measured during the rising phase of the sit-to-stand test using a validated mobile application. Unadjusted and adjusted logistic regressions by potential confounders were performed to identify the association between sarcopenia and reduced muscle power with health-related outcomes. Results: Sarcopenia prevalence was 3.4%, 3.8%, 12.4%, and 21.3% according to the SDOC, FNIH, EWGSOP2, and AWGS, respectively. Among these definitions, moderate and large associations with health-related outcomes were observed for EWGSOP2 and SDOC, respectively, but few associations were found for FNIH and AWGS criteria. Reduced muscle power was associated more frequently and moderately with health-related outcomes compared to sarcopenia definitions. These associations remained constant after adjusting for confounders. Conclusions: The prevalence and impact of sarcopenia varied depending on the definitions used. Among the sarcopenia definitions, the SDOC exhibited the strongest associations, while reduced muscle power was the variable most frequently associated with health-related outcomes compared to any of the four sarcopenia definitions in well-functioning and physically active community-dwelling older adults. Full article

(This article belongs to the Special Issue Risk Factors, Prevention and Management of Frailty and Sarcopenia in Elderly)

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16 pages, 985 KiB

Open AccessArticle

Xbox Kinect Sports vs. Nintendo Switch Sports and Their Effects on Body Composition and Physical Performance in Older Females: A Randomized Controlled Trial

by Jordan Hernandez-Martinez, Izham Cid-Calfucura, Tomás Herrera-Valenzuela, Nicole Fritz-Silva, Julio B. Mello, Joaquin Perez-Carcamo, Edgard Vásquez-Carrasco, Eugenio Merellano-Navarro, Braulio Henrique Magnani Branco and Pablo Valdés-Badilla

J. Clin. Med. 2024, 13(17), 4987; https://doi.org/10.3390/jcm13174987 (registering DOI) - 23 Aug 2024

Abstract

Background/Objectives: This study aimed to compare the effects of Xbox Kinect Sports (XKS) regarding Nintendo Switch Sports (NSS) and an inactive control group (CG) on body composition (body fat percentage, BFP; and fat-free mass) and physical performance (maximal isometric handgrip strength, MIHS; [...] Read more.

Background/Objectives: This study aimed to compare the effects of Xbox Kinect Sports (XKS) regarding Nintendo Switch Sports (NSS) and an inactive control group (CG) on body composition (body fat percentage, BFP; and fat-free mass) and physical performance (maximal isometric handgrip strength, MIHS; 30-s chair stand, 30-S; timed up-and-go, TUG; sit-and-reach; and 2-min step) in physically inactive older females. Methods: A randomized controlled trial study was conducted with three parallel groups: XKS (n = 13), NSS (n = 14), and CG (n = 16) considering three weekly 60-min sessions for 12 weeks with pre- and post-assessments. Results: A two-factor mixed analysis of variance (ANOVA) model with repeated measures was performed to measure the time × group effect. Multiple comparisons revealed significant differences in BFP (F_(2,18) = 6.12; p = 0.005; ηp² = 0.226, large effect), 30-S (F_(2,18) = 20.7; p = 0.000; ηp² = 0.496, large effect), TUG (F_(2,18) = 10.0; p = 0.000; ηp² = 0.323, large effect), sit-and-reach (F_(2,18) = 37.3; p = 0.000; ηp² = 0.640, large effect), and 2-min step (F_(2,18) = 9.85; p = 0.000; ηp² = 0.319, large effect) in favor of XKS regarding NSS and CG. The intragroup results only present in XKS a significant decrease in BFP (p = 0.02; d = 0.98) and significant improvements in the 30-S (p = 0.000; d = 1.88), TUG (p < 0.01; d = 2.00), sit-and-reach (p = 0.003; d = 2.58), and 2-min step (p = 0.004; d = 1.05). Conclusions: training using XKS significantly decreases BFP and improves 30-S, TUG, sit-and-reach, and 2-min step in physically inactive older females. Full article

(This article belongs to the Special Issue One Size Does Not Fit All: New Strategies to Improve Overall Health and Physical Activity Behavior in Vulnerable Populations)

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12 pages, 555 KiB

Open AccessArticle

Pharmacokinetics of Efmoroctocog alfa by Two-Compartment Model Highlights Hemophilia A Patients with Biphasic Decay, Long Mean Residence Time, and Beta Half-Life

by Massimo Morfini, Flora Peyvandi, Maria Elisa Mancuso, Emanuela Marchesini, Annarita Tagliaferri, Roberta Gualtierotti, Giancarlo Castaman, Berardino Pollio, Cristina Santoro, Luisa Banov, Mariasanta Napolitano, Paola Stefania Preti, Roberta Carlotta Santoro, Antonio Coppola, Silvia Linari, Elena Santagostino and Francesco Bernardi

J. Clin. Med. 2024, 13(17), 4986; https://doi.org/10.3390/jcm13174986 (registering DOI) - 23 Aug 2024

Abstract

Background/Objectives: A compartmental pharmacokinetics (PK) analysis of new extended half-life FVIII concentrates has never been performed in a large cohort of hemophilia patients. An improved PK analysis of individual outcomes may help to tailor hemophilia replacement treatment. Methods: PK outcomes after the infusion [...] Read more.

Background/Objectives: A compartmental pharmacokinetics (PK) analysis of new extended half-life FVIII concentrates has never been performed in a large cohort of hemophilia patients. An improved PK analysis of individual outcomes may help to tailor hemophilia replacement treatment. Methods: PK outcomes after the infusion of a standard single dose of Efmoroctocog alfa were collected from 173 patients with severe/moderately severe hemophilia A in 11 Italian hemophilia centers. Factor VIII clotting activity (FVIII:C) was measured by one-stage clotting assay (OSA) in all patients, and chromogenic substrate assay (CSA) in a subgroup (n = 52). Fifty patients underwent a comparative PK assessment with standard half-life (SHL) recombinant FVIII (rFVIII) products. Non-compartmental analysis (NCA), one compartment model (OCM), and TCM were used to analyze the decay curves of all patients, and one-way paired ANOVA to compare the PK outcomes. Results: All 173 PKs conformed to the NCA and OCM, but only 106 (61%) conformed to the TCM based on the biphasic features of their decay curves. According to the TCM, the Beta HL and MRT of rFVIIIFc were 20.42 ± 7.73 and 25.64 ± 7.61 h, respectively. ANOVA analysis of the outcomes from the three PK models showed significant differences in clearance, half-life (HL), and mean residence time (MRT) (p < 0.001 for all parameters). As anticipated, the HL and MRT of rFVIIIFc were longer than those of SHL rFVIII. Comparing OSA with CSA outcomes, Cmax resulted higher when measured by CSA (p = 0.05) and, according to TCM, Beta HL resulted longer when measured by OSA (p = 0.03). FVIII:C trough levels obtained with SHL concentrates were significantly lower than those obtained with rFVIIIFc at each post-infusion time point. Conclusions: In a large group of hemophilia A (HA) patients, three different PK models confirmed the improved pharmacokinetic (PK) characteristics of rFVIIIFc, compared with standard half-life rFVIII concentrates. The TCM only fits two-thirds of the PKs, highlighting their biphasic decay and a long Beta half-life. In these patients, the TCM would be preferable to properly evaluate individual PK features. Full article

(This article belongs to the Section Hematology)

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13 pages, 1818 KiB

Open AccessReview

Ranolazine Unveiled: Rediscovering an Old Solution in a New Light

by Giulia Azzurra De Santis, Tommaso De Ferrari, Francesca Parisi, Marco Franzino, Agustin Ezequiel Molinero, Alessandro Di Carlo, Lorenzo Pistelli, Giampaolo Vetta, Antonio Parlavecchio, Marco Torre, Matteo Parollo, Giacomo Mansi, Pietro Paolo Tamborrino, Antonio Canu, Gino Grifoni, Luca Segreti, Andrea Di Cori, Stefano Marco Viani and Giulio Zucchelli

J. Clin. Med. 2024, 13(17), 4985; https://doi.org/10.3390/jcm13174985 (registering DOI) - 23 Aug 2024

Abstract

Ranolazine is an anti-anginal medication that has demonstrated antiarrhythmic properties by inhibiting both late sodium and potassium currents. Studies have shown promising results for ranolazine in treating both atrial fibrillation and ventricular arrhythmias, particularly when used in combination with other medications. This review [...] Read more.

Ranolazine is an anti-anginal medication that has demonstrated antiarrhythmic properties by inhibiting both late sodium and potassium currents. Studies have shown promising results for ranolazine in treating both atrial fibrillation and ventricular arrhythmias, particularly when used in combination with other medications. This review explores ranolazine’s mechanisms of action and its potential role in cardiac arrhythmias treatment in light of previous clinical studies. Full article

(This article belongs to the Special Issue Novel Epidemiological Approaches in Clinical Pharmacology and Toxicology)

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8 pages, 534 KiB

Open AccessArticle

Similar Outcomes in Males and Females Undergoing Surgery for Infective Endocarditis

by Dror B. Leviner, Itay Schultz, Tom Friedman, Avishai Leizarowitz, Katia Orvin, Edward Itelman, Gil Bolotin and Erez Sharoni

J. Clin. Med. 2024, 13(17), 4984; https://doi.org/10.3390/jcm13174984 (registering DOI) - 23 Aug 2024

Abstract

Background: Sex-based differences in mortality have been previously observed in patients with surgically treated infective endocarditis. We sought to evaluate the risk factors leading to this difference. Methods: A retrospective cohort from three centers in Israel comprising 376 surgically treated patients, [...] Read more.

Background: Sex-based differences in mortality have been previously observed in patients with surgically treated infective endocarditis. We sought to evaluate the risk factors leading to this difference. Methods: A retrospective cohort from three centers in Israel comprising 376 surgically treated patients, comparing short- and long-term mortality rates and risk factors between female and male patients. Results: Compared to male patients, female patients had higher rates of hypertension (62% vs. 48%), higher rates of Gram-negative infections (20% vs. 11%), and more mitral valve replacement (55% vs. 42%). Diabetes and age were the most significant predictors for mortality and did not differ between female and male patients. In-hospital mortality rates did not differ between female and male patients (29% vs. 26%), and the difference in long-term mortality was not statistically significant (46% vs. 36% p = 0.088). Conclusions: No statistical difference was observed in short- and long-term mortality between female and male patients, most likely due to a lack of difference in the rates of important risk factors such as diabetes and age. Mortality rates decreased in the last 10 years, and a good prognosis is observed for patients surviving the initial 30 days after surgery. Full article

(This article belongs to the Special Issue Clinical Research and Treatment of Endocarditis)

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9 pages, 1128 KiB

Open AccessArticle

Liver Resection for Gastroenteropancreatic Neuroendocrine Tumors with Extrahepatic Disease

by Kelly M. Mahuron, Kristen E. Limbach, Matthew C. Hernandez, Philip H. G. Ituarte, Daneng Li, Jonathan Kessler and Gagandeep Singh

J. Clin. Med. 2024, 13(17), 4983; https://doi.org/10.3390/jcm13174983 (registering DOI) - 23 Aug 2024

Abstract

Background: Although survival outcomes for neuroendocrine liver metastases (NETLM) are improved with liver-direct therapies (LDT), including hepatic debulking and nonsurgical trans-arterial embolization, the benefit is less established in the setting of concurrent extrahepatic disease (EHD). We performed a population-based study to characterize [...] Read more.

Background: Although survival outcomes for neuroendocrine liver metastases (NETLM) are improved with liver-direct therapies (LDT), including hepatic debulking and nonsurgical trans-arterial embolization, the benefit is less established in the setting of concurrent extrahepatic disease (EHD). We performed a population-based study to characterize the rates of LDT being performed for NETLM with EHD patients and whether LDT is associated with survival outcomes. Methods: Patients with NETLM and EHD were identified using the California Cancer Registry database merged with data from the California Office of Statewide Health Planning and Development between 2000 and 2012. Demographics, clinical characteristics, and survival outcomes were analyzed for these patients with and without LDT. Results: 327 NETLM patients with EHD were identified. EHD sites included lung, peritoneum, bone, and brain. A total of 71 (22%) of these patients underwent LDT. Compared to NETLM with EHD patients who did not undergo LDT, patients who received LDT had longer median overall survival (27 vs. 16 months, p = 0.006). Within the LDT group, 23 patients underwent liver resection. Liver resection was associated with longer median overall survival compared to nonsurgical LDT (138 vs. 13 months, p < 0.001). Conclusions: LDT candidacy should be determined for patients on a case-by-case basis, but the presence of EHD should not preclude LDT with appropriate patient selection. Full article

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

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11 pages, 2916 KiB

Open AccessArticle

Fat Grafting and Prepectoral Prosthetic Reconstruction with Polyurethane-Covered Implants: Protective Role against Adjuvant Radiotherapy

by Liliana Barone Adesi, Federico Taraschi, Giulia Macrì, Lorenzo Scardina, Alba Di Leone, Gianluca Franceschini and Marzia Salgarello

J. Clin. Med. 2024, 13(17), 4982; https://doi.org/10.3390/jcm13174982 (registering DOI) - 23 Aug 2024

Abstract

Background/Objectives: Breast cancer treatment increasingly incorporates immediate prepectoral prosthetic reconstruction after conservative mastectomy, including nipple-sparing (NSMs) and skin-sparing mastectomies (SSMs). Although recent data from the literature show that postmastectomy radiotherapy (PMRT) after prepectoral reconstruction presents good clinical results, with reduction in capsular contracture [...] Read more.

Background/Objectives: Breast cancer treatment increasingly incorporates immediate prepectoral prosthetic reconstruction after conservative mastectomy, including nipple-sparing (NSMs) and skin-sparing mastectomies (SSMs). Although recent data from the literature show that postmastectomy radiotherapy (PMRT) after prepectoral reconstruction presents good clinical results, with reduction in capsular contracture and implant migration, compared to the traditional submuscular technique, these patients have higher rates of long-term complications when compared with nonradiated patients. This study evaluates the protective effects of autologous fat grafting to reduce long-term radiotherapy-induced complications in breast cancer patients submitted for prepectoral reconstruction with polyurethane-covered (PU) implants. Methods: A pilot study with two parallel cohorts of patients undergoing an NSM or SSM followed by PMRT was conducted. Patients were randomly assigned to either of the two groups to ensure homogeneity. One cohort underwent autologous fat grafting sessions, individually tailored based on periodic evaluations by the principal investigator (PI), M. Salgarello, at least six months after PMRT. The control group received standard clinical follow-ups without fat grafting. Inclusion criteria ensured participants were disease-free, non-smokers, and had a LENT-SOMA score within 2. Results: Preliminary findings indicate significant differences between the groups, with improved outcomes observed in patients undergoing tailored lipofilling. Specifically, these patients experienced a notable reduction in capsular contracture severity and reported higher satisfaction with the aesthetic results compared to the control group. Conclusions: Autologous fat grafting, customized per patient by the PI based on ongoing evaluations, appears to mitigate some adverse effects of radiotherapy in prepectoral breast reconstruction, suggesting a viable option for enhancing surgical outcomes in irradiated patients. Further research is needed to substantiate these findings and evaluate long-term benefits. Full article

(This article belongs to the Special Issue Breast Reconstruction: Clinical Updates and Perspectives)

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14 pages, 8401 KiB

Open AccessArticle

Distal Junctional Failure: A Feared Complication of Multilevel Posterior Spinal Fusions

by Soufiane Ghailane, Houssam Bouloussa, Manuel Fernandes Marques, Jean-Etienne Castelain, Vincent Challier, Matthieu Campana, Clément Jacquemin, Jean-Marc Vital and Olivier Gille

J. Clin. Med. 2024, 13(17), 4981; https://doi.org/10.3390/jcm13174981 (registering DOI) - 23 Aug 2024

Abstract

Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk [...] Read more.

Objectives: Distal junctional failure (DJF) is less commonly described than proximal junctional failure following posterior spinal fusion, and particularly adult spinal deformity (ASD) surgery. We describe a case series of patients with DJF, taking into account sagittal spinopelvic alignment, and suggest potential risk factors in light of the current literature. Methods: We performed a single-center, retrospective review of posterior spinal fusion patients with DJF who underwent subsequent revision surgery between June 2009 and January 2019. Demographics and surgical details were collected. Radiographical measurements included the following: preoperative and postoperative sagittal and coronal alignment for each index or revision surgery. The upper-instrumented vertebra (UIV), lower instrumented vertebra (LIV), and fusion length were recorded. Results: Nineteen cases (64.7 ± 13.5 years, 12 women, seven men) were included. The mean follow-up was 4.7 ± 2.4 years. The number of instrumented levels was 6.79 ± 2.97. Among the patients, 84.2% (n = 16) presented at least one known DJF risk factor. LIV was frequently L5 (n = 10) or S1 (n = 2). Six patients had an initial circumferential fusion at the distal end. Initial DJFs were vertebral fracture distal to the fusion (n = 5), screw pull-out (n = 9), spinal stenosis (n = 4), instability (n = 4), and one early DJK. The distal mechanical complications after a first revision included screw pull-out (n = 4), screw fracture (n = 3), non-union (n = 2), and an iatrogenic spondylolisthesis. Conclusions: In this case series, insufficient sagittal balance restoration, female gender, osteoporosis, L5 or S1 LIV in long constructs were associated with DJF. Restoring spinal balance and circumferentially fusing the base of constructs represent key steps to maintain correction and prevent revisions. Full article

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

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13 pages, 2401 KiB

Open AccessSystematic Review

Prevalence of Thrombocytopenia in Pregnant Women with COVID-19: A Systematic Review and Meta-Analysis

by María Teresa Murillo-Llorente, Ignacio Ventura, Francisco Tomás-Aguirre, Marta Defez-Martin, María Inmaculada Martín-Díaz, Sandra Atienza-Ramirez, Francisco Llorca-Colomer, Adalberto Asins-Cubells, María Ester Legidos-García and Marcelino Pérez-Bermejo

J. Clin. Med. 2024, 13(17), 4980; https://doi.org/10.3390/jcm13174980 (registering DOI) - 23 Aug 2024

Abstract

Background/Objectives: Although articles and reviews have been published on the effect of SARS-CoV-2 infection on pregnancy outcomes, they show mixed results with different hypotheses, and no work has focused specifically on the prevalence of thrombocytopenia. The objective of this systematic review and meta-analysis [...] Read more.

Background/Objectives: Although articles and reviews have been published on the effect of SARS-CoV-2 infection on pregnancy outcomes, they show mixed results with different hypotheses, and no work has focused specifically on the prevalence of thrombocytopenia. The objective of this systematic review and meta-analysis was to synthesize previous evidence and estimate the prevalence of thrombocytopenia in pregnant women with COVID-19. Methods: This systematic review was conducted according to the PRISMA-2020 and MOOSE guidelines. The Medline and Web of Science databases were searched in February 2024, and a meta-analysis of the overall prevalence of thrombocytopenia in pregnant women with COVID-19 was performed. The risk of bias was assessed using the Joanna Briggs Institute checklists. A leave-1-out sensitivity analysis was performed to test for disproportionate effect. Publication bias was assessed by visual inspection of funnel plots and Egger’s test. Results: A total of 23 studies met the inclusion criteria, of which 8 were included in the meta-analysis. There was significant (Q = 101.04) and substantial heterogeneity among the studies (I² = 93.07%). There were no quality-based exclusions from the review of eligible studies. The combined effect of the studies showed a prevalence of thrombocytopenia of 22.9% (95%CI 4.8–41.0%). Subgroup analysis revealed no statistically significant difference in the pooled prevalence of thrombocytopenia ([16.5%; 30.3%]; p = 0.375. Egger’s test for bias was not significant, indicating that smaller studies did not report larger estimates of prevalence (t = 1.01, p = 0.353). Moreover, no potential publication bias was found. Our results are consistent with those obtained in pregnant women without COVID-19 infection and extend those of previous reviews of the effect of COVID-19 infection on pregnancy outcomes. Conclusions: Infection during pregnancy does not seem to be an additional risk factor for platelet count, although monitoring platelet count in pregnant women with COVID-19 may be of great importance to determine possible therapeutic strategies, especially in emergency cases. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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12 pages, 574 KiB

Open AccessSystematic Review

Effectiveness of Artificial Intelligence Technologies in Cancer Treatment for Older Adults: A Systematic Review

by Doris C. Obimba, Charlene Esteva, Eurika N. Nzouatcham Tsicheu and Roger Wong

J. Clin. Med. 2024, 13(17), 4979; https://doi.org/10.3390/jcm13174979 (registering DOI) - 23 Aug 2024

Abstract

Background: Aging is a multifaceted process that may lead to an increased risk of developing cancer. Artificial intelligence (AI) applications in clinical cancer research may optimize cancer treatments, improve patient care, and minimize risks, prompting AI to receive high levels of attention in [...] Read more.

Background: Aging is a multifaceted process that may lead to an increased risk of developing cancer. Artificial intelligence (AI) applications in clinical cancer research may optimize cancer treatments, improve patient care, and minimize risks, prompting AI to receive high levels of attention in clinical medicine. This systematic review aims to synthesize current articles about the effectiveness of artificial intelligence in cancer treatments for older adults. Methods: We conducted a systematic review by searching CINAHL, PsycINFO, and MEDLINE via EBSCO. We also conducted forward and backward hand searching for a comprehensive search. Eligible studies included a study population of older adults (60 and older) with cancer, used AI technology to treat cancer, and were published in a peer-reviewed journal in English. This study was registered on PROSPERO (CRD42024529270). Results: This systematic review identified seven articles focusing on lung, breast, and gastrointestinal cancers. They were predominantly conducted in the USA (42.9%), with others from India, China, and Germany. The measures of overall and progression-free survival, local control, and treatment plan concordance suggested that AI interventions were equally or less effective than standard care in treating older adult cancer patients. Conclusions: Despite promising initial findings, the utility of AI technologies in cancer treatment for older adults remains in its early stages, as further developments are necessary to enhance accuracy, consistency, and reliability for broader clinical use. Full article

(This article belongs to the Section Oncology)

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15 pages, 9552 KiB

Open AccessArticle

Exploration of Choroidal Thinning Located Temporal to the Fovea: A Pilot Study

by Adèle Ehongo, Georgina Jawdat De Togme and Viviane De Maertelaer

J. Clin. Med. 2024, 13(17), 4978; https://doi.org/10.3390/jcm13174978 (registering DOI) - 23 Aug 2024

Abstract

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia [...] Read more.

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1–2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis^®-OCT, the area centered by the Bruch’s membrane opening–fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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13 pages, 3173 KiB

Open AccessArticle

Circulating Endothelin 1 but Not Transforming Growth Factor-β Levels Are Reduced after Pulmonary Endarterectomy in Subjects Affected by Chronic Thromboembolic Pulmonary Hypertension: A Prospective Cohort Study

by Pasquale Totaro, Claudio Tirelli, Mara De Amici, Fabrizio Grosjean, Giorgia Testa, Lucia Sacchi, Annalisa De Silvestri, Alessia Alloni, Eraldo Kushta, Riccardo Albertini, Teresa Rampino and Andrea Maria D’Armini

J. Clin. Med. 2024, 13(17), 4977; https://doi.org/10.3390/jcm13174977 (registering DOI) - 23 Aug 2024

Abstract

Background and objectives: Endothelin-1 (ET-1) and transforming growth factor-β (TGF-β) play a pivotal role in the pathophysiology and vascular remodeling of chronic thromboembolic pulmonary hypertension (CTEPH) which is an under-diagnosed complication of acute pulmonary embolism (PE). Currently, pulmonary endarterectomy (PEA) is still the [...] Read more.

Background and objectives: Endothelin-1 (ET-1) and transforming growth factor-β (TGF-β) play a pivotal role in the pathophysiology and vascular remodeling of chronic thromboembolic pulmonary hypertension (CTEPH) which is an under-diagnosed complication of acute pulmonary embolism (PE). Currently, pulmonary endarterectomy (PEA) is still the treatment of choice for selected patients suffering from CTEPH. The aim of this study was to evaluate the preoperative and postoperative circulating levels of ET-1 and TGF-β in subjects affected by CTEPH undergoing successful surgical treatment by PEA. Methods: The data from patients diagnosed with CTEPH who underwent PEA at the Foundation IRCCS Policlinico San Matteo Hospital (Pavia, Italy) were prospectively recorded in the Institutional database. Circulating ET-1 and TGF-β levels were assessed by an ELISA commercial kit before PEA, at 3 months and 1 year after PEA. The demographic data, preoperatory mean pulmonary arterial pressure (mPAP), cardiac output (CO), and pulmonary vascular resistance (PVR) were also recorded. Univariate and multivariate analyses were performed. Results: The analysis included 340 patients with complete ET-1 measurements and 206 patients with complete TGF-β measurements. ET-1 significantly decreased both at 3 months (p < 0.001) and at 1 year (p = 0.009) after PEA. On the other hand, preoperatory TGF-β levels did not significantly change after PEA. Furthermore, ET-1, but not TGF-β, was a good predictor for increased mPAP in multivariate analyses (p < 0.05). Conclusions: ET-1 but not TGF β was significantly modulated by PEA in subjects affected by CTEPH up to 1 year after surgery. The mechanisms leading to prolonged elevated circulating TGF-β levels and their clinical significance have to be further elucidated. Full article

(This article belongs to the Section Pulmonology)

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12 pages, 685 KiB

Open AccessArticle

Clinical and Hemodynamic Outcomes with Enalapril Orodispersible Minitablets in Young Children with Heart Failure Due to Congenital Heart Disease

by Maja Bijelic, Milan Djukic, Vladislav Vukomanovic, Vojislav Parezanovic, Milica Lazic, Andrija Pavlovic, Sasa Popovic, Miro Parezanovic, Igor Stefanovic, Stefan Djordjevic, Sanja Ninic, Sergej Prijic, Bojana Bozic Cvijan, Ida Jovanovic, Milica Bajcetic and LENA Study

J. Clin. Med. 2024, 13(17), 4976; https://doi.org/10.3390/jcm13174976 (registering DOI) - 23 Aug 2024

Abstract

Background: The angiotensin-converting enzyme inhibitor (ACEI) enalapril is often administered to infants and young children with heart failure (HF) in various dosing regimens and formulations not adapted for their age. Methods: This prospective, two-center, open-label 8-week study evaluated an age-appropriate formulation [...] Read more.

Background: The angiotensin-converting enzyme inhibitor (ACEI) enalapril is often administered to infants and young children with heart failure (HF) in various dosing regimens and formulations not adapted for their age. Methods: This prospective, two-center, open-label 8-week study evaluated an age-appropriate formulation of orodispersible minitablets (ODMTs) of enalapril (0.25 mg and 1 mg) in children aged 0 to 6 years with HF due to congenital heart disease. An age/weight-based dosing schedule was followed. Measures of echocardiographic parameters, blood pressure, heart rate, modified Ross score, and biochemistry were obtained over the 8-week period. The following two groups were assessed: ACEI-naïve and ACEI-pretreated patients. Results: In total, 53 children (age range of 0.05 to 4.8 years) were enrolled and 29 were ACEI-naïve. The average enalapril dose was 0.098 mg/kg (0.06–0.17 mg/kg) in the naïve group and 0.15 mg/kg (0.07–0.3 mg/kg) in pretreated patients. After 8 weeks, the modified Ross score and left ventricular diastolic dimension (LVD) z-score showed a significant decrease in both groups (p < 0.005). During 8 weeks follow-up, there were no difference in the z-scores for the systolic blood pressure (p = 0.071) or heart rate (p = 0.146). Conclusions: Pediatric patients treated with ODMTs of enalapril for 8 weeks had favorable improvements in LVD and HF symptoms. Full article

(This article belongs to the Section Clinical Pediatrics)

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11 pages, 3611 KiB

Open AccessReview

Patient-Tailored Therapy for Complex Aortic Arch Anatomy: An Evolving Research Field with Custom-Made Solutions

by Daniele Linardi, Jacopo Gardellini, Vincenzo Boschetti, Venanzio Di Nicola, Mariateresa Denora, Gino Puntel, Giovanni Puppini and Giovanni B. Luciani

J. Clin. Med. 2024, 13(17), 4975; https://doi.org/10.3390/jcm13174975 (registering DOI) - 23 Aug 2024

Abstract

The treatment of complex aortic pathologies requires specialized techniques and tailored approaches due to each patient’s unique anatomical and clinical challenges. The European Association for Cardiothoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) new guidelines identify the aorta as the body’s [...] Read more.

The treatment of complex aortic pathologies requires specialized techniques and tailored approaches due to each patient’s unique anatomical and clinical challenges. The European Association for Cardiothoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) new guidelines identify the aorta as the body’s 24th organ and reiterate that multidisciplinary aortic teams are recommended for shared decision-making to determine optimal treatment strategies. Patients treated for conditions such as aneurysms, dissections, intramural hematomas, or penetrating aortic ulcers may develop complex forms over time, necessitating careful follow-up and timely corrective actions. Endovascular solutions can be favorable for older patients with complex anatomies and multiple comorbidities. However, when endovascular treatment is not feasible, hybrid treatments or open surgery must be considered if the patient’s condition allows it. The risk–benefit ratio of each procedure must be carefully evaluated; choosing the best intervention or deciding not to intervene becomes a critical and challenging decision. At our Cardiac Surgery Center in Verona, a multidisciplinary team with over 20 years of experience in treating complex aortic arch pathologies extensively discussed different cases of complex aortic pathologies treated with endovascular, hybrid, or surgical approaches, emphasizing the importance of considering both anatomical and patient-specific characteristics. The decisions and treatments were often challenging, and unanimity was not always achieved, reflecting the complexity of finding the best solutions. Full article

(This article belongs to the Special Issue Recent Developments and Emerging Trends in Aortic Surgery)

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9 pages, 3908 KiB

Open AccessArticle

Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery

by Andrea Frosolini, Simone Benedetti, Lisa Catarzi, Olindo Massarelli, Paolo Gennaro and Guido Gabriele

J. Clin. Med. 2024, 13(17), 4974; https://doi.org/10.3390/jcm13174974 (registering DOI) - 23 Aug 2024

Abstract

Background: The surgical treatment of lymphedema has seen advancements in recent years, with supramicrosurgical lymphaticovenular anastomosis (sLVA) gaining global acceptance. The integration of 3D exoscopes into microsurgery offers potential ergonomic and educational benefits. However, systematic evaluation of their efficacy in sLVA remains limited. [...] Read more.

Background: The surgical treatment of lymphedema has seen advancements in recent years, with supramicrosurgical lymphaticovenular anastomosis (sLVA) gaining global acceptance. The integration of 3D exoscopes into microsurgery offers potential ergonomic and educational benefits. However, systematic evaluation of their efficacy in sLVA remains limited. Methods: A retrospective cross-sectional study was conducted comparing the use of 3D exoscopes to conventional operating microscopes (OM) in sLVA surgeries. Patient data from January 2019 to January 2024 were reviewed, with demographic, clinical, and surgical outcome variables analyzed. Ergonomic assessments were performed using Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA), while surgeon satisfaction was evaluated through the Microsurgical Intraoperative Satisfaction and Comfort questionnaire (MISCq). Results: An analysis of 25 patients (OM group: n = 14; exoscope group: n = 11) revealed no significant differences in age, sex, etiology, or surgical site between the two groups. Surgical time, number of incisions, and number of anastomoses showed nonsignificant variations between the OM and exoscope groups. Ergonomic assessments indicated potential benefits with exoscope use, particularly for the assistant surgeon. Survey results demonstrated comparable levels of surgeon satisfaction with both instruments, with no significant differences in image quality, contrast, illumination, magnification, visual field, ergonomic maintenance, or stereoscopic orientation. Conclusions: The study suggests that 3D exoscopes are a valuable tool for sLVA supermicrosurgery, offering comparable outcomes to traditional microscopes with potential ergonomic advantages. Their integration into microsurgical practice may contribute to improved surgical comfort and team performance. Further research is warranted to confirm these findings and explore additional factors such as cost-effectiveness and long-term patient outcomes. Full article

(This article belongs to the Section General Surgery)

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13 pages, 1672 KiB

Open AccessPerspective

Severe Hypertension in Pregnancy: Progress Made and Future Directions for Patient Safety, Quality Improvement, and Implementation of a Patient Safety Bundle

by Alissa Prior, Isabel Taylor, Kelly S. Gibson and Christie Allen

J. Clin. Med. 2024, 13(17), 4973; https://doi.org/10.3390/jcm13174973 (registering DOI) - 23 Aug 2024

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Abstract

Hypertensive disorders of pregnancy account for approximately 5% of pregnancy-related deaths in the United States and are one of the leading causes of maternal morbidity. Focus on improving patient outcomes in the setting of hypertensive disorders of pregnancy has increased in recent years, [...] Read more.

Hypertensive disorders of pregnancy account for approximately 5% of pregnancy-related deaths in the United States and are one of the leading causes of maternal morbidity. Focus on improving patient outcomes in the setting of hypertensive disorders of pregnancy has increased in recent years, and quality improvement initiatives have been implemented across the United States. This paper discusses patient safety and quality initiatives for hypertensive disorders of pregnancy, with an emphasis on progress made and a patient safety tool: the Alliance for Innovation on Maternal Health’s Severe Hypertension in Pregnancy patient safety bundle. Future patient safety and quality directions for the treatment of hypertensive disorders of pregnancy will be reviewed. Full article

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

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14 pages, 1344 KiB

Open AccessArticle

Expanding Horizons in Cardiac Transplant: Efficacy and Outcomes of Circulatory and Brain Death Donor Hearts in a Newly Implemented Cardiac Transplant Program with Limited Donor Accessibility and a Literature Review

by Maria del Val Groba Marco, Miriam Cabrera Santana, Mario Galvan Ruiz, Miguel Fernandez de Sanmamed, Jose Luis Romero Lujan, Jesus Maria Gonzalez Martin, Luis Santana Ortega, María Vazquez Espinar, Francisco Portela Torron, Vicente Peña Morant, Eduardo Jose Caballero Dorta and Antonio Garcia Quintana

J. Clin. Med. 2024, 13(17), 4972; https://doi.org/10.3390/jcm13174972 (registering DOI) - 23 Aug 2024

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Abstract

(1) Background: Cardiac donation after circulatory death (DCD) is an emerging paradigm in organ transplantation. However, this technique is recent and has only been implemented by highly experienced centers. This study compares the characteristics and outcomes of thoraco-abdominal normothermic regional perfusion (TANRP) and [...] Read more.

(1) Background: Cardiac donation after circulatory death (DCD) is an emerging paradigm in organ transplantation. However, this technique is recent and has only been implemented by highly experienced centers. This study compares the characteristics and outcomes of thoraco-abdominal normothermic regional perfusion (TANRP) and static cold-storage DCD and traditional donation after brain death (DBD) cardiac transplants (CT) in a newly stablished transplant program with restricted donor availability. (2) Method: We performed a retrospective, single-center study of all adult patients who underwent a CT between November 2019 and December 2023, with a follow-up conducted until August 2024. Data were retrieved from medical records. A review of the current literature on DCD CT was conducted to provide a broader context for our findings. The primary outcome was survival at 6 months after transplantation. (3) Results: During the study period, 76 adults (median age 56 years [IQR: 50–63 years]) underwent CT, and 12 (16%) were DCD donors. DCD donors had a similar age (46 vs. 47 years, p = 0.727), were mostly male (92%), and one patient had left ventricular dysfunction during the intraoperative DCD process. There were no significant differences in recipients’ characteristics. Survival was similar in the DCD group compared to DBD at 6 months (100 vs. 94%) and 12 months post-CT survival (92% vs. 94%), p = 0.82. There was no primary graft dysfunction in the DCD group (9% in DBD, p = 0.581). The median total hospital stay was longer in the DCD group (46 vs. 21 days, p = 0.021). An increase of 150% in transplantation activity due to DCD was estimated. (4) Conclusions: In a new CT program that utilized older donors and included recipients with similar illnesses and comorbidities, comparable outcomes between DCD and DBD hearts were observed. DCD was rapidly incorporated into the transplant activity, demonstrating an expedited learning curve and significantly increasing the availability of donor hearts. Full article

(This article belongs to the Special Issue Surgery Updates of Heart Transplantation in Children and Adults)

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J. Clin. Med., Volume 13, Issue 17 (September-1 2024) – 33 articles

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