Medicina

12 pages, 1118 KiB

Open AccessArticle

Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty

by Răzvan Marian Melinte, Emil Marian Arbănași, Adrian Blesneac, Dan Nicolae Zolog, Réka Kaller, Adrian Vasile Mureșan, Eliza Mihaela Arbănași, Ioana Marta Melinte, Raluca Niculescu and Eliza Russu

Medicina 2022, 58(10), 1502; https://doi.org/10.3390/medicina58101502 - 21 Oct 2022

Cited by 32 | Viewed by 3946

Abstract

Background and objectives: Deep vein thrombosis (DVT) is one of the most serious post-operative complications in the case of total knee arthroplasty (TKA). This study aims to verify the predictive role of inflammatory biomarkers [monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio [...] Read more.

Background and objectives: Deep vein thrombosis (DVT) is one of the most serious post-operative complications in the case of total knee arthroplasty (TKA). This study aims to verify the predictive role of inflammatory biomarkers [monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI)] in acute DVT following TKA. Materials and methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with surgical indications for TKA, admitted to the Department of Orthopedics, Regina Maria Health Network, Targu Mures, Romania, and the Department of Orthopedics, Humanitas MedLife Hospital, Cluj-Napoca, Romania between January 2017 and July 2022. The primary endpoint was the risk of acute DVT following the TKA, and the secondary endpoint was the length of hospital stay, and the outcomes were stratified for the baseline’s optimal MLR, NLR, PLR, SII, SIRI, and AISI cut-off value. Results: DVT patients were associated with higher age (p = 0.01), higher incidence of cardiac disease [arterial hypertension (p = 0.02), atrial fibrillation (p = 0.01)], malignancy (p = 0.005), as well as risk factors [smoking (p = 0.03) and obesity (p = 0.02)]. Multivariate analysis showed a high baseline value for all hematological ratios: MLR (OR: 11.06; p < 0.001), NLR (OR: 10.15; p < 0.001), PLR (OR: 12.31; p < 0.001), SII (OR: 18.87; p < 0.001), SIRI (OR: 10.86; p < 0.001), and AISI (OR: 14.05; p < 0.001) was an independent predictor of DVT after TKA for all recruited patients. Moreover, age above 70 (OR: 2.96; p = 0.007), AH (OR: 2.93; p = 0.02), AF (OR: 2.71; p = 0.01), malignancy (OR: 3.98; p = 0.002), obesity (OR: 2.34; p = 0.04), and tobacco (OR: 2.30; p = 0.04) were all independent predictors of DVT risk. Conclusions: Higher pre-operative hematological ratios MLR, NLR, PLR, SII, SIRI, and AISI values determined before operations strongly predict acute DVT following TKA. Moreover, age over 70, malignancy, cardiovascular disease, and risk factors such as obesity and tobacco were predictive risk factors for acute DVT. Full article

(This article belongs to the Section Surgery)

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7 pages, 2004 KiB

Open AccessCase Report

High-Grade Endometrioid Stromal Sarcoma of the Ovary: Malignant Transformation of Ovarian Mature Cystic Teratoma

by Hyoeun Kim and Jong Chul Baek

Medicina 2022, 58(10), 1501; https://doi.org/10.3390/medicina58101501 - 21 Oct 2022

Cited by 5 | Viewed by 2142

Abstract

We report an extremely rare case of ovarian high-grade endometrioid stromal sarcoma arising from a mature cystic teratoma with clinicopathologic features, and then we briefly review the pertinent literature. A 62-year-old nulliparous woman presented with lower abdominal pain that had begun 6 months [...] Read more.

We report an extremely rare case of ovarian high-grade endometrioid stromal sarcoma arising from a mature cystic teratoma with clinicopathologic features, and then we briefly review the pertinent literature. A 62-year-old nulliparous woman presented with lower abdominal pain that had begun 6 months earlier. Magnetic resonance imaging showed two adnexal masses with fat components, which suggested that they were mature cystic teratomas. The eccentric thick rim of the left mass showed irregular invasion of the uterus, which was suggestive of malignancy. Positron emission tomography/computed tomography demonstrated high fluorodeoxyglucose uptake in the corresponding area. The patient underwent debulking cytoreductive surgery. The diagnosis was of an International Federation of Obstetrics and Gynecology stage IIIC high-grade endometrioid stromal sarcoma arising from a mature cystic teratoma. After surgery, the patient received adjuvant chemotherapy with three courses of doxorubicin regimen. The cancer recurred 3 months after surgery, and the patient died of progressive disease. It might be helpful for clinicians to be aware of this rare disease and the poor prognosis when it is at an advanced stage. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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(A) Axial contrast medium-enhanced computed tomography showed a fat-containing mass in each adnexa. The left-sided mass had an eccentric thick rim (white arrows). Axial T1-weighted (B) and contrast medium-enhanced T1-weighted (C) magnetic resonance images (MRIs) showed suppression of high signal intensity of the fat component of both adnexal masses, which suggested that these masses were mature cystic teratomas. The eccentric thick rim of the left-sided mass ((B), arrows) showed vivid enhancement. (D) Sagittal T2-weighted MRI showed irregular invasion of the uterus (arrows), which indicated malignant transformation. (E) Sagittal T2-weighted MRI showed normal signal intensity of the endometrium of the atrophied uterus. (F) Positron emission tomography/computed tomography demonstrated high fluorodeoxyglucose uptake (arrows) in the corresponding area of the left-sided mass. Full article ">Figure 2
(A) Hematoxylin and eosin (H&E) staining of one specimen revealed that it was a teratoma, which contained mesenchymal cells of adipose tissue and epithelial components of skin (squamous epithelium, hair, and glands). (Original magnification, ×40). (B) Section of hair (arrows) embedded in the cystic component. (H&E stain; magnification, ×40). Inset: high-power view of the hair section. (H&E stain; magnification, ×100). (C) Section of sarcomatous component. (H&E stain; magnification, ×40). Inset: high-power view of sarcomatous component. (H&E stain; magnification, ×100). (D) Spindle-shaped cell proliferation with stromal pattern. (H&E stain; original magnification, ×100). (E) The tumors were composed of oval- to spindle-shaped cells and showed moderate pleomorphism and occasional anaplastic change, with large nucleoli. Mitosis was also observed. (H&E stain; original magnification, ×200). (F) Immunohistochemical analysis revealed strong positivity for CD10. (Original magnification, ×100). Full article ">

13 pages, 333 KiB

Open AccessArticle

Headache in Post-COVID-19 Patients: Its Characteristics and Relationship with the Quality of Life

by Endang Mutiawati, Hendrix Indra Kusuma, Marhami Fahriani, Harapan Harapan, Syahrul Syahrul and Nasrul Musadir

Medicina 2022, 58(10), 1500; https://doi.org/10.3390/medicina58101500 - 21 Oct 2022

Cited by 10 | Viewed by 3415

Abstract

Little is known on the characteristics of headaches associated with coronavirus disease 2019 (COVID-19) in Indonesia. The objective of this study was to describe the characteristics of headache in post-COVID-19 patients, and its impact on the patients’ quality of life (QoL), as well [...] Read more.

Little is known on the characteristics of headaches associated with coronavirus disease 2019 (COVID-19) in Indonesia. The objective of this study was to describe the characteristics of headache in post-COVID-19 patients, and its impact on the patients’ quality of life (QoL), as well as to determine the associated determinants of the poor QoL. A cross-sectional study was conducted in Banda Aceh, Indonesia. The demographic characteristics, clinical symptoms of COVID-19, characteristics of headache, and the QoL were collected and assessed. Headache was diagnosed and characterized using the International Classification of Headache Disorders, version 3 (ICHD-3). QoL was assessed using a Short Form 36 Health Survey (SF-36) tool. A logistic regression model was used to investigate the associated determinants of poor QoL in post-COVID-19 patients. A total of 215 post-COVID-19 patients were included in the final analysis, and 21.4% (46/215) of them had a poor QoL due to headache following COVID-19. Those who were unemployed and who contracted COVID-19 less than three months prior to the study had higher odds of having poor QoL compared to those who were employed and who contracted COVID-19 more than three months prior to the study. Low QoL was also related to headache that occurred less than one month after recovering from COVID-19 (compared to that which occurred longer than one month after); had a high frequency; had a combination sensation of pulsating, pressing, fiery, and stabbing pain; had a high severity score; and had additional symptoms accompanying the headache. In conclusion, headache related to COVID-19 is associated with low QoL among post-COVID-19 patients. A guideline on prevention measures of headache on COVID-19 patients, therefore, needs to be established to avoid long-term consequences. Full article

(This article belongs to the Section Neurology)

14 pages, 1513 KiB

Open AccessSystematic Review

Evaluation of Blood Intercellular Adhesion Molecule-1 (ICAM-1) Level in Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

by Mohammad Moslem Imani, Masoud Sadeghi, Mohammad Amir Gholamipour, Annette Beatrix Brühl, Dena Sadeghi-Bahmani and Serge Brand

Medicina 2022, 58(10), 1499; https://doi.org/10.3390/medicina58101499 - 21 Oct 2022

Cited by 8 | Viewed by 3135

Abstract

Background and objective: Intercellular adhesion molecule-1 (ICAM-1) appears to be an active and important biomarker for decreasing the risk of cardiovascular issues among individuals with obstructive sleep apnea (OSA). Herein, a systematic review and meta-analysis was designed to probe whether plasma/serum ICAM-1levels [...] Read more.

Background and objective: Intercellular adhesion molecule-1 (ICAM-1) appears to be an active and important biomarker for decreasing the risk of cardiovascular issues among individuals with obstructive sleep apnea (OSA). Herein, a systematic review and meta-analysis was designed to probe whether plasma/serum ICAM-1levels are different in adults with OSA compared to adults with no OSA, as well as adults with severe OSA compared to adults with mild/moderate OSA. Materials and methods: A thorough and systematic literature search was performed in four databases (PubMed/Medline, Web of Science, Scopus, and Cochrane Library) until 17 July 2022, without any age and sample size restrictions to retrieve the relevant articles. The standardized mean difference (SMD) along with a 95% confidence interval (CI) of plasma/serum of ICAM-1 levels was reported. Analyses, including sensitivity analysis, subgroup analysis, trial sequential analysis, meta-regression, and a funnel plot analysis, were performed in the pooled analysis. Results: A total of 414 records were identified in the databases, and 17 articles including 22 studies were entered into the meta-analysis. The pooled SMD of serum/plasma ICAM-1 levels in adults with OSA compared to controls was 2.00 (95%CI: 1.41, 2.59; p < 0.00001). The pooled SMD of serum/plasma ICAM-1 levels in adults with severe compared to mild/moderate OSA was 3.62 (95%CI: 1.74, 5.51; p = 0.0002). Higher serum/plasma ICAM-1 levels were associated with a higher mean age of controls, higher scores for the apnea-hypopnea index, and with a lower mean age of adults with OSA and with smaller sample sizes. Conclusions: Th results of the present meta-analysis showed that serum/plasma ICAM-1 levels in adults with OSA was higher than serum/plasma ICAM-1 levels in controls. Similarly, serum/plasma ICAM-1 levels in adults with severe OSA were higher compared to serum/plasma ICAM-1 levels of adults with mild or moderate OSA. Therefore, ICAM-1 may be used as an additional diagnostic and therapeutic biomarker in adults with OSA. Full article

(This article belongs to the Section Pulmonology)

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15 pages, 563 KiB

Open AccessArticle

Sensitivities and Dependencies of BRAF Mutant Colorectal Cancer Cell Lines with or without PIK3CA Mutations for Discovery of Vulnerabilities with Therapeutic Potential

by Ioannis A. Voutsadakis

Medicina 2022, 58(10), 1498; https://doi.org/10.3390/medicina58101498 - 21 Oct 2022

Cited by 3 | Viewed by 2714

Abstract

Background: Colorectal cancer represents a common malignancy and remains incurable in the metastatic stage. Identification of molecular alterations that are present in colorectal cancer has led to the introduction of targeted therapies that improve outcomes. BRAF and PIK3CA mutations are observed in a [...] Read more.

Background: Colorectal cancer represents a common malignancy and remains incurable in the metastatic stage. Identification of molecular alterations that are present in colorectal cancer has led to the introduction of targeted therapies that improve outcomes. BRAF and PIK3CA mutations are observed in a subset of colorectal cancers. Colorectal cancers bearing BRAF mutations may be treated with specific BRAF inhibitors. These drugs benefit patients with BRAF mutant colorectal cancers but responses are rather brief, and progression is the rule. In contrast, no PI3K inhibitors have proven successful yet in the disease. Thus, new treatments to supplement the currently available drugs would be welcome to further improve survival. Methods: Profiled colorectal cancer cell lines from the Cancer Cell Line Encyclopedia (CCLE) were examined for BRAF and PIK3CA mutations and were interrogated for molecular characteristics and concomitant alterations that mirror clinical sample alterations. The Genomics of Drug Sensitivity in Cancer (GDSC) project was used for determination of drug sensitivities of BRAF mutated colorectal cell lines with or without concomitant PIK3CA mutations. The Cancer Dependency Map project served as the basis for identification of molecular dependencies and vulnerabilities in these cell lines. Results: CCLE includes 84 colorectal cancer cell lines, which recapitulate the molecular landscape of colorectal cancer. Of these, 23 and 24 cell lines possess BRAF and PIK3CA mutations, respectively. Seven BRAF mutant cell lines have V600E mutations and 14 PIK3CA mutant cell lines have hotspot helical or kinase domain mutations. V600E BRAF mutant cell lines with or without hotspot PIK3CA mutations are heterogeneous in their MSI status and mimic colorectal cancer tissues in other prevalent abnormalities including APC and TP53 mutations. Essential genes for survival include CTNNB1, WRN, and pyrimidine metabolism enzyme CAD. Besides BRAF mutations, BRAF inhibitor sensitivity in colorectal cancer cell lines is conferred by SACS mutations and PRKN locus loss. Conclusions: Colorectal cancer cell lines bearing the frequent BRAF and PIK3CA mutations present many alterations of the parental cancer tissue. Described vulnerabilities represent leads for therapeutic exploration in colorectal cancers with the corresponding alterations. Full article

(This article belongs to the Special Issue Therapeutic Landscapes in Colorectal Carcinoma)

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9 pages, 6220 KiB

Open AccessCase Report

Open Sciatic Nerve Decompression for Compartment Syndrome after Prolonged Lithotomy Position: A Case Report

by Se-Hwan Lee, Hong-Pil Hwang and Sun-Jung Yoon

Medicina 2022, 58(10), 1497; https://doi.org/10.3390/medicina58101497 - 21 Oct 2022

Cited by 1 | Viewed by 3021

Abstract

Background: Position-related compressive nerve injury is a frequently reported complication of the lithotomy position. In contrast, compartment syndrome-induced neuropathy after lithotomy with prolonged surgery is rare and prone to misdiagnosis. This case describes the successful open decompression of sciatic neuropathy due to compartment [...] Read more.

Background: Position-related compressive nerve injury is a frequently reported complication of the lithotomy position. In contrast, compartment syndrome-induced neuropathy after lithotomy with prolonged surgery is rare and prone to misdiagnosis. This case describes the successful open decompression of sciatic neuropathy due to compartment syndrome after a prolonged lithotomy position. Case presentation: A 56-year-old male patient complained of an abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left foot and toes after laparoscopic anterior hepatic sectionectomy for 16 h in a lithotomy position. Physical examination revealed severe pain and paresthesia below the distal left thigh. In manual muscle test grading, dorsiflexion and plantarflexion of the left ankle and toes were classified as grade 1. Computed tomography and magnetic resonance imaging showed ischemic changes in the mid-thigh posterior muscles, and the sciatic nerve was severely swollen at the distal thigh, which was compressed by the proximal edge of the well-leg holder. After debridement of the necrotic tissue and decompression of the sciatic nerve, the pain subsided immediately, and the ankle and toe dorsiflexion motor function improved to grade 4. Conclusions: Most case reports of compressive neuropathy associated with the lithotomy position have been related to conservative treatment. However, if a lesion compressing the nerve is confirmed in an imaging study and the correlation with the patient’s symptoms is evident, early surgical intervention can be an effective treatment method to minimize neurological deficits. Full article

(This article belongs to the Section Surgery)

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(a) 56-year-old male patient complained of abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left ankle and toe. (b). Scarring (black arrowhead) due to prolonged compression by the well-leg holder is observed at the mid-thigh level, and a mass-like lesion is palpated below the line. Full article ">Figure 1 Cont.
(a) 56-year-old male patient complained of abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left ankle and toe. (b). Scarring (black arrowhead) due to prolonged compression by the well-leg holder is observed at the mid-thigh level, and a mass-like lesion is palpated below the line. Full article ">Figure 2
Computed tomography (CT) scan with contrast reveals ischemic changes in the adductor magnus, biceps femoris long and short head, semimembranosus, and semitendinosus muscles from 25 cm below the femoral head (blue arrow) in coronal view(a) and axial view(b). Full article ">Figure 3
The T1-weighted magnetic resonance (MR) image (a) shows ischemic changes in the thigh posterior muscles, as in the previous CT scan. The sciatic nerve is severely swollen compared to the contralateral side, and the T2-weighted signal intensity (b) is increased (blue arrow). T1-weighted sagittal imaging (c) shows the length of the swollen sciatic nerve (green bracket). Full article ">Figure 3 Cont.
The T1-weighted magnetic resonance (MR) image (a) shows ischemic changes in the thigh posterior muscles, as in the previous CT scan. The sciatic nerve is severely swollen compared to the contralateral side, and the T2-weighted signal intensity (b) is increased (blue arrow). T1-weighted sagittal imaging (c) shows the length of the swollen sciatic nerve (green bracket). Full article ">Figure 3 Cont.
The T1-weighted magnetic resonance (MR) image (a) shows ischemic changes in the thigh posterior muscles, as in the previous CT scan. The sciatic nerve is severely swollen compared to the contralateral side, and the T2-weighted signal intensity (b) is increased (blue arrow). T1-weighted sagittal imaging (c) shows the length of the swollen sciatic nerve (green bracket). Full article ">Figure 4
The intraoperative gross photo shows a severely compressed lesion of the sciatic nerve (green bracket). BF: Biceps femoris. SM: Semimembranosus. ST: Semitendinosus. Full article ">

20 pages, 1407 KiB

Open AccessReview

Non-Transfusion-Dependent Thalassemia: A Panoramic Review

by Hwazen Shash

Medicina 2022, 58(10), 1496; https://doi.org/10.3390/medicina58101496 - 21 Oct 2022

Cited by 13 | Viewed by 5685

Abstract

Non-transfusion-dependent thalassemia (NTDT) has been considered less severe than its transfusion-dependent variants. The most common forms of NTDT include β-thalassemia intermedia, hemoglobin E/beta thalassemia, and hemoglobin H disease. Patients with NTDT develop several clinical complications, despite their regular transfusion independence. Ineffective erythropoiesis, iron [...] Read more.

Non-transfusion-dependent thalassemia (NTDT) has been considered less severe than its transfusion-dependent variants. The most common forms of NTDT include β-thalassemia intermedia, hemoglobin E/beta thalassemia, and hemoglobin H disease. Patients with NTDT develop several clinical complications, despite their regular transfusion independence. Ineffective erythropoiesis, iron overload, and hypercoagulability are pathophysiological factors that lead to morbidities in these patients. Therefore, an early and accurate diagnosis of NTDT is essential to ascertaining early interventions. Currently, several conventional management options are available, with guidelines suggested by the Thalassemia International Federation, and novel therapies are being developed in light of the advancement of the understanding of this disease. This review aimed to increase clinicians’ awareness of NTDT, from its basic medical definition and genetics to its pathophysiology. Specific complications to NTDT were reviewed, along with the risk factors for its development. The indications of different therapeutic options were outlined, and recent advancements were reviewed. Full article

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9 pages, 1031 KiB

Open AccessArticle

Adverse Reaction Profiles Related to Gastrointestinal Bleeding Events Associated with BCR-ABL Tyrosine Kinase Inhibitors

by Kei Kawada, Tomoaki Ishida, Kohei Jobu, Shumpei Morisawa, Naohisa Tamura, Shouhei Sugimoto, Masafumi Okazaki, Saburo Yoshioka and Mitsuhiko Miyamura

Medicina 2022, 58(10), 1495; https://doi.org/10.3390/medicina58101495 - 20 Oct 2022

Cited by 1 | Viewed by 2653

Abstract

Background and Objectives: The aim of this study is to investigate the characteristics of gastrointestinal bleeding events associated with BCR-ABL tyrosine kinase inhibitor (TKI) treatment, using the reporting odds ratio (ROR) of the adverse event reports submitted to the Japanese Adverse Drug [...] Read more.

Background and Objectives: The aim of this study is to investigate the characteristics of gastrointestinal bleeding events associated with BCR-ABL tyrosine kinase inhibitor (TKI) treatment, using the reporting odds ratio (ROR) of the adverse event reports submitted to the Japanese Adverse Drug Event Report database between 2004 and 2020, and to examine the number of reported TKI-related gastrointestinal bleeding cases according to sex and age, as well as the actual number of TKI prescriptions issued in Japan. Materials and Methods: The RORs and 95% confidence intervals (CIs) of gastrointestinal bleeding events related to TKIs were calculated using the data of the 595,121 included cases. Results: Significant gastrointestinal bleeding events were detected for dasatinib (crude ROR: 4.47, 95% CI: 3.77–5.28) and imatinib (crude ROR: 1.22, 95% CI: 1.01–1.46). In multiple logistic regression analyses, significant gastrointestinal bleeding events were detected for dasatinib (adjusted ROR: 8.02, 95% CI: 5.75–10.2), imatinib (adjusted ROR: 1.81, 95% CI: 1.2–2.72), age (≥60 years, adjusted ROR: 2.22, 95% CI: 2.1–2.36), reporting year (adjusted ROR: 1.04, 95% CI: 1.04–1.05), and male sex (adjusted ROR: 1.47, 95% CI: 1.37–1.57). Interaction analysis revealed that the association of gastrointestinal bleeding with dasatinib was affected by age (≥60 years) and sex (female), with the number and proportion of dasatinib-related gastrointestinal bleeding cases increasing among those aged ≥60 years. Conclusions: Specific TKIs and patient characteristics were associated with gastrointestinal bleeding. Our results aid the prompt identification and treatment of TKI-related gastrointestinal bleeding. Full article

(This article belongs to the Section Oncology)

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15 pages, 1403 KiB

Open AccessArticle

The Role of miR-375-3p, miR-210-3p and Let-7e-5p in the Pathological Response of Breast Cancer Patients to Neoadjuvant Therapy

by Lorena Alexandra Lisencu, Andrei Roman, Simona Visan, Eduard-Alexandru Bonci, Andrei Pașca, Emilia Grigorescu, Elena Mustea, Andrei Cismaru, Alexandru Irimie, Cosmin Lisencu, Loredana Balacescu, Ovidiu Balacescu and Oana Tudoran

Medicina 2022, 58(10), 1494; https://doi.org/10.3390/medicina58101494 - 20 Oct 2022

Cited by 6 | Viewed by 2417

Abstract

Background and Objectives: Prediction of response to therapy remains a continuing challenge in treating breast cancer, especially for identifying molecular tissue markers that best characterize resistant tumours. Microribonucleic acids (miRNA), known as master modulators of tumour phenotype, could be helpful candidates for predicting [...] Read more.

Background and Objectives: Prediction of response to therapy remains a continuing challenge in treating breast cancer, especially for identifying molecular tissue markers that best characterize resistant tumours. Microribonucleic acids (miRNA), known as master modulators of tumour phenotype, could be helpful candidates for predicting drug resistance. We aimed to assess the association of miR-375-3p, miR-210-3p and let-7e-5p in breast cancer tissues with pathological response to neoadjuvant therapy (NAT) and clinicopathological data. Material and methods: Sixty female patients diagnosed with invasive breast cancer at The Oncology Institute “Ion Chiricuță”, Cluj-Napoca, Romania (IOCN) were included in this study. Before patients received any treatment, fresh breast tissue biopsies were collected through core biopsy under echographic guidance and processed for total RNA extraction and miRNA quantification. The Cancer Genome Atlas Breast Invasive Carcinoma (TCGA-BRCA) database was used as an independent external validation cohort. Results: miR-375-3p expression was associated with more differentiated tumours, hormone receptor presence and lymphatic invasion. According to the Miller–Payne system, a higher miR-375-3p expression was calculated for patients that presented with intermediate versus (vs.) no pathological response. Higher miR-210-3p expression was associated with an improved response to NAT in both Miller–Payne and RCB evaluation systems. Several druggable mRNA targets were correlated with miR-375-3p and miR-210-3p expression, with upstream analysis using the IPA knowledge base revealing a list of possible chemical and biological targeting drugs. Regarding let-7e-5p, no significant association was noticed with any of the analysed clinicopathological data. Conclusions: Our results suggest that tumours with higher levels of miR-375-3p are more sensitive to neoadjuvant therapy compared to resistant tumours and that higher miR-210-3p expression in responsive tumours could indicate an excellent pathological response. Full article

(This article belongs to the Special Issue Advances in Cancer Therapy from Research to Clinical Practice—Surgical, Molecular or Systemic Management of Cancer)

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TCGA miR-375-3p, miR-210-3p, and let-7e-5p expression according to PAM50 classification (n = 470 luminal A, n = 162 luminal B, n = 38 normal-like, n = 159 basal-like, and n = 71 HER2-enriched). Kruskal–Wallis test was used for between-groups comparison and Dunn test for multiple comparisons (* p < 0.05, ** p < 0.01, **** p < 0.0001). FR values between groups of interest along with individual p-values obtained by Dunn test are reported in <a href="#app1-medicina-58-01494" class="html-app">Table S1</a>. Full article ">Figure 2
TCGA miR-375-3p, miR-210-3p, and let-7e-5p expression according to pathologic tumour stage (n = 158 stage I, n = 510 stage II, n = 210 stage III, and n = 17 stage IV). Kruskal–Wallis test was used for between-groups comparison and Dunn test for multiple comparisons (* p < 0.05, ** p < 0.01, *** p < 0.001). FR values between groups of interest along with individual p-values obtained by Dunn test are reported in <a href="#app1-medicina-58-01494" class="html-app">Table S1</a>. Full article ">Figure 3
TCGA miR-375-3p, miR-210-3p, and let-7e-5p expression according to vital status. Groups: D—dead, with tumour or with a new tumour event (n = 77); A—alive, tumour-free, without a new event tumour (n = 724). Mann–Whitney test was used for group comparison (* p < 0.05). Full article ">Figure 4
(A) miR-375-3p- and miR-210-3p-correlated validated mRNA targets in the TCGA cohort. Node fill colour was continuously mapped according to the correlation coefficient, (B) Drugs that target mRNA downstream genes. Full article ">

13 pages, 501 KiB

Open AccessArticle

Clinical Outcome, Socioeconomic Status and Psychological Constrains of Patients Undergoing Preimplantation Genetic Testing (PGT) in Northern Greece

by Antonios Patrikiou, Alexandra Papadopoulou, Christos Noutsos, Panagiotis Tzekis, Nikolaos Koios, Ioannis Kourempeles, George Anifandis, Antonia Sioga, Grigoris Grimbizis, Basil C. Tarlatzis and Katerina Chatzimeletiou

Medicina 2022, 58(10), 1493; https://doi.org/10.3390/medicina58101493 - 20 Oct 2022

Cited by 2 | Viewed by 2584

Abstract

Background and objectives: Preimplantation genetic testing (PGT) offers patients the possibility of having a healthy baby free of chromosomal or genetic disorders. The present study focuses on the application of PGT for patients located in Northern Greece, investigating their clinical outcomes, their [...] Read more.

Background and objectives: Preimplantation genetic testing (PGT) offers patients the possibility of having a healthy baby free of chromosomal or genetic disorders. The present study focuses on the application of PGT for patients located in Northern Greece, investigating their clinical outcomes, their motives, and their overall physical and emotional experience during the treatment, in association with their socioeconomic background. Materials and Methods: Couples who underwent PGT for a monogenic condition (PGT-M, n = 19 cycles) or aneuploidy (PGT-A, n = 22 cycles) participated in the study. Fertilization, implantation, and pregnancy rates were recorded for all cycles. The couples were asked to fill in a questionnaire about the consultation they had received prior to treatment, their sociodemographic information, and the psychological impact PGT had on both the female and male partner. Results: The fertilization, implantation, and ongoing pregnancy rates for the PGT-M and PGT-A cycles were 81.3%, 70.6%, and 52.9%, and 78.2%, 64.3%, and 57.1%, respectively. Females experienced more intense physical pain than their male partners while psychological pain was encountered by both partners and occasionally in higher instances in males. No typical socioeconomic background of the patients referred for PGT in Northern Greece was noticed. Conclusion: PGT is an attractive alternative to prenatal diagnosis (PND), aiming to establisha healthy pregnancy by identifying and avoiding the transfer of chromosomally or genetically abnormal embryos to the uterus. Although the benefits of PGT were well-received by all patients undergoing the procedure, psychological pain was evident and especially prominent in patients with a previous affected child or no normal embryos for transfer. Holistic counseling is of utmost importance in order to make patients’ experience during their journey to have a healthy baby less emotionally demanding and help them make the right choices for the future. Full article

(This article belongs to the Section Genetics and Molecular Medicine)

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5 pages, 427 KiB

Open AccessBrief Report

The Prevalence of Iron Deficiency in Atrial Fibrillation: Low Hanging Fruit?

by Bachar Alabdullah, David Ferreira, Erin Bourke, Harish Kamalanathan, Ibrahim Elashri, Kushal Porwal, Michael J. Tiller, Payal H. Gadre, Sarah Jones and Michael McGee

Medicina 2022, 58(10), 1492; https://doi.org/10.3390/medicina58101492 - 19 Oct 2022

Viewed by 5104

Abstract

Background and Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. The relationship between AF and iron deficiency is poorly understood. Materials and Methods: We conducted an observational study investigating the prevalence of iron deficiency in those with AF. [...] Read more.

Background and Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. The relationship between AF and iron deficiency is poorly understood. Materials and Methods: We conducted an observational study investigating the prevalence of iron deficiency in those with AF. Iron deficiency was defined by the American College of Cardiology (ACC) criteria for iron deficiency in heart failure. Results: Of 134 eligible subjects, 81 (60.4%) met the ACC definition of iron deficiency in heart failure. Those who were iron deficient were more likely to be female (OR 1.876, p = 0.005), have a history of diabetes mellitus (OR 3.085, p = 0.001) a history of stroke (OR 3.147, p = 0.016), and have higher CHA₂DS₂-VASc (p ≤ 0.0001) and Charlson Comorbidity Index scores (CCI) (p = 0.007). Conclusions: The prevalence of iron deficiency in those with AF appears high and warrants evaluation in a prospective study. Full article

(This article belongs to the Special Issue New Advances in Atrial Fibrillation)

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10 pages, 331 KiB

Open AccessArticle

Decreased Activity of Erythrocyte Catalase and Glutathione Peroxidase in Patients with Schizophrenia

by Vladimir V. Djordjević, Jelena Kostić, Žilijeta Krivokapić, Dane Krtinić, Milica Ranković, Milan Petković and Vladan Ćosić

Medicina 2022, 58(10), 1491; https://doi.org/10.3390/medicina58101491 - 19 Oct 2022

Cited by 9 | Viewed by 2561

Abstract

Background and Objectives: Catalase and glutathione peroxidase (GPx) are important antioxidant enzymes that break down hydrogen peroxide (H₂O₂) in order to control its intracellular concentration, thus enabling its physiological role and preventing toxic effects. A lack or disruption of [...] Read more.

Background and Objectives: Catalase and glutathione peroxidase (GPx) are important antioxidant enzymes that break down hydrogen peroxide (H₂O₂) in order to control its intracellular concentration, thus enabling its physiological role and preventing toxic effects. A lack or disruption of their function leads to the accumulation of hydrogen peroxide and the occurrence of oxidative stress. Accumulating studies have shown that the activities of key antioxidant enzymes are impaired in patients with schizophrenia. Since the published results are contradictory, and our previous studies found significantly higher erythrocyte superoxide dismutase (SOD) activity in patients with schizophrenia, the aim of this study was to determine the activity of enzymes that degrade hydrogen peroxide in the same group of patients, as well as to examine their dependence on clinical symptoms, therapy, and parameters associated with this disease. Materials and Methods: Catalase and GPx activities were determined in the erythrocytes of 68 inpatients with schizophrenia and 59 age- and gender-matched healthy controls. The clinical assessment of patients was performed by using the Positive and Negative Syndrome Scale (PANSS). The catalase activity was measured by the kinetic spectrophotometric method, while the GPx activity was determined by the commercially available Ransel test. Results: Erythrocyte catalase and GPx activities were significantly lower (p < 0.001 and p < 0.01, respectively) in subjects with schizophrenia than they were in healthy individuals. Lower catalase activity does not depend on heredity, disease onset, the number of episodes, or disease duration, while GPx activity showed significant changes in patients who had more than one episode and in those who had been suffering from the disease for over a year. Significantly lower catalase activity was noted in the PANSS(+/−) group in comparison with the PANSS(+) and PANSS(−) groups. The lowest catalase activity was found in subjects who were simultaneously treated with first- and second-generation antipsychotics; this was significantly lower than it was in those who received only one class of antipsychotics. Conclusion: These results indicate the presence of oxidative stress in the first years of clinically manifested schizophrenia and its dependence on the number of psychotic episodes, illness duration, predominant symptomatology, and antipsychotic medication. Full article

(This article belongs to the Section Psychiatry)

9 pages, 508 KiB

Open AccessArticle

Preoperative Fibrinogen-to-Albumin Ratio as Potential Predictor of Bladder Cancer: A Monocentric Retrospective Study

by Biagio Barone, Luigi Napolitano, Pasquale Reccia, Luigi De Luca, Simone Morra, Carmine Turco, Alberto Melchionna, Vincenzo Francesco Caputo, Luigi Cirillo, Giovanni Maria Fusco, Francesco Mastrangelo, Francesco Paolo Calace, Ugo Amicuzi, Vincenzo Morgera, Lorenzo Romano, Massimiliano Trivellato, Gennaro Mattiello, Enrico Sicignano, Francesco Passaro, Gianpiero Ferretti, Gaetano Giampaglia, Federico Capone, Celeste Manfredi and Felice Crocetto Show full author list Hide full author list

Medicina 2022, 58(10), 1490; https://doi.org/10.3390/medicina58101490 - 19 Oct 2022

Cited by 13 | Viewed by 2175

Abstract

Background and objective: Fibrinogen and albumin are two proteins widely used, singularly and in combination, in cancer patients as biomarkers of nutritional status, inflammation and disease prognosis. The aim of our study was to investigate the preoperative fibrinogen-to-albumin ratio (FAR) as a preoperative [...] Read more.

Background and objective: Fibrinogen and albumin are two proteins widely used, singularly and in combination, in cancer patients as biomarkers of nutritional status, inflammation and disease prognosis. The aim of our study was to investigate the preoperative fibrinogen-to-albumin ratio (FAR) as a preoperative predictor of malignancy as well as advanced grade in patients with bladder cancer. Materials and Methods: A retrospective analysis of patients who underwent TURBT at our institution between 2017 and 2021 was conducted. FAR was obtained from preoperative venous blood samples performed within 30 days from scheduled surgery and was analyzed in relation to histopathological reports, as was the presence of malignancy. Statistical analysis was performed using a Kruskal–Wallis Test, and univariate and multivariate logistic regression analysis, assuming p < 0.05 to be statistically significant. Results: A total of 510 patients were included in the study (81% male, 19% female), with a mean age of 71.66 ± 11.64 years. The mean FAR was significantly higher in patients with low-grade and high-grade bladder cancer, with values of 80.71 ± 23.15 and 84.93 ± 29.96, respectively, compared to patients without cancer (75.50 ± 24.81) (p = 0.006). Univariate regression analysis reported FAR to be irrelevant when considered as a continuous variable (OR = 1.013, 95% CI = 1.004–1.022; p = 0.004), while when considered as a categorical variable, utilizing a cut-off set at 76, OR was 2.062 (95% CI = 1.378–3.084; p < 0.0001). Nevertheless, the data were not confirmed in the multivariate analysis. Conclusions: Elevated preoperative FAR is a potential predictor of malignancy as well as advanced grade in patients with bladder cancer. Further data are required to suggest a promising role of the fibrinogen-to-albumin ratio as a diagnostic biomarker for bladder tumors. Full article

(This article belongs to the Special Issue Advances in Urologic Oncology Biology and Therapy)

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12 pages, 3789 KiB

Open AccessArticle

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

by Paulo Ottoni di Tullio, Vincenzo Giordano, William Dias Belangero, Robinson Esteves Pires, Felipe Serrão de Souza, Pedro José Labronici, Caio Zamboni, Felipe Malzac, Paulo Santoro Belangero, Roberto Yukio Ikemoto, Sergio Rowinski and Hilton Augusto Koch

Medicina 2022, 58(10), 1489; https://doi.org/10.3390/medicina58101489 - 19 Oct 2022

Cited by 2 | Viewed by 5633

Abstract

Background and Objectives: Proximal humerus fractures are the second most frequent site of avascular necrosis (AVN), occurring in up to 16% of cases. The Hertel criteria have been used as a reference for the prediction of humerus head ischemia. However, these are [...] Read more.

Background and Objectives: Proximal humerus fractures are the second most frequent site of avascular necrosis (AVN), occurring in up to 16% of cases. The Hertel criteria have been used as a reference for the prediction of humerus head ischemia. However, these are based solely on the use of radiographs, which can make interpretation extremely difficult due to several reasons, such as the overlapping fragments, severity of the injury, and noncompliant acute pain patients. The objectives of the study were to evaluate the role of computed tomography (CT) in the interpretation of the Hertel criteria and to evaluate the intra- and interobserver agreement of orthopedic surgeons, comparing their area of expertise. Materials and Methods: The radiographs and CT scans of 20 skeletally mature patients who had fractures of the proximal humerus were converted to jpeg and mov, respectively. All images were evaluated by eight orthopedic surgeons (four trauma surgeons and four shoulder surgeons) in two different occasions. The intra- and interobserver agreement was assessed by using the Kappa coefficient. The level of significance was 5%. Results: There was a weak-to-moderate intraobserver agreement (κ < 0.59) for all examiners. Only the medial metaphyseal hinge greater than 2 mm was identified by 87.5% of evaluators both in the radiographic and CT examinations in the two rounds of the study (p < 0.05). There was no significant interobserver agreement (κ < 0.19), as it occurred only in some moments of the second round of evaluation. Conclusions: The prognostic criteria for humeral head ischemia evaluated in this study showed weak intra- and interobserver agreement in both the radiographic and tomographic evaluation. CT did not help surgeons in the primary interpretation of Hertel prognostic criteria used in this study when compared to the radiographic examination. Full article

(This article belongs to the Special Issue Current Status and Future Directions of Bone Trauma Surgery)

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7 pages, 488 KiB

Open AccessArticle

Diabetes Mellitus as a Predictive Factor for Urinary Tract Infection for Patients Treated with Kidney Transplantation

by Kaori Ozawa, Manabu Takai, Tomoki Taniguchi, Makoto Kawase, Shinichi Takeuchi, Kota Kawase, Daiki Kato, Koji Iinuma, Keita Nakane and Takuya Koie

Medicina 2022, 58(10), 1488; https://doi.org/10.3390/medicina58101488 - 19 Oct 2022

Cited by 3 | Viewed by 2395

Abstract

Background and Objectives: We aimed to investigate the rate of incidence and risk factors of post-transplant urinary tract infection (UTI) in patients receiving kidney transplantation (KT) at our institution. Materials and Methods: A retrospective cohort study was carried out on patients [...] Read more.

Background and Objectives: We aimed to investigate the rate of incidence and risk factors of post-transplant urinary tract infection (UTI) in patients receiving kidney transplantation (KT) at our institution. Materials and Methods: A retrospective cohort study was carried out on patients who underwent KT for end-stage kidney disease (ESKD) from January 2008 to December 2021 at Gifu University Hospital. UTI was defined as the existence of bacterial and/or fungal infection in urine with ≥105 colony-forming units/mL, with or without urinary and/or systemic symptoms of UTI. Patients were divided into two groups: those with UTI after KT (UTI group) and those without UTI (non-UTI group). The primary endpoint of this study was the relationship between covariates and UTI after KT. Results: Two hundred and forty patients with ESKD received KT at Gifu University Hospital. Thirty-four participants developed UTI after surgery, and the most common pathogen was Escherichia coli. At the end of the follow-up, graft loss was observed in six patients (2.5%), independent of UTI episodes. In the multivariate analysis, diabetes mellitus (DM) was statistically associated with post-transplant UTI in kidney transplant recipients. Conclusions: Preoperative serum glucose control in patients with DM may have a crucial role in preventing UTI and preserving renal function after KT. Full article

(This article belongs to the Special Issue Kidney Transplantation—Clinical and Surgical Challenges II)

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9 pages, 329 KiB

Open AccessArticle

Clinical Evaluation of Short Tuberosity Implants among Type 2 Diabetic and Non-Diabetic Patients: A 5 Year Follow-Up

by Huda I. Tulbah, Abdulaziz Alsahhaf, Hamad S. AlRumaih, Fahim Vohra and Tariq Abduljabbar

Medicina 2022, 58(10), 1487; https://doi.org/10.3390/medicina58101487 - 19 Oct 2022

Cited by 2 | Viewed by 1888

Abstract

Aim: To assess clinical and radiographic parameters including bleeding on probing (BoP); probing depth (PD), plaque index (PI) and crestal bone loss (CBL) around short tuberosity implants (STI) supporting fixed partial dentures in patients with Type 2 diabetes mellitus (T2DM) and non-diabetics. Material [...] Read more.

Aim: To assess clinical and radiographic parameters including bleeding on probing (BoP); probing depth (PD), plaque index (PI) and crestal bone loss (CBL) around short tuberosity implants (STI) supporting fixed partial dentures in patients with Type 2 diabetes mellitus (T2DM) and non-diabetics. Material and Methods: Participants with T2DM and without T2DM with at least one STI (6 mm) posteriorly restored with a fixed partial denture splinting premolar implant were included. A questionnaire collected demographic details including gender, age, duration of diabetes, habits of brushing, the total number of dental implants and location, implant loading after placement, restoration type, and family history of DM. Clinical and radiographic assessment of peri-implant parameters, i.e., bleeding on probing (BoP), probing depth (PD), plaque index (PI), and crestal bone loss (CBL) was performed. The restorative success of STI was determined by no sensation of the foreign body, lack of pain and dysesthesia, lack of infection, no radiolucency around the implant, and no mobility. The Kruskal–Wallis test was used for statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: Twenty-five T2DM (19 males and 6 females) and 25 non-diabetic (18 males and 7 females) participants were included. The number of STIs in T2DM was 41, whereas in non-diabetic it was 38. At 1 year follow-up, mean PI% in T2DM participants was 18.9% (19.2–21.4%) and in non-diabetics it was 17.6% (16.3–18.5%). The mean PD was recorded in diabetics (1.3 ± 5.0 mm) and non-diabetics (1.1 ± 3.2 mm). The BoP value in diabetics was 44.9% (39.8–46.4%) and 28.2% in non-diabetics (17.2–24.6%). At 5 years of follow-up, the mean PI% range in T2DM participants was 26.18% (25.4–29.1%) and 24.42% in non-diabetic (20.1–25.5%). The mean PD in millimeters around STI in T2DM was observed to be 2.3 ± 4.8 mm and 1.4 ± 3.4 mm in non-diabetics. In addition, BoP in diabetic participants was 39.54% (27.7–42.1%) and 24.42% in non-diabetics (20.1–25.5%). A total of six STIs failed, i.e., two in the non-diabetic and four in the T2DM group. Conclusions: Patients with T2DM have poor periodontal (BoP, PD, CBL) and restorative peri-implant parameters around STIs when compared to healthy (non-diabetic) participants at five years of follow-up. For long-term stability, glycemic control is pivotal along with following good plaque control. Full article

9 pages, 282 KiB

Open AccessArticle

Safety and Feasibility of Single-Port Trans-Axillary Robotic Thyroidectomy: Experience through Consecutive 100 Cases

by Il Ku Kang, Joonseon Park, Ja Seong Bae, Jeong Soo Kim and Kwangsoon Kim

Medicina 2022, 58(10), 1486; https://doi.org/10.3390/medicina58101486 - 19 Oct 2022

Cited by 4 | Viewed by 1892

Abstract

Background and Objectives: Recently, the single-port (SP) robotic system was introduced for minimally invasive operative techniques. Thus, this study aimed to validate the safety and feasibility of SP trans-axillary robotic thyroidectomy (SP-TART) through experiences in a single tertiary institution. Materials and Methods: This [...] Read more.

Background and Objectives: Recently, the single-port (SP) robotic system was introduced for minimally invasive operative techniques. Thus, this study aimed to validate the safety and feasibility of SP trans-axillary robotic thyroidectomy (SP-TART) through experiences in a single tertiary institution. Materials and Methods: This study retrospectively analyzed 100 consecutive patients who underwent SP-TART from October 2021 to June 2022 in Seoul St. Mary’s Hospital in Seoul, Korea. We analyzed the clinicopathological characteristics and perioperative outcomes, including complications. Results: Less than total thyroidectomy (LTT) was performed in 81, total thyroidectomy (TT) in 16, and TT with modified radical neck dissection (mRND) in 3 patients. The mean operation time (min) was 53.3 ± 13.7, 86.3 ± 15.1, and 245.7 ± 36.7 in LTT, TT, and TT with mRND, respectively. The mean postoperative hospital stay was 2.0 ± 0.2, 2.1 ± 0.3, and 3.7 ± 1.5 days, respectively. A total of 84 cases of thyroid cancer were included, and 97.6% of them (82 cases) were papillary carcinoma and the rest were follicular and poorly differentiated carcinomas. Regarding complications, five cases had major complications, including three cases of vocal cord palsy and two cases of transient hypoparathyroidism. Conclusions: SP-TART is safe and feasible with a short operation time and a short length of hospital stay. Full article

(This article belongs to the Special Issue Recent Clinical and Basic Research on Endocrine Surgery)

8 pages, 676 KiB

Open AccessArticle

Perineal Massage during Pregnancy for the Prevention of Postpartum Urinary Incontinence: Controlled Clinical Trial

by María Álvarez-González, Raquel Leirós-Rodríguez, Lorena Álvarez-Barrio and Ana F. López-Rodríguez

Medicina 2022, 58(10), 1485; https://doi.org/10.3390/medicina58101485 - 19 Oct 2022

Cited by 2 | Viewed by 3629

Abstract

Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction [...] Read more.

Background and objectives: Urinary incontinence is any involuntary loss of urine. It may result in anxiety, depression, low self-esteem and social isolation. Perineal massage has spread as a prophylactic technique for treating complications during labor. Acknowledged effects of perineal massage are reduction of incidence and severity of perineal tear and use of equipment directly related to the intrapartum perineal trauma. The aim of this study was to determine the effectiveness of massage in urinary incontinence prevention and identification of possible differences in its form of application (self-massage or by a physiotherapist), with the previous assumption that it is effective and that there are differences between the different forms of application. Materials and Methods: A controlled clinical trial with a sample of 81 pregnant women was conducted. The participants were divided into three groups: a group that received the massage applied by a specialized physiotherapist, another group that applied the massage to themselves, and a control group that only received ordinary obstetric care. Results: No differences were identified in the incidence or severity of urinary incontinence among the three groups. The severity of the incontinence was only affected by the body mass index and the weight of the baby at the time of delivery. Conclusions: A relationship between perineal massage interventions and development of urinary incontinence has not been observed. Full article

(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)

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11 pages, 3305 KiB

Open AccessCase Report

Congenital Absence of the Portal Vein as a Rare Cause of Portopulmonary Hypertension—A Case Study Series

by Tereza Hlavata, Monika Kaldararova, Filip Klauco, Erika Drangova, Adriana Reptova and Iveta Simkova

Medicina 2022, 58(10), 1484; https://doi.org/10.3390/medicina58101484 - 19 Oct 2022

Cited by 2 | Viewed by 2884

Abstract

Background. Congenital absence of the portal vein (CAPV) is an extremely rare malformation that is caused by aberrant venous development during embryogenesis and is usually associated with congenital portosystemic shunts (CPSS). This hemodynamic allows mesenteric blood to bypass the liver metabolism and [...] Read more.

Background. Congenital absence of the portal vein (CAPV) is an extremely rare malformation that is caused by aberrant venous development during embryogenesis and is usually associated with congenital portosystemic shunts (CPSS). This hemodynamic allows mesenteric blood to bypass the liver metabolism and causes an imbalance between vasodilators and vasoconstrictors in the pulmonary circulation, which, again, might lead to the development of secondary portopulmonary hypertension (PoPH). Establishing the exact morphology of the splanchnic venous system is important when evaluating possible therapeutic options (differentiating type I and II CAPV), because some variants enable the closure of the shunt, and this represents a potential cure for pulmonary arterial hypertension (PAH). Once PoPH is diagnosed, complex care in a specialized expert centre is necessary. If possible, CPSS closure is recommended. For long-term successful patient management, specific targeted PAH therapy administration is crucial. Significant morbidity and mortality in these patients may result not only from PAH itself but also due to specific PoPH complications, such as compression of the left main coronary artery by pulmonary artery aneurysm. Case Report. We report on two patients with PoPH due to CAPV and CPSS (without any liver disease) who presented as severe PAH and who, before admission to our expert centre, were misdiagnosed as idiopathic PAH. The case reports also represent our experience with respect to the long-term follow-up and PAH-specific medical treatment of these patients, as well as the possible (even fatal) complications of these rare and complex patients. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Pulmonary Hypertension)

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9 pages, 1726 KiB

Open AccessArticle

Comparison of Hybrid Abdominal Flap versus Homodigital Neurovascular Island Flap for Fingertip Amputation

by Yung Hoon Kim, Tae Hyung Kim and Jun Ho Park

Medicina 2022, 58(10), 1483; https://doi.org/10.3390/medicina58101483 - 19 Oct 2022

Cited by 1 | Viewed by 2908

Abstract

Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable [...] Read more.

Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable option. The aim of this study is to evaluate the functional and aesthetic outcomes of the “hybrid abdominal flap”, which consists of a random-pattern abdominal skin flap and an autologous bone graft. A retrospective analysis was performed on fingertip amputation patients from March 2019 to April 2021. The patients were managed by either hybrid abdominal flaps (HAFs) or homodigital neurovascular island flaps (HNIFs). The functional and aesthetic outcomes were assessed three months after the operations. In this study, a total of 20 fingers were treated with either HAFs or HNIFs. There was a significant difference in the range of motion (ROM) and the scar quality between the two groups. All of the flaps survived without flap necrosis, and non-union of the bone was not observed. The patients were satisfied with the appearance and function of their fingers, including the ROM and sensory aspects. Our novel HAF is a functionally and aesthetically valid option for fingertip amputations with crushed stumps. Full article

(This article belongs to the Section Surgery)

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Algorithm for hybrid abdominal flap. Full article ">Figure 2
(A) A 25-year-old man was injured in his right distal phalanx of the second and third finger. The second finger was amputated above the lunula, while the third finger was amputated below the lunula. (B) The crushed stump was in an ischemic state with a necrotic color change. (C) Preoperative X-ray finding. (D) Postoperative photographic finding 6 months after the operation (E) Postoperative X-ray finding. Full article ">Figure 3
(A) A 25-year-old man was injured on his right distal phalanx of the second and third finger. The second finger was amputated above the lunula, while the third finger was amputated below the lunula. (B) The crushed stump was in an ischemic state with a necrotic color change. (C) Preoperative X-ray finding. (D) Postoperative photographic finding 6 months after the operation (E) Postoperative X-ray finding. Full article ">Figure 4
(A) A 50-year-old woman experienced a crush injury of the right fourth finger below the lunula. The stump was crushed without bony framework. (B) Preoperative X-ray finding. (C,D) The olecranon bone was harvested, and an autologous bone graft was performed with a k-wire. (E) Postoperative photographic finding 6 months after the operation (F) Postoperative X-ray finding. Full article ">Figure 5
(A) 51-year-old man experienced a crush injury to the right second finger above the lunula. (B) A 3.5 cm × 1.5 cm-sized homodigital neurovascular island flap was elevated and transposed to the defect. (C,D) Postoperative photographic findings 6 months after the operation. Full article ">

20 pages, 1040 KiB

Open AccessReview

Deep Margin Elevation: Current Concepts and Clinical Considerations: A Review

by Majed Aldakheel, Khalid Aldosary, Shatha Alnafissah, Rahaf Alaamer, Anwar Alqahtani and Nora Almuhtab

Medicina 2022, 58(10), 1482; https://doi.org/10.3390/medicina58101482 - 18 Oct 2022

Cited by 11 | Viewed by 13262

Abstract

Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently [...] Read more.

Dietschi and Spreafico first proposed deep margin elevation (DME) in 1998 to address the multiple clinical problems associated with sub-gingival margins, where sub-gingival margins will be repositioned coronally using composite resin restorations. Given that dentistry is directing towards conservatism, its use is currently trending. Materials and Methods: a search was performed through PubMed, Scopus, and Google Scholar search engines to obtain relevant articles with no time restriction. Results: With biological width taken into consideration, well-defined and polished sub-gingival restorations are compatible with periodontal health. Marginal integrity in the DME technique seems to be affected by the type of adhesive, restoration, and incremental layering of the restoration. Regarding fracture resistance, DME has no significant effects. Conclusion: The DME technique seems to be a minimally invasive alternative to surgical crown lengthening (SCL) and orthodontic extrusion (OE) with respect to biological width. Well-controlled clinical trials are limited in this field; further long-term follow-up studies emphasizing the periodontal outcomes and prevention of complications are needed. Full article

(This article belongs to the Section Dentistry and Oral Health)

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11 pages, 664 KiB

Open AccessArticle

Spinal Meningioma Surgery in Octogenarians: Functional Outcomes and Complications over a 2-Year Follow-Up Period

by Pavlina Lenga, Gelo Gülec, Awais Akbar Bajwa, Mohammed Issa, Karl Kiening, Basem Ishak and Andreas W. Unterberg

Medicina 2022, 58(10), 1481; https://doi.org/10.3390/medicina58101481 - 18 Oct 2022

Cited by 3 | Viewed by 2452

Abstract

Background and Objectives: Population aging in industrial nations has led to an increased prevalence of benign spinal tumors, such as spinal meningiomas (SMs), in the elderly. The leading symptom of SM is local pain, and the diagnosis is confirmed after acute neurological [...] Read more.

Background and Objectives: Population aging in industrial nations has led to an increased prevalence of benign spinal tumors, such as spinal meningiomas (SMs), in the elderly. The leading symptom of SM is local pain, and the diagnosis is confirmed after acute neurological decline. However, little is known about the optimal treatment for this frail patient group. Therefore, this study sought to assess the clinical outcome, morbidity, and mortality of octogenarians with SMs and progressive neurological decline undergoing surgery and to determine potential risk factors for complications. Materials and Methods: Electronic medical records dated between September 2005 and December 2020 from a single institution were retrieved. Data on patient demographics, neurological conditions, functional status, degree of disability, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Results: Thirty patients aged ≥80 years who were diagnosed with SMs underwent posterior decompression via laminectomy and microsurgical tumor resection. The patients presented with a poor baseline history (mean CCI 8.9 ± 1.6 points). Almost all SMs were located in the thoracic spine (n = 25; 83.3%). Progressive preoperative neurological decline was observed in 21/30 (n = 21; 70%) patients with McCormick Scores (mMCS) ≥3, and their mean motor score (MS) was 85.9 ± 12.3. in the in-hospital and 90-day mortality rates were 6.7% and 10.0%, respectively. The MS (93.6 ± 8.3) and mMCS (1.8 ± 0.9) improved significantly postoperatively (p < 0.05). The unique risk factor for complications was the severity of comorbidities. Conclusions: Decompressive laminectomy and tumor removal in octogenarians with progressive neurological decline improved patient functional outcomes at discharge. Surgery seems to be the “state of the art” treatment for symptomatic SMs in elderly patients, even those with poor preoperative clinical and neurologic conditions, whenever there is an acceptable risk from an anesthesiological point of view. Full article

(This article belongs to the Special Issue Spinal Tumors)

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13 pages, 7580 KiB

Open AccessArticle

Anti-CXCL8 Autoantibody: A Potential Diagnostic Biomarker for Esophageal Squamous Cell Carcinoma

by Huili Chen, Guiying Sun, Zhuo Han, Huimin Wang, Jiaxin Li, Hua Ye, Chunhua Song, Jianying Zhang and Peng Wang

Medicina 2022, 58(10), 1480; https://doi.org/10.3390/medicina58101480 - 18 Oct 2022

Cited by 2 | Viewed by 2689

Abstract

Background and Objectives: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignancies. Anti-tumor associated antigen autoantibodies (TAAbs) can be used as biomarkers for tumor detection. The aim of this study was to identify a reliable TAAb as the diagnostic [...] Read more.

Background and Objectives: Esophageal squamous cell carcinoma (ESCC) is one of the most common malignancies. Anti-tumor associated antigen autoantibodies (TAAbs) can be used as biomarkers for tumor detection. The aim of this study was to identify a reliable TAAb as the diagnostic marker for ESCC. Materials and Methods: The Cancer Genome Atlas (TCGA) database was used to screen candidate genes. The mRNA expression of the key gene was then verified by micro array dataset GSE44021 from the Gene Expression Omnibus (GEO) database and the diag nostic value of the corresponding autoantibody to the key gene in ESCC was detected by enzyme-linked im muno sorbent assay (ELISA). Results: CXCL8 was identified as the key gene. The dataset GSE44021 showed that CXCL8 mRNA expression was prominently over-expressed in ESCC tissues compared with normal tissues. ELISA results showed that the level of anti-CXCL8 autoantibody in ESCC patients was significantly higher than in normal controls and the receiver operating char ac teristic (ROC) curve indicated that anti-CXCL8 autoantibody could discriminate ESCC patients from normal controls, with the area under the ROC curve (AUC) for the verification cohort, and the validation cohort were 0.713 and 0.751, respectively. Conclusions: Our study illustrated that anti-CXCL8 autoantibody had good diagnostic value, and may become a candidate biomarker for ESCC. Full article

(This article belongs to the Section Oncology)

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Volcano plot of all DEGs obtained from TCGA database. DEGs were selected with |log FC| > 2 and p-value < 0.05. The up-regulated, down-regulated, and unchanged genes were shown in red, green, and grey, respectively. Full article ">Figure 2
Functional annotation and identification of hub genes via the PPI network. (A) Gene ontology enrichment analysis. BP, Biological Process; CC, Cellular Components; and MF, Molecular Function. (B) KEGG enrichment analysis. (C) PPI network of DEGs analyzed by STRING database. (D) Detection of hub genes from the PPI network of common DEGs. The highlighted 10 genes are CXCL8, MMP9, IL17A1, SPP1, KNG1, CXCL1, CXCL10, CRP, CSF2, and CCL20. Full article ">Figure 3
Validation of mRNA expression level of CXCL8 in the GEO database. The mRNA expression level of CXCL8 was up-regulated in ESCC tissues compared with normal tissues (p < 0.05). p value was calculated using the t-test. Full article ">Figure 4
The expression level and diagnostic value of anti-CXCL8 autoantibody. The expression level of anti-CXCL8 autoantibody in the verification cohort (A), validation cohort (C) and all ESCC and all NC (E). The diagnostic performance of anti-CXCL8 autoantibody in the verification cohort (B), validation cohort (D) and all ESCC and all NC (F). Full article ">Figure 5
The expression of anti-CXCL8 autoantibody among subgroups of ESCC patients based on gender (A,B), age (C,D), tumor site (E,F), family tumor history (G,H), differentiation (I,J), TNM stage (K,L), lymph node metastasis (M,N), and distant metastasis (O,P). Full article ">

10 pages, 3844 KiB

Open AccessArticle

Surgical and Radiological Differences in Intersphenoid Sinus Septation and the Prevalence of Onodi Cells with the Endoscopic Endonasal Transsphenoidal Approach

by Yun Jin Kang, Il Hwan Lee, Sung Won Kim and Do Hyun Kim

Medicina 2022, 58(10), 1479; https://doi.org/10.3390/medicina58101479 - 18 Oct 2022

Cited by 3 | Viewed by 2502

Abstract

Background and Objectives: Understanding the anatomical variation in the sphenoid sinus is important to fully expose the sellar floor and clivus. Materials and Methods: The Onodi cell and intersphenoid sinus septation based on preoperative paranasal sinus computed tomography (PNS CT) and [...] Read more.

Background and Objectives: Understanding the anatomical variation in the sphenoid sinus is important to fully expose the sellar floor and clivus. Materials and Methods: The Onodi cell and intersphenoid sinus septation based on preoperative paranasal sinus computed tomography (PNS CT) and the surgical records of 877 patients who underwent the endoscopic endonasal transsphenoidal approach (EETSA) were retrospectively reviewed. Results: An intersphenoid sinus septum (ISS) blocking the clivus was defined as a pseudoclivus. Complete and incomplete pseudoclivuses were found in 2.97% and 10.5% of patients, respectively. Intraoperative and PNS CT ISS findings differed in 17.1% of patients. Misconceptions regarding a ridge or vertical ISS and confusion between an incomplete pseudoclivus and a vertical ISS were common. Conclusions: Because intraoperative and PNS CT findings may differ, anatomical variation in the paraclival area should be evaluated carefully. A pseudoclivus mimicking the clivus is important to attain a fully exposed EETSA surgical view. Full article

(This article belongs to the Section Surgery)

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11 pages, 1438 KiB

Open AccessEditor’s ChoiceArticle

Salivary Exosomal MicroRNA-486-5p and MicroRNA-10b-5p in Oral and Oropharyngeal Squamous Cell Carcinoma

by Cosmin Ioan Faur, Rareș Călin Roman, Ancuța Jurj, Lajos Raduly, Oana Almășan, Horațiu Rotaru, Magdalena Chirilă, Mădălina Anca Moldovan, Mihaela Hedeșiu and Cristian Dinu

Medicina 2022, 58(10), 1478; https://doi.org/10.3390/medicina58101478 - 18 Oct 2022

Cited by 20 | Viewed by 4824

Abstract

Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and [...] Read more.

Background and Objectives: The research aimed at evaluating the capacity of salivary exosomal miR-10b-5p and miR-486-5p for oral and oropharyngeal cancer detection. Materials and Methods: The saliva samples were harvested from histopathological diagnosed oral and oropharyngeal squamous cell carcinoma patients and healthy volunteer subjects. The exosomes were isolated by differential ultracentrifugation and quantified by Nano Track Analysis. The microRNAs were extracted and quantified from salivary exosomes by quantitative Real-Time Polymerase Chain Reaction. Results: This research comprised fifty participants. When compared to healthy controls, salivary exosomal miR-486-5p was elevated and miR-10b-5p was reduced in oral and oropharyngeal squamous cell carcinoma. Moreover, miR-486-5p had a high expression level in stage II of cancer in comparison to the other cancer stages. The cancer samples presented an increased exosome dimension compared to the control samples. Conclusions: Salivary exosomal miR-10b-5p and miR-486-5p have an altered expression in oral and oropharyngeal cancer. Full article

(This article belongs to the Section Dentistry and Oral Health)

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Characterization of salivary-derived exosomes isolated from healthy and cancer groups through ultracentrifugation. (a) Size distribution profiles of exosomes were determined based on their Brownian motion using NanoSight. (b) The concentration of salivary-derived exosomes based on the particle concentration (particles × 107). Data were analyzed using Mann-Whitney-Wilcoxon rank sum test. The miRs identification and expression level. Full article ">Figure 2
Expression level of (a) miR-10b-5p (p = 0.0001) and (b) miR-486-5p (p = 0.0002) in TCGA head and neck SCC patients cohort and healthy control group. Full article ">Figure 3
The evaluation of microRNAs expression profile in cancer and healthy samples using RT-qPCR method; (a) Difference between the expression level of miR-10b-5p in cancer and control groups; (b) Difference between the expression level of miR-486-5p in cancer and control groups. The data were normalized to U6 and RNU48 using the ΔΔCT method. Data were analyzed using Mann-Whitney-Wilcoxon rank sum test and represented as Log of Fold Change. The miR-10b-5p expression level presented no difference between oral cavity cancer (1.38 (0.35, 1.75 LR fold changes) and oropharyngeal cancer (1.38 (0.35, 1.75) LR fold changes). The miR-486-5p expression levels were elevated in in oropharyngeal cancer (2.11 (1.90, 2.33) LR fold changes) compared to oral cavity cancer (1.44 (0.80, 4.48) LR fold changes). The results were not statistically significant. Full article ">Figure 4
Tumor grading classification using the expression level of miR-486-5p and miR-10b-5p. Data were analyzed using Mann-Whitney-Wilcoxon rank sum test and represented as Log of Fold Change. (G1 = well-differentiated; G2 = intermediate-differentiated; G3 = poorly differentiated) ROC curves were built to assess the discriminatory capacity of the two dysregulated miRNAs as possible biomarkers for OOC detection The ROC curves express the sensitivity and specificity for each miRNA, the AUC indicating the discrimination power of the biomarker (<a href="#medicina-58-01478-t003" class="html-table">Table 3</a>). The miR-486-5p and miR-10b-5p exhibited relative AUCs (standard error; 95% confidence interval; p values) of 0.72 (0.07; 0.57, 0.88; 0.01) and 0.59 (0.08; 0.43, 0.76; 0.26) for malignancy identification. The miR-486-5p had a higher AUC in oropharynx cancer detection compared with oral cavity cancer. Furthermore, compared to stages III and IV, the miR-486-5p exhibited a greater cancer detection AUC in stage II and has the highest AUC for G3 and non-keratinized SCC identification. The miR-10b-5p had the greatest AUC OOC detection in stage IV of the disease and oral cavity cancer sites. The G2 and non-keratinized SCC presented a higher AUC compared with the other histopathological type of the OOC. Full article ">

10 pages, 1219 KiB

Open AccessArticle

Relation between Mid-Regional Pro-Adrenomedullin in Patients with Chronic Heart Failure and the Dose of Diuretics in 2-Year Follow-Up—Data from FAR NHL Registry

by Monika Špinarová, Jindřich Špinar, Lenka Špinarová, Jan Krejčí, Monika Goldbergová-Pávková, Jiří Pařenica, Ondřej Ludka, Filip Málek, Petr Ošťádal, Klára Benešová, Jiří Jarkovský and Karel Lábr

Medicina 2022, 58(10), 1477; https://doi.org/10.3390/medicina58101477 - 18 Oct 2022

Cited by 5 | Viewed by 2066

Abstract

Background and Objectives: The aim of this paper is to evaluate the impact of humoral substance mid-regional pro-adrenomedullin (MR-proADM) on the two-year survival of patients with chronic heart failure and relate it to the dosage of furosemide. Materials and Methods: The [...] Read more.

Background and Objectives: The aim of this paper is to evaluate the impact of humoral substance mid-regional pro-adrenomedullin (MR-proADM) on the two-year survival of patients with chronic heart failure and relate it to the dosage of furosemide. Materials and Methods: The data is taken from the stable systolic heart failure (EF < 50%) FAR NHL registry (FARmacology and NeuroHumoraL activation). The primary endpoint at two-year follow-up was death, heart transplantation, or LVAD implantation. Results: A total of 1088 patients were enrolled in the FAR NHL registry; MR-proADM levels were available for 569 of them. The mean age was 65 years, and 81% were male. The aetiology of HF was ischemic heart disease in 53% and dilated cardiomyopathy in 41% of patients. The mean EF was 31 ± 9%. Statistically significant differences (p < 0.001) were obtained in several parameters: patients with higher MR-proADM levels were older, rated higher in NYHA class, suffered more often from lower limb oedema, and had more comorbidities such as hypertension, atrial fibrillation, diabetes, and renal impairment. MR-proADM level was related to furosemide dose. Patients taking higher doses of diuretics had higher MR-proADM levels. The mean MR-proADM level without furosemide (n = 122) was 0.62 (±0.55) nmol/L, with low dose (n = 113) 1–39 mg/day was 0.67 (±0.30) nmol/L, with mid dose (n = 202) 40–79 mg/day was 0.72 (±0.34) nmol/L, with high dose (n = 58) 80–119 mg/day was 0.85 (±0.40) nmol/L, and with maximum dose (n = 74) ≥120 mg/day was 1.07 (±0.76) nmol/L, p < 0.001. Patients with higher MR-proADM levels were more likely to achieve the primary endpoint at a two-year follow-up (p < 0.001) according to multivariant analysis. Conclusions: Elevated plasma MR-proADM levels in patients with chronic heart failure are associated with an increased risk of death and hospitalization. Higher MR-proADM levels in combination with increased use of loop diuretics reflect residual congestion and are associated with a higher risk of severe disease progression. Full article

(This article belongs to the Collection The Utility of Biomarkers in Disease Management Approach)

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13 pages, 1533 KiB

Open AccessArticle

Vascular Function Recovery Following Saturation Diving

by Jean-Pierre Imbert, Salih-Murat Egi and Costantino Balestra

Medicina 2022, 58(10), 1476; https://doi.org/10.3390/medicina58101476 - 17 Oct 2022

Cited by 6 | Viewed by 3600

Abstract

Background and Objectives: Saturation diving is a technique used in commercial diving. Decompression sickness (DCS) was the main concern of saturation safety, but procedures have evolved over the last 50 years and DCS has become a rare event. New needs have evolved [...] Read more.

Background and Objectives: Saturation diving is a technique used in commercial diving. Decompression sickness (DCS) was the main concern of saturation safety, but procedures have evolved over the last 50 years and DCS has become a rare event. New needs have evolved to evaluate the diving and decompression stress to improve the flexibility of the operations (minimum interval between dives, optimal oxygen levels, etc.). We monitored this stress in saturation divers during actual operations. Materials and Methods: The monitoring included the detection of vascular gas emboli (VGE) and the changes in the vascular function measured by flow mediated dilatation (FMD) after final decompression to surface. Monitoring was performed onboard a diving support vessel operating in the North Sea at typical storage depths of 120 and 136 msw. A total of 49 divers signed an informed consent form and participated to the study. Data were collected on divers at surface, before the saturation and during the 9 h following the end of the final decompression. Results: VGE were detected in three divers at very low levels (insignificant), confirming the improvements achieved on saturation decompression procedures. As expected, the FMD showed an impairment of vascular function immediately at the end of the saturation in all divers but the divers fully recovered from these vascular changes in the next 9 following hours, regardless of the initial decompression starting depth. Conclusion: These changes suggest an oxidative/inflammatory dimension to the diving/decompression stress during saturation that will require further monitoring investigations even if the vascular impairement is found to recover fast. Full article

(This article belongs to the Special Issue Hyperbaric Medicine)

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A typical saturation worksite. The divers are deployed from the diving support vessel inside a diving bell. Once on site, the bell’s door opens, and the divers lock out in the water using an umbilical attached to the bell to breathe and being supplied with hot water in their suit for thermal comfort. The working depth corresponds to the maximum depth reached by the divers. The working depth defines the chamber storage depth from excursion tables prepared in the company diving manual. The bell depth is usually set at 5 msw deeper than the storage depth to clear from subsea structures when opened. The “storage” and the “bell” are almost at the same pressure allowing for getting back to storage after work without decompression needed. The excursion of the diver out of the diving bell is limited to some meters not to add additional decompression time. The breathing gas is Heliox (Helium-Oxygen) to limit the density of the breathed gas (significant at such pressures) to reduce the work of breathing as well as Oxygen toxicity and Nitrogen narcosis. Full article ">Figure 2
Description of the saturation in the UK sector: depth profile (compression, storage depth, bell dives, decompression) and associated PO2 profile. Full article ">Figure 3
Experimental flowchart. Full article ">Figure 4
Bar graph illustrating FMD changes during the first 2 h (First 120 min.) (n = 23) and last 2 h (n = 29) (7–9 h) after saturation decompression (**** = p < 0.0001) (One sample t-test). (FMD Changes are presented compared to predive values represented by the dotted line at 100%). Full article ">Figure 5
FMD evolution after exiting saturation the linear solution has been selected as the best fit approach, and the dotted lateral bands represent the 95% prediction bands. Full article ">

17 pages, 647 KiB

Open AccessReview

An Update on the Current and Emerging Use of Thiazolidinediones for Type 2 Diabetes

by Rosaria Vincenza Giglio, Nikolaos Papanas, Ali Abbas Rizvi, Marcello Ciaccio, Angelo Maria Patti, Ioannis Ilias, Anca Pantea Stoian, Amirhossein Sahebkar, Andrej Janez and Manfredi Rizzo

Medicina 2022, 58(10), 1475; https://doi.org/10.3390/medicina58101475 - 17 Oct 2022

Cited by 24 | Viewed by 4287

Abstract

Guidelines have increasingly stressed the concept that adequate glycemic control is required to prevent or decrease the macro- and microvascular complications of type 2 diabetes mellitus (T2DM). PPAR-gamma agonists (“glitazones”) are no longer prioritized due to their effects on heart failure. However, the [...] Read more.

Guidelines have increasingly stressed the concept that adequate glycemic control is required to prevent or decrease the macro- and microvascular complications of type 2 diabetes mellitus (T2DM). PPAR-gamma agonists (“glitazones”) are no longer prioritized due to their effects on heart failure. However, the association between these drugs and innovative therapies could be a valuable tool to attenuate the risk factors of the metabolic syndrome. Glitazones are used for the treatment of diabetes and associated comorbidities. There is substantial scientific evidence demonstrating the effect of glitazones at a cardiometabolic level, as well as on hematological and neurological pathologies that point to their usefulness. The use of glitazones has always been controversial both for the type of patients who must take these drugs and for the side effects associated with them. Unfortunately, the recent guidelines do not include them among the preferred drugs for the treatment of hyperglycemia and rosiglitazone is out of the market in many countries due to an adverse cardiovascular risk profile. Even though real-life studies have proven otherwise, and their pleiotropic effects have been highlighted, they have been unable to achieve primacy in the choice of antihyperglycemic drugs. It would be appropriate to demonstrate the usefulness of pioglitazone and its therapeutic benefit with further cardiovascular safety studies. Full article

(This article belongs to the Special Issue Modern Management and Treatment of Diabetes—Celebrating the 100th Anniversary of the First Diabetic Patient Who Received Insulin)

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12 pages, 1334 KiB

Open AccessArticle

Functional Outcomes of Cochlear Implantation in Children with Bilateral Cochlear Nerve Aplasia

by Goun Choe, Young Seok Kim, Seung-Ha Oh, Sang-Yeon Lee and Jun Ho Lee

Medicina 2022, 58(10), 1474; https://doi.org/10.3390/medicina58101474 - 17 Oct 2022

Cited by 4 | Viewed by 2263

Abstract

Background and Objectives: Many otologists face a dilemma in the decision-making process of surgical management of patients with cochlear nerve (CN) aplasia. The goal of this study is to provide fresh evidence on cochlear implantation (CI) results in patients with CN aplasia. [...] Read more.

Background and Objectives: Many otologists face a dilemma in the decision-making process of surgical management of patients with cochlear nerve (CN) aplasia. The goal of this study is to provide fresh evidence on cochlear implantation (CI) results in patients with CN aplasia. Materials and Methods: We scrutinized functional outcomes in 37 ears of 21 children with bilateral CN aplasia who underwent unilateral or bilateral CI based on cross-sectional and longitudinal assessments. Results: The Categories of Auditory Performance (CAP) scores gradually improved throughout the 3-year follow-up; however, variable outcomes existed between individuals. Specifically, 90% of recipients with a 1-year postoperative CAP score ≤1 could not achieve a CAP score over 1 even at 3-year postoperative evaluation, while the recipients with a 1-year postoperative CAP score >1 had improved auditory performance, and 72.7% of them were able to achieve a CAP score of 4 or higher. Meanwhile, intraoperative electrically evoked compound action potential was not correlated with postoperative CAP score. Conclusions: Our results further refine previous studies on the clinical feasibility of CI as the first treatment modality to elicit favorable auditory performance in children with CN aplasia. However, special attention should be paid to pediatric patients with an early postoperative CAP score ≤1 for identification of unsuccessful cochlear implants and switching to auditory brainstem implants. Full article

(This article belongs to the Special Issue Etiology and Pathogenesis of Hearing Loss: From Diagnosis to Cure)

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Figure 1
Representative imaging of cochlear nerve aplasia. (A) nonvisible cochlear nerve on oblique sagittal view of internal auditory canal magnetic resonance imaging. (B) absence of bony cochlear narrow canal on temporal bone computed tomography. Full article ">Figure 2
Preoperative and postoperative CAP scores in pediatric cochlear implantees with bilateral cochlear nerve deficiency. p-values are presented on the comparing lines. *, statistical significance (by Wilcoxon signed-rank test). CAP, Category of Auditory Performance; Preop, preoperative; M, postoperative months. Full article ">Figure 3
Longitudinal changes in CAP scores according to CAP score at 1 year postoperation. Patients were subclassified into four groups based on CAP scores at 1 year postoperation and depicted individual postoperative auditory performance. CAP, Category of Auditory Performance; CI, cochlear implant; Preop, preoperative; M, postoperative months. Full article ">Figure 4
Correlation analyses between the intraoperative positive ECAP ratio and CAP scores at postoperative stages. No statistically significant correlations between intraoperative ECAP response rate and CAP scores at 1 (A), 2 (B) and 3 years (C) after surgery were illustrated (using Spearman’s correlation analysis). Group 1 consisted of participants with CAP scores of 0-1 at 1 year postoperation, and Group 2 consisted of participants with CAP scores ≥2 at 1 year postoperation. CAP, Category of Auditory Performance; ECAP, electrically evoked compound action potential. Full article ">

13 pages, 908 KiB

Open AccessArticle

Application Value of Systemic Inflammatory Indexes in the Clinical Evaluation of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF)

by Ruxin Wang, Juan Wu, Haowen Ye, Xiaofang Zhang and Lihong Wang

Medicina 2022, 58(10), 1473; https://doi.org/10.3390/medicina58101473 - 17 Oct 2022

Cited by 10 | Viewed by 2349

Abstract

Background: In areas where medical resources are scarce, an economical and convenient way to assess patients’ condition so that treatment plans can be adjusted in a timely manner makes sense. The clinical value of systemic inflammatory indexes (SII) such as neutrophil-to-lymphocyte ratio (NLR), [...] Read more.

Background: In areas where medical resources are scarce, an economical and convenient way to assess patients’ condition so that treatment plans can be adjusted in a timely manner makes sense. The clinical value of systemic inflammatory indexes (SII) such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), albumin-to-gamma-glutamyl-transferase ratio (AGR), white-blood-cell-count-to-mean-platelet-volume ratio (WMR), high-density-lipoprotein-cholesterol-to-C-reactive-protein ratio (HCR), etc. were explored in heart failure (HF) with preserved ejection fraction (HFpEF) because of their easy availability and clinical value in the diagnosis, therapy and prognosis of cardiovascular diseases. Methods: 189 inpatients (including 48 patients with New York Heart Association (NYHA) I in the control group, and 141 patients with NYHA II-IV in the study group) from The First Affiliated Hospital of Jinan University, during the period July 2018 to March 2022, were included by retrieving electronic medical records. Logistic regression analysis, Spearman’s correlation coefficient, operating characteristic curve, etc. were used to analyze the data. Results: In patients with HFpEF, LMR (OR = 0.463, 95% CI 0.348–0.617, p = 0.000), NLR and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were independent predictors for the presence of HF, and LMR (OR = 2.630, 95% CI 2.016–3.435, p = 0.000), NLR, FAG, MHR, AGR and NT-proBNP were independent predictors for increased NYHA functional classification. There were good correlations (r > 0.4) between LMR (r = −0.667, p = 0.000), NLR, WMR, HCR, NT-proBNP (r = −0.681, p = 0.000) and NYHA functional classification, and LMR (AUC = 0.803, 95% CI 0.729–0.849, p = 0.0001), NLR and NT-proBNP (AUC = 0.805, 95% CI 0.738–0.861, p = 0.0001) had good diagnostic values (AUC > 0.7) for HF in patients with HFpEF. In addition, there were certain correlations between LMR, NT-proBNP and echocardiography indicators of cardiac structural. Conclusions: SII have a potential application value in the clinical evaluation of patients with HFpEF in the follow-up, especially in areas with limited medical resources, as they are more convenient and cost effective. Among different SII, LMR is probably the most promising metric. However, large-scale clinical trials are needed in the future to confirm these findings. Full article

(This article belongs to the Section Cardiology)

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