Journal of Clinical Medicine

12 pages, 1092 KiB

Open AccessArticle

Clinical Efficacy of Two Different Low-Level Laser Therapies for the Treatment of Trigeminal Neuralgia: A Randomized, Placebo-Controlled Trial

by İrem Karagözoğlu, Nermin Demirkol, Özge Parlar Öz, Gökçe Keçeci, Beste Çetin and Mutlu Özcan

J. Clin. Med. 2024, 13(22), 6890; https://doi.org/10.3390/jcm13226890 (registering DOI) - 15 Nov 2024

Abstract

Background: Trigeminal neuralgia (TN) is a disease that causes severe pain that can seriously affect the quality of life. This study aimed to compare the effectiveness of two different low-level laser therapies (LLLT) as alternatives to medical treatment to reduce pain and improve [...] Read more.

Background: Trigeminal neuralgia (TN) is a disease that causes severe pain that can seriously affect the quality of life. This study aimed to compare the effectiveness of two different low-level laser therapies (LLLT) as alternatives to medical treatment to reduce pain and improve the quality of life in patients with TN. Methods: A total of 45 patients were randomly divided into 3 groups. In the first group, a new-generation diode laser (GRR laser) was applied at predetermined points in the trigeminal nerve line. In the second group, a low-level neodymium-doped yttrium aluminum garnet (Nd:YAG) laser was applied along the affected nerve line. The placebo group received the same protocol with a Nd:YAG laser without the device switched on. The scores were recorded pre- and post-treatment using the Brief Pain Inventory-Facial (BPI-facial) scale. Results: A statistically significant difference was found between the pre- and post-treatment values of all four variables in the GRR laser, Nd:YAG laser, and placebo groups. When the post-treatment values were compared, statistically significant differences were found between the groups in pain frequency, pain intensity, and interference in facial-specific activities, but no differences were found in general activities. Conclusions: Both LLLTs can be considered alternative treatment modalities for TN, but the GRR laser treatment was more effective than the Nd:YAG laser treatment in reducing pain and improving the quality of life in patients with TN. Full article

(This article belongs to the Topic Advances in Dental Health)

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21 pages, 549 KiB

Open AccessArticle

Understanding Surgeons’ Reluctance to Adopt Intraoperative Coronary Graft Verification Procedures: A Literature Review Combined to AI-Driven Insights Under Human Supervision

by Gabriele Di Giammarco, Federico Cammertoni, Nicola Testa and Massimo Massetti

J. Clin. Med. 2024, 13(22), 6889; https://doi.org/10.3390/jcm13226889 (registering DOI) - 15 Nov 2024

Abstract

Background: Intraoperative graft verification in coronary surgery is accepted worldwidand equally discussed. In spite of multiple sources of evidence published up to now in favor of clinical benefits following the use of the procedure, there is a persistent skepticism in adopting the available [...] Read more.

Background: Intraoperative graft verification in coronary surgery is accepted worldwidand equally discussed. In spite of multiple sources of evidence published up to now in favor of clinical benefits following the use of the procedure, there is a persistent skepticism in adopting the available technologies. The object of the present review is to analyze the reluctance of surgeons toward the adoption of assessment methods. Materials and Method: A thorough literature review was carried out on Google Scholar based on the results obtained from AI’s answer to the question about the reasons for that reluctance. We took advantage of using ChatGPT-4 since the research based on PubMed Central alone was not able to return a detailed response, maybe because the reasons for the reluctance are veiled in the text of the published papers. Through the items suggested by AI and taken from the literature, we deepened the research, pointing attention to the issues published so far about the various technologies. Results: There are many convincing pieces of evidence about the utility of intraoperative graft control in coronary surgery, involving improved clinical outcome, efficacy and safety, and social cost saving. The opinion that arose through this analysis is that, beyond the objective difficulties in utilizing some technologies and the equally objective limitations of an economic and organizational nature, the reluctance is the result of a real unwillingness based on the various implications that the discovery of the technical error entails. Conclusions: This negative attitude, in light of the convincing scientific and clinical evidence published up to now, appears to overwhelm the benefits for patients. Full article

(This article belongs to the Section General Surgery)

9 pages, 550 KiB

Open AccessArticle

Minimally Invasive Repair of Pectus Excavatum: A Lifeline to Quality of Life

by Mostafa Higaze, Mohamed Anwar Haj Khalaf, Chirag Parjiea and Horia Sirbu

J. Clin. Med. 2024, 13(22), 6888; https://doi.org/10.3390/jcm13226888 (registering DOI) - 15 Nov 2024

Abstract

Background: Pectus excavatum, a deformity of the chest wall, can lead to significant emotional and social challenges, adversely affecting an individual’s overall well-being. While the Nuss procedure is a well-established treatment, this study evaluates the impact of a modified, minimally invasive approach [...] Read more.

Background: Pectus excavatum, a deformity of the chest wall, can lead to significant emotional and social challenges, adversely affecting an individual’s overall well-being. While the Nuss procedure is a well-established treatment, this study evaluates the impact of a modified, minimally invasive approach on patients’ quality of life. Methods: This retrospective study analyzed patients who underwent minimally invasive pectus excavatum repair (MIRPE) from 1 January 2010 to 31 January 2024. Collected data included demographics, operative details, and patient outcomes. Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire, administered preoperatively and at least four weeks post-surgery. Results: Two hundred thirty-four patients (195 male, mean age 20.5 ± 6 years) underwent MIRPE. Postoperative results showed statistically significant improvements in all dimensions of HRQoL (Physical Component Summary Score (PCS) p = 0.007; Mental Component Summary Score (MCS) p < 0.001). Importantly, postoperative HRQoL scores were not just improved but comparable to those of the general German population, providing reassurance and confidence in the effectiveness of MIRPE. Conclusions: This study demonstrates that MIRPE significantly enhances patients’ quality of life (HRQoL). The improvements observed post-surgery bring HRQoL to levels akin to healthy individuals in the German population. These findings underscore the profound positive impact of MIRPE on patients’ well-being, offering hope and optimism for the future of pectus excavatum treatment. Full article

(This article belongs to the Section General Surgery)

24 pages, 1497 KiB

Open AccessSystematic Review

Functional Measures in Non-COPD Chronic Respiratory Diseases: A Systematic Review

by Camile Ludovico Zamboti, Heloise Angélico Pimpão, Larissa Dragonetti Bertin, Gabriela Garcia Krinski, Tathielle Garcia, Sandro Laerth Souza dos Santos Filho, Vinicius Cavalheri, Fabio Pitta and Carlos Augusto Camillo

J. Clin. Med. 2024, 13(22), 6887; https://doi.org/10.3390/jcm13226887 (registering DOI) - 15 Nov 2024

Abstract

Background/Objectives: The extensive range of instruments designed for evaluating functional performance (FP) in chronic respiratory diseases (CRD) other than chronic obstructive pulmonary disease (COPD) presents a challenge in selecting the most appropriate one. Therefore, this systematic review aimed to summarise FP instruments, their [...] Read more.

Background/Objectives: The extensive range of instruments designed for evaluating functional performance (FP) in chronic respiratory diseases (CRD) other than chronic obstructive pulmonary disease (COPD) presents a challenge in selecting the most appropriate one. Therefore, this systematic review aimed to summarise FP instruments, their measurement properties, their minimum clinically important differences, and their associations with CRD course-related events or prognosis in non-COPD CRD. Methods: Studies employing patient-reported or performance-based instruments to assess FP in non-COPD CRD were systematically identified in the PubMed, PEDro, Embase, and Cochrane Library databases. COPD-exclusive studies or those solely reporting exercise capacity tests were excluded. Examination focused on measurement properties and associations with CRD course-related events or prognosis. The risk of bias was evaluated using the COSMIN, Downs and Black, and PEDro checklists based on the study design. Results: A total of 216 studies across seven CRD categories [asthma, bronchiectasis, cystic fibrosis, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), pre-/post-lung-transplantation] from various study types were included. Thirty-three instruments were identified, with the SF-36 questionnaire’s physical function domain being the most commonly used patient-reported tool. The 1 min sit-to-stand test was the most extensively studied performance-based measure, with its measurement properties frequently reported in non-COPD CRD studies. Associations with events were infrequently documented, primarily in ILD and PAH studies related to mortality. Conclusions: Despite the prevalent use of FP instruments, limited information exists concerning their measurement properties and clinical implications. This review furnishes a concise summary of available evidence, aiding informed clinical decisions when selecting FP tools for non-COPD CRD. Full article

(This article belongs to the Section Pulmonology)

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Study Flowchart. Full article ">Figure 2
Studies using functional performance tests by chronic respiratory disease. Abbreviations: ILD–interstitial lung disease; PAH—pulmonary arterial hypertension; 15steps-C—15-step climbing; CS-PFP—continuous scale physical function performance test; Glittre ADL—Glittre Activities of Daily Living; 8-FUGT—8-foot up-and-go; TUG—timed up-and-go; SPPB—short physical performance battery; 4MGS—four-metre gait speed; 3min-STS—3 min sit-to-stand; 5rep-STS—5-repetition sit-to-stand; 30 s-STS—30 sec sit-to-stand; 1min-STS—1 min sit-to-stand; PPT—physical performance test. Full article ">Figure 3
Frequency of patient-reported tools per disease. Abbreviations: ILD—interstitial lung disease; PAH—pulmonary arterial hypertension; pre-LTx—patients with chronic respiratory disease awaiting lung transplantation; post-LTx—patients with chronic respiratory disease who underwent lung transplantation; SF-36—Medical Outcomes Study 36-Item Short Form of Health Survey; SGRQ—Saint’s George Respiratory Questionnaire; WHOfc—World Health Organisation functional class; NYHA—New York Heart Association; AQLQ—Asthma Quality of Life Questionnaire; CFQoL—Cystic Fibrosis Quality of Life; SF-12—Medical Outcomes Study 12-Item Short Form of Health Survey; PROMIS-29—Patient-Reported Outcomes Measurement Information System; LWAQ—Living with Asthma Questionnaire; M-AQLQ—Mini Asthma Quality of Life Questionnaire; CAMPHOR—Cambridge Pulmonary Hypertension Outcome Review; QoL-EPM—Asthma Quality of Life from Escola Paulista de Medicina; MLHFQ—Minnesota Living with Heart Failure Questionnaire; QoL-B—Quality of Life in Bronchiectasis; London ADL—London Activities of Daily Living; FPI—functional performance inventory; SOLQ—Seattle Obstructive Lung Questionnaire; ECOPs—Eastern Cooperative Oncology Performance Status; PROMIS-PF—Patient-Reported Outcomes Measurement Information System Physical Function Short Form 8a; MDHAQ—Multidimensional Health Assessment Questionnaire; HAQ-DI—Health Assessment Questionnaire Disability Index. Full article ">

16 pages, 6572 KiB

Open AccessReview

Near-Infrared Autofluorescence: Early Detection of Retinal Pigment Epithelial Alterations in Inherited Retinal Dystrophies

by Simone Kellner, Silke Weinitz, Ghazaleh Farmand and Ulrich Kellner

J. Clin. Med. 2024, 13(22), 6886; https://doi.org/10.3390/jcm13226886 (registering DOI) - 15 Nov 2024

Abstract

Near-infrared autofluorescence (NIA) is a non-invasive retinal imaging technique used to examine the retinal pigment epithelium (RPE) based on the autofluorescence of melanin. Melanin has several functions within RPE cells. It serves as a protective antioxidative factor and is involved in the phagocytosis [...] Read more.

Near-infrared autofluorescence (NIA) is a non-invasive retinal imaging technique used to examine the retinal pigment epithelium (RPE) based on the autofluorescence of melanin. Melanin has several functions within RPE cells. It serves as a protective antioxidative factor and is involved in the phagocytosis of photoreceptor outer segments. Disorders affecting the photoreceptor–RPE complex result in alterations of RPE cells which are detectable by alterations of NIA. NIA allows us to detect early alterations in various chorioretinal disorders, frequently before they are ophthalmoscopically visible and often prior to alterations in lipofuscin-associated fundus autofluorescence (FAF) or optical coherence tomography (OCT). Although NIA and FAF relate to disorders affecting the RPE, the findings for both imaging methods differ and the area involved has been demonstrated to be larger in NIA compared to FAF in several disorders, especially inherited retinal dystrophies (IRDs), indicating that NIA detects earlier alterations compared to FAF. Foveal alterations can be much more easily detected using NIA compared to FAF. A reduced subfoveal NIA intensity is the earliest sign of autosomal dominant Best disease, when FAF and OCT are still normal. In other IRDs, a preserved subfoveal NIA intensity is associated with good visual acuity. So far, the current knowledge on NIA in IRD has been presented in multiple separate publications but has not been summarized in an overview. This review presents the current knowledge on NIA in IRD and demonstrates NIA biomarkers. Full article

(This article belongs to the Special Issue Advances in Ophthalmic Imaging)

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11 pages, 2099 KiB

Open AccessArticle

Midseptal and Anteroseptal Accessory Pathway Ablation in Children

by László Környei, Matevž Jan, Mohammad Ebrahim, Vjekoslav Radeljić, Mirta Rode, Diana Delić-Brkljačić, Ivana Kralik, Flóra Kocsis and Nikola Krmek

J. Clin. Med. 2024, 13(22), 6885; https://doi.org/10.3390/jcm13226885 (registering DOI) - 15 Nov 2024

Abstract

Objectives: The goal of this study is to document outcomes of ablation for high-risk accessory pathways in paediatrics using 3D mapping systems with minimal to zero fluoroscopy. Methods: It is a cross-sectional, multicentre study, conducted between 2013 and 2023, and involving four different [...] Read more.

Objectives: The goal of this study is to document outcomes of ablation for high-risk accessory pathways in paediatrics using 3D mapping systems with minimal to zero fluoroscopy. Methods: It is a cross-sectional, multicentre study, conducted between 2013 and 2023, and involving four different centres in Hungary, Croatia, Kuwait, and Slovenia. Results: A total of 128 procedures were performed on 111 patients. The cohort included 57.8% anteroseptal (AS) pathways and 42.2% midseptal (MS) pathways. The mean follow-up time was 2.0 ± 2.1 years. Cryoablation was used in 72.7% of the cases, and radiofrequency ablation was used in 27.3%. The EnSite Precision™ Cardiac Mapping System was the predominant system used. The overall acute success rate was 89.1%, with recurrence rates at 17.2% with similar results regardless of the type of energy used. The success rate was not significantly different between AS and MS substrates. The age and weight of the patient had no bearing on the outcomes (median age and weight were 13 years and 52 kg, respectively). The complications rate was at 4.69% and included transient AV block (three patients), hematoma (one patient), right bundle branch block (one patient), and possible permanent complete AV block (one patient). Fluoroscopy was utilized in 18 cases, with a fluoroscopy time mean of 3 min and 45 s. Conclusions: MS and AS AP in paediatric patients can be treated effectively with either RF or cryoablation and with a low dose of radiation using 3D mapping systems, with excellent acute success rates and low complication rates. Full article

(This article belongs to the Section Cardiology)

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12 pages, 1166 KiB

Open AccessArticle

Assessment of Post-COVID-19 Changes in Brain—Clinical and Imaging Evaluation Using MRI Vessel Wall Imaging and Complementary MRI Methods

by Jakub Okrzeja, Maciej Alimowski, Adam Garkowski, Marcin Hładuński, Bożena Kubas, Justyna Adamczuk, Piotr Czupryna, Karolina Narejko and Anna Moniuszko-Malinowska

J. Clin. Med. 2024, 13(22), 6884; https://doi.org/10.3390/jcm13226884 (registering DOI) - 15 Nov 2024

Abstract

Background/Objectives: The aim of the study was to evaluate the usefulness of vessel wall imaging and MRI in assessment of the post-COVID-19 changes in the brain. VWI is a progressive MRI technique that provides precise imaging of the pathological process in the [...] Read more.

Background/Objectives: The aim of the study was to evaluate the usefulness of vessel wall imaging and MRI in assessment of the post-COVID-19 changes in the brain. VWI is a progressive MRI technique that provides precise imaging of the pathological process in the wall of the vessel. It might help us to better understand the pathophysiology of COVID-19-related neurological lesions and may have an impact on management protocols. Methods: A total of 43 patients were included in the study; the post-COVID-19 group included 23 patients hospitalized for COVID-19 (mean age of the group: 53.52 years; 26% male, 74% female). The control group consisted of 20 patients from the general population who did not suffer from COVID-19 (mean age: 52.15 years; 35% male, 65% female). MRI examinations were performed on a 3T scanner (Biograph mMR, Siemens). The VW-MRI protocol included T1-weighted SPACE FS black-blood images, FLAIR images, SWI, and MRA. Results: Several radiological changes in post-COVID-19 patients were described: hyperintense foci in the white matter of the brain hemispheres, in the lower parts of the temporal lobes, and in the structures of the posterior cranial fossa; presence of engorgement of deep medullary veins or perivascular enhancement; presence of inflammatory vessel thickening in VWI images; changes in hippocampus size; presence of cortical atrophy; and thickening of the mucous membrane of the paranasal sinuses. The presence of atherosclerotic vessel thickening in VWI and the width of the third ventricle depended on the age of the patient. Conclusions: VWI and MRI may be useful in the assessment of post-COVID-19 lesions in the brain. Full article

(This article belongs to the Topic Post COVID-19: Latest Advances, Challenges and Methodologies)

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9 pages, 236 KiB

Open AccessArticle

Monoclonal Antibody Switching in Biologic Treatment of Chronic Rhinosinusitis with Nasal Polyps

by Michael Habenbacher, Ulrich Moser, Oliver Hadl, Peter Kiss, Clemens Holzmeister, Jakob Pock, Katharina Walla, Angelika Lang and Alexandros Andrianakis

J. Clin. Med. 2024, 13(22), 6883; https://doi.org/10.3390/jcm13226883 - 15 Nov 2024

Abstract

Objectives: to evaluate our real-world data on the efficacy and safety of switching between two monoclonal antibodies in biologic treatment of uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: All patients receiving biologic treatment for uncontrolled CRSwNP between April 2020 and March 2024 [...] Read more.

Objectives: to evaluate our real-world data on the efficacy and safety of switching between two monoclonal antibodies in biologic treatment of uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: All patients receiving biologic treatment for uncontrolled CRSwNP between April 2020 and March 2024 at a tertiary referral center who needed transitioning between biologic agents were retrospectively analyzed. The following parameters were investigated: patient’s clinical characteristics, wash-out periods, treatment outcome, and switching-related side effects. Results: Out of 91 CRSwNP patients who received biologic treatment, 4 patients (4.4%) necessitated switching to an alternative biologic agent. Three patients were switched to a different antibody because of insufficient symptom control with the initially prescribed biologic, while the other patient required switching to an alternative agent due to a side effect. Switching resulted in all four patients achieving a significant improvement in all outcome parameters. There were no switching-related side effects, and the switching procedure was performed in three cases without a wash-out period. Conclusion: CRSwNP patients under biologic therapy with an insufficient response or medication-related side effect may benefit from switching to an alternative biologic agent. Larger, prospective multicenter studies are warranted to further validate the effectiveness and safety of switching agents in the biologic treatment of CRSwNP. Full article

(This article belongs to the Section Otolaryngology)

17 pages, 2031 KiB

Open AccessArticle

Dysfunction and Morphological Involvement of Inner Macular Layers in Glaucoma

by Vincenzo Parisi, Lucia Ziccardi, Sara Giammaria, Lucilla Barbano, Lucia Tanga, Manuele Michelessi, Gloria Roberti, Carmela Carnevale, Carmen Dell’Aquila, Mattia D’Andrea, Gianluca Manni and Francesco Oddone

J. Clin. Med. 2024, 13(22), 6882; https://doi.org/10.3390/jcm13226882 - 15 Nov 2024

Abstract

Objectives: This study aimed to study the inner retina functional and morphological impairment of retinal ganglion cells (RGCs) from specific macular rings and sectors to identify whether selective macular regions were more vulnerable than others within the 20 central degrees in patients with [...] Read more.

Objectives: This study aimed to study the inner retina functional and morphological impairment of retinal ganglion cells (RGCs) from specific macular rings and sectors to identify whether selective macular regions were more vulnerable than others within the 20 central degrees in patients with open-angle glaucoma (OAG). Methods: In total, 21 OAG patients [mean age 50.19 ± 7.86 years, Humphrey Field Analyzer (HFA) 24-2 mean deviation (MD) between −5.02 and −22.38 dB, HFA 10-2 MD between −3.07 and −17.38 dB], providing 21 eyes, were enrolled in this retrospective case–control study. And 20 age-similar healthy subjects, providing 20 eyes, served as controls. The multifocal photopic negative response (mfPhNR) response amplitude density (RAD) from concentric rings and macular sectors and ganglion cell layer thickness (GCL-T) assessed by Spectral Domain–Optical Coherence Tomography (SD-OCT) was measured. Mean RAD and GCL-T values were compared between OAG and control ones by ANOVA. In OAG eyes, the relationship between mfPhNR and SD-OCT data was examined by linear regression analysis, and Pearson’s correlation coefficients were computed. Results: In considering all rings and sectors, compared to the controls, the OAG group showed a significant (p < 0.01) reduction in mean mfPhNR RAD and in GCL-T values with the greatest reduction in the central area. In OAG eyes, a significant (p < 0.01) correlation between all mfPhNR RAD and GCL-T values, with significant (p < 0.01) correlation coefficients, were found. Conclusions: In OAG eyes, RGC dysfunction was detectable by abnormal mfPhNR responses in localized macular areas, mainly in the central one. Localized macular RGC dysfunction was linearly correlated with the GCL morphological changes. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, and Prevention of Glaucoma: Second Edition)

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Figure 1
Representative example of functional analysis of retinal ganglion cells (RGCs) assessed with multifocal photopic negative response (mfPhNR) and morphological analysis of ganglion cell layer thickness (GCL-T) in one control eye (#10) and in one open-angle glaucoma eye (OAG#2). (A) Multifocal PhNR rings and OCT areas. mfPhNR response amplitude density (RAD) measured in nanoV/degree2 (nV/deg2) as baseline to trough with an implicit time between 50 and 90 milliseconds (ms) from the stimulus onset and indicated by an arrow (↕). Ring (R) analysis of averaged traces obtained from three circular areas with increasing eccentricity from the fovea, covering 0°–20° from the center. The traces derived from a circular area centered on the fovea with a radius of 5° are depicted in red [Ring 1 (R1)]; in green, an external annular area enclosed between 5° and 10° of foveal eccentricity [Ring 2 (R2)]; in purple, a more external annulus combining together the areas enclosed between 10° and 15° Ring 3 (R3)] and between 15° and 20° [Ring 4 (R4)] (R3 + R4). GCL-T data: the central area corresponds to Area 1 encompassing the superpixels in a 6.35° radius centered on the fovea; the annular parafoveal area corresponds to Area 2, analyzing the superpixels enclosed between 6.35° and 9.37° from the fovea; the annular perifoveal area corresponds to Area 3, analyzing the superpixels enclosed between 9.37° and 12.5° from the fovea. In each area, the GCL-T value is reported in micron (µm). (B) Multifocal PhNR and OCT sectors. mfPhNR response amplitude density (RAD) [measured in nanoV/degree2 (nV/deg2)] obtained in each macular sector. The first sector (S1) corresponds to R1 and analyzes a circular area centered on the fovea with a radius of 5°. The superior temporal (ST), inferior temporal (IT), inferior nasal (IN), and superior nasal (SN) sectors were quarters of an annulus within 5° (inner border) and 20° (outer border) of eccentricity from the fovea, corresponding to the sum of R2 + R3 + R4. The averaged R2 + R3 + R4 RADs for each sector (ST, IT, IN, SN) were measured. GCL-T data report the averaged values from four macular sectors (ST in blue; IT in green; IN in orange; SN in purple), determined by the horizontal and vertical midlines of the posterior pole and intersection at the fovea. The ST, IT, IN, and SN sectors comprise 13 superpixels each, corresponding to the ST, IT, IN, and SN portion of the posterior pole, respectively. GCL-T measurements are provided in microns (µm). OAG#2 eye shows reduced mfPhNR RADs and GCL-T in all rings and sectors when compared to Control#10 eye. Full article ">Figure 2
Relationship between multifocal photopic negative response (mfPhNR) response amplitude density (RAD) and ganglion cell layer thickness (GCL-T) values detected in rings and sectors in open-angle glaucoma (OAG) eyes and controls. (A) The multifocal photopic negative response (mfPhNR) average response amplitude densities (RADs) measured in controls and OAG eyes recorded in Ring 1, Ring 2, and Ring 3 + Ring 4. (B) The ganglion cell layer thickness (GCL-T) values measured in controls and OAG eyes recorded in Area 1, Area 2, and Area 3. (C) The multifocal photopic negative responses (mfPhNR) average response amplitude densities (RADs) measured in controls and OAG eyes recorded in the superior temporal (ST), inferior temporal (IT), inferior nasal (IN), and superior nasal (SN) sectors. (D) The ganglion cell layer thickness (GCL-T) values measured in controls and OAG eyes recorded in the superior temporal (ST), inferior temporal (IT), inferior nasal (IN), and superior nasal (SN) sectors. In OAG eyes, the averaged mfPhNR RAD and GCL-T values were lower compared to those in the controls but with a similar decreasing pattern at increasing eccentricity (from Ring 1 to Ring 3 + Ring 4 and from Area 1 to Area 3), which was particularly evident in controls (A,B). Similarly, in OAG eyes, the averaged mfPhNR RAD and GCL-T values were lower compared to in controls in all sectors. However, no significant pattern of changes was found for both averaged mfPhNR RAD and GCL-T values (C,D). Full article ">Figure 3
Correlations between mutifocal photopic negative response (mfPhNR) and ganglion cell layer thickness (GCL-T) individual values detected in open-angle glaucoma (OAG) eyes. (A) The individual GCL-T values measured in OAG eyes in Area 1, Area 2, and Area 3 were plotted as a function of the corresponding values of the mfPhNR response amplitude densities (RADs) recorded in Ring 1, Ring 2, and Ring 3 + Ring 4. (B) The individual GCL-T values measured in OAG eyes in superior temporal (ST), inferior temporal (IT), inferior nasal (IN), and superior nasal (SN) sectors were plotted as a function of the corresponding values of the mfPhNR RADs recorded in the Ring 2 + Ring3 + Ring 4 (R2–R4) ST, IT, IN, and SN sectors. In OAG eyes, the reduction in mfPhNR RADs was significantly correlated to the reduction in GCL-T in all examined rings or sectors. Full article ">

11 pages, 1172 KiB

Open AccessArticle

Reverse Split Hand as a Neurophysiological Hallmark of Spinal Muscular Atrophy

by Veria Vacchiano, Francesca Morabito, Luigi Bonan, Luca Teodorani, Claudia Faini, Giovanni Rizzo and Rocco Liguori

J. Clin. Med. 2024, 13(22), 6881; https://doi.org/10.3390/jcm13226881 - 15 Nov 2024

Abstract

Objective: Motor unit number estimation (MUNE) methods are crucial for estimating lower motor neuron loss in motor neuron diseases. The MScanFit MUNE (MScanFit) is a novel method that estimates MUNE values from compound motor action potential (CMAP) scans, demonstrating high sensitivity and reproducibility [...] Read more.

Objective: Motor unit number estimation (MUNE) methods are crucial for estimating lower motor neuron loss in motor neuron diseases. The MScanFit MUNE (MScanFit) is a novel method that estimates MUNE values from compound motor action potential (CMAP) scans, demonstrating high sensitivity and reproducibility in detecting motor unit loss in amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). In this study, we aimed to characterize the pattern of motor unit loss in the hand intrinsic muscles of SMA patients compared to ALS patients and healthy controls (HC) using MScanFit MUNE. Methods: Patients diagnosed with ALS, adult SMA patients, and HC were prospectively enrolled. MScanFit examinations were performed on the abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles. To focus on the different patterns of motor neuron degeneration in the intrinsic hand muscles, the ratio of CMAP amplitude of APB to ADM (CMAP ratio) and the ratio of MUNE values of APB to those of the ADM muscle (MUNE ratio) were calculated. Results: The study included 46 ALS patients, 16 SMA patients, and 23 HC. MScanFit MUNE revealed distinct patterns of motor unit degeneration in SMA patients, notably more severe in the ADM than in the APB muscle, indicating a “reverse” split-hand phenomenon. Both CMAP and MUNE ratios demonstrated high diagnostic accuracy in distinguishing ALS from SMA, with the MUNE ratio performing better. Conclusions: MScanFit MUNE is a valuable tool for exploring distinct patterns of motor neuron degeneration in patients with different types of motor neuron diseases. Full article

(This article belongs to the Special Issue Clinical Neurophysiology: New Perspective)

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(A): Group comparisons were implemented using the Kruskal–Wallis test. The CMAP ratio was significantly higher in SMA patients than in controls (p = 0.017) and ALS patients (p < 0.001), and it was lower in ALS patients than in controls (p = 0.014). The MUNE ratio was higher in SMA patients than in both ALS patients and controls (p < 0.001), and it was lower in ALS patients than in controls (p = 0.047). (B): General linear models adjusted for age. The CMAP ratio was significantly higher in SMA patients than in ALS patients and healthy controls (p < 0.001), but it was not significantly different between ALS patients and controls (p = 0.199). The MUNE ratio was significantly higher in SMA patients than in ALS patients and controls (p < 0.001), while it was not different between ALS patients and controls (p = 0.89). The LSMUP ratio was significantly lower in SMA patients than in ALS patients (p = 0.014) and showed a trend toward significance compared to controls (p = 0.05) (B). Full article ">Figure 2
ROC curve analysis to determine the AUC and cut-off values for both CMAP and MUNE ratios for distinguishing between ALS and SMA patients. CMAP ratio: AUC = 0.871 (95% CI: 0.779–0.963), sensitivity = 93.8%, specificity = 69.6%, and cut-off = 0.79 (p < 0.001). MUNE ratio: AUC = 0.931 (95% CI: 0.867–0.995), sensitivity = 93.8%, specificity = 71.7%, and cut-off = 0.69 (p < 0.001). Full article ">Figure 3
MUNE values of the APB muscle in a healthy control (A), an ALS patient (B), and a SMA subject (C). MUNE values of the ADM muscle in a healthy control (D), an ALS patient (E), and a SMA subject (F). On the horizontal axis, the stimulus current (mA) is displayed; on the vertical axis, the CMAP amplitude (mV) is displayed. Note the reverse pattern in the SMA patient, with MUNE 63 in the APB vs. MUNE 15 in the ADM muscle. Full article ">

11 pages, 785 KiB

Open AccessReview

Skin and Nail Predictors of Psoriatic Arthritis Development: A Holistic Overview Integrating Epidemiological and Physiopathological Data

by Zeno Fratton, Ivan Giovannini, Alen Zabotti and Enzo Errichetti

J. Clin. Med. 2024, 13(22), 6880; https://doi.org/10.3390/jcm13226880 - 15 Nov 2024

Abstract

Dermatological manifestations are considered to be of significant importance in identifying individuals with psoriasis at a higher risk of developing arthritis, as rheumatological involvement typically follows the onset of skin/nail lesions. This review summarizes the literature evidence about dermatological predictors of psoriatic arthritis [...] Read more.

Dermatological manifestations are considered to be of significant importance in identifying individuals with psoriasis at a higher risk of developing arthritis, as rheumatological involvement typically follows the onset of skin/nail lesions. This review summarizes the literature evidence about dermatological predictors of psoriatic arthritis (PsA) development, also analyzing the underlying physiopathological mechanisms and potential biases. Such an integration between statistical evidence and a mechanism-based approach aims to emphasize the most robust skin/nail risk factors upon which clinicians should focus most in daily clinical practice. Accordingly, psoriasis severity and nail changes due to matrix involvement would result in the most relevant risk factors for PsA occurrence, while other possible predictors (e.g., scalp and inverse psoriasis) do not seem to be supported by a significant pathogenetic link. Full article

(This article belongs to the Special Issue Clinical Management of Psoriatic Arthritis: Future Perspectives)

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Figure 1
A simplified schematic representation of the possible physiopathological pathway underlying the influence of psoriatic nail matrix and extensive skin inflammation on PsA development. Nail dysbiosis (most commonly Candida spp. colonization) induces the production of antimicrobial peptides (LL-37) by the nail bed epithelium, which will bind with DNA/RNA released by nail keratinocytes. LL-37 and DNA/RNA complexes stimulate plasmacytoid dendritic cells (pDCs), with consequent activation of myeloid dendritic cells (mDCs) able to produce interleukin-23, an interleukin regarded as “master regulator” of immunity in the pathogenesis of psoriasis and psoriatic arthritis. IL-23 in turn stimulates Th17 lymphocytes, with subsequent release of downstream effector cytokines (mainly IL-17A, IL-17F, and IL-22 by Th17 lymphocytes and TNF-α by mDCs and stressed keratinocytes) (Panel A). Such cytokines reach the near “synovio-entheseal complex” of distal interphalangeal joint, making it more prone to develop inflammation, especially triggered by trauma (resulting from either direct traumatism or mechanical stress transmitted through the nail) (Panel B). In psoriatic skin lesions, activated myeloid dendritic cells release several cytokines, especially TNF-α and IL-23, that, in turn, favor the differentiation of Th17 cells producing additional downstream effector cytokines (mainly IL-17A, IL-17F, and IL-22) (Panel C). In case of extensive psoriatic involvement, a significant amount of the aforementioned cytokines are released from the skin to the blood stream, thus reaching “synovio-entheseal complex” of distant joints and favoring local inflammation through the activation of resident Th17 cells and gamma-delta T cells, that, in turn, exert their action through the production of cytokines activating effector joint resident cells (such as fibroblast-like synoviocytes, chondrocytes, and osteoclasts, leading to the recruitment of inflammatory cells, stimulation of pro-inflammatory cytokines, and production of matrix metalloproteinases, ultimately resulting in the amplification of inflammation and joint damage) (Panel D). (Created with Biorender.com) IL-, interleukin-; TNF-α, tumor necrosis factor α; mDCs, myeloid dendritic cells; pDCs, plasmacytoid dendritic cells; Th17, T helper 17 lymphocyte; γδ cells, gamma-delta cells; IFN-γ, interferon gamma; OC, osteoclast; CC, chondrocyte; FL-S, fibroblast-like synoviocyte; PsA, psoriatic arthritis. Full article ">

13 pages, 2211 KiB

Open AccessArticle

Perifoveal Exudative Vascular Anomalous Complex (PEVAC): Retinal Vascular Density Findings

by Hamzah Aweidah, Deborah Cosette, Natan Lishinsky-Fischer, Tarek B. Eshak, Tomer Batash, Itay Chowers, Tareq Jaouni, Nadav Levinger and Jaime Levy

J. Clin. Med. 2024, 13(22), 6879; https://doi.org/10.3390/jcm13226879 - 15 Nov 2024

Abstract

Objectives: This study aimed to describe the clinical, optical coherence tomography (OCT) and OCT angiography (OCTA) findings and characteristics in patients with perifoveal exudative vascular anomalous complex (PEVAC) and compare the macular vascular density with the age-matched control group. Methods: We [...] Read more.

Objectives: This study aimed to describe the clinical, optical coherence tomography (OCT) and OCT angiography (OCTA) findings and characteristics in patients with perifoveal exudative vascular anomalous complex (PEVAC) and compare the macular vascular density with the age-matched control group. Methods: We conducted a case–control study to compare demographic information, clinical observations, and OCT/OCTA findings in eyes with PEVAC (n = 5 eyes in 5 patients) and a control group of subjects matched for age (n = 9). The Advanced Retina Imaging (ARI) network algorithms were utilized to evaluate OCTA observations. Statistical analysis was performed by the nonparametric Mann–Whitney U test. Results: Patients with PEVAC had a mean (±SD) age at presentation of 70 ± 12.6 years, the mean follow-up period was 7.8 ± 5.2 months, and unilateral disease was observed. Four out of the five patients in our cohort had a history of systemically treated hypertension and dyslipidemia. Three eyes had lesions in the inner temporal retinal zone, while the remaining two eyes had lesions in the inner inferior or central zone. Retina slab analysis using OCTA showed no significant difference in vascular density parameters between the PEVAC and control groups. Conclusions: Although limited by a small sample size, our study suggests that macular vessel density shows no significant difference between PEVAC cases and control eyes. Full article

(This article belongs to the Section Ophthalmology)

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Pseudocolor (A) and autofluorescence (B) ultra-widefield Optos images showing a perifoveal isolated aneurysmal lesion of P-5 (arrowheads). Full article ">Figure 2
B-scan with slab segmentation (highlighted between the yellow dotted lines) and OCTA imaging PEVAC eye and a control eye. Panel (A) represents the retina slab of the left eye in patient P-2. Panel (B) represents the choroid slab of the left eye in patient P-2. Panel (C) represents the retina slab of the right eye in patient C-3. Panel (D) represents the choroid slab of the right eye in patient C-3. Full article ">Figure 3
Optical coherence tomography angiography (OCTA) imaging of the right eye in patient P-2. (A) Superficial angio en face perfusion map showing the 9 zones (the central zone and the inner and outer nasal, temporal, superior, and inferior zones). (B) A retina slab image of the same eye shown in (A). (C) A skeletonized image of the retina slab shown in (B). Full article ">Figure 4
OCTA of the affected eye in patient P-4, confirming the presence of perifoveal capillary abnormalities (crossing lines) in the superficial capillary plexus (A) and deep capillary plexus (B). (C) B-scan image showing the presence of an isolated, well-defined perifoveal aneurismal lesion (purple line) with small intraretinal cystoid macular edema close to the PEVAC lesion. Full article ">Figure 5
OCTA images of the retina slab in the affected eye of PEVAC patients and one control eye. Panel (A) represents the left eye of patient P-1, panel (B) shows the left eye of patient P-2, panel (C) displays the left eye of patient P-3, panel (D) shows the left eye of patient P-4, panel (E) shows the right eye of patient P-5, and panel (F) shows the right eye of control subject C3. The PECAC lesion(s) are marked with a green asterisk. Full article ">

16 pages, 1736 KiB

Open AccessArticle

Revitalizing Effect on the Scalp After Injection with a Mechanically Stabilized Hyaluronic Acid Complex in Subjects with Androgenetic Alopecia

by Gabriel Siquier-Dameto, Sylvie Boisnic and Enrique Verdú

J. Clin. Med. 2024, 13(22), 6878; https://doi.org/10.3390/jcm13226878 - 15 Nov 2024

Abstract

Background: Treatments for androgenetic alopecia (AGA) include different drugs, but a treatment based on stabilized hyaluronic acid has not been tested. The aim of this study is to clinically evaluate the effect of six sessions of injections using a hyaluronic acid compound supplemented [...] Read more.

Background: Treatments for androgenetic alopecia (AGA) include different drugs, but a treatment based on stabilized hyaluronic acid has not been tested. The aim of this study is to clinically evaluate the effect of six sessions of injections using a hyaluronic acid compound supplemented with vitamins, ions, and amino acids (CH) on hair density and quality in volunteers. Methods: For this purpose, twenty-six healthy volunteers of both sexes with moderate AGA were injected with 3 mL of CH using the micro-papule technique. All received six CH sessions at two-week intervals. Hair loss, hair thickness, and shine were assessed using macro-photographs. A follow-up questionnaire was given to the volunteers at 40 days and at 90 days after the last treatment to determine their level of satisfaction. In addition, a dermatological control was carried out to assess the tolerance of the treatment applied. Results: The results indicate that, after treatment with CH, there is a significant improvement in the thickness, shine, and density of scalp hair, and that the treatment significantly reduces hair loss on the scalp. On a dermatological level, the tolerability of the treatment was excellent with no complications observed. In total, 88.5% of the volunteers indicated that CH treatment improved their appearance. In summary, it can be said that CH treatment reduces hair loss and promotes hair growth. Conclusions: It is suggested that this treatment is effective in reducing the signs and symptoms of alopecia. Full article

(This article belongs to the Section Dermatology)

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Hair quality after treatment with CELLBOOSTER® Hair (CH). This figure presents histograms displaying results for hair thickness (left), hair shine (center), and hair loss (right) at 0, 40, and 90 days of the follow-up. * p < 0.05; ** p < 0.01; *** p < 0.001. Values are mean ± standard deviation (n = 26 subjects). Full article ">Figure 2
Hair quality after treatment with CH using macro-photography and Glossymeter. The histograms display results for hair density (left), hair thickness (center), and hair shine (right) at 0, 40, and 90 days of the follow-up. ** p < 0.01; **** p < 0.0001. Values are mean ± standard deviation (n = 26 subjects). Full article ">Figure 3
Scalp photographs of women and men recruited in the study at 0, 40, and 90 days of the follow-up. All photographs correspond to the same individual for each follow-up day. Full article ">Figure 4
Results of the satisfaction questionnaire at 90 days after the follow-up. Histogram of the percentage of subjects who gave a response of not agree at all (red), not so much agree (orange), rather agree (yellow), or completely agree (green) for each of the questions in the questionnaire. The questionnaire questions are (1) Do you feel that the injection sessions have improved the condition of your hair overall? (2) Do you think your hairs are shinier? (3) Do you think your hair density is increased? (4) Do you think your hair loss is slowed down? (5) Do you think your hairs grow back faster? (6) Do you think your hairs are thicker? (7) I will recommend this product to my friends. Full article ">Figure 5
Result of the degree of satisfaction with the appearance of the subjects based on the GAIS scale. Histogram of the percentage of appearance satisfaction after treatment based on the GAIS scale, ranging from worsening to very much improved. n = 26 subjects. Full article ">

12 pages, 849 KiB

Open AccessReview

The Role of Small-Bowel Endoscopy in the Diagnosis and Management of Small-Bowel Neuroendocrine Tumours

by Elisabet Maristany Bosch, Faidon-Marios Laskaratos, Mikael Sodergren, Omar Faiz and Adam Humphries

J. Clin. Med. 2024, 13(22), 6877; https://doi.org/10.3390/jcm13226877 - 15 Nov 2024

Abstract

Neuroendocrine tumours (NETs) are relatively rare neoplasms but represent one of the most frequent types of primary small-bowel tumours. Their incidence is rising, and this is most likely because of their more frequent early-stage detection, physician awareness, and increasing availability and use of [...] Read more.

Neuroendocrine tumours (NETs) are relatively rare neoplasms but represent one of the most frequent types of primary small-bowel tumours. Their incidence is rising, and this is most likely because of their more frequent early-stage detection, physician awareness, and increasing availability and use of imaging and small-bowel endoscopic techniques, such as video capsule endoscopy and device-assisted enteroscopy, which enable the detection, localisation, and histological sampling of previously inaccessible and underdiagnosed small-bowel lesions. This review summarises the role of small-bowel endoscopy in the diagnosis and management of small-bowel NETs to assist clinicians in their practice. Small-bowel endoscopy may play a complementary role in the diagnosis of these tumours alongside other diagnostic tests, such as biomarkers, conventional radiology, and functional imaging. In addition, small-bowel enteroscopy may play a role in the preoperative setting for the identification and marking of these tumours for surgical resection and the management of rare complications, such as small-bowel variceal bleeding, in cases of portal hypertension due to the encasement of mesenteric vessels in fibrotic small-bowel NETs. Full article

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

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16 pages, 1022 KiB

Open AccessReview

Transcatheter Tricuspid Regurgitation Repair—An Overview of Techniques and Eligible Patient Selection

by Edme Roxana Mustafa, Daniela Marinescu, Cristina Florescu, Ionuț Donoiu and Octavian Istrătoaie

J. Clin. Med. 2024, 13(22), 6876; https://doi.org/10.3390/jcm13226876 - 15 Nov 2024

Abstract

Tricuspid regurgitation (TR) is frequently encountered in clinical practice. It is classified into primary TR (organic), which accounts for a minority of cases; and into secondary TR (functional), which has a higher prevalence. Although it can be asymptomatic for a long time, TR [...] Read more.

Tricuspid regurgitation (TR) is frequently encountered in clinical practice. It is classified into primary TR (organic), which accounts for a minority of cases; and into secondary TR (functional), which has a higher prevalence. Although it can be asymptomatic for a long time, TR causes right ventricle dysfunction and increases hospitalizations for heart failure and mortality. In most patients with severe, isolated TR, surgery is not indicated due to the high surgical risk. In the last 10 years, transcatheter tricuspid valve repair became feasible with the following good results: reduction in TR severity, reverse remodeling of the right heart chambers, improvement in symptoms and reduction in hospitalization time. This paper presents the main transcatheter techniques and data from relevant trials that used these techniques, focusing on patient characteristics that define eligibility and high probability of repair. Information is provided regarding the observed benefits and the complications. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 1009 KiB

Open AccessArticle

Clinical Spectrum of Monoclonal Protein and the Factors Associated with Lymphoplasmacytic Malignancies

by Ye Hyun Kim, Yong Jun Choi, Jooheon Park, Myung Geun Shin and Eun-Hee Nah

J. Clin. Med. 2024, 13(22), 6875; https://doi.org/10.3390/jcm13226875 - 15 Nov 2024

Abstract

Background: Monoclonal protein (MP) presents in various monoclonal gammopathies, ranging from benign conditions such as monoclonal gammopathy of undetermined significance (MGUS) to life-threatening conditions such as lymphoplasmacytic malignancies (LPMs), which include multiple myeloma (MM) and Waldenström macroglobulinemia (WM). Few studies have comprehensively assessed [...] Read more.

Background: Monoclonal protein (MP) presents in various monoclonal gammopathies, ranging from benign conditions such as monoclonal gammopathy of undetermined significance (MGUS) to life-threatening conditions such as lymphoplasmacytic malignancies (LPMs), which include multiple myeloma (MM) and Waldenström macroglobulinemia (WM). Few studies have comprehensively assessed the clinical spectrum of MP and its factors associated with LPMs. This study aimed to determine the clinical spectrum of MP and identify factors associated with LPMs. Methods: This retrospective study included patients who were first tested for capillary electrophoresis (CEP) and identified as having MP between 2014 and 2023 at two university hospitals. Univariate (crude) and multivariate (adjusted) logistic regression analyses were performed to identify factors associated with LPMs. Results: Among the 1135 included patients with MP, 744 (65.6%) were diagnosed with LPMs and 391 (34.4%) with MGUS. Among the 391 patients with MGUS, 310 (79.3%) had at least 1 clinical association, including 204 with renal diseases, 35 with autoimmune diseases, 33 with chronic liver diseases, 22 with hematologic diseases, and 96 with other conditions. Multivariate analyses indicated that LPMs were associated with female sex (OR = 2.08), lower age (OR = 0.95), higher MP level (OR = 3.53), an abnormal FLC ratio (OR = 6.15), lower hemoglobin level (OR = 0.82), and higher total calcium level (OR = 1.81) (all p < 0.05). Conclusions: This study provides insight into the distribution of MPs and their clinical association with MGUS and identifies factors related to LPM. These can help clinicians manage patients more effectively in the early stages of these conditions. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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18 pages, 956 KiB

Open AccessReview

The Role of Vitamin D3 Deficiency and Colonization of the Oral Mucosa by Candida Yeast-like Fungi in the Pathomechanism of Psoriasis

by Mariola Marchlewicz, Paulina Sagan, Marta Grabowska, Magdalena Kiedrowicz, Joanna Kruk, Kamil Gill, Małgorzata Piasecka and Ewa Duchnik

J. Clin. Med. 2024, 13(22), 6874; https://doi.org/10.3390/jcm13226874 - 15 Nov 2024

Abstract

Psoriasis is a chronic inflammatory skin disease with complex pathogenesis and variable severity. Performed studies have indicated the impact of vitamin D3 deficiency on the pathogenesis of psoriasis and its severity. However, there is no clear evidence of the influence of the mucosal [...] Read more.

Psoriasis is a chronic inflammatory skin disease with complex pathogenesis and variable severity. Performed studies have indicated the impact of vitamin D3 deficiency on the pathogenesis of psoriasis and its severity. However, there is no clear evidence of the influence of the mucosal microbiome on the onset and progression of psoriasis. This review aims to present the current evidence on the role of vitamin D3 and colonization of the oral mucosa by Candida yeast-like fungi in the pathogenesis of psoriasis. Candida albicans is a common yeast that can colonize the skin and mucosal surfaces, particularly in individuals with weakened immune systems or compromised skin barriers. In psoriasis, the skin’s barrier function is disrupted, potentially making patients more susceptible to fungal infections such as Candida. Since patients with psoriasis are at increased risk of metabolic syndrome, they may experience the vicious circle effect in which chronic inflammation leads to obesity. Vitamin D3 deficiency is also associated with microbiological imbalance, which may promote excessive growth of Candida fungi. Under normal conditions, the intestinal and oral microflora support the immune system. Vitamin D3 deficiency, however, leads to disruption of this balance, which allows Candida to overgrow and develop infections. Full article

(This article belongs to the Special Issue Modern Approaches to Psoriasis: Current Treatments and Future Possibilities)

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Pathogenesis of psoriasis; part I. Created with BioRender.com. When keratinocytes are exposed to trauma, they release various inflammatory mediators such as interleukin-1 (IL-1), IL-6, tumor necrosis factor α (TNFα), chemokines, and antimicrobial peptides (CAMPs), including cathelicidin (LL-37), β-defensin, and S100 proteins. In pathological conditions such as psoriasis, LL-37 or cathelicidin can bind to host DNA. This binding activates the toll-like receptor 9 (TLR-9) on dendritic cells, which then stimulates an immune response. Interferons IFNα and IFNβ secreted by keratinocytes play a role in the maturation of dendritic cells in the bone marrow and are responsible for the differentiation and proliferation of Th1 and Th17 cells, which secrete cytokines such as IL-17, IL-21, and IL-22. Full article ">Figure 2
Pathogenesis of psoriasis; part II. Created with BioRender.com. When keratinocytes are exposed to trauma, they release various inflammatory mediators such as interleukin-1 (IL-1), IL-6, tumor necrosis factor α (TNFα), chemokines, and antimicrobial peptides (CAMPs), including cathelicidin (LL-37), β-defensin, and S100 proteins. In pathological conditions such as psoriasis, LL-37 can bind to host RNA. This binding activates the toll-like receptor 8 (TLR-8) on dendritic cells, which then stimulates migration of dendritic cells to lymph nodes and the secretion of TNFα, IL-12, and IL-23. This results in the differentiation and proliferation of Th1 and Th17 cells, which secrete cytokines such as IL-17, IL-21, and IL-22. Full article ">Figure 3
Vitamin D metabolism. Created with BioRender.com. Vitamin D3 is produced from 7-dehydrocholesterol in the epidermis under UVB exposure, converting into cholecalciferol. Both vitamin D2 and D3 bind to DBP and are transported to the liver, where they convert to 25-hydroxyvitamin D (25(OH)D3 or calcidiol) via CYP2R1. This inactive form is then transported to the kidney’s proximal tubule, where it is hydroxylated by CYP24A1 at position 1 to form calcitriol [1,25(OH)2D3] or by CYP27B1 at position 24 to form 24,25(OH)2D3. Full article ">

20 pages, 935 KiB

Open AccessReview

Upper Limb Therapy for Infants and Young Children with Unilateral Cerebral Palsy: A Clinical Framework

by Susan Greaves and Brian Hoare

J. Clin. Med. 2024, 13(22), 6873; https://doi.org/10.3390/jcm13226873 - 15 Nov 2024

Abstract

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy [...] Read more.

Early detection and rehabilitation interventions are essential to optimise motor function in infants and young children with unilateral cerebral palsy. In this paper we report a clinical framework aimed at enhancing upper limb therapy for infants and young children with unilateral cerebral palsy during a sensitive period of brain development. We describe two major therapeutic approaches based on motor learning principles and evidence: constraint-induced movement therapy and bimanual therapy. These two therapies have demonstrated efficacy in older children and emerging evidence is available for their application to infants younger than 2 years of age. To provide clinicians with guidance as to when to implement these therapies, we discuss the key consideration when undertaking upper limb therapy programs. In addition, we describe the factors to consider when choosing which approach may be suitable for an individual child and family. Detailed strategies for implementing these therapies in infants and young children of different ability levels are given. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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17 pages, 2400 KiB

Open AccessArticle

Maximizing Survival in Pediatric Congenital Cardiac Surgery Using Machine Learning, Explainability, and Simulation Techniques

by David Mauricio, Jorge Cárdenas-Grandez, Giuliana Vanessa Uribe Godoy, Mirko Jerber Rodríguez Mallma, Nelson Maculan and Pedro Mascaro

J. Clin. Med. 2024, 13(22), 6872; https://doi.org/10.3390/jcm13226872 - 15 Nov 2024

Abstract

Background: Pediatric and congenital heart surgery (PCHS) is highly risky. Complications associated with this surgical procedure are mainly caused by the severity of the disease or the unnecessary, late, or premature execution of the procedure, which can be fatal. In this context, prognostic [...] Read more.

Background: Pediatric and congenital heart surgery (PCHS) is highly risky. Complications associated with this surgical procedure are mainly caused by the severity of the disease or the unnecessary, late, or premature execution of the procedure, which can be fatal. In this context, prognostic models are crucial to reduce the uncertainty of the decision to perform surgery; however, these models alone are insufficient to maximize the probability of success or to reverse a future scenario of patient death. Method: A new approach is proposed to reverse the prognosis of death in PCHS through the use of (1) machine learning (ML) models to predict the outcome of surgery; (2) an explainability technique (ET) to determine the impact of main risk factors; and (3) a simulation method to design health scenarios that potentially reverse a negative prognosis. Results: Accuracy levels of 96% in the prediction of mortality and survival were achieved using a dataset of 565 patients undergoing PCHS and assessing 10 risk factors. Three case studies confirmed that the ET known as LIME provides explanations that are consistent with the observed results, and the simulation of one real case managed to reverse the initial prognosis of death to one of survival. Conclusions: An innovative method that integrates ML models, ETs, and Simulation has been developed to reverse the prognosis of death in patients undergoing PCHS. The experimental results validate the relevance of this approach in medical decision-making, demonstrating its ability to reverse negative prognoses and provide a solid basis for more informed and personalized medical decisions. Full article

(This article belongs to the Special Issue Pediatric Surgery—Current Hurdles and Future Perspectives)

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