Journal of Clinical Medicine

16 pages, 3222 KiB

Open AccessSystematic Review

Effectiveness of Inferior Mesenteric Artery Embolization on Type II Endoleak-Related Complications after Endovascular Aortic Repair (EVAR): Systematic Review and Meta-Analysis

by Natalia Niklas, Michalina Malec, Piotr Gutowski, Arkadiusz Kazimierczak and Paweł Rynio

J. Clin. Med. 2022, 11(18), 5491; https://doi.org/10.3390/jcm11185491 - 19 Sep 2022

Cited by 2 | Viewed by 2147

Abstract

Type II endoleak is one of the most common and problematic complications after endovascular aneurysm repair. It has been suggested that the inferior mesenteric artery (IMA) embolization could prevent further adverse events and postoperative complications. This article is a systematic review and meta-analysis [...] Read more.

Type II endoleak is one of the most common and problematic complications after endovascular aneurysm repair. It has been suggested that the inferior mesenteric artery (IMA) embolization could prevent further adverse events and postoperative complications. This article is a systematic review and meta-analysis following PRISMA guidelines. The Medline, PubMed, Embase, and Cochrane databases were used to identify studies that investigated the effect of IMA embolization on the occurrence of type II endoleaks and secondary interventions in a group of patients with abdominal aortic aneurysm who underwent EVAR compared with results after EVAR procedure without embolization. A random effects meta-analysis was performed. Of 3510 studies, 6 studies involving 659 patients were included. Meta-analysis of all studies showed that the rate of secondary interventions was smaller in patients with IMA embolization (OR, 0.17; SE, 0.45; 95% CI, 0.07 to 0.41; p < 0.01; I² = 0%). The occurrence of type II endoleaks was also smaller in the embolization group (OR, 0.37; SE, 0.21; 95% CI, 0.25 to 0.57; p < 0.01; I² = 16.20%). This meta-analysis suggests that IMA embolization correlates with lower rates of type II endoleaks and secondary interventions. Full article

(This article belongs to the Special Issue Abdominal Aortic Aneurysm: Clinical Updates and Perspectives)

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14 pages, 321 KiB

Open AccessReview

The Unhappy Shoulder: A Conceptual Review of the Psychosomatics of Shoulder Pain

by Matthias Vogel, Marius Binneböse, Hannah Wallis, Christoph H. Lohmann, Florian Junne, Alexander Berth and Christian Riediger

J. Clin. Med. 2022, 11(18), 5490; https://doi.org/10.3390/jcm11185490 - 19 Sep 2022

Cited by 8 | Viewed by 3233

Abstract

Introduction: Chronic pain is a multifaceted disorder genuinely entangled with psychic and psychosomatic symptoms, which are typically involved in the processes of chronification. The impingement syndrome of the shoulder is no exception to this rule, but several studies have shown respective peculiarities among [...] Read more.

Introduction: Chronic pain is a multifaceted disorder genuinely entangled with psychic and psychosomatic symptoms, which are typically involved in the processes of chronification. The impingement syndrome of the shoulder is no exception to this rule, but several studies have shown respective peculiarities among those with pain and impingement of the shoulder. Notably, chronic pain is a lateralized experience, and, similarly, its psychosomatic correlates may be attached to the hemispheres functionally. Aim: The present review therefore gives an overview of the respective findings, with regard not only to psychopathology, but also to personality factors and psychologic trauma, since the latter are reportedly associated with chronic pain. Moreover, we acknowledge symmetry as a possible pathogenic factor. Methods: This narrative review followed the current standards for conducting narrative studies. Based on prior findings, our research strategy included the relevance of psychotraumatologic and symmetrical aspects, as well as comorbidity. We retrieved the relevant literature reporting on the impact of psychopathology as well as personality features on shoulder pain, as published up to January 2022 from the Medline database (1966–2022). Study selecton: We included numerous studies, and considered the contextual relevance of studies referring to the neuropsychosomatics of chronic pain. Results: Pain-specific fears, depression, and anxiety are important predictors of shoulder pain, and the latter is generally overrepresented in those with trauma and PTSD. Moreover, associations of shoulder pain with psychological variables are stronger as regards surgical therapies as compared to conservative ones. This may point to a specific and possibly trauma-related vulnerability for perioperative maladaptation. Additionally, functional hemispheric lateralization may explain some of those results given that limb pain is a naturally lateralized experience. Not least, psychosocial risk factors are shared between shoulder pain and its physical comorbidities (e.g., hypertension), and the incapacitated state of the shoulder is a massive threat to the function of the human body as a whole. Conclusions: This review suggests the involvement of psychosomatic and psychotraumatologic factors in shoulder impingement-related chronic pain, but the inconclusiveness and heterogeneity of the literature in the field is possibly suggestive of other determinants such as laterality. Full article

(This article belongs to the Special Issue Chronic Pain: Clinical Updates and Perspectives)

7 pages, 6664 KiB

Open AccessArticle

Three Different Types of Fat Grafting for Facial Systemic Sclerosis: A Case Series

by Antonio Arena, Umberto Committeri, Fabio Maglitto, Giovanni Salzano, Giovanni Dell’Aversana Orabona, Luigi Angelo Vaira, Pasquale Piombino, Michela Apolito, Gianluca Renato De Fazio and Luigi Califano

J. Clin. Med. 2022, 11(18), 5489; https://doi.org/10.3390/jcm11185489 - 19 Sep 2022

Cited by 2 | Viewed by 2411

Abstract

Systemic sclerosis (SSc) is a heterogeneous, chronic connective tissue disease, characterized by skin fibrosis as well as vascular and visceral lesions. It can involve the lungs, heart, kidneys, gastrointestinal tract, and bones. The orofacial manifestations of SSc can cause functional, aesthetic, and social [...] Read more.

Systemic sclerosis (SSc) is a heterogeneous, chronic connective tissue disease, characterized by skin fibrosis as well as vascular and visceral lesions. It can involve the lungs, heart, kidneys, gastrointestinal tract, and bones. The orofacial manifestations of SSc can cause functional, aesthetic, and social distress, resulting in significant psychological implications for the patients. In recent decades, fat grafting improved the aesthetic outcomes in terms of volume deficiency, contour asymmetry, and skin elasticity of the face thanks to the regenerative action of the stem cells contained within it. We describe five cases of a patient with SSc treated with fat grafting used to correct volume loss and facial elasticity of the lips and perioral region on the middle and lower third of the face. All the patients received regular postoperative checks at weeks 1 and 2. A multiple choice questionnaire was administered to assess the degree of tolerability of the procedure. The reliability of the questionnaire was evaluated by calculating the Cronbach alpha using the MedCalc Statistical Software version 20.113. The aim of our study is to describe three different types of fat grafting used to correct volume loss and restore facial elasticity of the lips and perioral region on the middle and lower third of the face. Full article

(This article belongs to the Special Issue Current Challenges and Advances in Skin Repair and Regeneration)

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10 pages, 4031 KiB

Open AccessReview

Robotic Retrograde Intrarenal Surgery: A Journey from “Back to the Future”

by Vineet Gauhar, Olivier Traxer, Sung-Yong Cho, Jeremy Yuen-Chun Teoh, Alba Sierra, Vishesh Gauhar, Kemal Sarica, Bhaskar Somani and Daniele Castellani

J. Clin. Med. 2022, 11(18), 5488; https://doi.org/10.3390/jcm11185488 - 19 Sep 2022

Cited by 16 | Viewed by 4043

Abstract

The introduction of robotics has revolutionized surgery. Robotic platforms have also recently been introduced in clinical practice specifically for flexible ureteroscopy. In this paper, we look at the robotic platforms currently available for flexible ureteroscopy, describing their advantages and limitations. The following robotic [...] Read more.

The introduction of robotics has revolutionized surgery. Robotic platforms have also recently been introduced in clinical practice specifically for flexible ureteroscopy. In this paper, we look at the robotic platforms currently available for flexible ureteroscopy, describing their advantages and limitations. The following robotic platforms are discussed: Roboflex Avicenna^®, EasyUretero^®, and ILY^® robot. Finally, potential future advancements in this field are presented. Full article

(This article belongs to the Section Nephrology & Urology)

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15 pages, 619 KiB

Open AccessSystematic Review

Correlation between Oral Lichen Planus and Viral Infections Other Than HCV: A Systematic Review

by Alberta Lucchese, Dario Di Stasio, Antonio Romano, Fausto Fiori, Guido Paolo De Felice, Carlo Lajolo, Rosario Serpico, Francesco Cecchetti and Massimo Petruzzi

J. Clin. Med. 2022, 11(18), 5487; https://doi.org/10.3390/jcm11185487 - 19 Sep 2022

Cited by 17 | Viewed by 3000

Abstract

Objectives: This review aimed to evaluate the correlation between viral infections (HPV, EBV, HSV-1, CMV) other than HCV and oral lichen planus to assess if there is sufficient evidence to establish if these viruses can play a role in the etiopathogenesis of the [...] Read more.

Objectives: This review aimed to evaluate the correlation between viral infections (HPV, EBV, HSV-1, CMV) other than HCV and oral lichen planus to assess if there is sufficient evidence to establish if these viruses can play a role in the etiopathogenesis of the disease. Materials and methods: We reviewed the literature using different search engines (PubMed, ISI Web of Science, and the Cochrane Library), employing MeSH terms such as “oral lichen planus” and “OLP” in conjunction with other terms. We utilized the Population, Intervention, Comparison, Outcomes, and Study design (PICOS) method to define our study eligibility criteria. Results: A total of 43 articles of the 1219 results initially screened were included in the study. We allocated the 43 selected items into four groups, according to each related virus: HPV, EBV, HSV-1, and CMV. Conclusions: Heterogeneous results neither confirm nor exclude a direct correlation between the investigated viral infections and oral lichen planus etiopathogenesis and its feasible malignant transformation. Many viral agents can cause oral lesions and act as cancerizing agents. Future studies could be desirable to produce comparable statistical analyses and enhance the quantity and quality of the outcomes to promote the translation of research into clinical practice. Full article

(This article belongs to the Topic Bridging Oral Medicine and Systemic Disease)

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12 pages, 636 KiB

Open AccessReview

Weight Gain and Asthenia Following Thyroidectomy: Current Knowledge from Literature Review

by Gregorio Scerrino, Giuseppe Salamone, Alessandro Corigliano, Pierina Richiusa, Maria Pia Proclamà, Stefano Radellini, Gianfranco Cocorullo, Giuseppina Orlando, Giuseppina Melfa and Nunzia Cinzia Paladino

J. Clin. Med. 2022, 11(18), 5486; https://doi.org/10.3390/jcm11185486 - 19 Sep 2022

Cited by 2 | Viewed by 3890

Abstract

Background: Thyroidectomy is a common procedure all over the world. Its complication rate is low, but some patients complain of weight gain and/or asthenia. The aim of this review is to investigate the correlation between thyroidectomy and weight change and asthenia. Materials and [...] Read more.

Background: Thyroidectomy is a common procedure all over the world. Its complication rate is low, but some patients complain of weight gain and/or asthenia. The aim of this review is to investigate the correlation between thyroidectomy and weight change and asthenia. Materials and Methods: Seven papers concerning weight gain and four concerning asthenia were found. Results: Weight gain would seem to be more related to the change in habits after surgery. Asthenia seems to be more linked to endocrine mechanisms not yet clarified although a deficiency of triiodothyronine and its metabolites could explain some of its aspects. Conclusion: Patients who are candidates for thyroidectomy should be adequately informed of the onset of both possible implications of the surgical act in terms of weight gain and chronic asthenia. Full article

(This article belongs to the Section General Surgery)

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14 pages, 1520 KiB

Open AccessArticle

High Inferior Vena Cava Diameter with High Left Ventricular End Systolic Diameter as a Risk Factor for Major Adverse Cardiovascular Events, Cardiovascular and Overall Mortality among Chronic Hemodialysis Patients

by Chung-Kuan Wu, Noi Yar, Zih-Kai Kao, Ming-Tsang Chuang and Tzu-Hao Chang

J. Clin. Med. 2022, 11(18), 5485; https://doi.org/10.3390/jcm11185485 - 19 Sep 2022

Cited by 4 | Viewed by 1765

Abstract

Background: Little is known about the association of inferior vena cava diameter (IVCD) and left ventricular end-systolic diameter (LVESD) with mortality in patients undergoing hemodialysis (HD). Methods: The single medical center observational cohort study enrolled 241 adult chronic HD patients from 1 October [...] Read more.

Background: Little is known about the association of inferior vena cava diameter (IVCD) and left ventricular end-systolic diameter (LVESD) with mortality in patients undergoing hemodialysis (HD). Methods: The single medical center observational cohort study enrolled 241 adult chronic HD patients from 1 October 2018 to 31 December 2018. Echocardiography results of IVCD and LVESD prior to dialysis were retrieved and patients were divided into high IVCD and low IVCD groups. Patients who received HD via a tunneled cuffed catheter were excluded. Study outcomes included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Subgroup analyses of HD patients with high and low LVESD were also performed. Results: The incidence of all-cause mortality, cardiovascular mortality, and MACE were higher in chronic HD patients with high IVCD (p < 0.01). High IVCD patients had significantly greater all-cause mortality, cardiovascular mortality, and MACE (log-rank test; p < 0.05). High IVCD patients are also associated with an increased risk of all-cause mortality and MACE relative to low IVCD patients (aHRs, 2.88 and 3.42; 95% CIs, 1.06–7.86 and 1.73–6.77, respectively; all p < 0.05). In the subgroup analysis of patients with high or low LVESD, the high IVCD remained a significant risk factor for all-cause mortality and MACE, and the HR is especially high in the high LVESD group. Conclusions: Dilated IVCD is a risk factor for all-cause mortality and MACE in chronic HD patients. In addition, these patients with high LVESD also have a significantly higher HR of all-cause mortality and MACE. Full article

(This article belongs to the Special Issue Hot Cardiovascular Topics in Chronic and End-Stage Renal Disease)

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15 pages, 2508 KiB

Open AccessArticle

Different Machine Learning Approaches for Implementing Telehealth-Based Cancer Pain Management Strategies

by Marco Cascella, Sergio Coluccia, Federica Monaco, Daniela Schiavo, Davide Nocerino, Mariacinzia Grizzuti, Maria Cristina Romano and Arturo Cuomo

J. Clin. Med. 2022, 11(18), 5484; https://doi.org/10.3390/jcm11185484 - 19 Sep 2022

Cited by 17 | Viewed by 2728

Abstract

Background: The most effective strategy for managing cancer pain remotely should be better defined. There is a need to identify those patients who require increased attention and calibrated follow-up programs. Methods: Machine learning (ML) models were developed using the data prospectively obtained from [...] Read more.

Background: The most effective strategy for managing cancer pain remotely should be better defined. There is a need to identify those patients who require increased attention and calibrated follow-up programs. Methods: Machine learning (ML) models were developed using the data prospectively obtained from a single-center program of telemedicine-based cancer pain management. These models included random forest (RF), gradient boosting machine (GBM), artificial neural network (ANN), and the LASSO–RIDGE algorithm. Thirteen demographic, social, clinical, and therapeutic variables were adopted to define the conditions that can affect the number of teleconsultations. After ML validation, the risk analysis for more than one remote consultation was assessed in target individuals. Results: The data from 158 patients were collected. In the training set, the accuracy was about 95% and 98% for ANN and RF, respectively. Nevertheless, the best accuracy on the test set was obtained with RF (70%). The ML-based simulations showed that young age (<55 years), lung cancer, and occurrence of breakthrough cancer pain help to predict the number of remote consultations. Elderly patients (>75 years) with bone metastases may require more telemedicine-based clinical evaluations. Conclusion: ML-based analyses may enable clinicians to identify the best model for predicting the need for more remote consultations. It could be useful for calibrating care interventions and resource allocation. Full article

(This article belongs to the Special Issue Advances in Postoperative Pain Management and Chronic Postoperative Pain)

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Flowchart of the study. Abbreviations: ML, machine learning; ECOG-PS, Eastern Cooperative Oncology Group Performance Status; MED, morphine-equivalent dose; PAMORAs, peripherally acting μ-opioid receptor antagonists; ROOs, rapid-onset opioids; IV-Morphine, intravenous morphine. Legend: the category “living with a partner” includes cohabitation and marriage. Full article ">Figure 2
Reasons for interruption of the telemedicine pathway (n = 158). Full article ">Figure 3
The area under the receiver operating characteristic (ROC) curve (AUC) of the considered models. False-positive rate (fpr) and true-negative rate (tpr) were considered. The plot shows the ROC curves calculated for each classifier over the entire dataset. RF and NN offer the best performance. Abbreviations: LASSO, LASSO–RIDGE regression; GBM, gradient boosting machine; ANN, artificial neural network; RF, random forest. Full article ">Figure 4
Simulation 1 refers to simulated odds ratios (SORs); percentages are labeled. This was performed for young patients (≤55 years old) with bone metastases and ROO use and young patients with bone metastases vs. those with no bone metastases. SORs for lung cancer were 2.72 (95%CI = 1.70–4.01); colorectal cancer 1.92 (95%CI = 1.40–2.56); other cancers 1.55 (95%CI = 1.19–2.07); breast cancer 1.91 (95%CI = 1.32, 2.58). Full article ">Figure 5
Simulation 2 refers to simulated odds ratios (SORs); percentages are labeled. This was performed for older patients (>75 years old) with bone metastases vs. patients without bone metastases. SORs for lung cancer were 4.35 (95%CI = 3.90–6.30); colorectal cancer 2.89 (95%CI = 2.18–3.77); other cancers 4.58 (95%CI = 3.53–5.95); breast cancer 1.82 (95%CI = 1.32, 2.47). Full article ">Figure 6
Simulation 3 refers to simulated odds ratios (SORs); percentages are labeled. It was performed for young individuals (≤55 years old) with bone metastases: male vs. female SORs. Young male patients had a significantly higher risk to receive multiple remote consultations when affected by lung cancer (SOR = 11.30, 95%CI = 4.60, 24.10) and colorectal cancer (SOR = 11.1, 95%CI = 5.90, 20.60). No statistical significance was found for other cancers (SOR = 0.97, 95%CI = 0.76, 1.23). Full article ">Figure 7
Simulation 4 refers to simulated odds ratios (SORs); percentages are labeled. This was performed for younger vs. older patients with bone metastases. Young patients had a significantly higher risk to receive multiple remote consultations for lung cancer. SORs were 1.89, 95%CI = 1.16, 2.82 for lung cancer and 1.70, 95%CI = 1.24, 2.43 for colorectal cancer. No statistical significance was found for other cancers (SOR = 1.16, 95%CI = 0.91, 1.52) and breast cancer (SOR = 1.19, 95%CI = 0.80, 1.65). Full article ">

11 pages, 2735 KiB

Open AccessArticle

The Impact of Non-Invasive Ventilation on Sleep Quality in COPD Patients

by Maximilian Wollsching-Strobel, Iris Anna Bauer, Johannes Julian Baur, Daniel Sebastian Majorski, Friederike Sophie Magnet, Jan Hendrik Storre, Wolfram Windisch and Sarah Bettina Schwarz

J. Clin. Med. 2022, 11(18), 5483; https://doi.org/10.3390/jcm11185483 - 19 Sep 2022

Cited by 4 | Viewed by 2369

Abstract

Background: Non-invasive ventilation (NIV) has been shown to be the most appropriate therapy for COPD patients with chronic respiratory failure. While physiological parameters and long-term outcome frequently serve as primary outcomes, very few studies have primarily addressed the impact of NIV initiation on [...] Read more.

Background: Non-invasive ventilation (NIV) has been shown to be the most appropriate therapy for COPD patients with chronic respiratory failure. While physiological parameters and long-term outcome frequently serve as primary outcomes, very few studies have primarily addressed the impact of NIV initiation on sleep quality in COPD. Methods: This single-center prospective cohort study comprised NIV-naïve patients with COPD. All patients underwent polysomnographic evaluation both at baseline and at 3 months follow-up, accompanied by the assessment of health-related quality of life (HRQL) using the Severe Respiratory Insufficiency Questionnaire (SRI) and the Epworth Sleepiness Scale (ESS). A subgroup evaluation was performed to address the impact of comorbid obstructive sleep apnea syndrome (OSAS). Results: Forty-six patients were enrolled and twenty-five patients completed the follow-up period (66.7 ± 7.4 years). NIV resulted in an increase in slow-wave sleep (+2% (−3.5/7.5), p = 0.465) and rapid eye movement sleep (+2.2% (−1.0/5.4), p = 0.174), although no statistical significance could be detected. ESS (−1.7(−3.6/0.1), p = 0.066) also showed a positive trend. Significant improvements in the Respiratory Disturbance Index (RDI) (−12.6(−23.7/−1.5), p = 0.027), lung function parameters, transcutaneous PCO₂ and the SRI summary scale (4.5(0.9/8), p = 0.016) were observed. Conclusion: NIV therapy does not decrease sleep quality and is even capable of improving HRQL, transcutaneous PaCO₂, daytime sleepiness and RDI, and the latter especially holds true for patients with comorbid OSAS. Full article

(This article belongs to the Section Pulmonology)

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Flow chart of study design and measurements. Abbreviations: NIV: non-invasive ventilation, ESS: Epworth Sleepiness Scale; SRI: Severe Respiratory Insufficiency Questionnaire; ABG: arterial blood gas analysis; PtcCO2: transcutaneous PCO2. Full article ">Figure 2
Flow diagram of subject recruitment and data availability. Abbreviations: n = number; NIV = non-invasive ventilation. Full article ">Figure 3
A series of boxplots illustrating the polysomnographic findings prior to NIV (t1) and at 3 months follow-up (t2) in the whole study population (n = 25). Notes: p-value of 2-tailed t-test; data for Cohan’s d are displayed with 95% confidence intervals in brackets. Abbreviations: d: Cohan’s d; m: minutes; REM: rapid eye movement. Full article ">Figure 4
Domains of the Severe Respiratory Insufficiency Questionnaire (SRI). Notes: Higher scores (range, 0–100) indicate a higher HRQL. * Significant mean differences (p ≤ 0.05) between t1 (prior non-invasive ventilation) and t2 (following 3 months of NIV). Abbreviations: RC: respiratory complaints; PF: physical functioning; AS: attendant symptoms and sleep; SR: social relationships; AX: anxiety; WB: psychological wellbeing; SF: social functioning; SS: summary scale. Full article ">Figure 5
Results of the Epworth Sleepiness Scale (ESS) Questionnaire. Notes: Higher scores (0–24) indicate increased daytime sleepiness. The p-value for the 2-tailed t-test and Cohan’s d for effect size are only reported for the entire cohort (n = 25). Abbreviations: OSAS: obstructive sleep apnea syndrome; NIV: non-invasive ventilation; d: Cohan’s d. Full article ">Figure 6
Results of the Respiratory Disturbance Index (RDI). Notes: RDI was used to classify the severity of respiratory events (mild 5–14.9, moderate 15–29.9, and severe >30). The p-value for the 2-tailed t-test and Cohan’s d for effect size are only reported for the entire cohort (n = 25). Abbreviations: RDI: index of abnormal breathing events per hour; OSAS: obstructive sleep apnea syndrome; NIV: non-invasive ventilation; d: Cohan’s d. Full article ">

9 pages, 608 KiB

Open AccessArticle

Vitamin D Status and Steatohepatitis in Obese Diabetic and Non-Diabetic Patients

by Laura Taban, Dana Stoian, Bogdan Timar, Daniela Amzar, Calin Adela, Alexandru Motofelea, Andreea Borlea, Romain Frisoni and Nadege Laguerre

J. Clin. Med. 2022, 11(18), 5482; https://doi.org/10.3390/jcm11185482 - 18 Sep 2022

Cited by 1 | Viewed by 1960

Abstract

Background and Aims: The presence of steatohepatitis in obese patients can be multifactorial. The current study tries to determine the differences between diabetic and non-diabetic patients regarding the presence of steatohepatitis. We evaluated sequential liver samples and collected the times of bariatric surgery [...] Read more.

Background and Aims: The presence of steatohepatitis in obese patients can be multifactorial. The current study tries to determine the differences between diabetic and non-diabetic patients regarding the presence of steatohepatitis. We evaluated sequential liver samples and collected the times of bariatric surgery to assess the presence of NASH in patients with obesity, in the circuit of bariatric surgery. Methods: We performed a retrospective study of 49 patients presenting high-grade obesity in the circuit of bariatric surgery, with liver biopsy. The patients underwent bariatric surgery at a single center in France and were followed for 2 years. The liver biopsies were performed intraoperatively on all 49 patients before the bariatric surgery. The primary endpoint of the study was to evaluate the relationships between steatohepatitis/liver fibrosis and the presence of diabetes and to evaluate the current relationships between the biochemical work-ups. Special importance was accorded to the correlations between vitamin D levels and the presence of hepatic steatosis, due to the antifibrogenic pattern in the liver, as shown in many important papers in the field. Results: Significant correlations were found between the presence of liver fibrosis and the presence of diabetes (p = 0.022), but not regarding the antidiabetic treatment. An important correlation was found between the vitamin D levels and the presence of liver fibrosis, as well as with the levels of A1C hemoglobin and LDL cholesterol levels. Conclusions: Vitamin D deficiency presents a strong correlation with hepatic steatosis in individuals with morbid obesity. Correcting vitamin D deficiency may present a beneficial role in treating hepatic steatosis, diabetes, and cardiovascular risk in patients with morbid obesity. Full article

(This article belongs to the Special Issue Clinical Management and Challenges in Metabolic Syndrome)

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14 pages, 1287 KiB

Open AccessArticle

MicroShunt versus Trabeculectomy for Surgical Management of Glaucoma: A Retrospective Analysis

by Michael X. Fu, Eduardo M. Normando, Sheila M. H. Luk, Mira Deshmukh, Faisal Ahmed, Laura Crawley, Sally Ameen, Niten Vig, Maria Francesca Cordeiro and Philip A. Bloom

J. Clin. Med. 2022, 11(18), 5481; https://doi.org/10.3390/jcm11185481 - 18 Sep 2022

Cited by 5 | Viewed by 2182

Abstract

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints [...] Read more.

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints included changes in intraocular pressure (IOP) and glaucoma medications. Secondary outcome measures included changes in retinal nerve fibre layer (RNFL) thickness, rates of complications, further theatre interventions, and the number of postoperative visits. From the baseline to Month-18, the median [interquartile range] IOP decreased from 22 [17–29] mmHg (on 4 [3–4] medications) to 15 [10–17] mmHg (on 0 [0–2] medications) and from 20 [16–28] mmHg (on 4 [3–4] medications) to 11 [10–13] mmHg (on 0 [0–0] medications) in the MicroShunt and trabeculectomy groups, respectively. IOP from Month-3 was significantly higher in the MicroShunt group (p = 0.006), with an increased number of medications from Month-12 (p = 0.024). There were greater RNFL thicknesses from Month-6 in the MicroShunt group (p = 0.005). The rates of complications were similar (p = 0.060) but with fewer interventions (p = 0.031) and postoperative visits (p = 0.001) in the MicroShunt group. Therefore, MicroShunt has inferior efficacy to trabeculectomy in lowering IOP and medications but provides a better safety profile and postoperative burden and may delay RNFL loss. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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Changes in median IOP during follow-up after MicroShunt and trabeculectomy (* denotes p ≤ 0.050 between groups; ** denotes p ≤ 0.010 between groups, *** denotes p ≤ 0.001 between groups, assessed using Mann–Whitney U tests). Error bars represent interquartile ranges. The cumulative percentage of eyes undergoing bleb revision for each group as the proportion of the total number of available eyes for analysis is displayed under each time point. Full article ">Figure 2
Changes in the median number of glaucoma medications during follow-up after MicroShunt and trabeculectomy (** denotes p ≤ 0.010 between groups, assessed using Mann–Whitney U tests). Error bars represent interquartile ranges. Full article ">Figure 3
Kaplan–Meier survival curve of both groups during follow-up after MicroShunt and trabeculectomy: (a) complete success (IOP ≤ 21 mmHg; no theatre reoperation for glaucoma; no loss of light perception vision; no chronic hypotony (defined as IOP ≤ 5 mmHg on 2 consecutive follow-up visits from 3 months); and no use of postoperative adjunct medications to maintain adequate IOP), (b) qualified success (the aforementioned criteria, but with use of postoperative medications), (c) strict success (‘complete success’ criteria with at least 20% IOP reduction from baseline), (d) same as ‘(a)’ but with IOP ≤ 18 mmHg, (e) same as ‘(b)’ but with IOP ≤ 18 mmHg, (f) same as ‘(c)’ but with IOP ≤ 18 mmHg, (g) same as ‘(a)’ but with IOP ≤ 14 mmHg, (h) same as ‘(b)’ but with IOP ≤ 14 mmHg, and (i) same as ‘(c)’ but with IOP ≤ 14 mmHg. Log-rank (Mantel–Cox) test p-values were (a) p = 0.715, (b) p = 0.595, (c) p = 0.489, (d) p = 0.645, (e) p = 0.828, (f) p = 0.494, (g) p = 0.616, (h) p = 0.464, and (i) p = 0.464. Full article ">

33 pages, 1407 KiB

Open AccessSystematic Review

Can Swallowing Cerebral Neurophysiology Be Evaluated during Ecological Food Intake Conditions? A Systematic Literature Review

by Yohan Gallois, Fabrice Neveu, Muriel Gabas, Xavier Cormary, Pascal Gaillard, Eric Verin, Renée Speyer and Virginie Woisard

J. Clin. Med. 2022, 11(18), 5480; https://doi.org/10.3390/jcm11185480 - 18 Sep 2022

Cited by 5 | Viewed by 2321

Abstract

Swallowing is a complex function that relies on both brainstem and cerebral control. Cerebral neurofunctional evaluations are mostly based on functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), performed with the individual laying down; which is a non-ecological/non-natural position for swallowing. [...] Read more.

Swallowing is a complex function that relies on both brainstem and cerebral control. Cerebral neurofunctional evaluations are mostly based on functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), performed with the individual laying down; which is a non-ecological/non-natural position for swallowing. According to the PRISMA guidelines, a review of the non-invasive non-radiating neurofunctional tools, other than fMRI and PET, was conducted to explore the cerebral activity in swallowing during natural food intake, in accordance with the PRISMA guidelines. Using Embase and PubMed, we included human studies focusing on neurofunctional imaging during an ecologic swallowing task. From 5948 unique records, we retained 43 original articles, reporting on three different techniques: electroencephalography (EEG), magnetoencephalography (MEG) and functional near infra-red spectroscopy (fNIRS). During swallowing, all three techniques showed activity of the pericentral cortex. Variations were associated with the modality of the swallowing process (volitional or non-volitional) and the substance used (mostly water and saliva). All techniques have been used in both healthy and pathological conditions to explore the precise time course, localization or network structure of the swallowing cerebral activity, sometimes even more precisely than fMRI. EEG and MEG are the most advanced and mastered techniques but fNIRS is the most ready-to-use and the most therapeutically promising. Ongoing development of these techniques will support and improve our future understanding of the cerebral control of swallowing. Full article

(This article belongs to the Section Otolaryngology)

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14 pages, 1488 KiB

Open AccessArticle

Composition of the Gut Microbiota Associated with the Response to Immunotherapy in Advanced Cancer Patients: A Chinese Real-World Pilot Study

by Xi Cheng, Jiawei Wang, Liu Gong, Yong Dong, Jiawei Shou, Hongming Pan, Zhaonan Yu and Yong Fang

J. Clin. Med. 2022, 11(18), 5479; https://doi.org/10.3390/jcm11185479 - 18 Sep 2022

Cited by 11 | Viewed by 2666

Abstract

Background: The composition of the gut microbiota is associated with the response to immunotherapy for different cancers. However, the majority of previous studies have focused on a single cancer and a single immune checkpoint inhibitor. Here, we investigated the relationship between the gut [...] Read more.

Background: The composition of the gut microbiota is associated with the response to immunotherapy for different cancers. However, the majority of previous studies have focused on a single cancer and a single immune checkpoint inhibitor. Here, we investigated the relationship between the gut microbiota and the clinical response to anti-programmed cell death protein 1 (PD-1) immunotherapy in patients with advanced cancers. Method: In this comprehensive study, 16S rRNA sequencing was performed on the gut microbiota of pre-immunotherapy and post-immunotherapy, of 72 advanced cancer patients in China. Results: At the phylum level, Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria were the main components of the microbiota in the 72 advanced cancer patients. At the genus level, Bacteroides and Prevotella were the dominant microbiota among these 72 patients. The PD_whole_tree, Chao1, Observed_species and Shannon indices of R.0 and R.T were higher than those of NR.0 and NR.T. The results of LEfSe showed that Archaea, Lentisphaerae, Victivallaceae, Victivallales, Lentisphaeria, Methanobacteriaceae, Methanobacteria, Euryarchaeota, Methanobrevibacter, and Methanobacteriales were significantly enriched in the response group before immunotherapy (R.0), and the Clostridiaceae was significantly enriched in the non-response group before immunotherapy (NR.0) (p < 0.05). Lachnospiraceae and Thermus were significantly enriched in the response group after immunotherapy (R.T), and Leuconostoc was significantly enriched in R.0 (p < 0.05). ROC analysis showed that the microbiota of R.T (AUC = 0.70) had obvious diagnostic value in differentiating Chinese cancer patients based on their response to immunotherapy. Conclusions: We demonstrated that the gut microbiota was associated with the clinical response to anti-PD-1 immunotherapy in cancer patients. Taxonomic signatures enriched in responders were effective biomarkers to predict the clinical response. Our findings provide a new strategy to improve the efficiency of responses to immunotherapy among cancer patients. Full article

(This article belongs to the Special Issue Target and Im-Oncology Therapeutic Approaches for Lung Cancer)

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9 pages, 1516 KiB

Open AccessArticle

Tibial Lengthening along Submuscular Plate with Simultaneous Acute Tibial Deformity Correction by High-Energy Osteotomy: A Comparative Study

by Kuei-Yu Liu, Kuan-Wen Wu, Chia-Che Lee, Sheng-Chieh Lin, Ken N. Kuo and Ting-Ming Wang

J. Clin. Med. 2022, 11(18), 5478; https://doi.org/10.3390/jcm11185478 - 18 Sep 2022

Cited by 1 | Viewed by 2319

Abstract

Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten [...] Read more.

Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten patients received tibial lengthening with acute knee angular deformity correction using high-energy osteotomy (Group 1), and nine patients received tibial lengthening only with osteotomy using multiple drills and osteotome (Group 2). Radiographic parameters retrieved before and after the operation included leg-length discrepancy, tibial length, length gained, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). There were significant differences between groups in terms of external fixator index (EFI) (p = 0.013) and healing index (HI) (p = 0.014), but no significance in the length gained (p = 0.356). The latest postoperative mLDFA (p = 0.315), MPTA (p = 0.497), and MAD (p = 0.211) of Group 1 were not distinguishable from Group 2. The functional outcomes were excellent, and there were no permanent complications. Despite showing a longer healing time, this alternative lengthening procedure which combines fixator-assisted plate lengthening in the tibia with simultaneous surgical intervention of acute tibial deformity correction using an oscillating saw is appropriate for patients with leg-length discrepancy and angular deformity of the tibia. Full article

(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies)

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Radiological measurements. The superolateral angle between the mechanical axis of the femur and the joint surface of the femoral condyle was defined as the mechanical lateral distal femoral angle (mLDFA). The inferomedial angle between the anatomical axis of the tibia and the articular axis of the proximal tibia was labeled as the medial proximal tibial angle (MPTA). The mechanical axis deviation (MAD) was designated as the distance from the center of the knee to the mechanical axis of the lower leg. Mechanical axis = AB. Full article ">Figure 2
Anteroposterior radiographs of an 18-year-old girl who underwent fixator-assisted plating and acute angular correction for leg-length discrepancy. (a) A preoperative anteroposterior view of the tibia. (b) The procedure was conducted using an Ilizarov apparatus and a submuscular plate. (c) Satisfactory tibial lengthening and alignment were achieved. (d) The distal part of the submuscular plate was fixed at removal of the external fixator. (e) The distracted callus healing with good consolidation was seen in the latest radiograph 40 months after the operation. Full article ">Figure 3
Lateral radiographs of an 18-year-old girl who underwent fixator-assisted plating and acute angular deformity correction for leg-length discrepancy. (a) A preoperative lateral view of the tibia. (b) The patient underwent tibial lengthening and deformity correction using an Ilizarov apparatus and a submuscular plate. (c) The distraction length and alignment were satisfied. (d) The distal part of the submuscular plate was fixed at removal of the external fixator. (e) Distraction osteogenesis was completed without complications 40 months after the procedure. Full article ">

20 pages, 1709 KiB

Open AccessArticle

Energy Homeostasis Gene Nucleotide Variants and Survival of Hemodialysis Patients—A Genetic Cohort Study

by Monika Katarzyna Świderska, Adrianna Mostowska, Damian Skrypnik, Paweł Piotr Jagodziński, Paweł Bogdański and Alicja Ewa Grzegorzewska

J. Clin. Med. 2022, 11(18), 5477; https://doi.org/10.3390/jcm11185477 - 18 Sep 2022

Cited by 1 | Viewed by 2324

Abstract

Background: Patients undergoing hemodialysis (HD) therapy have an increased risk of death compared to the general population. We investigated whether selected single nucleotide variants (SNVs) involved in glucose and lipid metabolism are associated with mortality risk in HD patients. Methods: The study included [...] Read more.

Background: Patients undergoing hemodialysis (HD) therapy have an increased risk of death compared to the general population. We investigated whether selected single nucleotide variants (SNVs) involved in glucose and lipid metabolism are associated with mortality risk in HD patients. Methods: The study included 805 HD patients tested for 11 SNVs in FOXO3, IGFBP3, FABP1, PCSK9, ANGPTL6, and DOCK6 using HRM analysis and TaqMan assays. FOXO3, IGFBP3, L-FABP, PCSK9, ANGPTL6, and ANGPTL8 plasma concentrations were measured by ELISA in 86 individuals. The Kaplan–Meier method and Cox proportional hazards models were used for survival analyses. Results: We found out that the carriers of a C allele in ANGPTL6 rs8112063 had an increased risk of all-cause, cardiovascular, and cardiac mortality. In addition, the C allele of DOCK6 rs737337 was associated with all-cause and cardiac mortality. The G allele of DOCK6 rs17699089 was correlated with the mortality risk of patients initiating HD therapy. The T allele of FOXO3 rs4946936 was negatively associated with cardiac and cardiovascular mortality in HD patients. We observed no association between the tested proteins’ circulating levels and the survival of HD patients. Conclusions: The ANGPTL6 rs8112063, FOXO3 rs4946936, DOCK6 rs737337, and rs17699089 nucleotide variants are predictors of survival in patients undergoing HD. Full article

(This article belongs to the Special Issue Clinical Management of Hemodialyzed Patients: From Pharmacological Interventions to Advanced Technologies)

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8 pages, 941 KiB

Open AccessArticle

Effects of Compression of the Ulnar Artery on the Radial Artery Catheterization

by Cho-Long Kim, Seung-Wan Hong and Seong-Hyop Kim

J. Clin. Med. 2022, 11(18), 5476; https://doi.org/10.3390/jcm11185476 - 18 Sep 2022

Viewed by 1724

Abstract

Background: The study was designed to evaluate the effects of compression of the ulnar artery on blood flow (BF) and internal cross-sectional area (CSAi) of the radial artery. We also evaluated the success rate and time of successful ultrasound-guided radial artery catheterization at [...] Read more.

Background: The study was designed to evaluate the effects of compression of the ulnar artery on blood flow (BF) and internal cross-sectional area (CSAi) of the radial artery. We also evaluated the success rate and time of successful ultrasound-guided radial artery catheterization at the first attempt with or without compression of the ulnar artery. Methods: Patients were randomly allocated to the Compression group or Standard group to be treated with or without the application of ulnar artery compression, respectively. Hemodynamic stability was confirmed, and ultrasound-guided radial artery catheterization was performed. In the Compression group, an assistant compressed the ulnar artery at 5 cm above the wrist crease and the catheterization was performed after the loss of the distal ulnar artery BF. In the Standard group, the catheterization was performed without compression of the ulnar artery. Before and after the catheterization, BF and CSAi of the radial artery were evaluated. Success rate and time to successful catheterization at the first attempt were recorded. Results: BF and CSAi of the radial artery were similar in the two groups (37.5 [19.3–66] vs. 37.0 [20.6–53.7] mL/min, respectively, p = 0.63; 4.0 [4.0–6.0] vs. 4.0 [3.0–5.0] mm², respectively, p = 0.095). In the Compression group, BF and CSAi were changed to 80.9 [35.9–128.5] mL/min (p < 0.001) and 5.0 [4.0–7.0] mm² (p < 0.001), respectively, after compression of the ulnar artery. There was a trend that the success rate of ultrasound-guided radial artery catheterization at the first attempt was higher in the Compression group than in the Standard group (58/59 vs. 53/59, respectively, p = 0.05), although the difference was not statistically significant. However, the time to successful ultrasound-guided radial artery catheterization at the first attempt was significantly shorter in the Compression group than in the Standard group (34 [27–41] s vs. 46 [36–60] s, p < 0.001). Conclusion: Compression of the ulnar artery augmented BF and CSAi of the radial artery. It resulted in a significantly shorter success time for ultrasound-guided radial artery catheterization at the first attempt. Full article

(This article belongs to the Section Anesthesiology)

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12 pages, 683 KiB

Open AccessArticle

Head and Neck Cutaneous Soft-Tissue Sarcoma Demonstrate Sex and Racial/Ethnic Disparities in Incidence and Socioeconomic Disparities in Survival

by Muhammad Umar Jawad, Lauren N. Zeitlinger, Arnaud F. Bewley, Edmond F. O’Donnell III, Sophia A. Traven, Janai R. Carr-Ascher, Arta M. Monjazeb, Robert J. Canter, Steven W. Thorpe and R. Lor Randall

J. Clin. Med. 2022, 11(18), 5475; https://doi.org/10.3390/jcm11185475 - 17 Sep 2022

Cited by 4 | Viewed by 2006

Abstract

Background: Cutaneous soft-tissue sarcoma (CSTS) of the head and neck are rare and are known to have aggressive clinical course. The current study utilizes a population-based registry in the U.S. to characterize these malignancies and explore disparities. Methods: National Cancer Institute’s (NCI) Surveillance, [...] Read more.

Background: Cutaneous soft-tissue sarcoma (CSTS) of the head and neck are rare and are known to have aggressive clinical course. The current study utilizes a population-based registry in the U.S. to characterize these malignancies and explore disparities. Methods: National Cancer Institute’s (NCI) Surveillance, Epidemiology and End Result (SEER) database from 2000 to 2018 was queried to report incidence and survival data in 4253 cases in the U.S. Results: Males were 5.37 times more likely and Non-Hispanic-White people (NHW) were 4.62 times more likely than females and Non-Hispanic-Black people (NHB) to develop CSTS of the head and neck. The overall incidence was 0.27 per 100,000 persons in 2018, with a significant increase since 2000. Advanced age and stage, histologic group other than ‘fibromatous sarcoma’ and lower SES groups were independent factors for worse overall survival. Conclusions: CSTS of the head and neck demonstrate sex and racial/ethnic disparities in incidence and socioeconomic disparities in overall survival. Level of evidence: II. Full article

(This article belongs to the Topic Socio-Environmental Determinants of the Disparities in Health Behaviors among Minority Youth)

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11 pages, 3041 KiB

Open AccessReview

Inner Ear Diagnostics and Drug Delivery via Microneedles

by Stephen Leong, Aykut Aksit, Sharon J. Feng, Jeffrey W. Kysar and Anil K. Lalwani

J. Clin. Med. 2022, 11(18), 5474; https://doi.org/10.3390/jcm11185474 - 17 Sep 2022

Cited by 8 | Viewed by 2298

Abstract

Objectives: Precision medicine for inner ear disorders has seen significant advances in recent years. However, unreliable access to the inner ear has impeded diagnostics and therapeutic delivery. The purpose of this review is to describe the development, production, and utility of novel microneedles [...] Read more.

Objectives: Precision medicine for inner ear disorders has seen significant advances in recent years. However, unreliable access to the inner ear has impeded diagnostics and therapeutic delivery. The purpose of this review is to describe the development, production, and utility of novel microneedles for intracochlear access. Methods: We summarize the current work on microneedles developed using two-photon polymerization (2PP) lithography for perforation of the round window membrane (RWM). We contextualize our findings with the existing literature in intracochlear diagnostics and delivery. Results: Two-photon polymerization lithography produces microneedles capable of perforating human and guinea pig RWMs without structural or functional damage. Solid microneedles may be used to perforate guinea pig RWMs in vivo with full reconstitution of the membrane in 48–72 h, and hollow microneedles may be used to aspirate perilymph or inject therapeutics into the inner ear. Microneedles produced with two-photon templated electrodeposition (2PTE) have greater strength and biocompatibility and may be used to perforate human RWMs. Conclusions: Microneedles produced with 2PP lithography and 2PTE can safely and reliably perforate the RWM for intracochlear access. This technology is groundbreaking and enabling in the field of inner ear precision medicine. Full article

(This article belongs to the Special Issue Innovative Technologies and Translational Therapies for Deafness)

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7 pages, 519 KiB

Open AccessArticle

Exploring the Risk Factors for Poor Survival in Lupus Pericarditis Patients: A Retrospective Cohort Study

by Yen-Fu Chen, Meng-Ru Hsieh, Che-Tzu Chang, Ping-Han Tsai and Yao-Fan Fang

J. Clin. Med. 2022, 11(18), 5473; https://doi.org/10.3390/jcm11185473 - 17 Sep 2022

Cited by 1 | Viewed by 1963

Abstract

Patients with systemic lupus erythematosus (SLE) have a higher risk of pericarditis, which could be fatal. The goal of this study was to identify the prognostic factors for mortality in patients with lupus pericarditis. Patients with lupus pericarditis treated at Chang Gung Memorial [...] Read more.

Patients with systemic lupus erythematosus (SLE) have a higher risk of pericarditis, which could be fatal. The goal of this study was to identify the prognostic factors for mortality in patients with lupus pericarditis. Patients with lupus pericarditis treated at Chang Gung Memorial Hospital were included in this observational cohort study. This study conducted univariate and multivariate COX regression, as well as Kaplan–Meier survival curve analysis, to investigate mortality risk in SLE patients. The average age at admission was 40.78 ± 15.92 years. A total of 113 (16.4%) of the 689 patients had lupus pericarditis. Patients with lupus pericarditis exhibited older age, shorter follow-up, higher disease activities, and higher incidence rates of comorbidities than patients without pericarditis. Cox regression adjusted analysis indicated that lupus pericarditis (hazard ratio = 1.963, 95% CI = 1.315, 2.963, p = 0.001), old age at admission (HR = 1.053, 95% CI = 1.040, 1.065, p < 0.001), high SLEDAI score (HR = 1.079, 95% CI = 1.043, 1.116, p < 0.001), and end-stage kidney disease (ESKD) (HR = 2.533, 95% CI = 1.620, 3.961, p < 0.001) were all linked to increased mortality. Moreover, the Kaplan–Meier survival curve analysis revealed that patients with pericarditis compared to those without pericarditis had a higher mortality rate (log-rank test, p < 0.001). A high proportion of SLE patients have manifestations of lupus pericarditis. Moreover, patients with lupus pericarditis have a greater risk of mortality even if they have no pericardial tamponade. Therefore, these patients need prompt diagnosis and treatment. Full article

(This article belongs to the Special Issue Systemic Immune Inflammatory Disease: New Updates)

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13 pages, 4163 KiB

Open AccessReview

The Small Posterior Cranial Fossa Syndrome and Chiari Malformation Type 0

by Enver I. Bogdanov, Aisylu T. Faizutdinova and John D. Heiss

J. Clin. Med. 2022, 11(18), 5472; https://doi.org/10.3390/jcm11185472 - 17 Sep 2022

Cited by 8 | Viewed by 3710

Abstract

Patients showing typical Chiari malformation type 1 (CM1) signs and symptoms frequently undergo cranial and cervical MRI. In some patients, MRI documents >5 mm of cerebellar tonsillar herniation (TH) and the diagnosis of CM1. Patients with 3–5 mm TH have “borderline” CM1. Patients [...] Read more.

Patients showing typical Chiari malformation type 1 (CM1) signs and symptoms frequently undergo cranial and cervical MRI. In some patients, MRI documents >5 mm of cerebellar tonsillar herniation (TH) and the diagnosis of CM1. Patients with 3–5 mm TH have “borderline” CM1. Patients with less than 3 mm of TH and an associated cervical syrinx are diagnosed with Chiari “zero” malformation (CM0). However, patients reporting CM1 symptoms are usually not diagnosed with CM if MRI shows less than 3–5 mm of TH and no syrinx. Recent MRI morphometric analysis of the posterior fossa and upper cervical spine detected anatomical abnormalities in and around the foramen magnum (FM) that explain these patients’ symptoms. The abnormalities include a reduced size of the posterior fossa, FM, and upper cervical spinal canal and extension of the cerebellar tonsils around the medulla rather than inferior to the foramen magnum, as in CM1. These morphometric findings lead some neurologists and neurosurgeons to diagnose CM0 in patients with typical CM1 signs and symptoms, with or without cervical syringes. This article reviews recent findings and controversies about CM0 diagnosis and updates current thinking about the clinical and radiological relationship between CM0, borderline CM1, and CM1. Full article

(This article belongs to the Special Issue Chiari 1 Malformation, Syringomyelia and Related Disorders: Advances in Diagnosis and Treatment for Adults and Children)

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Flow diagram of the search strategy. Full article ">Figure 2
Types of CM0 without syringomyelia. The McRae line (white line) is shown on the T1-weighted sagittal images (left panels). Axial images at McRae’s line are shown (right panels) on T1-weighted (3) and T2-weighted (1,2,4) images. Adult symptomatic CM0-only patients with tonsillar herniation ≤2 mm (panels (1–3)) and borderline CM1-only patients with tonsillar herniation 3 mm (4). All patients demonstrate short bones (CL and SO < 40 mm), crowdedness of the PCF, tight foramen magnum, and CM1-like clinical manifestations: transient localized suboccipital cough-related headaches (1) or constant and transient suboccipital headaches (2–4), truncal ataxia, vertigo, dizziness, and upper motor neuron signs. The sagittal images in (1,3) (left panels) also show spinal canal narrowing at the level of the odontoid. Full article ">Figure 2 Cont.
Types of CM0 without syringomyelia. The McRae line (white line) is shown on the T1-weighted sagittal images (left panels). Axial images at McRae’s line are shown (right panels) on T1-weighted (3) and T2-weighted (1,2,4) images. Adult symptomatic CM0-only patients with tonsillar herniation ≤2 mm (panels (1–3)) and borderline CM1-only patients with tonsillar herniation 3 mm (4). All patients demonstrate short bones (CL and SO < 40 mm), crowdedness of the PCF, tight foramen magnum, and CM1-like clinical manifestations: transient localized suboccipital cough-related headaches (1) or constant and transient suboccipital headaches (2–4), truncal ataxia, vertigo, dizziness, and upper motor neuron signs. The sagittal images in (1,3) (left panels) also show spinal canal narrowing at the level of the odontoid. Full article ">

11 pages, 411 KiB

Open AccessArticle

Neuropathic-like Pain Symptoms and Their Association with Muscle Strength in Patients with Chronic Musculoskeletal Pain

by Hee Jung Kim, Min Gi Ban, Kyung Bong Yoon, Woohyuk Jeon and Shin Hyung Kim

J. Clin. Med. 2022, 11(18), 5471; https://doi.org/10.3390/jcm11185471 - 17 Sep 2022

Cited by 4 | Viewed by 1963

Abstract

The relationship between sarcopenia and pain remains unclear; thus, this study evaluated whether muscle strength is independently associated with neuropathic-like pain symptoms in patients with chronic musculoskeletal pain. A cut-off score of painDETECT ≥13 was used to indicate a possible neuropathic component. Handgrip [...] Read more.

The relationship between sarcopenia and pain remains unclear; thus, this study evaluated whether muscle strength is independently associated with neuropathic-like pain symptoms in patients with chronic musculoskeletal pain. A cut-off score of painDETECT ≥13 was used to indicate a possible neuropathic component. Handgrip strength was measured, and muscle mass was estimated. A total of 2599 patients, including 439 patients who reported neuropathic-like pain symptoms (16.9%), were included for analysis. Handgrip strength was significantly lower in patients experiencing neuropathic-like pain symptoms (23.23 ± 10.57 vs. 24.82 ± 10.43 kg, p < 0.001), and this result was chiefly found in female patients. However, there was no difference in estimated muscle mass. Shorter duration of pain, opioid usage, pain in lower limbs, sleep disturbance, and lower handgrip strength were significantly associated with neuropathic-like pain symptoms. In patients with handgrip strength below the reference values by sex, experiencing radiating pain and at least moderate sensory symptoms by light touch and thermal stimulation were more frequently reported. In conclusion, lower handgrip strength appeared to be an independent factor associated with symptoms suggestive of neuropathic pain in this population. Interventional studies are required to determine whether improvement in muscle strength can reduce the neuropathic pain component in chronic musculoskeletal pain. Full article

(This article belongs to the Special Issue Rehabilitation and Management of Frailty, Sarcopenia and Malnutrition)

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4 pages, 182 KiB

Open AccessEditorial

New Concepts in Diagnosis, Risk Factors and Work Ability in Patients with Hematogenous Spinal Infection

by Panagiotis Korovessis

J. Clin. Med. 2022, 11(18), 5470; https://doi.org/10.3390/jcm11185470 - 17 Sep 2022

Cited by 1 | Viewed by 1279

Abstract

In the last decades, there is an increasing incidence of hematogenous septic spinal infection (HIS) [...] Full article

(This article belongs to the Section Orthopedics)

10 pages, 1333 KiB

Open AccessArticle

Transesophageal Endoscopic Ultrasound Fine Needle Biopsy for the Diagnosis of Mediastinal Masses: A Retrospective Real-World Analysis

by Daniela Assisi, Filippo Tommaso Gallina, Daniele Forcella, Riccardo Tajè, Enrico Melis, Paolo Visca, Federico Pierconti, Emanuela Venti and Francesco Facciolo

J. Clin. Med. 2022, 11(18), 5469; https://doi.org/10.3390/jcm11185469 - 17 Sep 2022

Cited by 4 | Viewed by 2689

Abstract

Background: Endoscopic ultrasound (EUS) plays an important role in the diagnosis and staging of thoracic disease. Our report studies the diagnostic performance and clinical impact of EUS fine needle aspiration (FNA) in a homogenous cohort of patients according to the distribution of the [...] Read more.

Background: Endoscopic ultrasound (EUS) plays an important role in the diagnosis and staging of thoracic disease. Our report studies the diagnostic performance and clinical impact of EUS fine needle aspiration (FNA) in a homogenous cohort of patients according to the distribution of the enlarged MLNs or pulmonary masses. Methods: We retrospectively reviewed the diagnostic performance of 211 EUS-FNA in 200 consecutive patients with enlarged or PET-positive MLNs and para-mediastinal masses who were referred to our oncological center between January 2019 and May 2020. Results: The overall sensitivity of EUS-FNA was 85% with a corresponding negative predictive value (NPV) of 56% and an accuracy of 87.5%. The sensitivity and accuracy in patients with abnormal MLNs were 81.1% and 84.4%, respectively. In those with para-mediastinal masses, sensitivity and accuracy were 96.4% and 96.8%. The accuracy for both masses and lymph nodes was 100%, and in the LAG (left adrenal gland), it was 66.6%. Conclusions: Our results show that, in patients with suspected mediastinal masses, EUS-FNA is an accurate technique to evaluate all reachable mediastinal nodal stations, including station 5. Full article

(This article belongs to the Special Issue The Role of Interventional Pulmonology in Respiratory Diseases: From Diagnosis to Treatment)

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6 pages, 223 KiB

Open AccessEditorial

Interval Training in Sports Medicine: Current Thoughts on an Old Idea

by Sascha Ketelhut, Reinhard G. Ketelhut, Burkhard Weisser and Claudio R. Nigg

J. Clin. Med. 2022, 11(18), 5468; https://doi.org/10.3390/jcm11185468 - 17 Sep 2022

Cited by 3 | Viewed by 2545

Abstract

In light of the global physical inactivity pandemic, the increasing prevalence of non-committable diseases, and mounting healthcare costs, effective and feasible prevention and treatment approaches are urgently needed [...] Full article

(This article belongs to the Special Issue Interval-Training in Sports Medicine)

8 pages, 948 KiB

Open AccessFeature PaperReview

Optic Nerve Changes Detected with Ocular Ultrasonography during Different Surgical Procedures: A Narrative Review

by Maddalena De Bernardo, Livio Vitiello, Martina De Luca, Aniello La Marca and Nicola Rosa

J. Clin. Med. 2022, 11(18), 5467; https://doi.org/10.3390/jcm11185467 - 16 Sep 2022

Cited by 7 | Viewed by 2590

Abstract

Ultrasonographic appraisal of the optic nerve sheath diameter has become popular in recent years as a useful diagnostic tool to detect intracranial pressure variations. Intracranial hypertension is a life-threatening disease with possible poor clinical outcomes and can be caused by a variety of [...] Read more.

Ultrasonographic appraisal of the optic nerve sheath diameter has become popular in recent years as a useful diagnostic tool to detect intracranial pressure variations. Intracranial hypertension is a life-threatening disease with possible poor clinical outcomes and can be caused by a variety of neurological and non-neurological conditions. Considering the latter, increases in intracranial pressure have also been described during several surgical procedures. Ocular ultrasonography might be utilized to identify intracranial pressure increases by evaluating optic nerve sheath diameter variations. The aim of this review is to provide a wide overview on the use of the optic nerve ultrasound evaluation to detect intracranial pressure changes during surgical procedures, also discussing the pitfalls of the B-scan technique, the most widely used for such a purpose. PubMed medical database, Web of Science and Scopus were used to carry out this review. The present review showed that ocular ultrasonography could be considered a valuable diagnostic tool in the surgical setting to indirectly assess intracranial pressure. However, the use of the B-scan ultrasound should always be coupled with the standardized A-scan technique for a more accurate, precise and trustworthy ultrasound assessment. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 1200 KiB

Open AccessArticle

Alanine-Serine-Cysteine Transporter 2 Inhibition Suppresses Prostate Cancer Cell Growth In Vitro

by Masanobu Saruta, Kiyoshi Takahara, Atsuhiko Yoshizawa, Atsuko Niimi, Toshiyuki Takeuchi, Takuhisa Nukaya, Masashi Takenaka, Kenji Zennami, Manabu Ichino, Hitomi Sasaki, Mamoru Kusaka, Motoshi Suzuki, Makoto Sumitomo and Ryoichi Shiroki

J. Clin. Med. 2022, 11(18), 5466; https://doi.org/10.3390/jcm11185466 - 16 Sep 2022

Cited by 2 | Viewed by 1956

Abstract

Alanine-serine-cysteine transporter 2 (ASCT2) has been associated with increased levels of metabolism in various malignant tumors. However, its biological significance in the proliferation of prostate cancer (PCa) cells remains under investigation. We used the cBioPortal database to assess the effect of ASCT2 expression [...] Read more.

Alanine-serine-cysteine transporter 2 (ASCT2) has been associated with increased levels of metabolism in various malignant tumors. However, its biological significance in the proliferation of prostate cancer (PCa) cells remains under investigation. We used the cBioPortal database to assess the effect of ASCT2 expression on the oncological outcomes of 108 PCa patients. To evaluate the function of ASCT2 in castration-sensitive PCa (CSPC) and castration-resistant PCa (CRPC), LNCaP cells and the ARV7-positive PCa cell line, 22Rv1, were assessed using cell proliferation assays and Western blot analyses. The ASCT2 expression level was associated with biochemical recurrence-free survival after prostatectomy in patients with a Gleason score ≥ 7. In vitro experiments indicated that the growth of LNCaP cells after combination therapy of ASCT2 siRNA and enzalutamide treatment was significantly reduced, compared to that following treatment with enzalutamide alone or ASCT2 siRNA transfection alone (p < 0.01, 0.01, respectively). After ASCT2 inhibition by siRNA transfection, the growth of 22Rv1 cells was significantly suppressed as compared with negative control siRNA via downregulation of ARV7 both in fetal bovine serum and androgen-deprivation conditions (p < 0.01, 0.01, respectively). We demonstrated that ASCT2 inhibition significantly reduced the proliferation rates of both CSPC and CRPC cells in vitro. Full article

(This article belongs to the Section Oncology)

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ASCT2 expression levels according to the cBioPortal database. (A) ASCT2 expression in the GS 6 group (n = 68) and GS ≥ 7 group (n = 39); (B) Kaplan–Meier curves for BCR-free survival according to ASCT2 expression level in the GS 6 group; (C) Kaplan–Meier curves for BCR-free survival according to ASCT2 expression level in the GS ≥ 7 group. Full article ">Figure 2
Knockdown of ASCT2 with siRNA transfection in LNCaP (A) and 22Rv1 (B) cells. Full article ">Figure 3
Effect of ASCT2 transfection and enzalutamide treatment in LNCaP cells. (A) Representative images of Western blot analyses of LNCaP cells after transfection of ASCT2 siRNA (10 nM) or negative control siRNA (10 nM). The proliferation of LNCaP cells transfected with ASCT2 siRNA (1, 10, 50 nM) or negative control siRNA (1, 10, 50 nM) or Lipofectamine alone was assessed on day 4 using the cell counting kit-8. The percentage of cells is expressed as proliferation activity relative to Lipofectamine alone. Histograms represent the mean ± SD (** p < 0.01). (B) Representative images of Western blot analyses of LNCaP cells after enzalutamide treatment (20 µM). AR, androgen receptor; FBS, fetal bovine serum. The proliferation of LNCaP cells after enzalutamide treatment (20 μM) or control (no treatment) was assessed on day 3 using the cell counting kit-8. The percentage of cells is expressed as proliferation activity relative to control. Histograms represent the mean ± SD (** p < 0.01). (C) Representative images of Western blot analyses of LNCaP cells after combination therapy with ASCT2 siRNA (20 nM) or negative control siRNA (20 nM) and enzalutamide treatment (20 μM). Full article ">Figure 4
Effect of ASCT2 siRNA transfection in 22Rv1 cells. (A) representative images of Western blot analyses of 22Rv1 cells after transfection with ASCT2 siRNA (10 nM) or negative control siRNA (10 nM); (B) The proliferation of 22Rv1 cells transfected with ASCT2 siRNA (1, 10, 50 nM) or negative control siRNA (1, 10, 50 nM) or Lipofectamine alone was assessed on day 4 using the cell counting kit-8. The percentage of cells is expressed as proliferation activity relative to Lipofectamine alone. Histograms represent the mean ± SD (** p < 0.01). Full article ">

19 pages, 7616 KiB

Open AccessReview

Imaging in Hip Arthroplasty Management—Part 1: Templating: Past, Present and Future

by Edouard Germain, Charles Lombard, Fatma Boubaker, Mathias Louis, Alain Blum, Pedro Augusto Gondim-Teixeira and Romain Gillet

J. Clin. Med. 2022, 11(18), 5465; https://doi.org/10.3390/jcm11185465 - 16 Sep 2022

Cited by 7 | Viewed by 3195

Abstract

Hip arthroplasty is a frequently used procedure with high success rates. Its main indications are primary or secondary advanced osteoarthritis, due to acute fracture, osteonecrosis of the femoral head, and hip dysplasia. The goals of HA are to reduce pain and restore normal [...] Read more.

Hip arthroplasty is a frequently used procedure with high success rates. Its main indications are primary or secondary advanced osteoarthritis, due to acute fracture, osteonecrosis of the femoral head, and hip dysplasia. The goals of HA are to reduce pain and restore normal hip biomechanics, allowing a return to the patient’s normal activities. To reach those goals, the size of implants must suit, and their positioning must meet, quality criteria, which can be determined by preoperative imaging. Moreover, mechanical complications can be influenced by implant size and position, and could be avoided by precise preoperative templating. Templating used to rely on standard radiographs, but recently the use of EOS^® imaging and CT has been growing, given the 3D approach provided by these methods. However, there is no consensus on the optimal imaging work-up, which may have an impact on the outcomes of the procedure. This article reviews the current principles of templating, the various imaging techniques used for it, as well as their advantages and drawbacks, and their expected results. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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Preoperative measurements. Those values can be measured on (a) an anteroposterior pelvic radiograph and on (b) a coronal CT image, in the plane established by the femoral neck axis and the femoral midshaft. AO corresponds to the acetabular offset (white line: distance between the femoral head center (blue circle) and the acetabular floor), FO to the femoral offset (little-dotted line: distance between the femoral head center and the femoral midshaft axis (mild transparent white line)), CDA to the cervico-diaphyseal angle (large-dotted white line). A measurement of AO from the pelvic midline is shown on (c) an AP pelvic view [<a href="#B21-jcm-11-05465" class="html-bibr">21</a>], as it is more suitable in case of hip prosthesis, especially in case of cup protrusion. Full article ">Figure 2
Femoral neck antetorsion measurement. Three axial CT slices must be selected: one shown in (a) at the femoral head center, one in (b) at the femoral neck to measure the femoral neck axis (yellow line), then one in (c) at the level of the roman arch to determine the intercondylar axis (green line). In (d), a global illumination reformat is shown to illustrate the 3D rendering of this measure, corresponding to the angle between the yellow and green lines. Full article ">Figure 3
Representation of the flexion/extension of the femoral stem, using 3D CT-scan reformat, adapted from Abe et al. [<a href="#B23-jcm-11-05465" class="html-bibr">23</a>]. The dotted white line represents the retrocondylar axis, the white line the sagittal femoral tilt, and the colored line the stem axis. A theoretical neutral position is shown in (a) with the orange line; a negative value superior to −3° between the femoral tilt and the sagittal stem tilt is defined as flexion in (b) with the yellow line, which is the actual axis of this prosthesis; and a positive value superior to 3° is defined as an extension in (c) with the red line. Full article ">Figure 4
Hip deformities. Five types of hip deformities are shown, adapted from Kase et al. [<a href="#B11-jcm-11-05465" class="html-bibr">11</a>]. On each scheme, the femoral head is colored in grey, the acetabulum in dark grey, and the acetabular cavity in transparent grey. The blue lines correspond to the acetabular center and the green dotted line to the vertical and horizontal axis of the femoral head. In (a), a centered hip is shown as both axes are superimposed; in (b), a medialized (medialization of the vertical axis of the femoral head with respect to the acetabular one); in (c) a lateralized (lateralization of the vertical axis of the femoral head with respect to the acetabular one); in (d) a proximalized (cephalic displacement of the horizontal axis of the femoral head with respect to the acetabular one); and in (e) a proximo-lateralized (cephalic displacement of the horizontal axis of the femoral head with respect to the acetabular one, and lateral displacement of the vertical axis of the femoral head with respect to the acetabular one). An arbitrary cut-off of 3 mm was used by the authors to consider a displacement in each plane. Full article ">Figure 5
Inter-teardrop axis. The inter-teardrop axis shown on an anteroposterior pelvic radiograph (white line), the teardrops being represented by the dotted lines. Full article ">Figure 6
Cortical index calculation. Cortical index is calculated by measuring the ratio between the diaphyseal diameter between the cortices at the level (orange double-headed arrow) and the inner canal diaphyseal diameter 10 cm below the lesser trochanter (yellow double-headed arrow). Full article ">Figure 7
EOS® imaging example showing pelvic and lower limbs measurements. In this example, pelvic parameters are shown (PS: sacral slope, IP: pelvic incidence, VP: pelvic version), and multiple lower limbs measurements are available (femoral and tibial length, femoral head diameter, femoral neck length, cervico-diaphyseal angle, femoral offset, femoral and tibial version/torsion, knee valgus/varus, hip-knee shaft angle, femoral flessum/recurvatum). Full article ">Figure 8
EOS® imaging example showing spine parameters and their relationship with pelvic parameters. Spinal kyphosis and lordosis angles are provided along with the sagittal vertical axis measurement, as well as pelvic parameters, to provide a global appreciation of the spinopelvic complex, considered well balanced in this example. Full article ">

19 pages, 1277 KiB

Open AccessArticle

Early Determinants of Adverse Motor Outcomes in Preschool Children with a Critical Congenital Heart Defect

by Maaike C. A. Sprong, Barbara C. H. Huijgen, Linda S. de Vries, Hanna Talacua, Kim van Loon, Rian M. J. C. Eijsermans, Joppe Nijman, Johannes M. P. J. Breur, Marco van Brussel and Martijn G. Slieker

J. Clin. Med. 2022, 11(18), 5464; https://doi.org/10.3390/jcm11185464 - 16 Sep 2022

Cited by 6 | Viewed by 2209

Abstract

Neurodevelopmental disabilities are common in infants with critical congenital heart disease (CCHD). A prospective, longitudinal cohort study was conducted to establish the prevalence and early determinants of adverse motor outcomes in infants who underwent cardiac surgery with cardiopulmonary bypass before six months of [...] Read more.

Neurodevelopmental disabilities are common in infants with critical congenital heart disease (CCHD). A prospective, longitudinal cohort study was conducted to establish the prevalence and early determinants of adverse motor outcomes in infants who underwent cardiac surgery with cardiopulmonary bypass before six months of age. Motor development was assessed in 147 preschoolers using the Movement Assessment Battery for children-II. Although the majority displayed an average motor development, 22% of preschool children with CCHD deteriorated in their motor developmental score compared to their previous assessment at 18 months, especially in those with an aortic arch anomaly (AAA) (35%). Individual stability over time appeared to be moderate and the number of children with a motor delay increased, up to 20% in children with AAA. Motor development up to 42 months was best predicted by gestational age, cardio pulmonary bypass time, aortic cross clamp time, number of heart catheterizations up to 18 months and early motor outcomes. The increase in number of preschool children with a motor delay underlines the importance of longitudinal screening of motor skills in children with CCHD at risk for adverse motor outcomes. Offering early interventions may protect their current and future cardiovascular health as motor development is an independent predictor of exercise capacity, physical activity and participation in daily living. Full article

(This article belongs to the Section Clinical Rehabilitation)

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15 pages, 3918 KiB

Open AccessArticle

Measures of Corticalization

by Marcin Kozakiewicz

J. Clin. Med. 2022, 11(18), 5463; https://doi.org/10.3390/jcm11185463 - 16 Sep 2022

Cited by 8 | Viewed by 2106

Abstract

After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how [...] Read more.

After the insertion of dental implants into living bone, the condition of the peri-implant bone changes with time. Implant-loading phenomena can induce bone remodeling in the form of the corticalization of the trabecular bone. The aim of this study was to see how bone index (BI) values behave in areas of bone loss (radiographically translucent non-trabecular areas) and to propose other indices specifically dedicated to detecting corticalization in living bone. Eight measures of corticalization in clinical standardized intraoral radiographs were studied: mean optical density, entropy, differential entropy, long-run emphasis moment, BI, corticalization index ver. 1 and ver. 2 (CI v.1, CI v.2) and corticalization factor (CF). The analysis was conducted on 40 cortical bone image samples, 40 cancellous bone samples and 40 soft tissue samples. It was found that each measure distinguishes corticalization significantly (p < 0.001), but only CI v.1 and CI v.2 do so selectively. CF or the inverse of BI can serve as a measure of peri-implant bone corticalization. However, better measures are CIs as they are dedicated to detecting this phenomenon and allowing clear clinical deduction. Full article

(This article belongs to the Topic Advances in Musculoskeletal Imaging and Their Applications)

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Regions of interest were located in cortical bone (ROI 1), trabecular bone (ROI 2) and soft tissue (ROI 3) in main window of MaZda. Next, a series of textural features was extracted (MZ Reports—on the left) and exported in comma-separated vector format (CSV). Full article ">Figure 2
The source material and the primary texture features extracted from it. The meanings of the ROIs are the same as in <a href="#jcm-11-05463-f001" class="html-fig">Figure 1</a>. Maps of the local intensity of the studied features are below the original radiographs. The map is created from square boxes of nine pixels. In the maps of features, lighter areas indicate higher local intensity of the feature, while darker areas indicate lower intensity of the feature. Full article ">Figure 3
Based on the above three features (DifEntrp, Mean optical density, LngREmph), the algorithm manages to initially separate the results for the three tissues (ROIs), but corticalization (Cortical) is not well discriminated here. It is worth noting that the simple measure of mean optical density itself shows the differences between the regions of interest studied. Full article ">Figure 4
The bone index (BI) was calculated for the detection of normal bone (i.e., trabecular bone) within dental alveolus during guide bone regeneration. That is why BI reaches the highest values in ROI 2 representing trabecular bone. There are significant statistical differences between each ROI. Full article ">Figure 5
Corticalization index ver. 1 (CI v. 1) is based on two components included in BI and mean optical density. The components are arranged inversely to the BI to emphasize the corticalization sites rather than trabeculation, and the mean optical density enhances this effect because it is located in the numerator and is highest in the cortical bone. Full article ">Figure 6
Corticalization index ver. 2 (CI v. 2). This corticalization measure differs from version 1 by replacing differential entropy (ver. 1) in the denominator with entropy (here, ver. 2). This was dictated by the good statistical separation of ROI 1 from the other two ROIs by entropy. However, due to the greater spread of entropy in ROIs than differential entropy, the separation between ROIs is weaker here (but still highly statistically significant: p < 0.001). Full article ">Figure 7
Corticalization Factor (CF). It has statistical features similar to BI, but it is most strongly expressed in cortical sites, weaker in trabecular bone and weakest in soft tissues. Full article ">Figure 8
The relationships of selected corticalization measures in the evaluation of intraoral radiographs. (a) Corticalization index ver.1 with bone index (BI). A probabilistic neural network (PNN) used to classify cases into different three structures in radiograph (cortical, trabecular, bone loss), based on two input variables (corticalization index ver.1 and bone index). Of the 120 ROIs, 93% were correctly classified by the network. (b) Corticalization index ver.1 with corticalization factor. Among the 120 ROIs used, 94% were correctly classified in this pair of corticalization evaluators. Full article ">

10 pages, 521 KiB

Open AccessArticle

Muscular Strength and Carotid Intima–Media Thickness in Physically Fit Young Adults: The CHIEF Atherosclerosis Study

by Gen-Min Lin, Kun-Zhe Tsai, Yun-Chen Chang, Wei-Chun Huang, Xuemei Sui and Carl J. Lavie

J. Clin. Med. 2022, 11(18), 5462; https://doi.org/10.3390/jcm11185462 - 16 Sep 2022

Cited by 6 | Viewed by 1935

Abstract

Background: Greater muscular strength (MusS) has been found to have an inverse association with subclinical atherosclerosis in children, as well as with mortality from cardiovascular diseases (CVDs) in middle-aged and elderly individuals. However, the association of the degree of MusS with atherosclerosis may [...] Read more.

Background: Greater muscular strength (MusS) has been found to have an inverse association with subclinical atherosclerosis in children, as well as with mortality from cardiovascular diseases (CVDs) in middle-aged and elderly individuals. However, the association of the degree of MusS with atherosclerosis may differ by sex and has not been clarified in young adults. Methods and Results: A total of 1021 Taiwanese military personnel, aged 18–40 years, participated in annual health examinations in 2018–2020. MusS was separately assessed by 2-min push-up and 2-min sit-up numbers. Subclinical atherosclerosis was measured by the left carotid bulb intima–media thickness (cIMT) using high-resolution ultrasonography. Multiple linear regression with adjustments for age, sex, alcohol intake, cigarette smoking, anthropometric indices, blood pressure, and lipid profiles was utilized to determine the correlation between MusS and cIMT. Both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.089 and −0.072, respectively; both p-values < 0.05). In men, both 2-min push-up and 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.076 and −0.086, respectively; both p-values < 0.05), while in women, 2-min push-up numbers but not 2-min sit-up numbers were inversely correlated with cIMT (standardized β: −0.204 and −0.01; p = 0.03 and 0.99, respectively). Conclusions: Among young adults, there was an inverse association between MusS and cIMT, emphasizing the beneficial impact of MusS on the regression of atherosclerosis. The study also revealed a sex difference and suggested that training of the upper arm muscles may be an effective preventive measure for young women to reduce the risk of early cardiovascular diseases. Full article

(This article belongs to the Section Sports Medicine)

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