Medicina

18 pages, 387 KiB

Open AccessEditor’s ChoiceReview

Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe

by Mariana Preda, Sylwia Smolinska and Florin-Dan Popescu

Medicina 2024, 60(9), 1494; https://doi.org/10.3390/medicina60091494 - 13 Sep 2024

Viewed by 1353

Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may [...] Read more.

Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)’s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks. Full article

(This article belongs to the Special Issue Chronic Respiratory Diseases: Updates on Pathophysiology, Symptoms, Diagnosis and Treatment)

9 pages, 529 KiB

Open AccessEditor’s ChoiceArticle

Association between Frailty and Asthma

by Jong Myung Park, Sujin Lee and Jae Ho Chung

Medicina 2024, 60(9), 1479; https://doi.org/10.3390/medicina60091479 - 10 Sep 2024

Viewed by 568

Abstract

Background and Objectives: This study investigated whether there is an association between elderly frailty and asthma. Material Methods: We examined 9745 elderly participants who did not have asthma and 275 elderly patients who had asthma diagnosed by a doctor from the [...] Read more.

Background and Objectives: This study investigated whether there is an association between elderly frailty and asthma. Material Methods: We examined 9745 elderly participants who did not have asthma and 275 elderly patients who had asthma diagnosed by a doctor from the 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons Survey. Study Selections: The Korean version of the fatigue, resistance, ambulation, illnesses, and loss of weight (K-FRAIL) scale was used to determine their level of frailty. The relationship between frailty and geriatric asthma was examined using multiple logistic regression analysis, which was adjusted for a number of confounding variables (socioeconomic, health behavior, psychological characteristics, and functional status). Results: Frailty as defined by the K-FRAIL scale was significantly higher in the asthma group (7.6%) than the non-asthma group (4.9%). The frailty phenotype component showed that resistance, ambulation, and illness severity were more severe in the asthma group than the non-asthma group. After adjusting, asthma was significantly associated with an increased risk of frailty (OR 1.45; 95% confidence interval [CI] 1.01–2.09) compared to the non-asthma group. Conclusions: Frailty might be associated with elderly asthma in patients from the Korean population. Frailty may not only be associated with asthma, but also with other diseases. So, more evidence is needed to establish this association. Full article

(This article belongs to the Section Pulmonology)

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10 pages, 266 KiB

Open AccessEditor’s ChoiceArticle

Anxiety and Depression in Advanced and Metastatic Lung Cancer Patients—Correlations with Performance Status and Type of Treatment

by Roxana-Andreea Rahnea-Nita, Laura-Florentina Rebegea, Mihaela Dumitru, Radu-Iulian Mitrica, Alexandru Nechifor, Dorel Firescu, Adrian-Cornel Maier, Georgiana Bianca Constantin, Valentin-Titus Grigorean and Gabriela Rahnea-Nita

Medicina 2024, 60(9), 1472; https://doi.org/10.3390/medicina60091472 - 9 Sep 2024

Viewed by 870

Abstract

Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these [...] Read more.

Background and Objectives: The treatment of advanced and metastatic lung cancer is multimodal, and it is coordinated by a multidisciplinary team. Anxiety and depression occur frequently in patients with lung cancer, creating considerable discomfort in therapeutic management. At the same time, these psychoemotional symptoms affect the patients’ quality of life. Objective: This research seeks to identify correlations both between anxiety and depression and the patients’ performance statuses, as well as between anxiety and depression and the type of treatment: radiotherapy, chemotherapy, tyrosine kinase inhibitors (TKI), immunotherapy and palliative care. Materials and Methods: The study evaluated 105 patients with lung cancer from two oncologic centers. Patients were assessed for anxiety and depression using the questionnaire Hospital Anxiety and Depression Scale (HADS). The HADS is a self-report rating scale of 14 items. It measures anxiety and depression, and has two subscales. There are seven items for each subscale. There are 4-point Likert scale ranging from 0 to 3. For each subscale, the score is the sum of the seven items, ranging from 0 to 21. Results: The most powerful correlation with statistical significance was observed between the IT type of treatment (immunotherapy) and the normal level of anxiety, PC = 0.82 (p < 0.001) as well as the normal level of depression. Palliative treatment was correlated with anxiety and depression, both borderline and abnormal. For ECOG 3–4 performance status and abnormal anxiety, respectively, abnormal depression was significantly associated. Also, continuous hospitalization was associated with abnormal anxiety and depression. Conclusions: Early assessments of anxiety and depression are necessary in patients with advanced and metastatic lung cancer, with unfavorable performance status, who have been admitted to continuous hospitalization, and who require palliative care. Full article

(This article belongs to the Section Psychiatry)

6 pages, 237 KiB

Open AccessEditor’s ChoiceOpinion

Age as a Mortality Predictor in ECPR Patients

by Radim Spacek, Vojtech Weiss, Petra Kavalkova, Otakar Jiravsky, Jan Barcak and Jan Belohlavek

Medicina 2024, 60(9), 1444; https://doi.org/10.3390/medicina60091444 - 4 Sep 2024

Viewed by 779

Abstract

Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced technique using extracorporeal membrane oxygenation (ECMO) to support patients with refractory cardiac arrest. Age significantly influences ECPR outcomes, with younger patients generally experiencing better survival and neurological outcomes due to many aspects. This review explores the [...] Read more.

Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced technique using extracorporeal membrane oxygenation (ECMO) to support patients with refractory cardiac arrest. Age significantly influences ECPR outcomes, with younger patients generally experiencing better survival and neurological outcomes due to many aspects. This review explores the impact of age on ECPR effectiveness, emphasizing the need to consider age alongside other clinical factors in patient selection. Survival rates differ notably between in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA), highlighting the importance of rapid intervention. The potential of artificial intelligence to develop predictive models for ECPR outcomes is discussed, aiming to improve decision-making. Ethical considerations around age-based treatment decisions are also addressed. This review advocates for a balanced approach to ECPR, integrating clinical and ethical perspectives to optimize patient outcomes across all age groups. Full article

(This article belongs to the Special Issue Extracorporeal Membrane Oxygenation (ECMO): New Insights and Future Directions)

11 pages, 3583 KiB

Open AccessEditor’s ChoiceArticle

Increased Scan Speed and Pitch on Ultra-Low-Dose Chest CT: Effect on Nodule Volumetry and Image Quality

by Heejoo Bae, Ji Won Lee, Yeon Joo Jeong, Min-Hee Hwang and Geewon Lee

Medicina 2024, 60(8), 1301; https://doi.org/10.3390/medicina60081301 - 12 Aug 2024

Viewed by 725

Abstract

Background and Objectives: This study’s objective was to investigate the influence of increased scan speed and pitch on image quality and nodule volumetry in patients who underwent ultra-low-dose chest computed tomography (CT). Material and Methods: One hundred and two patients who [...] Read more.

Background and Objectives: This study’s objective was to investigate the influence of increased scan speed and pitch on image quality and nodule volumetry in patients who underwent ultra-low-dose chest computed tomography (CT). Material and Methods: One hundred and two patients who had lung nodules were included in this study. Standard-speed, standard-pitch (SSSP) ultra-low-dose CT and high-speed, high-pitch (HSHP) ultra-low-dose CT were obtained for all patients. Image noise was measured as the standard deviation of attenuation. One hundred and sixty-three nodules were identified and classified according to location, volume, and nodule type. Volume measurement of detected pulmonary nodules was compared according to nodule location, volume, and nodule type. Motion artifacts at the right middle lobe, the lingular segment, and both lower lobes near the lung bases were evaluated. Subjective image quality analysis was also performed. Results: The HSHP CT scan demonstrated decreased motion artifacts at the left upper lobe lingular segment and left lower lobe compared to the SSSP CT scan (p < 0.001). The image noise was higher and the radiation dose was lower in the HSHP scan (p < 0.001). According to the nodule type, the absolute relative volume difference was significantly higher in ground glass opacity nodules compared with those of part-solid and solid nodules (p < 0.001). Conclusion: Our study results suggest that HSHP ultra-low-dose chest CT scans provide decreased motion artifacts and lower radiation doses compared to SSSP ultra-low-dose chest CT. However, lung nodule volumetry should be performed with caution for ground glass opacity nodules. Full article

(This article belongs to the Section Pulmonology)

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17 pages, 22700 KiB

Open AccessEditor’s ChoiceArticle

Identification of Schizophrenia Susceptibility Loci in the Urban Taiwanese Population

by Chih-Chung Huang, Yi-Guang Wang, Chun-Lun Hsu, Ta-Chuan Yeh, Wei-Chou Chang, Ajeet B. Singh, Chin-Bin Yeh, Yi-Jen Hung, Kuo-Sheng Hung and Hsin-An Chang

Medicina 2024, 60(8), 1271; https://doi.org/10.3390/medicina60081271 - 6 Aug 2024

Viewed by 875

Abstract

Background and Objectives: Genomic studies have identified several SNP loci associated with schizophrenia in East Asian populations. Environmental factors, particularly urbanization, play a significant role in schizophrenia development. This study aimed to identify schizophrenia susceptibility loci and characterize their biological functions and [...] Read more.

Background and Objectives: Genomic studies have identified several SNP loci associated with schizophrenia in East Asian populations. Environmental factors, particularly urbanization, play a significant role in schizophrenia development. This study aimed to identify schizophrenia susceptibility loci and characterize their biological functions and molecular pathways in Taiwanese urban Han individuals. Materials and Methods: Participants with schizophrenia were recruited from the Taiwan Precision Medicine Initiative at Tri-Service General Hospital. Genotype–phenotype association analysis was performed, with significant variants annotated and analyzed for functional relevance. Results: A total of 137 schizophrenia patients and 26,129 controls were enrolled. Ten significant variants (p < 1 × 10⁻⁵) and 15 expressed genes were identified, including rs1010840 (SOWAHC and RGPD6), rs11083963 (TRPM4), rs11619878 (LINC00355 and LINC01052), rs117010638 (AGBL1 and MIR548AP), rs1170702 (LINC01680 and LINC01720), rs12028521 (KAZN and PRDM2), rs12859097 (DMD), rs1556812 (ATP11A), rs78144262 (LINC00977), and rs9997349 (ENPEP). These variants and associated genes are involved in immune response, blood pressure regulation, muscle function, and the cytoskeleton. Conclusions: Identified variants and associated genes suggest a potential genetic predisposition to schizophrenia in the Taiwanese urban Han population, highlighting the importance of potential comorbidities, considering population-specific genetic and environmental interactions. Full article

(This article belongs to the Section Psychiatry)

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15 pages, 617 KiB

Open AccessEditor’s ChoiceReview

The Relationship between Cognitive Impairment and Violent Behavior in People Living with Schizophrenia Spectrum Disorders: A Critical Review and Treatment Considerations

by Gabriele Nibbio, Lorenzo Bertoni, Irene Calzavara-Pinton, Nicola Necchini, Stefano Paolini, Antonio Baglioni, Daniela Zardini, Laura Poddighe, Viola Bulgari, Jacopo Lisoni, Giacomo Deste, Stefano Barlati and Antonio Vita

Medicina 2024, 60(8), 1261; https://doi.org/10.3390/medicina60081261 - 3 Aug 2024

Viewed by 1034

Abstract

Cognitive impairment is a core feature of schizophrenia spectrum disorders (SSD). Violent and aggressive behavior represents a complex issue in psychiatry, and people with SSD have been shown to be at risk of being both victims and perpetrators of violence. In this review, [...] Read more.

Cognitive impairment is a core feature of schizophrenia spectrum disorders (SSD). Violent and aggressive behavior represents a complex issue in psychiatry, and people with SSD have been shown to be at risk of being both victims and perpetrators of violence. In this review, the complex relationship between cognitive impairment and violent behavior is explored, also considering the usefulness of treating cognitive impairment to improve violence-related outcomes. Several studies report that cognitive impairment is linked to violent behavior, but significant differences between domains and conflicting results are also present, leaving the identification of specific cognitive profiles predicting violent behavior in SSD as an important aim for future research. Evidence regarding the effectiveness of treating cognitive impairment to improve violent behavior, while heterogeneous, provides more consistent results: cognition-targeting interventions appear to provide significant benefits also in the prevention of aggression in people living with SSD, and preliminary evidence shows cognition-focused interventions targeting violent behavior improve both cognition- and violence-related outcomes. Implementing these interventions in clinical practice could be of great usefulness, particularly in forensic contexts. Physical exercise, which improves cognitive performance and psychosocial functioning in SSD, appears to reduce violent behavior in healthy individuals, but requires further studies in clinical samples. Full article

(This article belongs to the Special Issue The Management of Patients with Psychotic Disorders in Forensic Psychiatry)

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15 pages, 551 KiB

Open AccessEditor’s ChoiceSystematic Review

The Relationship between Psychological Stress and Anthropometric, Biological Outcomes: A Systematic Review

by Joanna Rog, Katarzyna Nowak and Zuzanna Wingralek

Medicina 2024, 60(8), 1253; https://doi.org/10.3390/medicina60081253 - 1 Aug 2024

Viewed by 1135

Abstract

Background and Objectives: Challenges and threats to global security and the growing demands of today’s society lead to significantly increased exposure to stress. Stress can negatively affect numerous physiological processes, including metabolic changes. An unhealthy lifestyle might intensify this disruption. The aim [...] Read more.

Background and Objectives: Challenges and threats to global security and the growing demands of today’s society lead to significantly increased exposure to stress. Stress can negatively affect numerous physiological processes, including metabolic changes. An unhealthy lifestyle might intensify this disruption. The aim of the systematic review was to establish the effect of psychological stress on metabolic and anthropometric factors in healthy individuals. Materials and Methods: The study was conducted according to the PRISMA guidelines; and the risk of bias (ROB) assessment was based on the Newcastle–Ottawa Scale (NOS). A literature search of the MEDLINE/PubMed database was conducted using specific search terms. Results: We identified 32 articles meeting the inclusion criteria for the review with the different experimental designs and aims. Most of the papers were at high ROB. The included studies were conducted in groups of adults and children/teenagers. The most-often-applied tool to measure stress severity was the Perceived Stress Scale (PSS). Twenty-two studies analyzed the connection between stress and body composition, and bioimpedance analysis (BIA) was the most often used method. For biological parameters, the most frequently analyzed was cortisol (n = 9). The other examined factors included glucose, insulin, parameters related to food intake regulation, carbohydrates, lipid metabolism, inflammation, and oxidative stress. The included studies were incompliance in relation to the assessment method and type of assessed biological fluids. Conclusions: The vast majority of studies do not support the effect of chronic distress on anthropometric measurements and biological markers levels. However, many of them suggest adverse, synergistic effects of unhealthy lifestyle patterns and the stress on the examined variables. Further experiments should implement a similar and repeatable methodology. Full article

(This article belongs to the Special Issue Chronic Stress and Obesity: Psychology, Nutrition and Modern Lifestyle Behavior)

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14 pages, 518 KiB

Open AccessEditor’s ChoiceArticle

Anxiety Evolution among Healthcare Workers—A Prospective Study Two Years after the Onset of the COVID-19 Pandemic Including Occupational and Psychoemotional Variables

by Fernanda Gil-Almagro, Fernando José García-Hedrera, Cecilia Peñacoba-Puente and Francisco Javier Carmona-Monge

Medicina 2024, 60(8), 1230; https://doi.org/10.3390/medicina60081230 - 29 Jul 2024

Viewed by 1033

Abstract

Background and objectives: Although previous research has found a high prevalence of anxiety during the COVID-19 pandemic among healthcare workers, longitudinal studies on post-pandemic anxiety and predictor variables have been less abundant. To examine the evolution of anxiety in healthcare workers from the [...] Read more.

Background and objectives: Although previous research has found a high prevalence of anxiety during the COVID-19 pandemic among healthcare workers, longitudinal studies on post-pandemic anxiety and predictor variables have been less abundant. To examine the evolution of anxiety in healthcare workers from the beginning of the pandemic until one and a half years later, analyzing the influence of occupational and psychosocial variables, as well as their possible predictors. Materials and Methods: This was a prospective longitudinal design with three periods of data collection: (1) between 5 May and 21 June 2020, (2) six months after the end of the state of alarm (January–March 2021), and (3) one year after this second assessment (April–July 2022), in which generalized anxiety (GAD-7) was evaluated, as well as occupational and psycho-emotional variables (i.e., social support, self-efficacy, resilience, and cognitive fusion) in healthcare workers in direct contact with COVID-19 patients in Spain. Results: A high prevalence of anxiety was found, with a clear decrease over time. Associations were found between anxiety and certain sociodemographic and work variables (i.e., years of experience, p = 0.046; COVID-19 symptoms, p = 0.001; availability of PPE, p = 0.002; workload, p < 0.001; family contagion concern, p = 0.009). Anxiety maintained negative relationships with social support (p < 0.001), self-efficacy (p < 0.001), and resilience (p < 0.001) and positive associations with cognitive fusion (p < 0.001). Cognitive fusion seemed to be a clear predictor of anxiety. Conclusions: Our findings suggest that social support, self-efficacy, and resilience act as buffers for anxiety, whilst cognitive fusion was found to be a clear risk factor for anxiety. It is important to emphasize the risk role played by cognitive fusion on HCWs as a clear risk factor for stressful work events. The findings emphasize the need to implement specific interventions to promote the mental well-being of healthcare workers, particularly in crisis contexts such as the COVID-19 pandemic. Full article

(This article belongs to the Section Psychiatry)

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13 pages, 500 KiB

Open AccessEditor’s ChoiceArticle

Association between Menopausal Women’s Quality of Life and Aging Anxiety: The Role of Life Satisfaction and Depression

by Seunghee Lee, Mijung Jang, Dohhee Kim and KyooSang Kim

Medicina 2024, 60(8), 1189; https://doi.org/10.3390/medicina60081189 - 23 Jul 2024

Viewed by 1043

Abstract

Background and Objectives: This study investigated the links among quality of life, life satisfaction, depression, and aging anxiety in menopausal middle-aged women. The objective was to establish an understanding of how these factors are associated, which would be the foundation for developing [...] Read more.

Background and Objectives: This study investigated the links among quality of life, life satisfaction, depression, and aging anxiety in menopausal middle-aged women. The objective was to establish an understanding of how these factors are associated, which would be the foundation for developing programs aimed at enhancing the health and well-being of menopausal women. Materials and Methods: An online survey was administered to 993 middle-aged women, aged 45 to 65, residing in Seoul, Korea. The survey evaluated menopausal quality of life, life satisfaction, depression, and aging anxiety. Additionally, a Process Macro Model 4 was used to assess the links between life satisfaction, depression, menopausal quality of life, and aging anxiety. Results: Aging anxiety in middle-aged women was associated with a lower score on the menopausal quality of life scale (r = 0.37, p < 0.001), lower life satisfaction (r = −0.46, p < 0.001), and higher depression (r = 0.42, p < 0.001). In addition, there was an indirect effect—mediated by depression (95% CI = 0.025, 0.058) and life satisfaction (95% CI = 0.038, 0.064)—between menopausal quality of life and aging anxiety. Conclusions: The present study demonstrated a direct effect of low menopausal quality of life on aging anxiety and a mediating effect of low depression and higher life satisfaction on aging anxiety. These results suggest the need for programs to increase menopausal quality of life, decrease depression and improve life satisfaction to reduce aging anxiety. Full article

(This article belongs to the Section Psychiatry)

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16 pages, 1413 KiB

Open AccessEditor’s ChoiceArticle

A Chronic Obstructive Pulmonary Disease Self-Management Intervention for Improving Patient-Reported Outcomes in Primary Care in Greece

by Filothei Tsaousi, Izolde Bouloukaki, Antonios Christodoulakis, Despo Ierodiakonou, Nikos Tzanakis and Ioanna Tsiligianni

Medicina 2024, 60(3), 377; https://doi.org/10.3390/medicina60030377 - 23 Feb 2024

Cited by 1 | Viewed by 2288

Abstract

Background and Objectives: Self-management programs are essential for increasing COPD patient participation and autonomy in making appropriate decisions about their chronic condition. The present study aimed to assess the impact of COPD self-management interventions on quality of life, functional status, patient education, [...] Read more.

Background and Objectives: Self-management programs are essential for increasing COPD patient participation and autonomy in making appropriate decisions about their chronic condition. The present study aimed to assess the impact of COPD self-management interventions on quality of life, functional status, patient education, depression, and anxiety in primary care. Materials and Methods: We conducted a randomized controlled trial recruiting patients with COPD (GOLD A and B) from four primary care centers in Crete, Greece, with one intervention group (n = 40) receiving self-management educational support and one control group (n = 80) receiving usual care. To measure quality of life, functional status, patient education, depression, and anxiety, we used patient-reported outcome measures (PROMs) at baseline and 6 months post-intervention, including the Short-Form Health survey (SF-12), Clinical COPD Questionnaire (CCQ), mMRC, Beck Anxiety Inventory (BAI), Beck Depression Inventory, Health Education Impact Questionnaire (HeiQ), and Health Literacy Questionnaire (HLQ). Results: At the end of the 6-month intervention, most PROMs improved significantly in the intervention group (p < 0.05) but did not show significant changes in the control group. The greatest improvements at follow-up compared to baseline measurements were observed for dyspnea (mMRC—38.6%), anxiety (BAI—35%), depression (BDI—20.2%), COPD health status (CCQ—34.1%), and the actively managing my health subscale of HLQ (23.5%). Conclusions: Our results suggest that a self-management intervention could be an effective strategy for improving PROMs in primary care. Although more research is needed to identify the long-term effects of such interventional programs, policymakers could implement similar programs to improve the overall health of these patients. Full article

(This article belongs to the Section Pulmonology)

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12 pages, 1318 KiB

Open AccessEditor’s ChoiceArticle

Next-Generation Sequencing in Lung Cancers—A Single-Center Experience in Taiwan

by Wei-An Lai, Yen-Shuo Huang, Kung-Chao Chang, Sheau-Fang Yang, Chih-Jen Yang, Yu-Wei Liu and Huan-Da Chen

Medicina 2024, 60(2), 236; https://doi.org/10.3390/medicina60020236 - 29 Jan 2024

Cited by 1 | Viewed by 2615

Abstract

Background and Objectives: Lung cancer is a leading cause of cancer mortality in Taiwan. With rapid advancement of targeted therapeutics in non-small cell lung cancers, next-generation sequencing (NGS) is becoming an important tool for biomarker testing. In this study, we describe institutional [...] Read more.

Background and Objectives: Lung cancer is a leading cause of cancer mortality in Taiwan. With rapid advancement of targeted therapeutics in non-small cell lung cancers, next-generation sequencing (NGS) is becoming an important tool for biomarker testing. In this study, we describe institutional experience of NGS analysis in non-small cell carcinoma (NSCLC). Materials and Methods: A cohort of 73 cases was identified from the institutional pathology archive in the period between November 2020 and December 2022. Results: Adenocarcinoma was the most common histologic type (91.8%). Most patients presented with stage IIIB and beyond (87.7%). Twenty-nine patients (39.7%) were evaluated at the time of initial diagnosis, while the others had received prior chemotherapy or targeted therapy. The most frequently mutated gene was EGFR (63%), and this was followed by TP53 (50.7%), KRAS (13.7%), RB1 (13.7%), and CDKN2A (13.7%). Clinically actionable mutations associated with a guideline-suggested targeted therapy were identified in 55 cases (75.3%) overall, and in 47.1% of cases excluding EGFR TKI-sensitizing mutation. Biomarkers other than EGFR TKI-sensitizing mutations were compared. Cases without TKI-sensitizing EGFR mutation had more level 1 or 2 biomarkers (excluding EGFR TKI-sensitizing mutations) than cases with TKI-sensitizing EGFR mutations (47.1% versus 20.1%, p = 0.016). Progressive disease was associated with co-occurrence of clinically actionable mutations (20.5% versus 0%, p < 0.05). Eight of the nine cases with co-occurring actionable genetic alternations had an EGFR mutation. After an NGS test, 46.1% of actionable or potentially actionable genetic alternations led to patients receiving a matched therapy. Conclusions: Our study demonstrated that NGS analysis identifies therapeutic targets and may guide treatment strategies in NSCLC. NGS tests may be advantageous over multiple single-gene tests for optimization of treatment plans, especially for those with non-EGFR mutations or those with progressive disease. Full article

(This article belongs to the Section Pulmonology)

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32 pages, 2649 KiB

Open AccessEditor’s ChoiceReview

Use of Infrared Thermography in Medical Diagnosis, Screening, and Disease Monitoring: A Scoping Review

by Dorothea Kesztyüs, Sabrina Brucher, Carolyn Wilson and Tibor Kesztyüs

Medicina 2023, 59(12), 2139; https://doi.org/10.3390/medicina59122139 - 9 Dec 2023

Cited by 14 | Viewed by 6835

Abstract

Thermography provides non-invasive, radiation-free diagnostic imaging. Despite the extensive literature on medical thermography, a comprehensive overview of current applications is lacking. Hence, the aim of this scoping review is to identify the medical applications of passive infrared thermography and to catalogue the technical [...] Read more.

Thermography provides non-invasive, radiation-free diagnostic imaging. Despite the extensive literature on medical thermography, a comprehensive overview of current applications is lacking. Hence, the aim of this scoping review is to identify the medical applications of passive infrared thermography and to catalogue the technical and environmental modalities. The diagnostic performance of thermography and the existence of specific reference data are evaluated, and research gaps and future tasks identified. The entire review process followed the Joanna Briggs Institute (JBI) approach and the results are reported according to PRISMA-ScR guidelines. The scoping review protocol is registered at the Open Science Framework (OSF). PubMed, CENTRAL, Embase, Web of Science, OpenGrey, OSF, and PROSPERO were searched using pretested search strategies based on the Population, Concept, Context (PCC) approach. According to the eligibility criteria, references were screened by two researchers independently. Seventy-two research articles were identified describing screening, diagnostic, or monitoring studies investigating the potential of thermography in a total of 17,314 participants within 38 different health conditions across 13 therapeutic areas. The use of several camera models from various manufacturers is described. These and other facts and figures are compiled and presented in a detailed, descriptive tabular and visual format. Thermography offers promising diagnostic capabilities, alone or in addition to conventional methods. Full article

(This article belongs to the Special Issue Thermology Health Care Applications and Medical Thermography)

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12 pages, 642 KiB

Open AccessEditor’s ChoiceArticle

Is Systemic Immune-Inflammation Index a Real Non-Invasive Biomarker to Predict Oncological Outcomes in Patients Eligible for Radical Cystectomy?

by Pierluigi Russo, Filippo Marino, Francesco Rossi, Francesco Pio Bizzarri, Mauro Ragonese, Francesco Dibitetto, Giovanni Battista Filomena, Denise Pires Marafon, Chiara Ciccarese, Roberto Iacovelli, Savio Domenico Pandolfo, Achille Aveta, Simone Cilio, Luigi Napolitano and Nazario Foschi

Medicina 2023, 59(12), 2063; https://doi.org/10.3390/medicina59122063 - 22 Nov 2023

Cited by 9 | Viewed by 1629

Abstract

Background and Objectives: To assess the potential prognostic role of the systemic immune-inflammation index (SII) in predicting oncological outcomes in a cohort of patients treated with radical cystectomy (RC). Materials and Methods: From 2016 to 2022, a retrospective monocentric study enrolled [...] Read more.

Background and Objectives: To assess the potential prognostic role of the systemic immune-inflammation index (SII) in predicting oncological outcomes in a cohort of patients treated with radical cystectomy (RC). Materials and Methods: From 2016 to 2022, a retrospective monocentric study enrolled 193 patients who were divided into two groups based on their SII levels using the optimal cutoff determined by the Youden index. The SII was obtained from a preoperative blood test approximately one month before RC. Univariable and multivariable logistic regression analyses were conducted to investigate the capacity of SII to predict lymph node invasion (N), advanced pT stage (pT3/pT4), and locally advanced condition at the time of RC. Multivariable Cox regression models adjusted for preoperative and postoperative features were used to analyze the prognostic effect of SII on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results: The optimal cutoff value of the SII was 640.27. An elevated SII was seen in 113 (58.5%) patients. Using the multivariable preoperative logistic regression models, an elevated SII was correlated with nodal invasion (N; p = 0.03), advanced pT stage (p = 0.04), and locally advanced disease (p = 0.005), with enhancement of AUCs for predicting locally advanced disease (p = 0.04). In multivariable Cox regression models that considered preoperative clinicopathologic factors, an elevated SII was linked to poorer RFS (p = 0.005) and OS (p = 0.01). Moreover, on multivariable Cox regression postoperative models, a high SII was linked to RFS (p = 0.004) and to OS (p = 0.01). Conclusions: In this monocentric retrospective study, higher preoperative SII values predicted worse oncological outcomes in patients with bladder cancer (BCa) who underwent RC. Full article

(This article belongs to the Section Urology & Nephrology)

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12 pages, 1122 KiB

Open AccessEditor’s ChoiceBrief Report

Ultrasound Prevalence and Clinical Features of Nonalcoholic Fatty Liver Disease in Patients with Inflammatory Bowel Diseases: A Real-Life Cross-Sectional Study

by Ludovico Abenavoli, Rocco Spagnuolo, Giuseppe Guido Maria Scarlata, Emidio Scarpellini, Luigi Boccuto and Francesco Luzza

Medicina 2023, 59(11), 1935; https://doi.org/10.3390/medicina59111935 - 1 Nov 2023

Cited by 10 | Viewed by 1880

Abstract

Background and Objectives: Inflammatory bowel disease (IBD) is a condition characterized by chronic intestinal inflammation. We can identify two major forms: Crohn’s disease (CD) and ulcerative colitis (UC). One of the extraintestinal manifestations of IBD is nonalcoholic fatty liver disease (NAFLD). IBD [...] Read more.

Background and Objectives: Inflammatory bowel disease (IBD) is a condition characterized by chronic intestinal inflammation. We can identify two major forms: Crohn’s disease (CD) and ulcerative colitis (UC). One of the extraintestinal manifestations of IBD is nonalcoholic fatty liver disease (NAFLD). IBD and NAFLD share common pathogenetic mechanisms. Ultrasound (US) examination is the most commonly used imaging method for the diagnosis of NAFLD. This cross-sectional observational retrospective study aimed to evaluate the US prevalence of NAFLD in IBD patients and their clinical features. Materials and Methods: A total of 143 patients with IBD underwent hepatic US and were divided into two different groups according to the presence or absence of NAFLD. Subsequently, new exclusion criteria for dysmetabolic comorbidities (defined as plus) were applied. Results: The US prevalence of NAFLD was 23% (21% in CD and 24% in UC, respectively). Most IBD–NAFLD patients were male and older and showed significantly higher values for body mass index, waist circumference, disease duration, and age at onset than those without NAFLD. IBD–NAFLD patients showed a significantly higher percentage of stenosing phenotype and left-side colitis. Regarding metabolic features, IBD–NAFLD patients showed a significantly higher percentage of hypertension and IBD plus dysmetabolic criteria. Also, higher values of alanine aminotransferase and triglycerides and lower levels of high-density lipoproteins are reported in these patients. Conclusions: We suggest performing liver US screening in subjects affected by IBD to detect NAFLD earlier. Also, patients with NAFLD present several metabolic comorbidities that would fall within the new definition of metabolic-associated fatty liver disease. Finally, we encourage larger longitudinal studies, including healthy controls, to provide further confirmation of our preliminary data. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases)

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28 pages, 1190 KiB

Open AccessEditor’s ChoiceReview

Oxidative Stress and Male Infertility: The Protective Role of Antioxidants

by Aris Kaltsas

Medicina 2023, 59(10), 1769; https://doi.org/10.3390/medicina59101769 - 4 Oct 2023

Cited by 17 | Viewed by 8427

Abstract

Oxidative stress is a significant factor in male infertility, compromising sperm function and overall reproductive health. As male infertility garners increasing attention, effective therapeutic interventions become paramount. This review investigates the therapeutic role of antioxidants in addressing male infertility. A detailed examination was [...] Read more.

Oxidative stress is a significant factor in male infertility, compromising sperm function and overall reproductive health. As male infertility garners increasing attention, effective therapeutic interventions become paramount. This review investigates the therapeutic role of antioxidants in addressing male infertility. A detailed examination was conducted on antioxidants such as vitamin C, E, B12, D, coenzyme Q10, zinc, folic acid, selenium, l-carnitine, l-arginine, inositols, and alpha-lipoic acid. This analysis examines the methodologies, outcomes, and constraints of current clinical studies. Antioxidants show notable potential in counteracting the negative effects of oxidative stress on sperm. Based on the evidence, these antioxidants, individually or synergistically, can enhance sperm health and reproductive outcomes. However, certain limitations in the studies call for careful interpretation. Antioxidants are integral in tackling male infertility attributed to oxidative stress. The current findings underscore their therapeutic value, yet there’s a pressing need for deeper, comprehensive research. Future studies should focus on refining dosage guidelines, identifying potential side effects, and discerning the most efficacious antioxidant combinations for male infertility solutions. Full article

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16 pages, 1031 KiB

Open AccessEditor’s ChoiceReview

Augmented Reality in Neurosurgery: A New Paradigm for Training

by Grace Hey, Michael Guyot, Ashley Carter and Brandon Lucke-Wold

Medicina 2023, 59(10), 1721; https://doi.org/10.3390/medicina59101721 - 26 Sep 2023

Cited by 18 | Viewed by 4776

Abstract

Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been [...] Read more.

Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use. Full article

(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)

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18 pages, 763 KiB

Open AccessEditor’s ChoiceSystematic Review

New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario?

by Francesco Marchegiani, Leandro Siragusa, Alizée Zadoroznyj, Vito Laterza, Orsalia Mangana, Carlo Alberto Schena, Michele Ammendola, Riccardo Memeo, Paolo Pietro Bianchi, Giuseppe Spinoglio, Paschalis Gavriilidis and Nicola de’Angelis

Medicina 2023, 59(7), 1264; https://doi.org/10.3390/medicina59071264 - 7 Jul 2023

Cited by 16 | Viewed by 5872

Abstract

Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. [...] Read more.

Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills’ transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit. Full article

(This article belongs to the Section Surgery)

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11 pages, 1720 KiB

Open AccessEditor’s ChoiceArticle

Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome

by Danilo Donati, Fabio Vita, Roberto Tedeschi, Stefano Galletti, Alessandro Biglia, Tommaso Gistri, Pasquale Arcuri, Flavio Origlio, Francesco Castagnini, Cesare Faldini, Davide Pederiva and Maria Grazia Benedetti

Medicina 2023, 59(7), 1211; https://doi.org/10.3390/medicina59071211 - 28 Jun 2023

Cited by 12 | Viewed by 1922

Abstract

Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 [...] Read more.

Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy. Full article

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

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12 pages, 1682 KiB

Open AccessEditor’s ChoiceReview

Hypermagnesemia in Clinical Practice

by Aya Hasan Aal-Hamad, Abdullah M. Al-Alawi, Masoud Salim Kashoub and Henrik Falhammar

Medicina 2023, 59(7), 1190; https://doi.org/10.3390/medicina59071190 - 24 Jun 2023

Cited by 18 | Viewed by 9597

Abstract

Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is [...] Read more.

Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is a prevalent electrolyte disturbance that can lead to several neuromuscular, cardiac, or nervous system disorders. Hypermagnesemia has been associated with adverse clinical outcomes, particularly in hospitalized patients. Prompt identification and management of hypermagnesemia are crucial to prevent complications, such as respiratory and cardiovascular negative outcomes, neuromuscular dysfunction, and coma. Preventing hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements. Clinical management of hypermagnesemia involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases. Furthermore, healthcare providers should monitor serum magnesium concentration in patients at risk of hypermagnesemia and promptly intervene if the concentration exceeds the normal range. Full article

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8 pages, 321 KiB

Open AccessEditor’s ChoiceArticle

Predictors of Short-Term Mortality in Patients with Ischemic Stroke

by Silvina Iluţ, Ştefan Cristian Vesa, Vitalie Văcăraș and Dafin-Fior Mureșanu

Medicina 2023, 59(6), 1142; https://doi.org/10.3390/medicina59061142 - 13 Jun 2023

Cited by 10 | Viewed by 1639

Abstract

Background and Objectives: The purpose of this study is to investigate the predictive factors for intrahospital mortality in ischemic stroke patients. We will examine the association between a range of clinical and demographic factors and intrahospital mortality, including age, sex, comorbidities, laboratory [...] Read more.

Background and Objectives: The purpose of this study is to investigate the predictive factors for intrahospital mortality in ischemic stroke patients. We will examine the association between a range of clinical and demographic factors and intrahospital mortality, including age, sex, comorbidities, laboratory values, and medication use. Materials and Methods: This retrospective, longitudinal, analytic, observational cohort study included 243 patients over 18 years old with a new ischemic stroke diagnosis who were hospitalized in Cluj-Napoca Emergency County Hospital. Data collected included the patient demographics, baseline characteristics at hospital admission, medication use, carotid artery Doppler ultrasound, as well as cardiology exam, and intrahospital death. Results: Multivariate logistic regression was used to determine which variables were independently associated with intrahospital death. An NIHSS score > 9 (OR—17.4; p < 0.001) and a lesion volume > 22.3 mL (OR—5.8; p = 0.003) were found to be associated with the highest risk of death. In contrast antiplatelet treatment (OR—0.349; p = 0.04) was associated with lower mortality rates. Conclusions: Our study identified a high NIHSS score and large lesion volume as independent risk factors for intrahospital mortality in ischemic stroke patients. Antiplatelet therapy was associated with lower mortality rates. Further studies are needed to explore the potential mechanisms underlying these associations and to develop targeted interventions to improve patient outcomes. Full article

(This article belongs to the Section Neurology)

21 pages, 892 KiB

Open AccessEditor’s ChoiceReview

Angiogenesis and Hepatocellular Carcinoma: From Molecular Mechanisms to Systemic Therapies

by Elisa Pinto, Filippo Pelizzaro, Fabio Farinati and Francesco Paolo Russo

Medicina 2023, 59(6), 1115; https://doi.org/10.3390/medicina59061115 - 9 Jun 2023

Cited by 12 | Viewed by 3174

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The hypervascular nature of the majority of HCCs and the peculiar vascular derangement occurring during liver carcinogenesis underscore the importance of angiogenesis in the development and progression of these tumors. Indeed, several angiogenic [...] Read more.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The hypervascular nature of the majority of HCCs and the peculiar vascular derangement occurring during liver carcinogenesis underscore the importance of angiogenesis in the development and progression of these tumors. Indeed, several angiogenic molecular pathways have been identified as deregulated in HCC. The hypervascular nature and the peculiar vascularization of HCC, as well as deregulated angiogenic pathways, represent major therapeutic targets. To a large extent, intra-arterial locoregional treatments (transarterial-(chemo)embolization) rely on tumor ischemia caused by embolization of tumor feeding arteries, even though this may represent the “primum movens” of tumor recurrence through the activation of neoangiogenesis. Considering systemic therapies, the currently available tyrosine kinase inhibitors (sorafenib, regorafenib, cabozantinib and lenvatinib) and monoclonal antibodies (ramucirumab and bevacizumab, in combination with the anti-PD-L1, atezolizumab) primarily target, among others, angiogenic pathways. Considering the importance of angiogenesis in the pathogenesis and treatment of liver cancer, in this paper, we aim to review the role of angiogenesis in HCC, addressing the molecular mechanisms, available antiangiogenic therapies and prognostic biomarkers in patients receiving these treatments. Full article

(This article belongs to the Special Issue Advance in the Diagnosis, Treatment and Prognosis of Hepatocellular Carcinoma)

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32 pages, 1351 KiB

Open AccessEditor’s ChoiceReview

Alzheimer’s Disease Treatment: The Search for a Breakthrough

by Allison B. Reiss, Dalia Muhieddine, Berlin Jacob, Michael Mesbah, Aaron Pinkhasov, Irving H. Gomolin, Mark M. Stecker, Thomas Wisniewski and Joshua De Leon

Medicina 2023, 59(6), 1084; https://doi.org/10.3390/medicina59061084 - 4 Jun 2023

Cited by 11 | Viewed by 7015

Abstract

As the search for modalities to cure Alzheimer’s disease (AD) has made slow progress, research has now turned to innovative pathways involving neural and peripheral inflammation and neuro-regeneration. Widely used AD treatments provide only symptomatic relief without changing the disease course. The recently [...] Read more.

As the search for modalities to cure Alzheimer’s disease (AD) has made slow progress, research has now turned to innovative pathways involving neural and peripheral inflammation and neuro-regeneration. Widely used AD treatments provide only symptomatic relief without changing the disease course. The recently FDA-approved anti-amyloid drugs, aducanumab and lecanemab, have demonstrated unclear real-world efficacy with a substantial side effect profile. Interest is growing in targeting the early stages of AD before irreversible pathologic changes so that cognitive function and neuronal viability can be preserved. Neuroinflammation is a fundamental feature of AD that involves complex relationships among cerebral immune cells and pro-inflammatory cytokines, which could be altered pharmacologically by AD therapy. Here, we provide an overview of the manipulations attempted in pre-clinical experiments. These include inhibition of microglial receptors, attenuation of inflammation and enhancement of toxin-clearing autophagy. In addition, modulation of the microbiome-brain-gut axis, dietary changes, and increased mental and physical exercise are under evaluation as ways to optimize brain health. As the scientific and medical communities work together, new solutions may be on the horizon to slow or halt AD progression. Full article

(This article belongs to the Special Issue Commemorative Issue Celebrating the 20th Anniversary of the Alzheimer’s Foundation of America: Understanding and Treating Alzheimer’s Disease)

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15 pages, 5347 KiB

Open AccessEditor’s ChoiceArticle

Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient

by Roberto Minici, Federico Fontana, Massimo Venturini, Giuseppe Guzzardi, Agostino Siciliano, Filippo Piacentino, Raffaele Serra, Andrea Coppola, Pasquale Guerriero, Biagio Apollonio, Rita Santoro, MGJR Research Team, Luca Brunese and Domenico Laganà

Medicina 2023, 59(6), 1062; https://doi.org/10.3390/medicina59061062 - 1 Jun 2023

Cited by 8 | Viewed by 3409

Abstract

Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3–6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including [...] Read more.

Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3–6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including spontaneous heparin-induced thrombocytopenia, thrombocytopenia, the hyperfibrinolytic state, the consumption of coagulation factors, and thromboprophylaxis with anticoagulants. This study aims to assess the efficacy and safety of TAE in the management of bleeding in COVID-19 patients. Materials and Methods: This multicenter retrospective study analyzes data from COVID-19 patients subjected to transcatheter arterial embolization for the management of bleeding from February 2020 to January 2023. Results: Transcatheter arterial embolization was performed in 73 COVID-19 patients for acute non-neurovascular bleeding during the study interval (February 2020–January 2023). Coagulopathy was observed in forty-four (60.3%) patients. The primary cause of bleeding was spontaneous soft tissue hematoma (63%). A 100% technical success rate was recorded; six cases of rebleeding resulted in a 91.8% clinical success rate. No cases of non-target embolization were observed. Complications were recorded in 13 (17.8%) patients. The efficacy and safety endpoints did not differ significantly between the coagulopathy and non-coagulopathy groups. Conclusions: Transcatheter Arterial Embolization (TAE) is an effective, safe and potentially life-saving option for the management of acute non-neurovascular bleeding in COVID-19 patients. This approach is effective and safe even in the subgroup of COVID-19 patients with coagulopathy. Full article

(This article belongs to the Section Surgery)

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20 pages, 1704 KiB

Open AccessEditor’s ChoiceOpinion

Laser Treatment Monitoring with Reflectance Confocal Microscopy

by Stefania Guida, Caterina Longo, Simone Amato, Anthony M. Rossi, Marco Manfredini, Silvana Ciardo, Marco Spadafora, Steven P. Nisticò, Santo R. Mercuri, Franco Rongioletti, Nicola Zerbinati and Giovanni Pellacani

Medicina 2023, 59(6), 1039; https://doi.org/10.3390/medicina59061039 - 28 May 2023

Cited by 11 | Viewed by 2006

Abstract

Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be [...] Read more.

Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be applied to cosmetically sensitive skin areas such as the face, without the need for skin biopsies. For these reasons, apart from its current use in skin cancer diagnosis, our systematic review reveals how RCM can be employed in the field of laser treatment monitoring, being particularly suitable for the evaluation of variations in epidermis and dermis, and pigmentary and vascular characteristics of the skin. This systematic review article aims to provide an overview on current applications of RCM laser treatment monitoring, while describing RCM features identified for different applications. Studies on human subjects treated with laser treatments, monitored with RCM, were included in the current systematic review. Five groups of treatments were identified and described: skin rejuvenation, scar tissue, pigmentary disorders, vascular disorders and other. Interestingly, RCM can assist treatments with lasers targeting all chromophores in the skin and exploiting laser induced optical breakdown. Treatment monitoring encompasses assessment at baseline and examination of changes after treatment, therefore revealing details in morphologic alterations underlying different skin conditions and mechanisms of actions of laser therapy, as well as objectify results after treatment. Full article

(This article belongs to the Special Issue Advances in Laser Treatment for Skin Diseases)

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11 pages, 2681 KiB

Open AccessEditor’s ChoiceReview

Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation

by Gregorio Tersalvi, Lorenzo Gaiero, Michele Capriolo, Yvonne Cristoforetti, Stefano Salizzoni, Gaetano Senatore, Giovanni Pedrazzini and Luigi Biasco

Medicina 2023, 59(6), 1017; https://doi.org/10.3390/medicina59061017 - 24 May 2023

Cited by 11 | Viewed by 4100

Abstract

Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US [...] Read more.

Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation. Full article

(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)

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12 pages, 623 KiB

Open AccessEditor’s ChoiceSystematic Review

Remission of Type 2 Diabetes Mellitus (T2DM) after Sleeve Gastrectomy (SG), One-Anastomosis Gastric Bypass (OAGB), and Roux-en-Y Gastric Bypass (RYGB): A Systematic Review

by Vignesh Balasubaramaniam and Sjaak Pouwels

Medicina 2023, 59(5), 985; https://doi.org/10.3390/medicina59050985 - 19 May 2023

Cited by 12 | Viewed by 3850

Abstract

Background and Objectives: The three most widely performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one-anastomosis gastric bypass (OAGB). Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM [...] Read more.

Background and Objectives: The three most widely performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one-anastomosis gastric bypass (OAGB). Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM (type 2 diabetes mellitus). There are limited data that directly compare these three procedures. This study aims to compare the short-term and long-term remission of T2DM after RYGB, SG, and OAGB. Materials and Methods: Three databases (Embase, PubMed, and Cochrane) were searched for randomised controlled trials, prospective studies, and retrospective studies that compared the effects of RYGB, SG, and OAGB on T2DM remission. Studies published between 2001 and 2022 were analysed. Only patients with T2DM and who had primary bariatric surgery were included. Results: After applying the inclusion and exclusion criteria, seven articles were included in the review. It was found that all three procedures had comparable T2DM remission. RYGB was noted to have the highest complication rate when compared to SG and OAGB. Importantly, it was noted that other predictive factors such as age, duration of diabetes, baseline HbA1c, BMI, and use of antidiabetic medication play a crucial role in T2DM remission. Conclusions: This systematic literature review confirms the existing data that all three bariatric surgeries induce remission of T2DM. Increasing in popularity, OAGB had comparable outcomes to RYGB and SG in inducing T2DM remission. In addition to the choice of bariatric surgery, there are other independent predictive factors that have an impact on T2DM remission. Further studies with larger sample sizes, longer follow-up periods, and studies that control confounding factors are required in this field. Full article

(This article belongs to the Special Issue Combining Gastroenterology and Surgery: New Treatment Insights)

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12 pages, 470 KiB

Open AccessEditor’s ChoiceSystematic Review

Fluoride Exposure and ADHD: A Systematic Review of Epidemiological Studies

by Gianluca Fiore, Federica Veneri, Rosaria Di Lorenzo, Luigi Generali, Marco Vinceti and Tommaso Filippini

Medicina 2023, 59(4), 797; https://doi.org/10.3390/medicina59040797 - 19 Apr 2023

Cited by 11 | Viewed by 5511

Abstract

Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: [...] Read more.

Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: A literature search was performed on 31 March 2023 in the following databases: PubMed, Embase and Web of Science. We defined the following inclusion criteria according to the PECOS statement: a healthy child and adolescent population (P), fluoride exposure of any type (E), comparison with low or null exposure (C), ADHD spectrum disorder (O), and ecological, cross-sectional, case–control and cohort studies (S). Results: We found eight eligible records corresponding to seven different studies investigating the effect of fluoride exposure on children and adolescents. One study had a cohort design and one a case–control one, while five were cross-sectional. Only three studies applied validated questionnaires for the purpose of ADHD diagnosis. As regards exposure assessment, levels of fluoride in urine and tap water were, respectively used in three and two studies, while two used both. Three studies reported a positive association with ADHD risk, all assessing exposure through fluoride levels. By using urinary fluoride, conversely, a positive correlation with inattention, internalizing symptoms, cognitive and psychosomatic problems was found in three studies, but no relation was found in the other one. Conclusions: The present review suggests that early exposure to fluoride may have neurotoxic effects on neurodevelopment affecting behavioral, cognitive and psychosomatic symptoms related to ADHD diagnosis. However, due to the heterogeneity of the studies included, current evidence does not allow to conclusively confirm that fluoride exposure is specifically linked to ADHD development. Full article

(This article belongs to the Special Issue Attention-Deficit/Hyperactivity Disorder in Adulthood and Adolescence)

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13 pages, 941 KiB

Open AccessEditor’s ChoiceReview

The Promise of Artificial Intelligence in Digestive Healthcare and the Bioethics Challenges It Presents

by Miguel Mascarenhas, João Afonso, Tiago Ribeiro, Patrícia Andrade, Hélder Cardoso and Guilherme Macedo

Medicina 2023, 59(4), 790; https://doi.org/10.3390/medicina59040790 - 18 Apr 2023

Cited by 11 | Viewed by 4960

Abstract

With modern society well entrenched in the digital area, the use of Artificial Intelligence (AI) to extract useful information from big data has become more commonplace in our daily lives than we perhaps realize. Medical specialties that rely heavily on imaging techniques have [...] Read more.

With modern society well entrenched in the digital area, the use of Artificial Intelligence (AI) to extract useful information from big data has become more commonplace in our daily lives than we perhaps realize. Medical specialties that rely heavily on imaging techniques have become a strong focus for the incorporation of AI tools to aid disease diagnosis and monitoring, yet AI-based tools that can be employed in the clinic are only now beginning to become a reality. However, the potential introduction of these applications raises a number of ethical issues that must be addressed before they can be implemented, among the most important of which are issues related to privacy, data protection, data bias, explainability and responsibility. In this short review, we aim to highlight some of the most important bioethical issues that will have to be addressed if AI solutions are to be successfully incorporated into healthcare protocols, and ideally, before they are put in place. In particular, we contemplate the use of these aids in the field of gastroenterology, focusing particularly on capsule endoscopy and highlighting efforts aimed at resolving the issues associated with their use when available. Full article

(This article belongs to the Special Issue Artificial Intelligence in Gastrointestinal Endoscopy: Disrupting Landscape in GI Practice)

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25 pages, 1772 KiB

Open AccessEditor’s ChoiceArticle

Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group

by Gabriele Savioli, Iride Francesca Ceresa, Maria Antonietta Bressan, Gaia Bavestrello Piccini, Angelica Varesi, Viola Novelli, Alba Muzzi, Sara Cutti, Giovanni Ricevuti, Ciro Esposito, Antonio Voza, Antonio Desai, Yaroslava Longhitano, Angela Saviano, Andrea Piccioni, Fabio Piccolella, Abdel Bellou, Christian Zanza and Enrico Oddone

Medicina 2023, 59(4), 781; https://doi.org/10.3390/medicina59040781 - 17 Apr 2023

Cited by 8 | Viewed by 5361

Abstract

Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must [...] Read more.

Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care. Full article

(This article belongs to the Section Emergency Medicine)

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9 pages, 693 KiB

Open AccessEditor’s ChoiceCase Report

Autoimmune Thyroiditis Shifting from Hashimoto’s Thyroiditis to Graves’ Disease

by Narantsatsral Daramjav, Junko Takagi, Hideyuki Iwayama, Kaori Uchino, Daisuke Inukai, Kazuo Otake, Tetsuya Ogawa and Akiyoshi Takami

Medicina 2023, 59(4), 757; https://doi.org/10.3390/medicina59040757 - 13 Apr 2023

Cited by 10 | Viewed by 3600

Abstract

In 15–20% of cases, Graves’ disease (GD) shifts to Hashimoto’s thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with [...] Read more.

In 15–20% of cases, Graves’ disease (GD) shifts to Hashimoto’s thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with myxedema was diagnosed with Hashimoto’s disease due to hypothyroidism and the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb); she also had thyroid stimulating antibodies (TSAb) without any signs of GD. Although thyroid hormone replacement therapy improved her thyroid function, 2 months later, hyperthyroidism appeared and did not improve after discontinuation of the replacement therapy. The patient was diagnosed with GD, which improved with antithyroid agent administration. To date, only 50 cases regarding conversion from HT to GD have been reported. The median age is 44 years (range, 23–82 years), and the median time of conversion is 7 years (range, 0.1–27 years). The male-to-female ratio of HT conversion to GD is 1:9, closer to that of regular GD (1:10) than that of general HT (1:18). All patients received thyroid hormone replacement therapy for hypothyroidism due to HT. Continuous evaluation of TSAb levels is recommended in HT, particularly in cases of TSAb-positive and those under replacement, since it may help predict conversion to GD. Evaluating the clinical characteristics of patients with HT preceding GD is crucial to ensure appropriate treatment and reduce the risk of adverse events. Full article

(This article belongs to the Section Endocrinology)

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17 pages, 412 KiB

Open AccessEditor’s ChoiceReview

Risk Factors for Testicular Cancer: Environment, Genes and Infections—Is It All?

by Sertac Yazici, Dario Del Biondo, Giorgio Napodano, Marco Grillo, Francesco Paolo Calace, Domenico Prezioso, Felice Crocetto and Biagio Barone

Medicina 2023, 59(4), 724; https://doi.org/10.3390/medicina59040724 - 7 Apr 2023

Cited by 25 | Viewed by 5412

Abstract

The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk [...] Read more.

The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk factors have been identified. The reasons for the increase in testicular cancer are however unknown while risk factors are still poorly understood. Several studies have suggested that exposure to various factors in adolescence as well as in adulthood could be linked to the development of testicular cancer. Nevertheless, the role of environment, infections, and occupational exposure are undoubtedly associated with an increase or a decrease in this risk. The aim of this narrative review is to summarize the most recent evidence regarding the risk factors associated with testicular cancer, starting from the most commonly evaluated (cryptorchidism, family history, infections) to the newer identified and hypothesized risk factors. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Testicular Cancer)

18 pages, 3353 KiB

Open AccessEditor’s ChoiceArticle

Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study

by Roberto Minici, Massimo Venturini, Federico Fontana, Giuseppe Guzzardi, Armando Pingitore, Filippo Piacentino, Raffaele Serra, Andrea Coppola, Rita Santoro and Domenico Laganà

Medicina 2023, 59(4), 710; https://doi.org/10.3390/medicina59040710 - 4 Apr 2023

Cited by 10 | Viewed by 2888

Abstract

Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep [...] Read more.

Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as “magma-like” progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy. Full article

(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)

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11 pages, 706 KiB

Open AccessEditor’s ChoicePerspective

Changes in the Global Epidemiology of Type 1 Diabetes in an Evolving Landscape of Environmental Factors: Causes, Challenges, and Opportunities

by Ioannis Ogrotis, Theocharis Koufakis and Kalliopi Kotsa

Medicina 2023, 59(4), 668; https://doi.org/10.3390/medicina59040668 - 28 Mar 2023

Cited by 15 | Viewed by 5053

Abstract

The worldwide incidence of type 1 diabetes mellitus (T1DM) has increased in recent decades. The reasons behind this phenomenon are not yet fully understood. Early life infections, prenatal and perinatal factors, and diet composition have been associated with the triggering of autoimmunity and [...] Read more.

The worldwide incidence of type 1 diabetes mellitus (T1DM) has increased in recent decades. The reasons behind this phenomenon are not yet fully understood. Early life infections, prenatal and perinatal factors, and diet composition have been associated with the triggering of autoimmunity and the risk of presentation of T1DM. However, the rapid increase in new cases of the disease raises the hypothesis that lifestyle factors, which have traditionally been associated with type 2 diabetes, such as obesity and unhealthy eating patterns could also play a role in the genesis of autoimmune diabetes. This article aims to highlight the changing epidemiology of T1DM and the importance of properly recognizing the environmental factors behind it, as well as the connections with the pathogenesis of the disorder and the need to prevent or delay T1DM and its long-term complications. Full article

(This article belongs to the Special Issue Clinical Research in the Diagnosis and Treatment of Pediatric Endocrinology)

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8 pages, 3898 KiB

Open AccessEditor’s ChoiceArticle

Short-Term Outcomes of Intravitreal Faricimab Injection for Diabetic Macular Edema

by Sentaro Kusuhara, Maya Kishimoto-Kishi, Wataru Matsumiya, Akiko Miki, Hisanori Imai and Makoto Nakamura

Medicina 2023, 59(4), 665; https://doi.org/10.3390/medicina59040665 - 27 Mar 2023

Cited by 11 | Viewed by 3641

Abstract

Background and Objectives: Faricimab is a novel bispecific antibody with Fab regions inhibiting both vascular endothelial growth factor-A and angiopoietin-2. Therefore, this study aimed to obtain short-term outcomes of intravitreal injection of faricimab (IVF) for the treatment of diabetic macular edema (DME) [...] Read more.

Background and Objectives: Faricimab is a novel bispecific antibody with Fab regions inhibiting both vascular endothelial growth factor-A and angiopoietin-2. Therefore, this study aimed to obtain short-term outcomes of intravitreal injection of faricimab (IVF) for the treatment of diabetic macular edema (DME) in daily clinical practice. Materials and Methods: A retrospective review was carried out on consecutive patients with DME who had been treated with IVF and were followed up for at least 1 month. Outcome measures included changes in logMAR best-corrected visual acuity (logMAR BCVA), central retinal thickness (CRT), number of IVF administrations, and safety. Clinical outcomes were also compared between the treatment-naïve and switch groups. Results: A total of 21 consecutive DME eyes from 19 patients were identified. The mean number of IVFs was 1.6 ± 0.8 during the mean follow-up time of 5.5 months. The overall mean logMAR BCVA following IVF was 0.236, 0.204, 0.190, and 0.224 at baseline, 1, 3, and 6 months, respectively, without a significant change from baseline to 1 month (p = 0.176) or for 6 months (p = 0.923). The overall mean CRT (μm) following IVF was 400.6, 346.6, 342.1, and 327.5 at baseline, 1, 3, and 6 months, respectively. CRT significantly decreased from baseline to 1 month (p = 0.001) but did not reach a significant level over 6 months following IVF (p = 0.070). No significant difference in BCVA or CRT was observed between the treatment-naïve and switch groups. No serious safety concerns were noted. Conclusions: IVF for the treatment of DME may preserve visual acuity and improve macular thickness without serious safety concerns in the short term in a real-world clinical setting. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches for Managing Ophthalmic Complications of Diabetes)

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18 pages, 1609 KiB

Open AccessEditor’s ChoiceReview

A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going

by Aurelio Mauro, Francesca Lusetti, Davide Scalvini, Marco Bardone, Federico De Grazia, Stefano Mazza, Lodovica Pozzi, Valentina Ravetta, Laura Rovedatti, Carmelo Sgarlata, Elena Strada, Francesca Torello Viera, Letizia Veronese, Daniel Enrique Olivo Romero and Andrea Anderloni

Medicina 2023, 59(3), 636; https://doi.org/10.3390/medicina59030636 - 22 Mar 2023

Cited by 12 | Viewed by 6085

Abstract

Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. [...] Read more.

Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice. Full article

(This article belongs to the Special Issue Digestive Endoscopy: Inside the Evidence and Outside)

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24 pages, 32179 KiB

Open AccessEditor’s ChoiceReview

Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review

by Mugurel Constantin Rusu, Răzvan Costin Tudose, Alexandra Diana Vrapciu, Corneliu Toader and Şerban Arghir Popescu

Medicina 2023, 59(3), 622; https://doi.org/10.3390/medicina59030622 - 21 Mar 2023

Cited by 10 | Viewed by 9763

Abstract

(1) Background: The external jugular vein (EJV) descends on the sternocleidomastoid muscle to drain deep into the subclavian vein. Anatomical variations of the EJV are relevant for identification of the greater auricular nerve, flap design and preparation, or EJV cannulation. (2) Methods [...] Read more.

(1) Background: The external jugular vein (EJV) descends on the sternocleidomastoid muscle to drain deep into the subclavian vein. Anatomical variations of the EJV are relevant for identification of the greater auricular nerve, flap design and preparation, or EJV cannulation. (2) Methods: Different publications were comprehensively reviewed. Dissections and three-dimensional volume renderings of peculiar cases were used to sample the review. (3) Results: Different anatomical possibilities of the EJV were critically reviewed and documented: fenestrations and double fenestrations, true or false duplications, triplication, absence, aberrant origin or course, or bifurcation. Tributaries of the EJV, such as the facial and posterior external jugular veins, are discussed. The internal jugular vein termination of the EJV is also presented. (4) Conclusions: Care should be taken when different morphological features of the EJV are encountered or reported. Full article

(This article belongs to the Topic Human Anatomy and Pathophysiology, 2nd Volume)

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9 pages, 1116 KiB

Open AccessEditor’s ChoiceArticle

Tinnitus Prevalence in the Adult Population—Results from the Gutenberg Health Study

by Berit Hackenberg, Karoline O’Brien, Julia Döge, Karl J. Lackner, Manfred E. Beutel, Thomas Münzel, Norbert Pfeiffer, Andreas Schulz, Irene Schmidtmann, Philipp S. Wild, Christoph Matthias and Katharina Bahr-Hamm

Medicina 2023, 59(3), 620; https://doi.org/10.3390/medicina59030620 - 20 Mar 2023

Cited by 13 | Viewed by 5557

Abstract

Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. [...] Read more.

Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. The aim of this study was to assess tinnitus prevalence in a large German cohort and to determine its dependence on hearing impairment. Materials and Methods: The Gutenberg Health Study (GHS) is a population-based cohort study and representative for the population of Mainz and its district. Participants were asked whether they suffer from tinnitus and how much they are burdened by it. Extensive audiological examinations using bone- and air-conduction were also performed. Results: 4942 participants (mean age: 61.0, 2550 men and 2392 women) were included in the study. The overall prevalence of tinnitus was 26.1%. Men were affected significantly more often than women. The prevalence of tinnitus increased with age, peaking at ages 75 to 79 years. Considering only annoying tinnitus, the prevalence was 9.8%. Logistic regression showed that participants with severe to complete hearing loss (>65 dB) were more likely to have tinnitus. Conclusions: Tinnitus is a common symptom, and given demographic changes, its prevalence is expected to increase. Full article

(This article belongs to the Section Epidemiology & Public Health)

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14 pages, 1066 KiB

Open AccessEditor’s ChoiceReview

Metabolic-Dysfunction-Associated Fatty Liver Disease and Gut Microbiota: From Fatty Liver to Dysmetabolic Syndrome

by Ludovico Abenavoli, Giuseppe Guido Maria Scarlata, Emidio Scarpellini, Luigi Boccuto, Rocco Spagnuolo, Bruno Tilocca, Paola Roncada and Francesco Luzza

Medicina 2023, 59(3), 594; https://doi.org/10.3390/medicina59030594 - 17 Mar 2023

Cited by 23 | Viewed by 8507

Abstract

Metabolic-dysfunction-associated fatty liver disease (MAFLD) is the recent nomenclature designation that associates the condition of non-alcoholic fatty liver disease (NAFLD) with metabolic dysfunction. Its diagnosis has been debated in the recent period and is generally associated with a diagnosis of steatosis and at [...] Read more.

Metabolic-dysfunction-associated fatty liver disease (MAFLD) is the recent nomenclature designation that associates the condition of non-alcoholic fatty liver disease (NAFLD) with metabolic dysfunction. Its diagnosis has been debated in the recent period and is generally associated with a diagnosis of steatosis and at least one pathologic condition among overweight/obesity, type 2 diabetes mellitus, and metabolic dysregulation. Its pathogenesis is defined by a “multiple-hit” model and is associated with alteration or dysbiosis of the gut microbiota. The pathogenic role of dysbiosis of the gut microbiota has been investigated in many diseases, including obesity, type 2 diabetes mellitus, and NAFLD. However, only a few works correlate it with MAFLD, although common pathogenetic links to these diseases are suspected. This review underlines the most recurrent changes in the gut microbiota of patients with MAFLD, while also evidencing possible pathogenetic links. Full article

(This article belongs to the Special Issue Recent Advances and Future Challenges in Gastroenterology and Hepatology)

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16 pages, 2705 KiB

Open AccessEditor’s ChoiceArticle

Recovery from Exercise in Persons with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

by Geoffrey E. Moore, Betsy A. Keller, Jared Stevens, Xiangling Mao, Staci R. Stevens, John K. Chia, Susan M. Levine, Carl J. Franconi and Maureen R. Hanson

Medicina 2023, 59(3), 571; https://doi.org/10.3390/medicina59030571 - 15 Mar 2023

Cited by 8 | Viewed by 28353

Abstract

Background and Objectives: Post-exertional malaise (PEM) is the hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but there has been little effort to quantitate the duration of PEM symptoms following a known exertional stressor. Using a Symptom Severity Scale (SSS) that includes nine [...] Read more.

Background and Objectives: Post-exertional malaise (PEM) is the hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but there has been little effort to quantitate the duration of PEM symptoms following a known exertional stressor. Using a Symptom Severity Scale (SSS) that includes nine common symptoms of ME/CFS, we sought to characterize the duration and severity of PEM symptoms following two cardiopulmonary exercise tests separated by 24 h (2-day CPET). Materials and Methods: Eighty persons with ME/CFS and 64 controls (CTL) underwent a 2-day CPET. ME/CFS subjects met the Canadian Clinical Criteria for diagnosis of ME/CFS; controls were healthy but not participating in regular physical activity. All subjects who met maximal effort criteria on both CPETs were included. SSS scores were obtained at baseline, immediately prior to both CPETs, the day after the second CPET, and every two days after the CPET-1 for 10 days. Results: There was a highly significant difference in judged recovery time (ME/CFS = 12.7 ± 1.2 d; CTL = 2.1 ± 0.2 d, mean ± s.e.m., Chi² = 90.1, p < 0.0001). The range of ME/CFS patient recovery was 1–64 days, while the range in CTL was 1–10 days; one subject with ME/CFS had not recovered after one year and was not included in the analysis. Less than 10% of subjects with ME/CFS took more than three weeks to recover. There was no difference in recovery time based on the level of pre-test symptoms prior to CPET-1 (F = 1.12, p = 0.33). Mean SSS scores at baseline were significantly higher than at pre-CPET-1 (5.70 ± 0.16 vs. 4.02 ± 0.18, p < 0.0001). Pharmacokinetic models showed an extremely prolonged decay of the PEM response (Chi² > 22, p < 0.0001) to the 2-day CPET. Conclusions: ME/CFS subjects took an average of about two weeks to recover from a 2-day CPET, whereas sedentary controls needed only two days. These data quantitate the prolonged recovery time in ME/CFS and improve the ability to obtain well-informed consent prior to doing exercise testing in persons with ME/CFS. Quantitative monitoring of PEM symptoms may provide a method to help manage PEM. Full article

(This article belongs to the Special Issue Advances in ME/CFS Research and Clinical Care)

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15 pages, 370 KiB

Open AccessEditor’s ChoiceReview

New Insights in the Setting of Transplant Oncology

by Silvia Quaresima, Fabio Melandro, Francesco Giovanardi, Kejal Shah, Valerio De Peppo, Gianluca Mennini, Davide Ghinolfi, Ashley Limkemann, Timothy M. Pawlik and Quirino Lai

Medicina 2023, 59(3), 568; https://doi.org/10.3390/medicina59030568 - 14 Mar 2023

Cited by 8 | Viewed by 2481

Abstract

Background and Objectives: Liver transplantation (LT) is the best strategy for curing several primary and secondary hepatic malignancies. In recent years, growing interest has been observed in the enlargement of the transplant oncology indications. This paper aims to review the most recent [...] Read more.

Background and Objectives: Liver transplantation (LT) is the best strategy for curing several primary and secondary hepatic malignancies. In recent years, growing interest has been observed in the enlargement of the transplant oncology indications. This paper aims to review the most recent developments in the setting of LT oncology, with particular attention to LT for unresectable colorectal liver metastases (CRLM) and cholangiocellular carcinoma (CCA). Materials and Methods: A review of the recently published literature was conducted. Results: Growing evidence exists on the efficacy of LT in curing CRLM and peri-hilar and intrahepatic CCA in well-selected patients when integrating this strategy with (neo)-adjuvant chemotherapy, radiotherapy, or locoregional treatments. Conclusion: For unresectable CCA and CRLM management, several prospective protocols are forthcoming to elucidate LT’s impact relative to alternative therapies. Advances in diagnosis, treatment protocols, and donor-to-recipient matching are needed to better define the oncological indications for transplantation. Prospective, multicenter trials studying these advances and their impact on outcomes are still required. Full article

(This article belongs to the Special Issue New Insights on Liver Transplantation and Regeneration)

11 pages, 1073 KiB

Open AccessEditor’s ChoiceArticle

Pituitary Abscess: A Challenging Preoperative Diagnosis—A Multicenter Study

by Charles-Henry Mallereau, Julien Todeschi, Mario Ganau, Hélène Cebula, Maria Teresa Bozzi, Antonio Romano, Tuan Le Van, Irene Ollivier, Ismail Zaed, Giorgio Spatola, Beniamino Nannavecchia, Pierre Mahoudeau, Idir Djennaoui, Christian Debry, Francesco Signorelli, Gianfranco K. I. Ligarotti, Raoul Pop, Seyyid Baloglu, Elsa Fasciglione, Bernard Goichot, Caroline Bund, Jeannot Gaudias, Francois Proust and Salvatore Chibbaro Show full author list Hide full author list

Medicina 2023, 59(3), 565; https://doi.org/10.3390/medicina59030565 - 14 Mar 2023

Cited by 9 | Viewed by 2839

Abstract

Background and Objectives: Pituitary abscess (PA) is a rare occurrence, representing less than 1% of pituitary lesions, and is defined by the presence of an infected purulent collection within the sella turcica. Pas can be classified as either primary, when the underlying pituitary [...] Read more.

Background and Objectives: Pituitary abscess (PA) is a rare occurrence, representing less than 1% of pituitary lesions, and is defined by the presence of an infected purulent collection within the sella turcica. Pas can be classified as either primary, when the underlying pituitary is normal prior to infection, or secondary, when there is associated a pre-existing sellar pathology (i.e., pituitary adenoma, Rathke’s cleft cysts, or craniopharyngioma), with or without a recent history of surgery. Preoperative diagnosis, owing to both non-specific symptoms and imaging features, remains challenging. Treatment options include endonasal trans-sphenoidal pus evacuation, as well as culture and tailored antibiotic therapy. Methods: A retrospective multicenter study, conducted on a prospectively built database over a 20-year period, identified a large series of 84 patients harboring primary sellar abscess. The study aimed to identify crucial clinical and imaging features in order to accelerate appropriate management. Results: The most common clinical presentation was a symptom triad consisting of various degrees of asthenia (75%), visual impairment (71%), and headache (50%). Diagnosis was achieved in 95% of cases peri- or postoperatively. Functional recovery was good for visual disturbances and headache. Pituitary function recovery remained very poor (23%), whereas the preoperative diagnosis represented a protective factor. Conclusions: In light of the high prevalence of pituitary dysfunction following the management of PAs, early diagnosis and treatment might represent a crucial issue. Currently, there are no standard investigations to establish a conclusive preoperative diagnosis; however, new, emerging imaging methods, in particular nuclear imaging modalities, represent a very promising tool, whose potential warrants further investigations. Full article

(This article belongs to the Section Endocrinology)

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11 pages, 895 KiB

Open AccessEditor’s ChoiceSystematic Review

Emotional and Social Impact of Halitosis on Adolescents and Young Adults: A Systematic Review

by Raluca Briceag, Aureliana Caraiane, Gheorghe Raftu, Razvan Mihai Horhat, Iulia Bogdan, Roxana Manuela Fericean, Luai Shaaban, Malina Popa, Bogdan Andrei Bumbu, Melania Lavinia Bratu, Marius Pricop and Serban Talpos

Medicina 2023, 59(3), 564; https://doi.org/10.3390/medicina59030564 - 14 Mar 2023

Cited by 9 | Viewed by 5296

Abstract

Background and Objectives: Halitosis is a condition characterized by unpleasant breath smell that is starting to receive serious scientific attention, considering it reflects on people’s social and personal life. While most studies focus on the prevalence of halitosis, its medical etiology, and [...] Read more.

Background and Objectives: Halitosis is a condition characterized by unpleasant breath smell that is starting to receive serious scientific attention, considering it reflects on people’s social and personal life. While most studies focus on the prevalence of halitosis, its medical etiology, and the psychological impact on adults, there is a lack of evidence regarding the social impact of halitosis on the younger population. Therefore, this systematic review aimed to observe the social and emotional impact that halitosis has on adolescents and young adults. Materials and Methods: The review followed the PRISMA protocol, and four electronic databases (Scopus, Scholar, Web of Science, and ProQuest) were searched. From a total of 593 studies retrieved, only 6 were included in the study after assessing the eligibility criteria. Results: The main results showed that the levels of self-reported halitosis ranged from 23.1% to 77.5%, with an average of 44.7%, indicating a significant heterogeneity among the studies reporting this issue. Adolescents and young adults who experienced bad breath were feeling more anxious and depressed according to the non-standardized questionnaires and the standardized questionnaires (OHIP-14 and SCL-9-R). The respondents were isolated from social interactions and consequently had lower self-esteem and impaired quality of life. Conclusions: The conclusions drawn indicate the need for action on a medical level, as well as on a psychological level, in order to improve people’s oral health and help them navigate through the difficulties of maintaining social interactions as they live with halitosis. Full article

(This article belongs to the Special Issue Oral Psychophysiology: Stress, Pain, and Behavior in Dental Care)

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20 pages, 1008 KiB

Open AccessEditor’s ChoiceReview

Ovarian Cancer—Insights into Platinum Resistance and Overcoming It

by Andrei Havasi, Simona Sorana Cainap, Ana Teodora Havasi and Calin Cainap

Medicina 2023, 59(3), 544; https://doi.org/10.3390/medicina59030544 - 10 Mar 2023

Cited by 22 | Viewed by 6781

Abstract

Ovarian cancer is the most lethal gynecologic malignancy. Platinum-based chemotherapy is the backbone of treatment for ovarian cancer, and although the majority of patients initially have a platinum-sensitive disease, through multiple recurrences, they will acquire resistance. Platinum-resistant recurrent ovarian cancer has a poor [...] Read more.

Ovarian cancer is the most lethal gynecologic malignancy. Platinum-based chemotherapy is the backbone of treatment for ovarian cancer, and although the majority of patients initially have a platinum-sensitive disease, through multiple recurrences, they will acquire resistance. Platinum-resistant recurrent ovarian cancer has a poor prognosis and few treatment options with limited efficacy. Resistance to platinum compounds is a complex process involving multiple mechanisms pertaining not only to the tumoral cell but also to the tumoral microenvironment. In this review, we discuss the molecular mechanism involved in ovarian cancer cells’ resistance to platinum-based chemotherapy, focusing on the alteration of drug influx and efflux pathways, DNA repair, the dysregulation of epigenetic modulation, and the involvement of the tumoral microenvironment in the acquisition of the platinum-resistant phenotype. Furthermore, we review promising alternative treatment approaches that may improve these patients’ poor prognosis, discussing current strategies, novel combinations, and therapeutic agents. Full article

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

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17 pages, 1549 KiB

Open AccessEditor’s ChoiceOpinion

Controlling the Impact of Helicobacter pylori-Related Hyperhomocysteinemia on Neurodegeneration

by Jannis Kountouras, Michael Doulberis, Apostolis Papaefthymiou, Stergios A. Polyzos, Christos Zavos, Evangelos Kazakos, Stergios Arapoglou, Foteini Kyrailidi, Maria C. Mouratidou, Marina Boziki and Elisabeth Vardaka

Medicina 2023, 59(3), 504; https://doi.org/10.3390/medicina59030504 - 4 Mar 2023

Cited by 11 | Viewed by 4261

Abstract

Helicobacter pylori infection consists a high global burden affecting more than 50% of the world’s population. It is implicated, beyond substantiated local gastric pathologies, i.e., peptic ulcers and gastric cancer, in the pathophysiology of several neurodegenerative disorders, mainly by inducing hyperhomocysteinemia-related brain cortical [...] Read more.

Helicobacter pylori infection consists a high global burden affecting more than 50% of the world’s population. It is implicated, beyond substantiated local gastric pathologies, i.e., peptic ulcers and gastric cancer, in the pathophysiology of several neurodegenerative disorders, mainly by inducing hyperhomocysteinemia-related brain cortical thinning (BCT). BCT has been advocated as a possible biomarker associated with neurodegenerative central nervous system disorders such as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and/or glaucoma, termed as “ocular Alzheimer’s disease”. According to the infection hypothesis in relation to neurodegeneration, Helicobacter pylori as non-commensal gut microbiome has been advocated as trigger and/or mediator of neurodegenerative diseases, such as the development of Alzheimer’s disease. Among others, Helicobacter pylori-related inflammatory mediators, defensins, autophagy, vitamin D, dietary factors, role of probiotics, and some pathogenetic considerations including relevant involved genes are discussed within this opinion article. In conclusion, by controlling the impact of Helicobacter pylori-related hyperhomocysteinemia on neurodegenerative disorders might offer benefits, and additional research is warranted to clarify this crucial topic currently representing a major worldwide burden. Full article

(This article belongs to the Section Neurology)

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11 pages, 4034 KiB

Open AccessEditor’s ChoiceReview

Role of Microaneurysms in the Pathogenesis and Therapy of Diabetic Macular Edema: A Descriptive Review

by Yoshihiro Takamura, Yutaka Yamada and Masaru Inatani

Medicina 2023, 59(3), 435; https://doi.org/10.3390/medicina59030435 - 22 Feb 2023

Cited by 9 | Viewed by 4775

Abstract

Background and Objectives: This study aims to elucidate the role of microaneurysms (MAs) in the pathogenesis and treatment of diabetic retinopathy (DR) and diabetic macular edema (DME), the major causes of acquired visual impairment. Materials and Methods: We synthesized the relevance of findings [...] Read more.

Background and Objectives: This study aims to elucidate the role of microaneurysms (MAs) in the pathogenesis and treatment of diabetic retinopathy (DR) and diabetic macular edema (DME), the major causes of acquired visual impairment. Materials and Methods: We synthesized the relevance of findings on the clinical characteristics, pathogenesis, and etiology of MAs in DR and DME and their role in anti-vascular endothelial growth factor (VEGF) therapy. Results: MAs, a characteristic feature in DR and DME, can be detected by fluorescein angiography, optical coherence tomography (OCT) and OCT angiography. These instrumental analyses demonstrated a geographic and functional association between MA and ischemic areas. MA turnover, the production and loss of MA, reflects the activity of DME and DR. Several cytokines are involved in the pathogenesis of MAs, which is characterized by pericyte loss and endothelial cell proliferation in a VEGF-dependent or -independent manner. Ischemia and MAs localized in the deep retinal layers are characteristic of refractory DME cases. Even in the current anti-VEGF era, laser photocoagulation targeting MAs in the focal residual edema is still an effective therapeutic tool, but it is necessary to be creative in accurately identifying the location of MAs and performing highly precise and minimally invasive coagulation. Conclusions: MAs play a distinctive and important role in the pathogenesis of the onset, progression of DR and DME, and response to anti-VEGF treatment. Further research on MA is significant not only for understanding the pathogenesis of DME but also for improving the effectiveness of treatment. Full article

(This article belongs to the Special Issue Macular Edema: Pathogenesis, Diagnosis and Therapies)

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12 pages, 1370 KiB

Open AccessEditor’s ChoiceSystematic Review

Efficacy and Safety of Endoscopic Ultrasound-Guided Radiofrequency Ablation for Pancreatic Neuroendocrine Tumors: A Systematic Review and Metanalysis

by Elia Armellini, Antonio Facciorusso and Stefano Francesco Crinò

Medicina 2023, 59(2), 359; https://doi.org/10.3390/medicina59020359 - 14 Feb 2023

Cited by 20 | Viewed by 4276

Abstract

Introduction: The development of dedicated endoscopes and the technical evolution of endoscopic ultrasound (EUS) have allowed a direct approach to pancreatic neoplastic lesions both for diagnosis and treatment. Among the more promising targets are pancreatic neuroendocrine tumors (Pan-NETs). Aim: to describe [...] Read more.

Introduction: The development of dedicated endoscopes and the technical evolution of endoscopic ultrasound (EUS) have allowed a direct approach to pancreatic neoplastic lesions both for diagnosis and treatment. Among the more promising targets are pancreatic neuroendocrine tumors (Pan-NETs). Aim: to describe the evolution of endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) with particular attention to the treatment of PanNETs, focusing on safety and clinical efficacy of the technique. Methods: MEDLINE, Scopus, and Cochrane Library databases were searched for studies reporting about EUS-RFA for the treatment of PanNETs. Studies with outcomes of interest were selected and results were reported to describe clinical success, complications, fol-low-ups, and electrodes used. Clinical success was defined as the disappearance of clinical symp-toms for functional (F-) PanNETs and as complete ablation per nonfunctional (NF)-PanNETs. The pooled data were analyzed by a random-effects model. Results: Nineteen studies were selected, including 183 patients (82 males, 44.8%) with 196 lesions (101 F-PanNETs and 95 NF-PanNETs). Pooled estimates for the overall AE rates for the clinical efficacy were 17.8% (95% CI 9.1–26.4%) and 95.1% (95% CI 91.2–98.9%) for F-PanNETs and 24.6% (95% CI 7.4–41.8%) and 93.4% (95% CI 88.4–98.4%) for NF-PanNETs. Conclusions: EUS-RFA appears to be a mini-invasive technique with a good safety and efficacy profile for the treatment of F- and NF-PanNETs. EUS-RFA could be of-fered as possible alternative to surgery for the treatment of low-grade NF- or F-PanNETs, especially for those patients that are not eligible or are at high-risk for surgery. Full article

(This article belongs to the Special Issue Digestive Endoscopy: Inside the Evidence and Outside)

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10 pages, 638 KiB

Open AccessEditor’s ChoiceArticle

Dermoscopic Clues of Histopathologically Aggressive Basal Cell Carcinoma Subtypes

by Elisa Camela, Paula Ilut Anca, Konstantinos Lallas, Chryssoula Papageorgiou, Sofia-Magdalini Manoli, Theodosia Gkentsidi, Polychronia Eftychidou, Konstantinos Liopyris, Dimitrios Sgouros, Zoe Apalla and Aimilios Lallas

Medicina 2023, 59(2), 349; https://doi.org/10.3390/medicina59020349 - 13 Feb 2023

Cited by 10 | Viewed by 3093

Abstract

Background: The group of histopathologically aggressive BCC subtypes includes morpheaform, micronodular, infiltrative and metatypical BCC. Since these tumors are at increased risk of recurring, micrographically controlled surgery is considered the best therapeutic option. Although dermoscopy significantly improves the clinical recognition of BCC, scarce [...] Read more.

Background: The group of histopathologically aggressive BCC subtypes includes morpheaform, micronodular, infiltrative and metatypical BCC. Since these tumors are at increased risk of recurring, micrographically controlled surgery is considered the best therapeutic option. Although dermoscopy significantly improves the clinical recognition of BCC, scarce evidence exists on their dermoscopic criteria. Aim: To investigate the dermoscopic characteristics of histopathologically aggressive BCC subtypes. Materials and Methods: Dermoscopic images of morpheaform, micronodular, infiltrative and metatypical BCC were analyzed for the presence of predefined variables. Descriptive and analytical statistics were performed. Results: Most histopathologically aggressive BCCs were located on the head and neck. Infiltrative was the most common subtype. All subtypes, except micronodular BCC, rarely displayed dermoscopic pigmentation. The most frequent dermoscopic features of infiltrative BCC were arborizing vessels (67.1%), shiny white structures (48.6%) and ulceration (52.9%). The features prevailing in morpheaform BCC were arborizing vessels (68.4%), ulceration (n = 12, 63.2%) and white porcelain areas (47.4%). Micronodular BCC was typified by milky red structureless areas (53.8%), arborizing vessels (53.8%), short fine telangiectasias (50%), ulceration (46.2%) and blue structures (57.7%). The most common findings in metatypical BCC were arborizing vessels (77.8%), shiny white structures (66.7%), ulceration (62.9%) and keratin mass (29.6%). Limitations: Study population of only white skin and relatively small sample size in some groups. Conclusions: Our study provided data on the clinical, dermoscopic and epidemiological characteristics of histopathologically aggressive BCCs. Full article

(This article belongs to the Special Issue Updates on the Diagnosis and Therapy of Skin Neoplasms)

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11 pages, 1840 KiB

Open AccessEditor’s ChoiceArticle

Tibiotalar and Tibiotalocalcaneal Arthrodesis with Paragon28 Silverback^TM Plating System in Patients with Severe Ankle and Hindfoot Deformity

by Carlo Perisano, Adriano Cannella, Chiara Polichetti, Antonio Mascio, Chiara Comisi, Vincenzo De Santis, Silvio Caravelli, Massimiliano Mosca, Giorgio Alfredo Spedicato, Giulio Maccauro and Tommaso Greco

Medicina 2023, 59(2), 344; https://doi.org/10.3390/medicina59020344 - 11 Feb 2023

Cited by 9 | Viewed by 4179

Abstract

Background and Objectives: The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as [...] Read more.

Background and Objectives: The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as numerous devices proposed for internal fixation (retrograde intramedullary nails, cannulated screws, and plating systems). The aim of this study was to retrospectively analyze the results, with at least 18 months of follow-up, with Silverback^TM TT/TTC Plating System Paragon28 in a group of 20 patients with severe OA and hindfoot deformities (mainly secondary post-traumatic OA). Materials and Methods: The demographic characteristics and past medical history of the patients were collected and analyzed to identify the cause of the pathology. The degree of OA and deformity were quantified based on foot and ankle weight-bearing radiography and CT examination. Pre- and post-operative clinical and functional scores (ROM, VAS, AOFAS, FFI, and SF-36) and radiographic parameters (anterior distal tibial angle, tibiotalar angle, coronal tibiotalar angle, and hindfoot alignment angle) were evaluated. Results: All of the patients showed clinical and radiographic fusion at an average of 14 weeks (range 12–48), with improvement in pain and functional scores, without major surgical complications and/or infections. Conclusions: Despite the limitations of our study, the results with this new plating system showed good results in terms of bone consolidation, post-operative complications, and improvement of pain and quality of life in patients with severe OA and deformities of the ankle and hindfoot. Full article

(This article belongs to the Special Issue Chronic Soft Tissue and Bone Ankle Injury: From Cure to Prevention)

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13 pages, 955 KiB

Open AccessEditor’s ChoiceSystematic Review

Correlation between the Altered Gut Microbiome and Lifestyle Interventions in Chronic Widespread Pain Patients: A Systematic Review

by María Elena Gonzalez-Alvarez, Eleuterio A. Sanchez-Romero, Silvia Turroni, Josué Fernandez-Carnero and Jorge H. Villafañe

Medicina 2023, 59(2), 256; https://doi.org/10.3390/medicina59020256 - 29 Jan 2023

Cited by 9 | Viewed by 3250

Abstract

Background: Lifestyle interventions have a direct impact on the gut microbiome, changing its composition and functioning. This opens an innovative way for new therapeutic opportunities for chronic widespread patients. Purpose: The goal of the present study was to evaluate a correlation [...] Read more.

Background: Lifestyle interventions have a direct impact on the gut microbiome, changing its composition and functioning. This opens an innovative way for new therapeutic opportunities for chronic widespread patients. Purpose: The goal of the present study was to evaluate a correlation between lifestyle interventions and the gut microbiome in patients with chronic widespread pain (CWP). Methods: The systematic review was conducted until January 2023. Pain and microbiome were the two keywords selected for this revision. The search was conducted in PubMed, Chochrane, PEDro and ScienceDirect, where 3917 papers were obtained. Clinical trials with lifestyle intervention in CWP patients were selected. Furthermore, these papers had to be related with the gut microbiome, excluding articles related to other types of microbiomes. Results: Only six articles were selected under the eligibility criteria. Lifestyle interventions were exercise, electroacupuncture and ingesting a probiotic. Conclusions: Lifestyle intervention could be a suitable choice to improve the gut microbiome. This fact could be extrapolated into a better quality of life and lesser levels of pain. Full article

(This article belongs to the Special Issue Age-Related Musculoskeletal Disorders)

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