Journal of Clinical Medicine

12 pages, 1331 KiB

Open AccessArticle

Are Age and Trauma Mechanism Associated with Volume Change in the Fractures of the Bony Orbit?

by Ella Starck, Niilo Lusila, Juho Suojanen and Eeva Kormi

J. Clin. Med. 2024, 13(12), 3618; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123618 (registering DOI) - 20 Jun 2024

Abstract

Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones [...] Read more.

Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones can lead to changes in the orbital volume, which may cause enophthalmos, diplopia, and impaired facial aesthetics. Objectives: The aim of this study is to investigate whether there is an association between volume change of the bony orbit and age, gender, or trauma mechanism. Methods: A retrospective study of patients with unilateral blowout or blow-in fractures treated and examined in Päijät-Häme Central Hospital, Lahti, Finland was conducted. Altogether, 127 patients met the inclusion criteria. Their computed tomographs (CT) were measured with an orbit-specific automated segmentation-based volume measurement tool, and the relative orbital volume change between fractured and intact orbital vault was calculated. Thereafter, a statistical analysis was performed. A p-value less than 0.05 was considered significant. Results: We found that relative increase in orbital volume and age have a statistically significant association (p = 0.022). Trauma mechanism and gender showed no significant role. Conclusions: Patient’s age is associated with increased volume change in fractures of the bony orbit. Full article

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

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10 pages, 1210 KiB

Open AccessArticle

Comparison between the Efficacy of Sacral Erector Spina Plane Block and Pudendal Block on Catheter-Related Bladder Discomfort: A Prospective Randomized Study

by Bilge Olgun Keleş, Elvan Tekir Yılmaz and Ali Altınbaş

J. Clin. Med. 2024, 13(12), 3617; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123617 (registering DOI) - 20 Jun 2024

Abstract

Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block [...] Read more.

Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block (SESPB) and pudendal nerve block (PNB) in reducing the incidence and score of CRBD. Methods: This study was conducted between November and December 2023. ASA I-III, fifty-four TURP patients were divided into two groups: Group 1 received SESPB (n = 27) and Group 2 received PNB (n = 27) under ultrasound guidance at the end of surgery. The incidence of CRBD, CRBD score, numerical rating scale (NRS) score, use of rescue analgesics, block performance time, first call for analgesics, patient satisfaction, and side effects were recorded for 24 h. Results: The incidence of CRBD was lowest at 33.3% and highest at 48.1% in Group 1 and lowest at 25.9% and highest at 48.1% in Group 2, with no significant difference between the groups at all measurement times. CRBD scores and NRS scores were low and similar between the two groups. Block performance times were 9 ± 1.7 min in SESPB and 20 ± 2.5 min in PNB, and there was a significant difference between the mean times (p < 0.001). Patient satisfaction was adequate and similar in both groups. Conclusions: SESPB demonstrated a similar decreasing effect to PNB on the incidence and scores of CRBD in the first 24 h following TURP operations. The duration of SESPB administration was shorter than PNB. Full article

(This article belongs to the Section Nephrology & Urology)

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11 pages, 3695 KiB

Open AccessArticle

The Migration Pattern of a Short-Tapered Femoral Stem Correlates with the Occurrence of Cortical Hypertrophies: A 10-Year Longitudinal Study Using Ein Bild Röntgen Analyse–Femoral Component Analysis

by Tobias Freitag, Michael Fuchs, David Friedrich, Ralf Bieger, Heiko Reichel and Moritz Oltmanns

J. Clin. Med. 2024, 13(12), 3616; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123616 (registering DOI) - 20 Jun 2024

Abstract

Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact [...] Read more.

Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact on 10-year outcomes. Methods: It included 100 consecutive total hip arthroplasties (THAs) using the Fitmore stem (Zimmer, Warsaw, Indiana), with clinical and radiographic follow-ups at 1, 2, 5, and at least 10 years post-surgery. Results: No revisions were performed due to aseptic loosening after a mean of 11.6 years (range: 10–13.5 years). CH was observed in 26% of hips, primarily in Gruen zones 3 and 5. There was no significant difference in the Harris Hip Score between patients with and without CH. Larger stem sizes and greater axial subsidence significantly correlated with CH occurrence (OD 1.80, (1.13–1.92), p = 0.004; OD 1.47, (1.04–2.08), p = 0.028). The Fitmore stem demonstrated excellent survival rates and favorable outcomes over 10 years. Conclusions: Despite a lower CH rate compared to other studies, significant correlations with stem size and subsidence were identified. This study underscores the importance of patient selection and achieving high primary stability to maintain the metaphyseal anchoring concept. Full article

(This article belongs to the Special Issue State of the Art in Hip Replacement Surgery)

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10 pages, 587 KiB

Open AccessArticle

Improving Spiritual Well-Being of Polish Pain Outpatients: A Feasibility Mixed Methods Study

by Maciej Wiktor Klimasiński, Ewa Baum, Katarzyna Wieczorowska-Tobis and Bogusław Stelcer

J. Clin. Med. 2024, 13(12), 3615; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123615 (registering DOI) - 20 Jun 2024

Abstract

Introduction: A physician in a chronic pain treatment clinic must recognize that the relationship between pain and spirituality is bidirectional. Chronic pain can decrease the level of spiritual well-being, and low spiritual well-being can also significantly intensify the perception of pain and [...] Read more.

Introduction: A physician in a chronic pain treatment clinic must recognize that the relationship between pain and spirituality is bidirectional. Chronic pain can decrease the level of spiritual well-being, and low spiritual well-being can also significantly intensify the perception of pain and worsen coping with it. Currently, for many scientific and medical communities, it is evident that spiritual care is an indispensable element of holistic medicine. Objective: The authors developed a non-religious spiritual care model provided by a physician at a chronic pain treatment clinic from May 2022 to February 2024. Method: The study utilized a mixed-method approach to conduct the research. The analysis consisted of twelve patients. A FACIT-Sp-12 questionnaire evaluated the individual’s spiritual well-being before the intervention. The intervention involved asking patients open-ended questions about their life history, experiences, and spiritual beliefs and the physician’s use of active listening and empathetic responses to what patients shared (relationship-building activities). The intervention aimed to assist patients in accepting the limitations of an incurable chronic disease, affirming the value of their lives, enhancing inner harmony, and increasing their sense of belonging to something greater. After the intervention, a re-assessment of the patient’s spiritual well-being was conducted using the FACIT-Sp-12 questionnaire. Researchers collected qualitative data through a confidential survey that included the following instructions: “Please express an anonymous opinion on how you perceive the spiritual care provided by the physician”. Results: There was an increase in spiritual well-being, assessed using the FACIT-Sp-12 scale, in 9 out of 12 patients. The median, as well as the average, level of spiritual well-being increased in a statistically significant way after the intervention (p < 0.05). This was primarily due to the higher value of the peace subscale of the questionnaire. Qualitative analysis revealed benefits reported by patients (personal development, gratitude, satisfaction, support, hope) resulting from physician’s actions. Conclusions: Both qualitative and quantitative data showed that establishing a relationship with the doctor improves the spiritual well-being of patients. Therefore, this model can be recommended for physicians in chronic pain treatment clinics. Full article

(This article belongs to the Section Anesthesiology)

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13 pages, 1931 KiB

Open AccessFeature PaperArticle

Correlations between the Frankfort Plane and the Presence of Myofascial Trigger Points in Posterior Cervical Musculature: An Exploratory Study

by Darío Sánchez-Guilabert and Ángel Martínez-Carrasco

J. Clin. Med. 2024, 13(12), 3614; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123614 (registering DOI) - 20 Jun 2024

Abstract

Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the [...] Read more.

Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the subjects was used to determine the Frankfort plane and to study its degree of inclination. Myofascial pain syndrome is one of the most common causes of musculoskeletal pain. Trigger points are hyperirritable spots located in a palpable taut band of skeletal muscle that is painful on compression or stretch and causes a local twitch in response to snapping or palpation of the band. Objectives: The aim of this study was to analyze the relationship between the Frankfort plane and the presence of myofascial trigger points causing cervical myofascial pain. Methods: This is a cross-sectional descriptive observational study. All subjects underwent a photographic study to determine the degree of Frankfort plane inclination, and the posterior cervical musculature was palpated to find myofascial trigger points that were measured with a pressure algometer in three cervical locations on the right and left sides. Results: Our study included 47 subjects who had suffered at least one episode of cervical pain in their lifetimes. The mean age was 22.3 ± 2.9 years. Statistically significant results were found in the first right location and sports practice (p = 0.007), in the second right location and gender (p = 0.0097), in the second right location and sports practice (p = 0.0486), in the third right location and gender (p = 0.0098), and in the first, second, and third left locations and gender (p = 0.0083; p = 0.024; p = 0.0016, respectively). In the correlation between the Frankfort plane and the presence of myofascial trigger points, all locations were positive, with the first right location being statistically significant (p = 0.048). Conclusions: A positive relationship was found between the Frankfort plane and the presence of myofascial trigger points. The greater the angle of the Frankfort plane, the less the myofascial pain. Full article

(This article belongs to the Special Issue Physiotherapy Update in the Management of Musculoskeletal Pain)

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11 pages, 13590 KiB

Open AccessArticle

The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction—A Case Series

by Christoph Steiner, Maximilian Neubert, Gian B. Bottini, Shinnosuke Nogami, Katharina Zeman-Kuhnert and Alexander Gaggl

J. Clin. Med. 2024, 13(12), 3613; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123613 (registering DOI) - 20 Jun 2024

Abstract

Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the [...] Read more.

Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery. Full article

(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)

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13 pages, 463 KiB

Open AccessReview

The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?

by Benjamin Reardon, Leonardo Pasalic and Emmanuel J. Favaloro

J. Clin. Med. 2024, 13(12), 3612; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123612 (registering DOI) - 20 Jun 2024

Abstract

Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations in which viscoelastic testing is reportedly superior to standard routine laboratory testing for hemostasis. We report the current testing platforms and terminology, as well [...] Read more.

Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations in which viscoelastic testing is reportedly superior to standard routine laboratory testing for hemostasis. We report the current testing platforms and terminology, as well as providing a concise narrative review of the published evidence to guide its use in various clinical settings. Notably, there is increasing evidence of the potential utility of viscoelastic testing for assessment of direct oral anticoagulants, and bleeding associated with chronic liver disease, orthotopic liver transplantation, cardiac surgery, trauma, obstetrics and pediatrics. Full article

(This article belongs to the Section Hematology)

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35 pages, 2611 KiB

Open AccessReview

Novel Treatment Strategies for Hormone Receptor (HR)-Positive, HER2-Negative Metastatic Breast Cancer

by Antonella Ferro, Michela Campora, Alessia Caldara, Delia De Lisi, Martina Lorenzi, Sara Monteverdi, Raluca Mihai, Alessandra Bisio, Mariachiara Dipasquale, Orazio Caffo and Yari Ciribilli

J. Clin. Med. 2024, 13(12), 3611; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123611 (registering DOI) - 20 Jun 2024

Abstract

Estrogen receptor (ER)-positive breast cancer (BC) is the most common BC subtype. Endocrine therapy (ET) targeting ER signaling still remains the mainstay treatment option for hormone receptor (HR)-positive BC either in the early or in advanced setting, including different strategies, such as the [...] Read more.

Estrogen receptor (ER)-positive breast cancer (BC) is the most common BC subtype. Endocrine therapy (ET) targeting ER signaling still remains the mainstay treatment option for hormone receptor (HR)-positive BC either in the early or in advanced setting, including different strategies, such as the suppression of estrogen production or directly blocking the ER pathway through SERMs—selective estrogen receptor modulators—or SERDs—selective estrogen receptor degraders. Nevertheless, the development of de novo or acquired endocrine resistance still remains challenging for oncologists. The use of novel ET combined with targeted drugs, such as cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, has significantly improved long-term outcome rates, thus changing the therapeutic algorithm for metastatic BC (MBC) and recently the therapeutic strategy in the adjuvant setting for early high-risk BC. Eluding the resistance to CDK4/6 inhibitors combined with ET is currently an unmet medical need, and there is disagreement concerning the best course of action for patients who continue to progress after this combination approach. Genetic changes in the tumor along its growth uncovered by genomic profiling of recurrent and/or metastatic lesions through tumor and/or liquid biopsies may predict the response or resistance to specific agents, suggesting the best therapeutic strategy for each patient by targeting the altered ER-dependent pathway (novel oral SERDs and a new generation of anti-estrogen agents) or alternative ER-independent signaling pathways such as PI3K/AKT/mTOR or tyrosine kinase receptors (HER2 mutations or HER2 low status) or by inhibiting pathways weakened through germline BRCA1/2 mutations. These agents are being investigated as single molecules and in combination with other target therapies, offering promising weapons to overcome or avoid treatment failure and propose increasingly more personalized treatment approaches. This review presents novel insights into ET and other targeted therapies for managing metastatic HR⁺/HER2⁻ BC by exploring potential strategies based on clinical evidence and genomic profiling following the failure of the CDK4/6i and ET combination. Full article

(This article belongs to the Special Issue Breast Cancer: Novel Insights into Hormone Therapy)

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10 pages, 499 KiB

Open AccessArticle

Clinical Characteristics of Cutaneous Pain in Psoriasis

by Magdalena Kotewicz, Piotr K. Krajewski, Andrzej K. Jaworek and Jacek C. Szepietowski

J. Clin. Med. 2024, 13(12), 3610; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123610 (registering DOI) - 20 Jun 2024

Abstract

Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the [...] Read more.

Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the study (34% female; mean age 42.1 ± 13.0 years). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Itch severity was evaluated using the numeric rating scale (NRS) and 4-Item Itch Score (4IIS). The intensity of skin pain was measured through the NRS, short-form McGill pain questionnaire (SF-MPQ), visual analog scale (VAS), and Douleur Neuropathique-4 questionnaire (DN4). Results: In the past week, 84.9% of psoriasis patients reported itch, while 50% of them reported skin pain. The average NRS for itch was 4.52 ± 2.88 points, and the 4IIS yielded a mean score of 6.79 ± 4.37 points. In terms of the intensity of cutaneous pain, the mean NRS was 2.42 ± 2.96 points; the SF-MPQ score averaged 4.84 ± 7.51 points; and the VAS score was 1.92 ± 2.65 points. Furthermore, 17% of adult psoriasis patients reported neuropathic pain. In 84.9% of the participants, skin pain was concurrent with areas affected by itch, while 18.9% of patients exhibited cutaneous pain encompassing all itchy areas. The pain NRS demonstrated significant correlations with the SF-MPQ (r = 0.531, p < 0.001), VAS (r = 0.779, p < 0.001), itch NRS (r = 0.551, p < 0.001), and 4IIS (r = 0.569, p < 0.001). No association was found between the pain NRS and PASI or disease duration. Conclusions: Skin pain of mild intensity and itch of moderate intensity are prevalent symptoms in psoriasis patients. Strong correlations between skin pain and itch can be explained by the process of neurogenic inflammation. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: An Update for Clinician—Part II)

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12 pages, 3333 KiB

Open AccessArticle

Is Feto-Maternal Transfusion after Cesarean Delivery Different in Singleton and Twin Pregnancy?

by Anna Stachurska-Skrodzka, Damian Mielecki, Anna Fijałkowska, Kinga Żebrowska, Monika Kasperczak and Katarzyna Kosińska-Kaczyńska

J. Clin. Med. 2024, 13(12), 3609; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123609 (registering DOI) - 20 Jun 2024

Abstract

Background: The aim of the study was to investigate if feto-maternal transfusion was related to the size of the fetal-maternal interface, and, therefore, was larger in twin pregnancy in comparison with singleton pregnancy. Methods: Blood samples from women with singleton (n [...] Read more.

Background: The aim of the study was to investigate if feto-maternal transfusion was related to the size of the fetal-maternal interface, and, therefore, was larger in twin pregnancy in comparison with singleton pregnancy. Methods: Blood samples from women with singleton (n = 11), and monochorionic (n = 11) and dichorionic (n = 13) twin gestations were tested. Flow cytometry tests with hemoglobin F, glycophorin A, and hemoglobin F and carbonic anhydrase simultaneous staining were used to detect fetal red blood cells and maternal F cells. Results: In all cases, the volume of feto-maternal transfusion was estimated to be low. The highest rate of fetal red blood cells in the maternal circulation was observed in the blood of women with dichorionic twin gestations both before and after delivery. An increase in fetal red blood cells was observed after cesarean section in singletons and twins. The median rate of maternal F cells was 2.23% in singleton, 2.1% in monochorionic and 3.95% in dichorionic pregnancy. Conclusions: Feto-maternal transfusion during pregnancy may be related to the multiplicity and chorionicity of pregnancy. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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3 pages, 180 KiB

Open AccessComment

Comment on Salazar et al. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J. Clin. Med. 2024, 13, 1143

by Athanasios G. Pantelis

J. Clin. Med. 2024, 13(12), 3608; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123608 (registering DOI) - 20 Jun 2024

Abstract

I read the article by Salazar J. [...] Full article

(This article belongs to the Special Issue Clinical Advances in Obesity and Bariatric Surgery)

11 pages, 515 KiB

Open AccessArticle

In Patients with Cardiogenic Shock, Extracorporeal Membrane Oxygenation Is Associated with Very High All-Cause Inpatient Mortality Rate

by Mohammad Reza Movahed, Arman Soltani Moghadam and Mehrtash Hashemzadeh

J. Clin. Med. 2024, 13(12), 3607; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123607 (registering DOI) - 20 Jun 2024

Abstract

Background: The goal of this study was to evaluate the effect of extracorporeal membrane oxygenation (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between [...] Read more.

Background: The goal of this study was to evaluate the effect of extracorporeal membrane oxygenation (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of ECMO in adults over the age of 18 and mortality and complications with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for ECMO and cardiogenic shock for the available years 2016–2020 were utilized. A total of 796,585 (age 66.5 ± 14.4) patients had a diagnosis of cardiogenic shock excluding Impella. Of these patients, 13,160 (age 53.7 ± 15.4) were treated with ECMO without IABP use. Total inpatient mortality without any device was 32.7%. It was 47.9% with ECMO. In a multivariate analysis adjusting for 47 variables such as age, gender, race, lactic acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., ECMO utilization remained highly associated with mortality (OR: 1.78, CI: 1.6–1.9, p < 0.001). Evaluating teaching hospitals only revealed similar findings. Major complications were also high in the ECMO cohort. Conclusions: In patients with cardiogenic shock, the use of ECMO was associated with the high in-hospital mortality regardless of comorbid condition, high-risk futures, or type of hospital. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)

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10 pages, 1134 KiB

Open AccessArticle

Efficacy of Vonoprazan vs. Intravenous Proton Pump Inhibitor in Prevention of Re-Bleeding of High-Risk Peptic Ulcers: A Randomized Controlled Pilot Study

by Tanawat Pattarapuntakul, Thanawin Wong, Panu Wetwittayakhlang, Nisa Netinatsunton, Suriya Keeratichananont, Apichat Kaewdech, Sawangpong Jandee, Naichaya Chamroonkul, Pimsiri Sripongpun and Peter L. Lakatos

J. Clin. Med. 2024, 13(12), 3606; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123606 - 20 Jun 2024

Abstract

Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to [...] Read more.

Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to evaluate the comparative efficacy of intravenous PPI infusion versus VPZ in preventing re-bleeding after endoscopic hemostasis in patients with high-risk peptic ulcers. Methods: A randomized, double-blind, controlled, and double-dummy design was employed. Patients with peptic ulcer bleeding (Forrest class IA/IB or IIA/IIB) who underwent endoscopic hemostasis were randomly assigned to either the PPI group or the VPZ group. Re-bleeding rates at 3, 7, and 30 days, the number of blood transfusions required, length of hospitalization, and ulcer healing rate at 56 days were assessed. Results: A total of 44 eligible patients were enrolled, including 20 patients (PPI group, n = 11; VPZ group, n = 9) with high-risk peptic ulcers. The mean age was 66 years, with 70% being male. Re-bleeding within 72 h occurred in 9.1% of the PPI group versus 0% in the VPZ group (p = 1.000). There was no significant difference in re-bleeding rates within 7 days and 30 days (18.2% vs. 11.1%, p = 1.000). Additionally, the ulcer healing rate did not significantly differ between the groups (87.5% vs. 77.8%). Conclusions: This pilot study demonstrates comparable efficacy between oral vonoprazan and continuous PPI infusion in preventing recurrent bleeding events among high-risk peptic ulcer patients following successful endoscopic hemostasis. Full article

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

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14 pages, 5743 KiB

Open AccessArticle

Reliability of the AI-Assisted Assessment of the Proximity of the Root Apices to Mandibular Canal

by Wojciech Kazimierczak, Natalia Kazimierczak, Kamila Kędziora, Marta Szcześniak and Zbigniew Serafin

J. Clin. Med. 2024, 13(12), 3605; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123605 - 20 Jun 2024

Abstract

This study evaluates the diagnostic accuracy of an AI-assisted tool in assessing the proximity of the mandibular canal (MC) to the root apices (RAs) of mandibular teeth using computed tomography (CT). This study involved 57 patients aged 18–30 whose CT scans were analyzed [...] Read more.

This study evaluates the diagnostic accuracy of an AI-assisted tool in assessing the proximity of the mandibular canal (MC) to the root apices (RAs) of mandibular teeth using computed tomography (CT). This study involved 57 patients aged 18–30 whose CT scans were analyzed by both AI and human experts. The primary aim was to measure the closest distance between the MC and RAs and to assess the AI tool’s diagnostic performance. The results indicated significant variability in RA-MC distances, with third molars showing the smallest mean distances and first molars the greatest. Diagnostic accuracy metrics for the AI tool were assessed at three thresholds (0 mm, 0.5 mm, and 1 mm). The AI demonstrated high specificity but generally low diagnostic accuracy, with the highest metrics at the 0.5 mm threshold with 40.91% sensitivity and 97.06% specificity. This study underscores the limited potential of tested AI programs in reducing iatrogenic damage to the inferior alveolar nerve (IAN) during dental procedures. Significant differences in RA-MC distances between evaluated teeth were found. Full article

(This article belongs to the Special Issue Emerging Technologies for Dental Imaging)

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19 pages, 543 KiB

Open AccessSystematic Review

Combined Central and Peripheral Demyelination (CCPD) Associated with MOG Antibodies: Report of Four New Cases and Narrative Review of the Literature

by Marianna Papadopoulou, Dimitrios Tzanetakos, Christos Moschovos, Anastasia Korona, George Vartzelis, Konstantinos Voudris, Stella Fanouraki, Evangelia-Makrina Dimitriadou, Georgios Papadimas, John S. Tzartos, Sotirios Giannopoulos and Georgios Tsivgoulis

J. Clin. Med. 2024, 13(12), 3604; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123604 (registering DOI) - 20 Jun 2024

Abstract

Background/Objectives: Myelin oligodendrocyte glycoprotein (MOG) is exclusively expressed in the central nervous system (CNS) and is found on the outer surface of oligodendrocytes. Antibodies to MOG are associated with CNS demyelination, whereas peripheral nervous system (PNS) demyelination is seldom reported to be [...] Read more.

Background/Objectives: Myelin oligodendrocyte glycoprotein (MOG) is exclusively expressed in the central nervous system (CNS) and is found on the outer surface of oligodendrocytes. Antibodies to MOG are associated with CNS demyelination, whereas peripheral nervous system (PNS) demyelination is seldom reported to be related to MOG-IgG. Methods: The database of patients seen in our neurological academic center was searched for MOG-IgG seropositivity and concomitant demyelinating polyneuropathy. For the purpose of the review, in March 2024, we searched for case reports and case series in the following databases: PubMed, Scopus, Cochrane, and ScienceDirect. Inclusion criteria were MOG-IgG seropositivity and demyelinating polyneuropathy. Exclusion criteria were type of publication other than case reports and case series, unconfirmed diagnosis of demyelinating polyneuropathy, and other diseases causing demyelination in either the CNS or PNS. Critical appraisal of the selected case reports and case series was realized by JBI. Results: Four new cases were identified with MOG-IgG and confirmed demyelinating polyneuropathy. This review identified 22 cases that have been published since 2018. Clinical, imaging, neurophysiological, and immunological characteristics, as well as treatment options and outcomes are presented and compared to those of other cases with combined central and peripheral demyelination (CCPD). Conclusions: The pathogenetic mechanism is unclear; thus, different hypotheses are discussed. New case reporting and large cohort studies will help further the exploration of the underlying mechanism and guide more effective therapeutic interventions. Full article

(This article belongs to the Section Clinical Neurology)

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6 pages, 546 KiB

Open AccessBrief Report

Discontinuation of Palliative Brain Radiotherapy in Patients with Brain Metastases: A Case–Control Study

by Paul Windisch, Jamie Lütscher, Robert Förster, Daniel R. Zwahlen and Christina Schröder

J. Clin. Med. 2024, 13(12), 3603; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123603 - 20 Jun 2024

Abstract

Background: Discontinuation of radiotherapy is rarely discussed in the scientific literature. The goal of this study was, therefore, to estimate the frequency of and reasons for treatment discontinuations in patients receiving radiotherapy for brain metastases from solid tumors and to identify factors [...] Read more.

Background: Discontinuation of radiotherapy is rarely discussed in the scientific literature. The goal of this study was, therefore, to estimate the frequency of and reasons for treatment discontinuations in patients receiving radiotherapy for brain metastases from solid tumors and to identify factors predicting said discontinuations. Methods: All patients treated for brain metastases from solid tumors between 2010 and 2020 at our institution were retrospectively reviewed. In addition to collecting relevant patient characteristics, the Recursive Partitioning Analysis (RPA) and disease-specific Graded Prognostic Assessment (GPA) groups for each patient were calculated to assess the performance of these scores in predicting treatment discontinuations. Results: Out of 468 patients who underwent cranial radiotherapy, 35 treatments (7.5%) were discontinued. The most frequent reason was clinical deterioration, which was documented in 26 (74.3%) of discontinued treatments. Patients whose radiotherapy was discontinued had, on average, more leptomeningeal disease (20.0% vs. 12.6%), worse ECOG performance status (mean ECOG performance status 1.86 vs. 1.39), and more uncontrolled extracranial metastases (85.3% vs. 70.8%). The frequencies of treatment discontinuation increased with worse prognosis and differed significantly across RPA groups (p = 0.037) but not across GPA groups (p = 0.612). Conclusions: Treatment discontinuation occurred in 7.5% of cases, mostly due to clinical deterioration. Poor performance status, as well as more advanced disease and, in turn, poor prognosis, were associated with higher discontinuation rates. Full article

(This article belongs to the Section Oncology)

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20 pages, 2410 KiB

Open AccessArticle

Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities

by Jasna Mihailović, Jelena Roganović, Ivana Starčević, Ivan Nikolić, Nataša Prvulović Bunović and Zoran Nikin

J. Clin. Med. 2024, 13(12), 3602; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123602 - 20 Jun 2024

Abstract

Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC [...] Read more.

Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution’s Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824–0.946; p < 0.001), 0.844 (95% CI: 0.772–0.916; p < 0.001), 0.753 (95% CI: 0.612–0.844; p < 0.001), and 0.547 (95% CI: 0.442–0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers. Full article

(This article belongs to the Special Issue Nuclear Medicine Procedures in Oncology: New Prospects)

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10 pages, 709 KiB

Open AccessArticle

The Potential Role of CA-125 as a Biomarker for Short-Term Mortality Risk in Patients with Acute Symptomatic Pulmonary Embolism

by Crhistian-Mario Oblitas, Francisco Galeano-Valle, Marta-Olimpia Lago-Rodríguez, Marina López-Rubio, Jesús Baltasar-Corral, Mercedes García-Gámiz, Angielys Zamora-Trillo, Luis-Antonio Alvarez-Sala Walther and Pablo Demelo-Rodríguez

J. Clin. Med. 2024, 13(12), 3601; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123601 - 20 Jun 2024

Abstract

Background: Antigen carbohydrate 125 (CA-125) is a complex glycoprotein extensively studied as a prognostic biomarker in heart failure, yet its potential role in the short-term prognosis of an acute pulmonary embolism (PE) remains unexplored. Methods: In this observational, prospective, single-center study, [...] Read more.

Background: Antigen carbohydrate 125 (CA-125) is a complex glycoprotein extensively studied as a prognostic biomarker in heart failure, yet its potential role in the short-term prognosis of an acute pulmonary embolism (PE) remains unexplored. Methods: In this observational, prospective, single-center study, consecutive patients aged 18 and older with a confirmed acute symptomatic PE and no history of prior anticoagulant therapy were enrolled. Primary and secondary objectives aimed to assess the prognostic capacity of CA-125 at PE diagnosis for 30-day mortality and major bleeding, respectively. Results: A total of 164 patients were included (mean age 69.8 years, SD 17), with 56.1% being male. Within 30 days, 17 patients (10.4%) died and 9 patients (5.5%) suffered major bleeding. ROC curve analysis for 30-day mortality yielded an area under the curve of 0.69 (95% CI 0.53–0.85) with an optimal CA-125 cut-off point of 20 U/mL and a negative predictive value of 96%. Multivariate analysis revealed a significant association between CA-125 levels exceeding 20 U/mL and 30-day mortality (adjusted odds ratio 4.95; 95% CI 1.61–15.2) after adjusting for age, cancer, NT-proBNP > 600 ng/mL, and the simplified pulmonary embolism severity index score. Survival analysis for 30-day mortality exhibited a hazard ratio of 5.47 (95% CI 1.78–16.8). No association between CA-125 levels and 30-day major bleeding was found. Conclusions: CA-125 emerges as a promising surrogate biomarker for short-term mortality prediction in an acute symptomatic PE. Future investigations should explore the integration of CA-125 into PE mortality prediction scores to enhance the prognostic accuracy in this patient population. Full article

(This article belongs to the Section Cardiovascular Medicine)

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9 pages, 493 KiB

Open AccessArticle

Socioeconomic Status and Clinical Outcomes in Chronic Kidney Disease: Bootstrap Validation of a Simple Indicator

by Annalisa Pitino, Graziella D’Arrigo, Carmela Marino, Patrizia Pizzini, Graziella Caridi, Francesca Mallamaci, Giovanni Tripepi and Carmine Zoccali

J. Clin. Med. 2024, 13(12), 3600; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123600 - 20 Jun 2024

Abstract

Background: Chronic Kidney Disease (CKD) is a complex health condition that interacts significantly with socioeconomic determinants, particularly income status and education. This study developed a simple indicator of socioeconomic status (SES), which is composed of income status and education in CKD patients, and [...] Read more.

Background: Chronic Kidney Disease (CKD) is a complex health condition that interacts significantly with socioeconomic determinants, particularly income status and education. This study developed a simple indicator of socioeconomic status (SES), which is composed of income status and education in CKD patients, and evaluated its impact on health outcomes in this population. Methods: This study was conducted on 561 CKD patients, stages 2–5. The composite SES score was developed by combining the regression coefficients of income and education as predictors of the study endpoint in a multivariable Cox model, normalizing these coefficients to derive weights, and then using these weights to calculate an individual percentage score based on each person’s income and education. The composed SES indicator was internally validated through bootstrap analysis. Over a median follow-up time of 36 months, we tracked all-cause death and non-fatal cardiovascular events. Results: Both lack of income (p = 0.020) and low educational level (p = 0.034) were independently related to the combined endpoint. Based on these covariates‘ regression coefficients, a composite socioeconomic score considering income and educational level was generated. In a Cox regression model, a 10% increase in this composite risk score entailed a 25% increase in the hazard ratio (HR) of the combined endpoint [HR (10% increase): 1.25], and the internally validated 95% CI ranged from 1.14 to 1.41 (p < 0.001). Conclusions: This study underscores the significant impact of a simple, bootstrap-validated composite SES indicator on CKD patients’ health outcomes. These findings highlight the importance of considering education and socioeconomic factors in managing and treating CKD patients and inform future research and policy considerations for this population. Full article

(This article belongs to the Special Issue Novelty in the Management of Progression and Complications of CKD)

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8 pages, 4008 KiB

Open AccessArticle

Evaluation of a Semi-Automated Wound-Halving Algorithm for Split-Wound Design Studies: A Step towards Enhanced Wound-Healing Assessment

by Paul Julius Georg, Meret Emily Schmid, Sofia Zahia, Sebastian Probst, Simone Cazzaniga, Robert Hunger and Simon Bossart

J. Clin. Med. 2024, 13(12), 3599; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123599 - 20 Jun 2024

Abstract

Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the “split-wound design” approach for wound studies using objective measures. We further improved this relatively new approach [...] Read more.

Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the “split-wound design” approach for wound studies using objective measures. We further improved this relatively new approach and combined it with a semi-automated wound measurement algorithm. Method: The algorithm is capable of plotting an objective halving line that is calculated by splitting the bounding box of the wound surface along the longest side. To evaluate this algorithm, we compared the accuracy of the subjective wound halving of manual operators of different backgrounds with the algorithm-generated halving line and the ground truth, in two separate rounds. Results: The median absolute deviation (MAD) from the ground truth of the manual wound halving was 2% and 3% in the first and second round, respectively. On the other hand, the algorithm-generated halving line showed a significantly lower deviation from the ground truth (MAD = 0.3%, p < 0.001). Conclusions: The data suggest that this wound-halving algorithm is suitable and reliable for conducting wound studies. This innovative combination of a semi-automated algorithm paired with a unique study design offers several advantages, including reduced patient recruitment needs, accelerated study planning, and cost savings, thereby expediting evidence generation in the field of wound care. Our findings highlight a promising path forward for improving wound research and clinical practice. Full article

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

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15 pages, 7650 KiB

Open AccessArticle

Normative Values for Sternoclavicular Joint and Clavicle Anatomy Based on MR Imaging: A Comprehensive Analysis of 1591 Healthy Participants

by Theo Morgan Languth, Anne Prietzel, Robin Bülow, Till Ittermann, René Laqua, Lyubomir Haralambiev, Axel Ekkernkamp and Mustafa Sinan Bakir

J. Clin. Med. 2024, 13(12), 3598; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123598 - 19 Jun 2024

Abstract

Background: The clavicle remains one of the most fractured bones in the human body, despite the fact that little is known about the MR imaging of it and the adjacent sternoclavicular joint. This study aims to establish standardized values for the diameters of [...] Read more.

Background: The clavicle remains one of the most fractured bones in the human body, despite the fact that little is known about the MR imaging of it and the adjacent sternoclavicular joint. This study aims to establish standardized values for the diameters of the clavicle as well as the angles of the sternoclavicular joint using whole-body MRI scans of a large and healthy population and to examine further possible correlations between diameters and angles and influencing factors like BMI, weight, height, sex, and age. Methods: This study reviewed whole-body MRI scans from the Study of Health in Pomerania (SHIP), a German population-based cross-sectional study in Mecklenburg–Western Pomerania. Descriptive statistics, as well as median-based regression models, were used to evaluate the results. Results: We could establish reference values based on a shoulder-healthy population for each clavicle parameter. Substantial differences were found for sex. Small impacts were found for height, weight, and BMI. Less to no impact was found for age. Conclusions: This study provides valuable reference values for clavicle and sternoclavicular joint-related parameters and shows the effects of epidemiological features, laying the groundwork for future studies. Further research is mandatory to determine the clinical implications of these findings. Full article

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

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13 pages, 291 KiB

Open AccessArticle

Counteracting HPV Cervical and Anal Infection through Dietary Supplementation of EGCG, Folic Acid, Vitamin B12 and Hyaluronic Acid: Clinical Case Reports

by Marco Calcagno, Bernadette Incocciati, Ludovica Di Fraia and Vittorio Unfer

J. Clin. Med. 2024, 13(12), 3597; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123597 - 19 Jun 2024

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Abstract

Background: Human papilloma virus (HPV) infection and the management of its persistence is still a great medical challenge. Recently, scientific evidence has supported the potential therapeutic effects of four combined natural molecules—epigallocatechin gallate (EGCG), folic acid, vitamin B12 and hyaluronic acid (HA)—in counteracting [...] Read more.

Background: Human papilloma virus (HPV) infection and the management of its persistence is still a great medical challenge. Recently, scientific evidence has supported the potential therapeutic effects of four combined natural molecules—epigallocatechin gallate (EGCG), folic acid, vitamin B12 and hyaluronic acid (HA)—in counteracting HPV DNA positivity and related cytological lesions. Methods: Each patient of these five clinical cases had persistent HPV positivity in the anogenital site and assumed a dietary supplement based on a combination of 200 mg of EGCG, 50 mg of HA, 1 mg of vitamin B12 and 400 mcg of folic acid (Pervistop^®, Farmares s.r.l., Rome, Italy) at a dosage of 1 or 2 caps/day for 6 or 3 months, respectively, depending on clinical history. Results: After treatment, all the patients reported a negative HPV DNA test and improved cytological lesions, thus demonstrating the ability of these combined molecules to counteract both anal and cervical HPV infection and related manifestations. Conclusions: Overall, these data corroborate previous evidence about the effectiveness of such natural molecules in the management of HPV infection and its persistence. Naturally, further studies with a larger population and long-term follow-up will contribute to reinforce the positive effects of this dietary supplement in counteracting HPV infection. Full article

(This article belongs to the Special Issue Human Papillomaviruses (HPV) Infection: How to Treat and Prevent?)

10 pages, 720 KiB

Open AccessArticle

Kinematic Alignment Achieves a More Balanced Total Knee Arthroplasty than Mechanical Alignment among CPAK Type I Patients: A Simulation Study

by Noriaki Arai, Seikai Toyooka, Hironari Masuda, Hirotaka Kawano and Takumi Nakagawa

J. Clin. Med. 2024, 13(12), 3596; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123596 - 19 Jun 2024

Viewed by 46

Abstract

Background: There is no consensus on whether mechanical alignment (MA) or kinematic alignment (KA) should be chosen for total knee arthroplasty (TKA) for coronal plane alignment of the knee (CPAK) Type I with a varus arithmetic HKA (aHKA) and apex distal joint [...] Read more.

Background: There is no consensus on whether mechanical alignment (MA) or kinematic alignment (KA) should be chosen for total knee arthroplasty (TKA) for coronal plane alignment of the knee (CPAK) Type I with a varus arithmetic HKA (aHKA) and apex distal joint line obliquity (JLO). The aim of this study was to investigate whether MA or KA is preferable for soft tissue balancing in TKA for this phenotype. Method: This prospective cohort study included 64 knees with CPAK Type I osteoarthritis that had undergone cruciate-retaining TKA. Using optical tracking software, we simulated implant placement in the Mako system before making the actual bone cut and compared the results between MA and KA. Extension balance (the difference between medial and lateral gaps in extension) and medial balance (the difference in medial gaps in flexion and extension) were examined. These gap differences within 2 mm were defined as good balance. Achievement of overall balance was defined as an attainment of good extension and medial balance. The incidence of balance in each patient was compared with an independent sample ratio test. Results: Compared with the MA group, the KA group achieved better soft tissue balance in extension balance (p < 0.001). A total of 75% of the patients in the KA group achieved overall balance, which was greater than the 38% achieved in the MA group (p < 0.001). Conclusions: In robot-assisted TKA for CPAK Type I osteoarthritis, KA achieved knee balance during extension without soft tissue release in a greater percentage of patients than MA. Full article

(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)

10 pages, 385 KiB

Open AccessArticle

Surgical Outcomes of Hugo™ RAS Robot-Assisted Partial Nephrectomy for Cystic Renal Masses: Technique and Initial Experience

by Francesco Prata, Andrea Iannuzzi, Francesco Tedesco, Alberto Ragusa, Angelo Civitella, Matteo Pira, Marco Fantozzi, Leonilde Sica, Roberto Mario Scarpa and Rocco Papalia

J. Clin. Med. 2024, 13(12), 3595; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123595 - 19 Jun 2024

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Abstract

Background: The Hugo™ Robot-Assisted Surgery (RAS) system is a new cutting-edge robotic platform designed for clinical applications. Nevertheless, its application for cystic renal tumors has not yet been thoroughly investigated. In this context, we present an initial series of Robot-Assisted Partial Nephrectomy [...] Read more.

Background: The Hugo™ Robot-Assisted Surgery (RAS) system is a new cutting-edge robotic platform designed for clinical applications. Nevertheless, its application for cystic renal tumors has not yet been thoroughly investigated. In this context, we present an initial series of Robot-Assisted Partial Nephrectomy (RAPN) procedures carried out using the Hugo™ RAS system for cystic renal masses. Methods: Between October 2022 and January 2024, twenty-seven RAPN procedures for renal tumors were performed at Fondazione Policlinico Universitario Campus Bio-Medico. Our prospective board-approved dataset was queried for “cystic features” (n = 12). Perioperative data were collected. The eGFR was calculated according to the CKD-EPI formula. Post-operative complications were reported according to the Clavien–Dindo classification. Computed tomography (CT) scans for follow-up were performed according to the EAU guidelines. Trifecta was defined as the coexistence of negative surgical margin status, no Clavien–Dindo grade ≥ 3 complications, and eGFR decline ≤ 30%. Results: All the patients successfully underwent RAPN without the need for conversion or additional port placement. The median docking and console time were 5.5 (IQR, 4–6) and 79.5 min (IQR, 58–91 min), respectively. No intraoperative complications occurred, as well as clashes between instruments or with the bedside assistant. Two minor postoperative complications were recorded (Clavien–Dindo II). At discharge, serum creatinine and eGFR were comparable to preoperative values. Only one patient (8.4%) displayed positive surgical margins. The rate of trifecta achievement was 91.7%. Conclusions: RAPN for cystic renal masses using the novel Hugo™ RAS system can be safely and effectively performed. This robotic system provided satisfactory peri-operative outcomes, preserving renal function and displaying low postoperative complications and a high trifecta rate achievement. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Patients Undergoing Nephrectomy—Series 2)

18 pages, 13611 KiB

Open AccessArticle

Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants—An Accuracy Study of Digital High-Tech Procedures

by Bilal Msallem, Lara Veronesi, Michel Beyer, Florian S. Halbeisen, Michaela Maintz, Adrian Franke, Paula Korn, Adrian Dragu and Florian M. Thieringer

J. Clin. Med. 2024, 13(12), 3594; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123594 - 19 Jun 2024

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Abstract

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling [...] Read more.

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future. Full article

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

11 pages, 871 KiB

Open AccessArticle

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study

by Jaewon Huh, Jung-Min Koo, Minju Kim, Hoon Choi, Hyung-Joo Park, Gong-Min Rim and Wonjung Hwang

J. Clin. Med. 2024, 13(12), 3593; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123593 - 19 Jun 2024

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Abstract

Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children [...] Read more.

Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3–6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1–6 h, 6–12 h, and 12–24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1–6, 6–12, and 12–24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1–6 and 6–12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE. Full article

(This article belongs to the Special Issue Advances in Pediatric Anesthesiology)

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13 pages, 908 KiB

Open AccessArticle

The Role of CyberKnife Stereotactic Radiosurgery in Recurrent Cranial Medulloblastomas across Pediatric and Adult Populations

by Kelly H. Yoo, Neelan J. Marianayagam, David J. Park, Aroosa Zamarud, Xuejun Gu, Erqi Pollom, Scott G. Soltys, Antonio Meola and Steven D. Chang

J. Clin. Med. 2024, 13(12), 3592; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123592 - 19 Jun 2024

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Abstract

Background/Objectives: Medulloblastoma is the most common malignant brain tumor in children. In recent decades, the therapeutic landscape has undergone significant changes, with stereotactic radiosurgery (SRS) emerging as a promising treatment for recurrent cases. Our study provides a comprehensive analysis of the long-term [...] Read more.

Background/Objectives: Medulloblastoma is the most common malignant brain tumor in children. In recent decades, the therapeutic landscape has undergone significant changes, with stereotactic radiosurgery (SRS) emerging as a promising treatment for recurrent cases. Our study provides a comprehensive analysis of the long-term efficacy and safety of SRS in recurrent medulloblastomas across both pediatric and adult patients at a single institution. Methods: We retrospectively reviewed the clinical and radiological records of patients who underwent CyberKnife SRS for recurrent cranial medulloblastomas at our institution between 1998 and 2023. Follow-up data were available for 15 medulloblastomas in 10 patients. The cohort comprised eight pediatric patients (ages 3–18) and two adult patients (ages 19–75). The median age at the time of SRS was 13 years, the median tumor volume accounted for 1.9 cc, the median biologically equivalent dose (BED) was 126 Gy, and the single-fraction equivalent dose (SFED) was 18 Gy. The SRS was administered at 75% of the median isodose line. Results: Following a median follow-up of 39 months (range: 6–78), 53.3% of the medulloblastomas progressed, 13.3% regressed, and 33.3% remained stable. The 3-year local tumor control (LTC) rate for all medulloblastomas was 65%, with lower rates observed in the adult cohort (50%) and higher rates in pediatric patients (67%). The 3-year overall survival (OS) rate was 70%, with significantly higher rates in pediatric patients (75%) compared to adult patients (50%). The 3-year progression-free survival (PFS) rate was 58.3%, with higher rates in pediatric patients (60%) compared to adult patients (50%). Two pediatric patients developed radiation-induced edema, while two adult patients experienced radiation necrosis at the latest follow-up, with both adult patients passing away. Conclusions: Our study provides a complex perspective on the efficacy and safety of CyberKnife SRS in treating recurrent cranial medulloblastomas across pediatric and adult populations. The rarity of adverse radiation events (AREs) underscores the safety profile of SRS, reinforcing its role in enhancing treatment outcomes. The intricacies of symptomatic outcomes, intertwined with factors such as age, tumor location, and prior surgeries, emphasize the need for personalized treatment approaches. Our findings underscore the imperative for ongoing research and the development of more refined treatment strategies for recurrent medulloblastomas. Given the observed disparities in treatment outcomes, a more meticulous tailoring of treatment approaches becomes crucial. Full article

(This article belongs to the Topic Innovative Radiation Therapies)

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14 pages, 3729 KiB

Open AccessArticle

Functional and Radiological Results Following Revision Blade Plating and Cephalomedullary Nailing in Aseptic Trochanteric and Subtrochanteric Nonunion

by Julia Rehme-Röhrl, Andreas Brand, Annika Dolt, Dag Grünewald, Reinhard Hoffmann, Fabian Stuby, Uwe Schweigkofler and Christian von Rüden

J. Clin. Med. 2024, 13(12), 3591; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123591 - 19 Jun 2024

Viewed by 126

Abstract

Background: Trochanteric and subtrochanteric fractures result in nonunion in more than 20% of cases. The aim of this study was to assess the functional and radiological results following revision cephalomedullary nailing and 95-degree angled blade plating in aseptic trochanteric and subtrochanteric nonunion. Methods: [...] Read more.

Background: Trochanteric and subtrochanteric fractures result in nonunion in more than 20% of cases. The aim of this study was to assess the functional and radiological results following revision cephalomedullary nailing and 95-degree angled blade plating in aseptic trochanteric and subtrochanteric nonunion. Methods: In a retrospective multi-center study between January 2010 and December 2020, a total of 68 consecutive patients (21 women and 47 men) from two European level I trauma centers with the diagnosis of aseptic nonunion were recruited. Follow-up assessment and the patients’ convenience were assessed using the Harris Hip Score, Visual Analog Scale for pain at rest and on stress/exertion and Short Form-12. Results: The patients’ mean age was 57 (range 26–85) years. After a follow-up period of 12 months, one case of persistent nonunion in the cephalomedullary nail group and 10 cases in the blade plate group were identified. The mean duration of surgery was 137 ± 47 min in the cephalomedullary nail group and 202 ± 59 min in the blade plate group (<0.0001). Short-term postoperative complications included wound dehiscence, bleeding, mismatched screw and hematoma. The mid-term results 12 months after surgical revision demonstrated significantly different osseous union rates (p = 0.018). The long-term functional outcome according to the Harris Hip Score 6 years (range 2–10) after revision surgery demonstrated 81 ± 21 points in the cephalomedullary nail group and 64 ± 23 points in the plate group (p = 0.026). Conclusions: This study demonstrated that the revision treatment of trochanteric and subtrochanteric nonunion using a 95-degree blade plate or cephalomedullary nail resulted in a high percentage of osseous union, with a low incidence of complications and good functional results for both methods. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: Part II)

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14 pages, 1629 KiB

Open AccessSystematic Review

Comprehensive Insights into Metastasis-Associated Spinal Cord Compression: Pathophysiology, Diagnosis, Treatment, and Prognosis: A State-of-the-Art Systematic Review

by Michail Vavourakis, Evangelos Sakellariou, Athanasios Galanis, Panagiotis Karampinas, Dimitrios Zachariou, Georgios Tsalimas, Vasileios Marougklianis, Evangelia Argyropoulou, Meletis Rozis, Angelos Kaspiris and Spiros G. Pneumatikos

J. Clin. Med. 2024, 13(12), 3590; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123590 - 19 Jun 2024

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Abstract

Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting [...] Read more.

Background: Spinal cord compression is a formidable complication of advanced cancer, and clinicians of copious specialities often have to encounter significant complex challenges in terms of diagnosis, management, and prognosis. Metastatic lesions from cancer are a common cause of spinal cord compression, affecting a substantial portion of oncology patients, and only in the US has the percentage risen to 10%. Acute metastasis-correlated spinal cord compression poses a considerable clinical challenge, necessitating timely diagnosis and intervention to prevent neurological deficits. Clinical presentation is often non-specific, emphasizing the importance of thorough evaluation and appropriate differential diagnosis. Diagnostic workup involves various imaging modalities and laboratory studies to confirm the diagnosis and assess the extent of compression. Treatment strategies focus on pain management and preserving spinal cord function without significantly increasing patient life expectancy, while multidisciplinary approaches are often required for optimal outcomes. Prognosis depends on several factors, highlighting the importance of early intervention. We provide an up-to-date overview of acute spinal cord compression in metastases, accentuating the importance of comprehensive management strategies. Objectives: This paper extensively explores the pathophysiology, clinical presentation, diagnostic strategies, treatment modalities, and prognosis associated with spinal cord metastases. Materials and Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Conclusions: We aim to help healthcare professionals make informed clinical decisions when treating patients with spinal cord metastases by synthesizing current evidence and clinical insights. Full article

(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)

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12 pages, 1639 KiB

Open AccessArticle

Diagnostic Utility of Specific Frailty Questionnaire: The Kihon Checklist for Hippocampal Atrophy in COPD

by Tsunahiko Hirano, Shun Takahashi, Ayumi Fukatsu-Chikumoto, Kasumi Yasuda, Takuya Ishida, Tomohiro Donishi, Kazuyoshi Suga, Keiko Doi, Keiji Oishi, Shuichiro Ohata, Yoriyuki Murata, Yoshikazu Yamaji, Maki Asami-Noyama, Nobutaka Edakuni, Tomoyuki Kakugawa and Kazuto Matsunaga

J. Clin. Med. 2024, 13(12), 3589; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm13123589 - 19 Jun 2024

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Abstract

Background/Objectives: COPD patients who are frail have been reported to develop brain atrophy, but no non-invasive diagnostic tool has been developed to detect this condition. Our study aimed to explore the diagnostic utility of the Kihon Checklist (KCL), a frailty questionnaire, in [...] Read more.

Background/Objectives: COPD patients who are frail have been reported to develop brain atrophy, but no non-invasive diagnostic tool has been developed to detect this condition. Our study aimed to explore the diagnostic utility of the Kihon Checklist (KCL), a frailty questionnaire, in assessing hippocampal volume loss in patients with COPD. Methods: We recruited 40 COPD patients and 20 healthy individuals using the KCL to assess frailty across seven structural domains. Hippocampal volumes were obtained from T1-weighted MRI images, and ROC analysis was performed to detect hippocampal atrophy. Results: Our results showed that patients with COPD had significantly greater atrophic left hippocampal volumes than healthy subjects (p < 0.05). The univariate correlation coefficient between the left hippocampal volume and KCL (1–20), which pertains to instrumental and social activities of daily living, was the largest (ρ = −0.54, p < 0.0005) among the KCL subdomains. Additionally, both KCL (1–25) and KCL (1–20) demonstrated useful diagnostic potential (93% specificity and 90% sensitivity, respectively) for identifying individuals in the lowest 25% of the left hippocampal volume (AUC = 0.82). Conclusions: Our study suggests that frailty questionnaires focusing on daily vulnerability, such as the KCL, can effectively detect hippocampal atrophy in COPD patients. Full article

(This article belongs to the Section Pulmonology)

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J. Clin. Med., Volume 13, Issue 12 (June-2 2024) – 263 articles

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