Journal of Clinical Medicine

10 pages, 366 KiB

Open AccessArticle

Risk of Surgical Site Infection in Posterior Spine Surgery Using Different Closing Techniques: A Retrospective Study of Two Neurosurgical Centers

by Granit Molliqaj, Sara Lener, Michele Da Broi, Aria Nouri, Nalla Silva Baticam, Karl Schaller, Claudius Thomé, Pierre-Pascal Girod and Enrico Tessitore

J. Clin. Med. 2024, 13(24), 7675; https://doi.org/10.3390/jcm13247675 (registering DOI) - 16 Dec 2024

Abstract

: Objectives: To determine whether a closed dressing protocol reduces the surgical site infections (SSI) rate compared to conventional closing techniques. Methods: Patients who underwent lumbar spine surgery at two neurosurgical centers were retrospectively included from June 2015 to December 2019. [...] Read more.

: Objectives: To determine whether a closed dressing protocol reduces the surgical site infections (SSI) rate compared to conventional closing techniques. Methods: Patients who underwent lumbar spine surgery at two neurosurgical centers were retrospectively included from June 2015 to December 2019. Data on patients, general risk factors, and surgical risk factors for SSI were collected. Patients were subdivided into two groups: a Closed Protocol where the Dermabond^® ± Prineo^® dressing system was used, and a Conventional Protocol, namely sutures or staples. Statistical analysis was undertaken to compare the infection rates among the different closure techniques. Results: Altogether, 672 patients were included. In the whole cohort, 157 (23.36%) underwent skin closure with staples, 122 (18.15%) with sutures, 98 (14.58%) with intracutaneous sutures, 78 (11.61%) with Dermabond^®, and 217 (32.29%) with Demabond^®+ Prineo^®. The overall infection rate was 2.23% (n = 15). Skin suture had the highest infection rate (4.10%), while the lowest was Dermabond^® (1.28%) and Dermabond^®+ Prineo^® (1.4%), though the difference was not significant. Risk factors for SSI included higher BMI (29.46 kg/m² vs. 26.96 kg/m², p = 0.044), other sites infection (20.00% vs. 2.38%, p = 0.004), and a higher national nosocomial infections surveillance score (p = 0.003). Conclusions: This study showed that a closed protocol with the use of adhesive dressing with or without mesh had a slight tendency to lower infection rates compared to conventional protocol with sutures or staples, although no statistically significant difference was found between the closure techniques. Larger randomized studies are needed to investigate this potential benefit avoiding selection bias. Full article

(This article belongs to the Section Orthopedics)

15 pages, 1309 KiB

Open AccessCase Report

Is Whole-Body Cryostimulation Useful in Modulating Spasticity in Adults with Cerebral Palsy? A Case Study

by Paolo Piterà, Matteo Bigoni, Elisa Prina, Boris Barrera, Duru Ceren Yavuz, Federica Verme, Jacopo Maria Fontana, Lorenzo Priano, Alessandro Mauro and Paolo Capodaglio

J. Clin. Med. 2024, 13(24), 7674; https://doi.org/10.3390/jcm13247674 (registering DOI) - 16 Dec 2024

Abstract

Background: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by [...] Read more.

Background: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by motor impairments, including spasticity, which significantly impacts mobility and quality of life. The current treatments for spasticity often have limited efficacy and considerable side effects, making alternative therapies like WBC an area of interest. Methods: The patient underwent a 10-day inpatient rehabilitation program integrated with five WBC sessions at −110 °C for 2 min. The treatment effects were assessed immediately before and after the five WBC sessions using the Ashworth Scale, Fugl-Meyer Assessment, H-reflex test, and gait analysis. Psychosocial outcomes were measured with the SF-36, WHO-5, PSQI, ESS, and BDI questionnaires. Results: Immediately after the WBC cycle, gait analysis showed increased walking speed (0.48 to 0.61 m/s left; 0.49 to 0.57 m/s right) and step length (0.30 to 0.38 m left; 0.30 to 0.35 m right). The H/M ratio in the H-reflex test improved, indicating a better neuromuscular efficiency. Psychosocial assessments revealed a 42.5% reduction in pain and a 24% improvement in overall quality of life and well-being. Discussion and Conclusions: The objective improvements in gait parameters and neuromuscular modulation, along with the subjectively reported enhancements in functional abilities, highlight the potential of WBC as a valuable addition to rehabilitation strategies for this population. Further research is needed to confirm these findings and assess long-term outcomes. Full article

(This article belongs to the Special Issue Toward Improved Evaluation, Treatment, and Management of Movement Disorders and Cognitive Impairments in People with Cerebral Palsy)

20 pages, 592 KiB

Open AccessArticle

Effect of the COVID-19 Pandemic on the Management of Breast Cancer Patients

by Yasin Dalda, Sami Akbulut, Zeynep Kucukakcali, Zeki Ogut, Ozlem Dalda, Saadet Alan and Burak Isik

J. Clin. Med. 2024, 13(24), 7673; https://doi.org/10.3390/jcm13247673 (registering DOI) - 16 Dec 2024

Abstract

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, [...] Read more.

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom–Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients. Full article

(This article belongs to the Special Issue Challenges of General Surgery during the COVID-19 Pandemic)

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12 pages, 430 KiB

Open AccessArticle

The Etiology of Total Knee Arthroplasty Failure Influences on Improvement in Knee Function: A Follow-Up Study

by Sandy Weis, Lisa Seifert, Moritz Oltmanns, Farouk Khury, Ralf Bieger and Martin Faschingbauer

J. Clin. Med. 2024, 13(24), 7672; https://doi.org/10.3390/jcm13247672 (registering DOI) - 16 Dec 2024

Abstract

Background: Outcomes following total knee arthroplasty (TKA) revisions are variable, and it is hypothesized that the underlying cause of primary TKA failure impacts postoperative outcomes. This study analyzes the results of TKA revisions seven years after surgery, in relation to the etiology of [...] Read more.

Background: Outcomes following total knee arthroplasty (TKA) revisions are variable, and it is hypothesized that the underlying cause of primary TKA failure impacts postoperative outcomes. This study analyzes the results of TKA revisions seven years after surgery, in relation to the etiology of primary failure and other influencing factors. A previous study conducted in 2013 examined the same cohort of patients three months after revision surgery. Methods: From the original study, 97 patients were followed up, and 49 patients were eligible for inclusion. Patients were classified into four groups: “periprosthetic infection” (PPI), “aseptic loosening,” “instability,” and “arthrofibrosis.” Outcomes were analyzed using established scores (the Knee Society Score (KSS), New Knee Society Score (nKSS), and the Western Ontario and McMaster Universities (WOMAC) index) and considering factors such as age, gender, BMI, and ASA classification. The outcomes were analyzed using three time intervals: “Outcome Short” (preoperative to 3 months postoperative); “Outcome Long” (preoperative to 7 years postoperative); and “Delta PostOP” (3 months postoperative to 7 years postoperative). Results: Significant improvements were observed in all time intervals, especially in the “Outcome Short” (p < 0.001) and “Delta PostOP” (p < 0.001) periods. The “instability” and “aseptic loosening” groups showed better outcomes in terms of range of motion and knee scores than the “arthrofibrosis” and “infection” groups (p < 0.05). A lower BMI and an ASA status of II were associated with better outcomes (p < 0.05). Women also showed superior results in the nKSS (p < 0.05). Discussion: Patients with “aseptic loosening” and “instability” had the best long-term outcomes. Lower BMI and better ASA status also correlated with improved results. These findings can inform patients of the potential outcomes of revision surgery, thereby facilitating informed decision-making. Full article

(This article belongs to the Special Issue New Insights into Joint Arthroplasty)

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11 pages, 8205 KiB

Open AccessFeature PaperArticle

Exploring the Role of Perfusion in Skin Graft Viability on the Scalp and Lower Limb: An Analysis of Graft Bed, Margin, and Donor Skin Using Laser Speckle

by André Pinho, Ana Brinca and Ricardo Vieira

J. Clin. Med. 2024, 13(24), 7671; https://doi.org/10.3390/jcm13247671 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: Reperfusion is a major determinant of skin graft viability. The contributions of the perfusion status of the wound bed, wound margin, and donor skin to the success of the skin graft are unclear. We aimed to evaluate the relationship between perfusion [...] Read more.

Background/Objectives: Reperfusion is a major determinant of skin graft viability. The contributions of the perfusion status of the wound bed, wound margin, and donor skin to the success of the skin graft are unclear. We aimed to evaluate the relationship between perfusion variables and graft necrosis extension on the scalp and lower limb. Methods: A prospective study was conducted on adults undergoing skin graft closure after skin cancer excision on the scalp (n = 22) and lower limb (n = 20). Perfusion was measured intraoperatively and non-invasively with laser speckle contrast imaging on the graft bed, margin, and donor skin. By day 28, graft necrosis extension was quantified. Results: On the scalp and lower limb, graft bed perfusion very strongly correlated with necrosis extension (r = −0.82, p < 0.001 and r = −0.94, p < 0.001, respectively). A significant correlation (r = −0.57, p = 0.01) between margin perfusion and necrosis extension was only observed on the lower limb. The donor skin perfusion and necrosis extension did not correlate in either location (p > 0.05). The graft bed perfusion explained 68% and 89% of the variation in necrosis extension on the scalp and lower limb, respectively. Regression models of necrosis extension based on graft bed perfusion were obtained. For each unit increase in the perfusion of the graft bed, a similar decrease in necrosis extension was observed on the scalp and lower limb (40 and 48 percentage points, respectively). Conclusions: Unlike the perfusion of the wound margin and donor skin, wound bed perfusion plays a significant role in skin graft viability and can predict necrosis extension. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

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Figure 1
Schematic representation of the donor skin area (arrow) of a split-thickness skin graft for lower limb defect closure (a). Clinical image (b) and LSCI perfusion image (c) of donor skin. LSCI perfusion images range from black (no perfusion) to red (intense perfusion). LSCI also gives perfusion in arbitrary units (not presented) that can be normalised to the mean arterial pressure, yielding the cutaneous vascular conductance. Full article ">Figure 2
Schematic representation of the regions of interest relating to the graft bed (long arrow) and graft margin with a 1 cm width (short arrow) (a). Clinical image of the surgical defect (b), and LSCI perfusion image of the graft bed (c) and graft margin (d). Darker colours (black and blue) denote a poor perfusion assessed using LSCI, while the yellow to red colours represent a high perfusion. Full article ">Figure 3
Evolution of a full-thickness graft healing on the scalp. Graft pictures were collected on days 0 (a), 7 (b), 14 (c), 21 (d), and 28 (e). From the clinical pictures of day 28, the necrosis extension was calculated with the software SketchAndCalc™. Full article ">Figure 4
Scatter plots of perfusion, measured as cutaneous vascular conductance (CVC) [in arbitrary perfusion units (APU)/mmHg], on the graft bed, margin, and donor skin and necrosis extension on day 28, either on the scalp or lower limb. Statistically significant correlations (r) are denoted by an asterisk (*). Full article ">

13 pages, 1494 KiB

Open AccessArticle

Potential Causal Association Between Atrial Fibrillation/Flutter and Primary Open-Angle Glaucoma: A Two-Sample Mendelian Randomisation Study

by Young Lee and Je Hyun Seo

J. Clin. Med. 2024, 13(24), 7670; https://doi.org/10.3390/jcm13247670 (registering DOI) - 16 Dec 2024

Abstract

Background: A few studies have reported controversial relationships between atrial fibrillation/flutter (AF/L) and primary open-angle glaucoma (POAG). This study aimed to investigate the potential causal relationship between AF/L and POAG. Methods: Single-nucleotide polymorphisms associated with exposure to AF/L were selected as [...] Read more.

Background: A few studies have reported controversial relationships between atrial fibrillation/flutter (AF/L) and primary open-angle glaucoma (POAG). This study aimed to investigate the potential causal relationship between AF/L and POAG. Methods: Single-nucleotide polymorphisms associated with exposure to AF/L were selected as instrumental variables with significance (p < 5.0 ×

10^{- 8}

) from a genome-wide association study (GWAS) by FinnGen. The GWAS summary of POAG from the UK Biobank was used as the outcome dataset. A two-sample Mendelian randomisation (MR) study was performed to assess the causal effects of AF/L on POAG. In addition, potential confounders, including hypertension, autoimmune hyperthyroidism, sleep apnoea, and alcohol use disorder, were assessed using multivariable MR analysis. Results: There was a significant causal association of AF/L with POAG (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.07–1.48, p = 0.005 using inverse-variance weighting [IVW]). Multivariable MR analysis confirmed a causal association of AF/L with POAG (OR = 1.24, 95% CI = 1.02–1.51, p = 0.034 using IVW), but hypertension, hyperthyroidism, sleep apnoea and alcohol use disorder did not show significant causal associations with POAG (all p > 0.05). Conclusions: This established causal relationship between AF/L and POAG supports the need for further investigation into the role of AF/L as a possible risk factor for POAG. Further research is required to confirm these findings. Full article

(This article belongs to the Special Issue New Insights into Glaucoma)

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Figure 1
Diagram of two-sample Mendelian randomisation analysis. Solid lines indicate an association, while dashed lines indicate none. Abbreviation: SNP, single-nucleotide polymorphism. Full article ">Figure 2
Forest plot of causal association of AF/L with POAG. The plot presents causal effect estimates from various MR methods, including IVW, MR-Egger, and MR-Egger with SIMEX correction. Each method is represented with its corresponding causal estimate and 95% CI. The x-axis indicates the OR for POAG associated with the presence of AF/L. Odds ratios greater than 1 suggest that AF/L increases the risk of POAG. Abbreviations: AF/L, atrial fibrillation and flutter; CI, confidence interval; OR, odds ratio; SNP, single-nucleotide polymorphism; IVW, inverse-variance weighting; MR, Mendelian randomisation; POAG, primary open-angle glaucoma; SIMEX, simulation extrapolation. Full article ">Figure 3
Scatterplot of MR tests showing the effect of AF/L on POAG. Each dot corresponds to an SNP, with the x-axis representing the association between the SNP and the exposure and the y-axis representing the association between the SNP and the outcome. The regression lines are colour-coded: light blue for IVW, dark blue for MR-Egger, light green for MR-Egger (SIMEX), and dark green for the Weighted Median method. The slope of each line indicates the causal effect estimate obtained through the respective method. Abbreviations: MR, Mendelian randomisation; AF/L, atrial fibrillation and flutter; IVW, inverse-variance weighting; SIMEX, simulation extrapolation; SNP, single-nucleotide polymorphism; POAG, primary open-angle glaucoma. Full article ">Figure 4
Leave-one-out plot in univariable MR analysis for the effect of AF/L on POAG. Each black dot represents the OR estimate of the causal effect after excluding a specific SNP, with the horizontal line around each dot indicating the corresponding 95% CI. The red dot and horizontal line represent the overall causal estimate (OR and CI) calculated using all SNPs. The x-axis represents ORs, where values greater than 1 suggest that AF/L increases the risk of POAG. Abbreviations: MR, Mendelian randomisation; AF/L, atrial fibrillation and flutter; POAG, primary open-angle glaucoma; OR, odds ratio; CI, confidence interval. Full article ">

12 pages, 1143 KiB

Open AccessArticle

Continuous Epidural Versus Non-Epidural Pain Management After Minimally Invasive Esophagectomy: A Real-Life, High-Case-Load Center Experience

by Sebastian Boehler, Markus Huber, Patrick Y. Wuethrich, Christian M. Beilstein, Stefano M. Arigoni, Marc A. Furrer, Yves Borbély and Dominique Engel

J. Clin. Med. 2024, 13(24), 7669; https://doi.org/10.3390/jcm13247669 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: Esophagectomy is a key component of esophageal cancer treatment, with minimally invasive esophagectomy (MIE) increasingly replacing open esophagectomy (OE). Effective postoperative pain management can be achieved through various analgesic modalities. This study compares the efficacy of thoracic epidural anesthesia (TEA) with [...] Read more.

Background/Objectives: Esophagectomy is a key component of esophageal cancer treatment, with minimally invasive esophagectomy (MIE) increasingly replacing open esophagectomy (OE). Effective postoperative pain management can be achieved through various analgesic modalities. This study compares the efficacy of thoracic epidural anesthesia (TEA) with non-TEA methods in managing postoperative pain following MIE. Methods: A retrospective review was conducted on 110 patients who underwent MIE between 2018 and 2023. 1. TEA vs. 2. intravenous patient-controlled analgesia (PCA) alone vs. 3. transversus abdominis plane (TAP) catheter with PCA vs. 4. single-shot TAP block with paravertebral catheter (PVB) in combination with PCA were compared. The primary outcome was postoperative pain within the first 72 h, assessed using the numeric rating scale. Secondary outcomes included postoperative surgical complications (Clavien–Dindo classification (CDC)), patient satisfaction, and duration of induction and emergence, among others. Results: The incidence of an NRS > 3 during movement was 47.1%, 51%, 60.1%, and 48.3% for TEA, PCA alone, TAP + PCA, and PVB + PCA, respectively. For pain at rest, the rates were 8.3%, 4.3%, 11.2%, and 5%, respectively. High surgical complication rates were observed across all groups (CDC IIIa-V 31.6% overall), with patient satisfaction similarly high, regardless of the analgesic modality used (85% satisfied or very satisfied). No differences in the other secondary outcomes were observed. Conclusions: PVB combined with PCA offered analgesic efficacy and patient satisfaction comparable to TEA in managing postoperative pain following MIE. Full article

(This article belongs to the Section Anesthesiology)

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18 pages, 1041 KiB

Open AccessReview

Menstrual Disorders in Adolescence: Diagnostic and Therapeutic Challenges

by Christiane Anthon, Marcel Steinmann, Angela Vidal and Carolin Dhakal

J. Clin. Med. 2024, 13(24), 7668; https://doi.org/10.3390/jcm13247668 (registering DOI) - 16 Dec 2024

Abstract

Background: Adolescence is the period of life between the ages of 10 and 19. This period is essentially dominated by puberty. The first menstruation, called menarche, occurs, on average, at the age of 12–13. The period after menarche, especially the first 2 [...] Read more.

Background: Adolescence is the period of life between the ages of 10 and 19. This period is essentially dominated by puberty. The first menstruation, called menarche, occurs, on average, at the age of 12–13. The period after menarche, especially the first 2 years, is characterized by anovulatory cycles, which can be accompanied by menstrual irregularities. This review aims to describe the current status of the diagnostic and therapeutic challenges of the physiological and pathological causes of menstrual irregularities in adolescence and evaluates the benefits from interdisciplinary collaboration to ensure optimal care. Methods: A systematic literature search was conducted in the PubMed database in April 2024 using the following term: “menstrual disorder adolescence”. A total of 1724 abstracts were screened, and relevant articles from the last 10 years were included. In addition, a supplementary topic-relevant literature search of the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) and the guidelines of the Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaft (awmf) was carried out. Results: In addition to cycle irregularities that occur physiologically as a result of anovulatory cycles in the context of the immaturity of the hypothalamic–pituitary–gonadal axis, there are other cycle abnormalities that can be classified as pathological and need to be recognized and treated. Conclusions: Increasing awareness of the various specialist disciplines of physiological and pathological cycle abnormalities in adolescence and interdisciplinary cooperation between them can have a positive influence on the quality of life of adolescent women with cycle abnormalities. Full article

(This article belongs to the Section Obstetrics & Gynecology)

14 pages, 485 KiB

Open AccessArticle

On-Target Low-Density Lipoprotein Cholesterol in Adults with Diabetes Not at High Cardiovascular Disease Risk Predicts Greater Mortality, Independent of Early Deaths or Frailty

by Bruna C. Chwal, Rodrigo C. P. dos Reis, Maria I. Schmidt, Antonio L. P. Ribeiro, Sandhi M. Barreto, Rosane H. Griep, Paulo A. Lotufo and Bruce B. Duncan

J. Clin. Med. 2024, 13(24), 7667; https://doi.org/10.3390/jcm13247667 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: Lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL is recommended for most patients with diabetes. However, clinical trials investigating subjects with diabetes who are not at high cardiovascular risk are inconclusive regarding the all-cause mortality benefit of the current target, and real-world [...] Read more.

Background/Objectives: Lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL is recommended for most patients with diabetes. However, clinical trials investigating subjects with diabetes who are not at high cardiovascular risk are inconclusive regarding the all-cause mortality benefit of the current target, and real-world studies suggest greater mortality. We aimed to assess the all-cause mortality at different LDL-C levels among subjects with diabetes not at high risk and to examine the potential roles of early deaths and frailty for this greater mortality. Methods: We followed 2098 such participants of the ELSA-Brasil cohort between 2008 and 2019. Results: Over 10.3 (1.4) years of follow-up, 204 (9.7%) individuals died. In the proportional hazards models, participants with LDL-C values <100 mg/dL and <70 mg/dL had greater adjusted mortality compared to those with LDL-C 100–129 mg/dL (HR = 1.67; 95%CI 1.21–2.30 and HR = 2.27; 95%CI 1.51–3.41, respectively). Increased risk when LDL-C was <100 mg/dL was higher in those >60 years (HR = 2.12; 95%CI 1.35–3.34) and greatest for deaths due to cancer (HR = 2.55; 95%CI 1.10–5.91). Further analyses for those with LDL-C <100 mg/dL that excluded early deaths and adjusted for the frailty phenotype (HR = 2.01; 1.19–3.41) or frailty index (HR = 1.92; 1.17–3.16) did not materially alter the results. The risk of death across the spectrum of LDL-C was U-shaped, with a nadir at 112.2 mg/dL. Conclusions: The higher risk of all-cause mortality in these subjects with LDL-C within currently recommended levels was not explained by early deaths or frailty. Given the recent decline in cardiovascular mortality and the increased risk of cancer and infections in persons with diabetes, the clinical significance of low LDL-C in diabetes requires reconsideration and the definition of LDL-C treatment targets in diabetes warrants further trial evaluation. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

15 pages, 1166 KiB

Open AccessArticle

Assessment of Facial Pain After Internal Carotid Artery Stenting: The Role of External Carotid Artery Overstenting

by Dorota Łyko-Morawska, Łukasz Szkółka, Michał Serafin, Emila Senderek, Paweł Kiczmer, Magdalena Górska and Wacław Kuczmik

J. Clin. Med. 2024, 13(24), 7666; https://doi.org/10.3390/jcm13247666 (registering DOI) - 16 Dec 2024

Abstract

Background: The external carotid artery (ECA) supplies blood to various facial and neck regions and may contribute to collateral cerebral perfusion. With the rise in carotid artery stenting (CAS) as a treatment for carotid stenosis, ECA overstenting has become a common procedure [...] Read more.

Background: The external carotid artery (ECA) supplies blood to various facial and neck regions and may contribute to collateral cerebral perfusion. With the rise in carotid artery stenting (CAS) as a treatment for carotid stenosis, ECA overstenting has become a common procedure feature. This study aimed to assess the incidence, characteristics, and duration of facial pain following CAS, hypothesizing that ECA overstenting may contribute to facial pain. Materials and Methods: This prospective study included 55 patients treated with CAS for internal carotid artery (ICA) stenosis at a single center. Patients’ facial pain was evaluated using a numeric rating scale (NRS) before, immediately after, and 24 h post-CAS. Patient data, including demographics, comorbidities, and procedural details, were analyzed to assess the relationship between ICA stenosis degree, ECA diameter changes, and facial pain incidence. Results: CAS was associated with intraoperative facial pain in 27.27% of patients, with 7.28% reporting residual pain 24 h post-procedure. Pain occurrence was significantly higher in patients with lower ICA stenosis (p = 0.04). The median ECA diameter decreased from 4.11 mm to 3.16 mm (p < 0.001) after CAS, with ECA overstenting observed in 96.4% of cases. No significant relationship was found between pain severity and stent width or length. Conclusions: This study highlights that CAS significantly decreases the diameter of ECA. Additionally, ECA overstenting might be associated with perioperative and postoperative facial pain, emphasizing the need for careful monitoring of ECA patency following CAS. Full article

(This article belongs to the Special Issue Vascular Surgery: Recent Developments and Emerging Trends)

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Pre-procedural angiograms with the measurements of external carotid artery (ECA) diameter (a) in a 69-year-old woman and (b) in a 76-year-old man (RadiAnt DICOM VIEWER, Medixant, Poznań, Poland). Full article ">Figure 2
Post-procedural angiograms with the measurements of external carotid artery (ECA) diameter (a) in a 69-year-old woman and (b) in a 76-year-old man (RadiAnt DICOM VIEWER, Medixant, Poland). Full article ">Figure 3
Comparison between external carotid artery diameter before and after carotid artery stenting (Statistica, StatSoft, USA). Full article ">Figure 4
Facial pain severity during carotid artery stenting using the numerical rating scale depending on the (a) width of the carotid stent and (b) length of the carotid stent (Statistica, StatSoft, USA). Full article ">Figure 5
Occurrence of perioperative facial pain after carotid artery stenting depending on the internal carotid stenosis (Statistica, StatSoft, USA). Full article ">Figure 6
Occurrence of postoperative facial pain after carotid artery stenting depending on the internal carotid stenosis (Statistica, StatSoft, USA). Full article ">

21 pages, 1108 KiB

Open AccessArticle

Predictive and Prognostic Values of Glycoprotein 96, Androgen Receptors, and Extranodal Extension in Sentinel Lymph Node-Positive Breast Cancer: An Immunohistochemical Retrospective Study

by Tihana Klarica Gembić, Damir Grebić, Tamara Gulić, Mijo Golemac and Manuela Avirović

J. Clin. Med. 2024, 13(24), 7665; https://doi.org/10.3390/jcm13247665 (registering DOI) - 16 Dec 2024

Abstract

Objectives: In this paper, we investigate the association of glycoprotein 96 (GP96) and androgen receptor (AR) expression with clinicopathological factors, additional axillary lymph node burden, and their potential role in predicting 5-year overall survival (OS) and disease-free survival (DFS) in breast cancer [...] Read more.

Objectives: In this paper, we investigate the association of glycoprotein 96 (GP96) and androgen receptor (AR) expression with clinicopathological factors, additional axillary lymph node burden, and their potential role in predicting 5-year overall survival (OS) and disease-free survival (DFS) in breast cancer (BC) patients with sentinel lymph node (SLN) involvement. We also explore the prognostic value of the presence of extranodal extension (ENE) in SLN. Methods: We retrospectively enrolled 107 female patients with cT1-T2 invasive BC and positive SLN biopsy. GP96 and AR expression were immunohistochemically evaluated on tissue microarrays constructed from two 2 mm diameter cores of formalin-fixed paraffin-embedded tumor tissues from each patient. ENE in SLN was measured in the highest (HD-ENE) and widest diameter (WD-ENE). Relative GP96 gene expression was determined using real-time quantitative PCR. Results: The analysis revealed ENE in SLN as the strongest predictive factor for non-SLN metastases. Patients with WD-ENE > HD-ENE had a higher risk of non-SLN metastases and worse DFS compared to those with WD-ENE ≤ HD-ENE. High GP96 expression was associated with a greater relative risk for locoregional recurrence but showed no significant impact on OS or DFS. Histological grade 3, extensive intraductal component (EIC), higher lymph node ratio (LNR), and negative AR were associated with worse DFS, while age, histological grade 3, EIC, and higher LNR were independent predictors of OS. GP96 mRNA levels were elevated in BC tissue compared to normal breast tissue. Conclusions: ENE in SLN is the strongest predictor of non-SLN involvement and could also have prognostic significance. While GP96 expression does not influence survival outcomes, AR expression could be used as a valuable biomarker in the follow-up of BC patients. Full article

(This article belongs to the Section Oncology)

14 pages, 6256 KiB

Open AccessArticle

Radiological Perspectives in Congenital Sensorineural Hearing Loss: Insights from Cochlear Implant Candidates

by Sabri Şirolu, Rauf Hamid, Seyfullah Halit Karagöz, Osman Aykan Kargın, Vefa Salt, Sevda Yener, Halide Çetin Kara, Emine Deniz Gözen, Serdar Arslan, Bora Korkmazer, Onur Tutar and Osman Kızılkılıç

J. Clin. Med. 2024, 13(24), 7664; https://doi.org/10.3390/jcm13247664 (registering DOI) - 16 Dec 2024

Abstract

Objectives: Congenital hearing loss is a significant health concern, with diverse etiologies encompassing cochlear and cochleovestibular pathologies. Preoperative radiological evaluation in cochlear implant candidates is pivotal for treatment planning. We aim to elucidate the spectrum of radiological findings in patients with congenital hearing [...] Read more.

Objectives: Congenital hearing loss is a significant health concern, with diverse etiologies encompassing cochlear and cochleovestibular pathologies. Preoperative radiological evaluation in cochlear implant candidates is pivotal for treatment planning. We aim to elucidate the spectrum of radiological findings in patients with congenital hearing loss undergoing cochlear implant assessment. Methods: An analysis included 389 sensorineural hearing loss (SNHL) patients who underwent cochlear implantation at a tertiary university hospital, of which 177 were congenital SNHL. Computed tomography (CT) and magnetic resonance imaging (MRI) data were meticulously assessed for diverse congenital pathologies, focusing on congenital malformations. Results: In the congenital SNHL group, comprising 177 patients (80 females and 97 males), congenital cochleovestibular malformations were evident in 56 ears of 29 cases. Different congenital cochleovestibular malformations, ranging from labyrinthine aplasia to isolated large vestibular aqueducts, were detected. Among the various anomalies, incomplete partitions and cochlear hypoplasia emerged as more frequent patterns. Conclusions: This study offers a comprehensive radiological analysis of congenital SNHL patients undergoing cochlear implantation, revealing a spectrum of anomalies. It demonstrates the diverse nature of anomalies affecting the external auditory canal, middle ear structures, and cochleovestibular system. These insights provide a deeper understanding of congenital SNHL and contribute to developing informed treatment strategies. Full article

(This article belongs to the Section Otolaryngology)

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The pie chart represents the distribution of patients included in the study, outlining the process of inclusion and study design. It highlights the proportions of patients based on imaging availability and diagnostic categories. SNHL, sensorineural hearing loss; CT, computed tomography; MRI, magnetic resonance imaging. Full article ">Figure 2
(A) Measurement of the LSCC (left semicircular canal) bony island in the axial section and (B) measurement of the height of the cochlea in the coronal reformatted section as described by Purcell et al. [<a href="#B13-jcm-13-07664" class="html-bibr">13</a>]. Full article ">Figure 3
Patient with right-sided IP-1 (incomplete partition type-1) and left-sided LA (labyrinthine aplasia). On the right side, the cochlea (c) and the vestibule (v) are clearly differentiated. The cochlea has a near-normal size but lacks the entire modiolus and interscalar septa. None of the labyrinthine structures except the dense otic bone (*) can be seen on the left side. Full article ">Figure 4
(A) CT and (B) MRI images of a case of bilateral IP-3 (incomplete partition type-3). Note that despite the relative preservation of the outer contour of both cochleae (c) and the presence of interscalar septae (black and white arrows), the inner structure is featureless and the modiolus is absent. Full article ">Figure 5
A case of bilateral lateral semicircular canal-vestibular dysplasia (LCVD). Both vestibules (v) are dilated and form a common cavity with the lateral semicircular canals (LSCC). The cochlea (c) can be normal (partially shown). IAC, internal acoustic canal. Full article ">

10 pages, 697 KiB

Open AccessArticle

Subclinical Detection of Hydroxychloroquine-Induced Retinopathy in Patients with Systemic Lupus Erythematous Using Multifocal Electroretinography and Optical Coherence Tomography

by Suk Hoon Jung, Young-Hoon Park and Young Gun Park

J. Clin. Med. 2024, 13(24), 7663; https://doi.org/10.3390/jcm13247663 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: Although hydroxychloroquine (HCQ) is used to treat systemic lupus erythematosus (SLE), it is associated with retinal toxicity. Early diagnosis can prevent the further progression of HCQ-associated retinopathy by discontinuing HCQ treatments. This study aimed to evaluate the early diagnostic parameters in patients [...] Read more.

Background/Objectives: Although hydroxychloroquine (HCQ) is used to treat systemic lupus erythematosus (SLE), it is associated with retinal toxicity. Early diagnosis can prevent the further progression of HCQ-associated retinopathy by discontinuing HCQ treatments. This study aimed to evaluate the early diagnostic parameters in patients with SLE treated with HCQ and identify the best approach using multifocal electroretinography (mfERG) and swept-source optical coherence tomography (SS-OCT) to reflect subclinical retinal toxicity. Methods: Thirty-eight patients with SLE (76 eyes) and 18 healthy controls (36 eyes) were enrolled. They were referred for HCQ retinopathy screening without visual field defects. The patients were tested using a standard 61-hexagon mfERG stimulus and SS-OCT. Ten groups of the mfERG responses from the sectors were averaged to compare the quadrants, hemiretinal areas, consecutive ring amplitudes, and ring ratios (R1/R2–R5) from the center to the periphery. Additionally, the ganglion cell complex (GCC) analyses were performed using SS-OCT. Results: No difference was observed in GCC thickness on the OCT images, in the P1 amplitudes, and in the implicit time of mfERG. However, the R1/Rx ring ratios, except the R1/R2 ratio, showed significant differences among the three groups (p = 0.759, 0.018, 0.029, and 0.029, respectively). The R1/R3, R1/R4, and R1/R5 ring ratios demonstrated a correlation with the duration of HCQ therapy (r = −0.303, −0.279, and −0.266; p = 0.003, 0.006, and 0.009). The areas under the receiver operating characteristic curve of the ring ratios R1/R3–R5 were 0.730, 0.702, and 0.724, respectively (p = 0.004, 0.012, and 0.006), indicating the likelihood of being categorized as a high-risk group for subclinical HCQ retinopathy. Conclusions: The ring ratio of mfERG reflects the subclinical electrophysiological alterations induced by HCQ and can become more clinically useful by simplifying screening examinations. Full article

(This article belongs to the Special Issue An Update on Retinal Diseases: From Diagnosis to Treatment)

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11 pages, 1978 KiB

Open AccessArticle

A Pilot Study on the Replacement of Fibrinogen with Fibrinogen Concentrates During Therapeutic Plasma Exchange with Mild to Moderate Bleeding Risk—A Comparison with Fresh Frozen Plasma and Albumin Replacement

by Matej Zrimsek, Jakob Gubensek and Andreja Marn Pernat

J. Clin. Med. 2024, 13(24), 7662; https://doi.org/10.3390/jcm13247662 (registering DOI) - 16 Dec 2024

Abstract

Background: Therapeutic plasma exchange (TPE) removes coagulation factors and leads to depletion coagulopathy. The aim of the study was to compare hemostasis between TPE procedures without coagulation factor replacement (electrolyte group), the partial replacement of fibrinogen with fibrinogen concentrates (fibrinogen group) and [...] Read more.

Background: Therapeutic plasma exchange (TPE) removes coagulation factors and leads to depletion coagulopathy. The aim of the study was to compare hemostasis between TPE procedures without coagulation factor replacement (electrolyte group), the partial replacement of fibrinogen with fibrinogen concentrates (fibrinogen group) and partial coagulation factors replacement with fresh frozen plasma (partial FFP group). Methods: A total of 73 TPE procedures in patients with fibrinogen levels 1–2 g/L were divided into three study groups depending on clinically estimated bleeding risk. Standard coagulation and ROTEM^® tests were performed before and after TPE. Results: Fibrinogen levels before TPE (p = 0.88) and after TPE (p = 0.33) were comparable between the fibrinogen and partial FFP groups. INR and ROTEM^® parameters reflected moderately worse hemostasis after TPE with fibrinogen-only replacement compared to partial FFP replacement, which could result in increased bleeding risk. In the electrolyte group, most laboratory tests confirmed the most deranged hemostasis after TPE, as compared to fibrinogen or partial FFP replacement. A mild allergic reaction to FFP infusion was noted during one TPE. No clinically significant bleeding occurred in any of the study groups. Conclusions: Fibrinogen concentrate supplementation and partial FFP replacement can both maintain fibrinogen levels > 1 g/L after TPE, but modest differences in classical coagulation tests and bedside ROTEM^® tests favor FFP replacement (NCT03801135). Full article

(This article belongs to the Section Nephrology & Urology)

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Treatment algorithm and choice of replacement solution during TPE based on fibrinogen level and estimated bleeding risk (see also <a href="#jcm-13-07662-t001" class="html-table">Table 1</a>). Full article ">Figure 2
Mean fibrinogen values before and after the TPE procedure in all three groups. See <a href="#app1-jcm-13-07662" class="html-app">Supplementary Table S2</a> for exact values and comparisons. *—significant differences (p < 0.05 by ANOVA post hoc test) between groups. Full article ">Figure 3
Mean INR and aPTT values before and after the TPE procedure in all three groups. See <a href="#app1-jcm-13-07662" class="html-app">Supplementary Table S2</a> for exact values and comparisons. *—significant differences (p < 0.05 by ANOVA post hoc test) between the groups. Full article ">Figure 4
Mean ROTEM values before and after the TPE procedure in all three groups. See <a href="#app1-jcm-13-07662" class="html-app">Supplementary Table S2</a> for exact values and comparisons. *—significant differences (p < 0.05 by ANOVA post hoc test) between the groups. Full article ">Figure 5
Mean percent change between before and after TPE values of EXTEM and INTEM in all three groups. See <a href="#app1-jcm-13-07662" class="html-app">Supplementary Table S2</a> for exact values and comparisons. Full article ">

15 pages, 932 KiB

Open AccessArticle

Targeted Motor Control Considering Sternal Position Improves Spinal Alignment in Pregnant Women at Risk for Preterm Birth with Low Back Pain

by Arkadiusz Łukasz Żurawski, Sun Young Ha, Grzegorz Świercz, Olga Adamczyk Gruszka and Wojciech Piotr Kiebzak

J. Clin. Med. 2024, 13(24), 7661; https://doi.org/10.3390/jcm13247661 (registering DOI) - 16 Dec 2024

Abstract

Background: Lumbopelvic pain (LBP) is a prevalent condition during pregnancy, affecting a significant proportion of pregnant women. It arises from hormonal, biomechanical, and postural changes, often exacerbating discomfort and impairing quality of life. This study aimed to evaluate the effects of targeted motor [...] Read more.

Background: Lumbopelvic pain (LBP) is a prevalent condition during pregnancy, affecting a significant proportion of pregnant women. It arises from hormonal, biomechanical, and postural changes, often exacerbating discomfort and impairing quality of life. This study aimed to evaluate the effects of targeted motor control interventions focusing on sternal alignment on spinal alignment, pain, and muscle activity in pregnant women at risk of preterm birth. Methods: This pre–post quasi-experimental study included 32 pregnant women at 28–32 weeks of gestation, who were hospitalized due to the risk of preterm birth. Inclusion criteria required participants to have LBP lasting at least two weeks and the ability to walk and stand for 40 min. The intervention involved targeted motor control exercises designed to optimize sternal and sacral alignment. Spinal alignment, pain intensity, and muscle activity were measured pre- and post-intervention using the DIERS formetric system, numerical rating scale (NRS), and electromyography (EMG), respectively. Data were analyzed using Wilcoxon signed-rank tests. Results: Significant improvements were observed in spinal alignment parameters, including reductions in the sternal angle, sacral angle, cervical and lumbar lordosis depths, thoracic kyphosis angle, and pelvic tilt (p < 0.05). Pain intensity decreased significantly from a mean NRS score of 5.77 ± 1.42 in the relaxed posture to 2.54 ± 0.71 in the corrected posture (p < 0.05). Muscle activity of the rhomboid muscles increased in the corrected posture, correlating with improved thoracic kyphosis, while activity of the serratus anterior muscle showed reductions (p < 0.05). Conclusions: Targeted motor control focusing on sternal alignment effectively improved spinal alignment and reduced pain in pregnant women at risk of preterm birth with LBP. The intervention offers a safe, non-invasive, and practical approach to managing pregnancy-related musculoskeletal challenges. Future research should validate these findings in diverse populations and explore long-term effects and broader clinical applications. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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10 pages, 2627 KiB

Open AccessArticle

Diabetes Mellitus: A Risk Factor in Schlemm’s Canal-Based Minimally Invasive Glaucoma Surgery

by Etsuo Chihara, Eri Nakano and Tomoyuki Chihara

J. Clin. Med. 2024, 13(24), 7660; https://doi.org/10.3390/jcm13247660 (registering DOI) - 16 Dec 2024

Abstract

Objectives: The objective of this study was to evaluate the impact of diabetes mellitus (DM) on the outcome of Schlemm’s canal-based minimally invasive glaucoma surgery (MIGS). Methods: In a retrospective interventional cohort study, postoperative intraocular pressure (IOP) and intracameral bleeding were analyzed [...] Read more.

Objectives: The objective of this study was to evaluate the impact of diabetes mellitus (DM) on the outcome of Schlemm’s canal-based minimally invasive glaucoma surgery (MIGS). Methods: In a retrospective interventional cohort study, postoperative intraocular pressure (IOP) and intracameral bleeding were analyzed in 25 diabetic patients and 84 non-diabetic patients, with primary open-angle glaucoma (POAG) or ocular hypertension (OH). Results: The mean follow-up period for all 109 eyes was 35.3 ± 24.8 months. There was no significant difference in preoperative IOP between cohorts with or without diabetes. However, the post-surgical IOP between 3 months and 2 years was significantly higher in the cohort with diabetes (p = 0.019 to 0.001). The 3-year survival probability of achieving an IOP ≤ 15 mmHg was 17.8 ± 0.09% in patients with diabetes, significantly lower than the 30.4 ± 0.06% observed in patients without diabetes (p = 0.042 Log-rank test). The 3-year survival probability of achieving an IOP ≤ 18 mmHg was 56.7 ± 0.12% in patients with diabetes compared to 79.5 ± 0.05% in patients without diabetes, indicating a marginally significant difference between cohorts with and without diabetes (p = 0.065). When the random effect of diabetes mellitus (DM) was analyzed alongside the fixed effects of preoperative IOP, age, refractive error, and the extent of canal opening using a multivariate linear mixed model, DM emerged as a significant risk factor for higher postoperative IOP at both 6 and 12 months (p < 0.001). Conclusions: Diabetes mellitus is a significant risk factor for poor outcomes following Schlemm’s canal-based MIGS, particularly in achieving lower postoperative IOP. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 498 KiB

Open AccessArticle

Sacubitril/Valsartan and Dapagliflozin in Patients with a Failing Systemic Right Ventricle: Effects on the Arrhythmic Burden

by Giovanni Domenico Ciriello, Ippolita Altobelli, Flavia Fusco, Diego Colonna, Anna Correra, Giovanni Papaccioli, Emanuele Romeo, Giancarlo Scognamiglio and Berardo Sarubbi

J. Clin. Med. 2024, 13(24), 7659; https://doi.org/10.3390/jcm13247659 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: Angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are essential medications in heart failure (HF) therapy, and their potential antiarrhythmic effects have been reported. Recently, ARNI and SGLT2i use for HF in adult congenital heart disease (ACHD) has [...] Read more.

Background/Objectives: Angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are essential medications in heart failure (HF) therapy, and their potential antiarrhythmic effects have been reported. Recently, ARNI and SGLT2i use for HF in adult congenital heart disease (ACHD) has been studied. However, whether any beneficial effects may be achieved on the arrhythmic burden in the complex population of ACHD with a systemic right ventricle (sRV) is still to be determined. Methods: We retrospectively collected all significant arrhythmic events from a cohort of patients with a failing sRV attending our tertiary care center on optimal guideline-directed medical therapy (GDMT) with ARNI and/or SGLT2i. Results: A total of 46 patients (mean age 38.2 ± 10.7 years, 58% male) on sacubitril/valsartan were included. Twenty-three (50%) patients were also started on dapagliflozin. After a median follow-up of 36 [Q1–Q3: 34–38] months, arrhythmic events occurred globally in 13 (28%) patients. Survival analysis showed significant reduction of clinically relevant atrial and ventricular arrhythmia at follow-up (p = 0.027). Conclusions: Our findings suggest that GDMT including sacubitril/valsartan and dapagliflozin may also offer an antiarrhythmic effect in ACHD patients with a failing sRV, by reducing the incidence of arrhythmic events at follow-up. Full article

(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Congenital Heart Disease)

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11 pages, 3755 KiB

Open AccessArticle

Experience of Metronidazole Triple Therapy After Clarithromycin Triple Therapy Failure for Helicobacter pylori Eradication in Korea

by Chang-Min Lee, Seong-Je Kim, Jung-Woo Choi, Hyun-Chin Cho and Ok-Jae Lee

J. Clin. Med. 2024, 13(24), 7658; https://doi.org/10.3390/jcm13247658 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: Bismuth quadruple therapy (BQT) is recommended as the best second-line regimen after failure of first-line clarithromycin triple therapy (CTT) for Helicobacter pylori eradication. However, there are some limitations to this approach, including the lack of an appropriate sequel regimen after failure of [...] Read more.

Background/Objectives: Bismuth quadruple therapy (BQT) is recommended as the best second-line regimen after failure of first-line clarithromycin triple therapy (CTT) for Helicobacter pylori eradication. However, there are some limitations to this approach, including the lack of an appropriate sequel regimen after failure of BQT and complicated administration. Metronidazole triple therapy (MTT) is simple to administer, but it is not widely recommended. This study was conducted to determine the efficacy of MTT as second-line regimen for H. pylori eradication after failure of CTT. Methods: We retrospectively reviewed the medical records of the Korean patients with H. pylori infection who underwent second-line treatment after failure of first-line CTT from October 2013 to October 2019. The efficacy of MTT and BQT for H. pylori eradication was compared. Results: The eradication rate in the BQT group tended to be higher than that in the MTT group; however, the difference was not statistically significant (208/233, 89.3% versus 244/284, 85.9%, p = 0.287). Among 40 patients with second-line MTT eradication failure, 21 received the third-line BQT, and 15 showed successful eradication (15/21, 71.4%). In the men 70 years or older, the eradication rate of MTT was lower than that of BQT without statistical significance (75.8% versus 94.1%, p = 0.141). Conclusions: These findings suggested that MTT could be a second-line treatment option, reserving BQT for Helicobacter pylori eradication after first line CTT failure, except in elderly men 70 years or older. Full article

(This article belongs to the Special Issue Clinical and Molecular Treatment of Gastrointestinal and Helicobacter pylori Disorders)

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8 pages, 729 KiB

Open AccessArticle

Put Down the ACE: Low Clinical Utility for Angiotensin-Converting Enzyme Levels in Sarcoidosis: A Single-Center Retrospective Cohort Study

by Amit Druyan, Noam Shuv and Merav Lidar

J. Clin. Med. 2024, 13(24), 7657; https://doi.org/10.3390/jcm13247657 (registering DOI) - 16 Dec 2024

Abstract

Background/Objectives: ACE (angiotensin-converting enzyme) is considered a serological marker of sarcoidosis as elevated levels have been reported in 30–80% of patients. However, elevated ACE levels are also encountered in other medical conditions, and the clinical correlation between ACE levels and disease activity [...] Read more.

Background/Objectives: ACE (angiotensin-converting enzyme) is considered a serological marker of sarcoidosis as elevated levels have been reported in 30–80% of patients. However, elevated ACE levels are also encountered in other medical conditions, and the clinical correlation between ACE levels and disease activity in sarcoidosis is disputable as well. To determine the significance of elevated ACE levels in the diagnosis and follow-up of sarcoidosis patients. Methods: All electronic patient records in which an ACE level was recorded in a large tertiary hospital were identified using a computerized algorithm. Medical diagnoses, ACE numerical values, and clinical data were also automatically extracted. Furthermore, all records with a diagnosis of sarcoidosis were manually reviewed for ascertainment of the diagnosis and searched for additional clinical manifestations and treatment responses. Results: A total of 1416 records with a documented ACE level were found in the database, and 146 of the records had a diagnosis of sarcoidosis in the medical record. However, the diagnosis was excluded in 27 of these cases after a manual review of the records. Elevated ACE levels were most commonly encountered among patients with sarcoidosis, non-Hodgkin’s lymphoma, cirrhosis, and interstitial lung disease. Elevated ACE levels had a positive predictive value of 12.76% and a negative predictive value of 94.6% for the diagnosis of sarcoidosis in our cohort, with a sensitivity of 63.5% and a specificity of 59.5%. Among patients with sarcoidosis, ACE levels around the time of diagnosis were higher than ACE levels in remission. However, a paired analysis did not find a statistically significant difference in ACE levels between the two timepoints. A positive correlation between lack of cardiac involvement and elevated ACE levels was found on multivariate analysis. Conclusions: ACE levels are a non-specific serological marker with low specificity and sensitivity for sarcoidosis and a poor positive predictive value, but with a negative predictive value of 94.6%. Furthermore, elevated ACE levels correlated poorly with disease activity in our cohort. Full article

(This article belongs to the Section Immunology)

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