Journal of Clinical Medicine (2024)

All articles published by MDPI are made immediately available worldwide under an open access license. No specialpermission is required to reuse all or part of the article published by MDPI, including figures and tables. Forarticles published under an open access Creative Common CC BY license, any part of the article may be reused withoutpermission provided that the original article is clearly cited. For more information, please refer tohttps://www.mdpi.com/openaccess.

Original Submission Date Received: .

5.4

3.9

Journals

JCM

Digital Therapeutics for Improving Effectiveness of Pharmaceutical Drugs and Biological Products: Preclinical and Clinical Studies Supporting Development of Drug + Digital Combination Therapies for Chronic Diseases
Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care
Lifestyle and Lipoprotein(a) Levels: Does a Specific Counseling Make Sense?
From Clinical Suspicion to Diagnosis: A Review of Diagnostic Approaches and Challenges in Fungal Keratitis
Prostate Cancer Liver Metastasis: An Ominous Metastatic Site in Need of Distinct Management Strategies

Journal Description

Journal of Clinical Medicineis an international,peer-reviewed, open access journal of clinical medicine, published semimonthly online by MDPI. TheInternational Bone Research Association (IBRA), Italian Resuscitation Council (IRC), Spanish Society of Hematology and Hemotherapy (SEHH),Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) andothers are all affiliated with JCM, and their members receive a discount on article processing charges.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility:indexed within Scopus,SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
Journal Rank:JCR- Q2(Medicine, General & Internal)/CiteScore- Q1 (GeneralMedicine)
Rapid Publication: manuscripts are peer-reviewed and a firstdecision is provided to authors approximately 17.9 days after submission; acceptanceto publication is undertaken in 2.6 days (median values for papers published inthis journal in the second half of 2023).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Companion journals forJCM include: Epidemiologia, Transplantology, Uro,Sinusitis, Rheumato, , Journal of Vascular Diseases, Osteology,Complications,Therapeutics,and Sclerosis.

Impact Factor:3.9 (2022);5-Year Impact Factor:4.1 (2022)

subjectImprint Informationget_appJournal Flyer Open Access ISSN: 2077-0383

Latest Articles

10 pages, 1048 KiB

Open AccessReview

Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm

byLawrence Y. Lu, Jacques G. Eastment and Yogeesan Sivakumaran

J. Clin. Med. 2024, 13(9), 2598; https://doi.org/10.3390/jcm13092598 (registeringDOI) - 28 Apr 2024

Abstract

Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. Due to the anatomical proximity to the foregut, MALS has significant implications in hepato-pancreato-biliary (HPB) surgery. It can pose complications in pancreatoduodenectomy and orthotopic liver transplantation, where the collateral arterial supply from the superior mesenteric artery is often disrupted. The estimated prevalence of MALS in HPB surgery is approximately 10%. Overall, there is consensus for a cautious approach to MALS when embarking on complex foregut surgery, with a low threshold for intraoperative median arcuate ligament release or hepatic artery reconstruction. The role of endovascular intervention in the management of MALS prior to HPB surgery continues to evolve, but more evidence is required to establish its efficacy. Recognizing the existing literature gap concerning optimal management in this population, we describe our tertiary center experience as a clinical algorithm to facilitate decision-making. Research question: What is the significance and management of median arcuate ligament syndrome in patients undergoing hepato-pancreato-biliary surgery?Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Surgery: Management and Future Opportunities)

►Show Figures

Figure 1

14 pages, 3004 KiB

Open AccessReview

Stress and Heart in Remodeling Process: Multiple Stressors at the Same Time Kill

byFatih Yalçin, Maria Roselle Abraham and Mario J. Garcia

J. Clin. Med. 2024, 13(9), 2597; https://doi.org/10.3390/jcm13092597 (registeringDOI) - 28 Apr 2024

Abstract

Myocardial remodeling is developed by increased stress in acute or chronic pathophysiologies. Stressed heart morphology (SHM) is a new description representing basal septal hypertrophy (BSH) caused by emotional stress and chronic stress due to increased afterload in hypertension. Acute stress cardiomyopathy (ASC) and hypertension could be together in clinical practice. Therefore, there are some geometric and functional aspects regarding this specific location, septal base under acute and chronic stress stimuli. The findings by our and the other research groups support that hypertension-mediated myocardial involvement could be pre-existed in ASC cases. Beyond a frequently seen predominant base, hyperkinetic tissue response is detected in both hypertension and ASC. Furthermore, hypertension is the responsible factor in recurrent ASC. The most supportive prospective finding is BSH in which a hypercontractile base takes a longer time to exist morphologically than an acutely developed syndrome under both physiologic exercise and pressure overload by transaortic binding in small animals using microimaging. However, cardiac decompensation with apical ballooning could mask the possible underlying hypertensive disease. In fact, enough time for the assessment of previous hypertension history or segmental analysis could not be provided in an emergency unit, since ASC is accepted as an acute coronary syndrome during an acute episode. Additional supportive findings for SHM are increased stress scores in hypertensive BSH and the existence of similar tissue aspects in excessive sympathetic overdrive like pheochromocytoma which could result in both hypertensive disease and ASC. Exercise hypertension as the typical form of blood pressure variability is the sum of physiologic exercise and pathologic increased blood pressure and results in increased mortality. Hypertension is not rare in patients with a high stress score and leads to repetitive attacks in ASC supporting the important role of an emotional component as well as the potential danger due to multiple stressors at the same time. In the current review, the impact of multiple stressors on segmental or global myocardial remodeling and the hazardous potential of multiple stressors at the same time are discussed. As a result, incidentally determined segmental remodeling could be recalled in patients with multiple stressors and contribute to the early and combined management of both hypertension and chronic stress in the prevention of global remodeling and heart failure.Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

►Show Figures

Figure 1

---

Figure 2

---

Figure 3

---

Figure 4

---

Scheme 1

12 pages, 8187 KiB

Open AccessArticle

Reliability of Ultrasonographic Assessment of Depth of Invasion and Tumor Thickness in Intraoral Mucosa Lesions: A Preliminary Experience

byAnna Russo, Vittorio Patanè, Luigia Fusco, Lorenzo fa*ggioni, Ciro Emiliano Boschetti, Mario Santagata, Emanuele Neri, Salvatore Cappabianca and Alfonso Reginelli

J. Clin. Med. 2024, 13(9), 2595; https://doi.org/10.3390/jcm13092595 (registeringDOI) - 28 Apr 2024

Abstract

Introduction: Despite the progress made in multidisciplinary care, there has been little improvement in the oncologic outcomes of oral cavity squamous cell carcinomas (OSCCs). In the latest edition of the TNM staging, “depth of invasion” (DOI) has recently been introduced as one of the criteria for determining the T stage, alongside other factors. DOI is widely recognized as an independent risk factor for nodal metastases and is a crucial consideration in the preoperative staging of OSCCs, along with measurements of tumor thickness (TT). While various diagnostic methods exist for assessing DOI, intraoral ultrasonography (IOUS) has gained popularity for its efficacy in evaluating OSCCs. Methods: This study sought to evaluate the diagnostic accuracy and reliability of ultrahigh-frequency ultrasound (UHFUS) in assessing oral cavity lesions compared to histopathological analysis. Results: The results revealed strong reliability in ultrasonographic measurements (ICC TT: 0.94; ICC DOI: 0.97) and distinct ultrasonographic features specific to different oral pathologies. This highlights the potential of UHFUS as a non-invasive imaging tool for precise diagnostic evaluations. Conclusions: Despite limitations such as a small sample size and focus on specific lesions, these promising results suggest that UHFUS could significantly enhance oral lesion diagnostics. Further research involving larger cohorts is necessary to validate and build upon these initial findings.Full article

(This article belongs to the Special Issue State of the Art: Application of Ultrasound Imaging in Tumor Diagnosis)

►Show Figures

Graphical abstract

---

Figure 2

---

Figure 3

---

Figure 4

---

Figure 5

attachment

10 pages, 494 KiB

Open AccessArticle

C3 Hypocomplementemia Predicts the Progression of CKD towards End-Stage Kidney Disease in IgA Nephropathy, Irrespective of Histological Evidence of Thrombotic Microangiopathy

byGiovanni Maria Rossi, Federico Ricco, Isabella Pisani, Marco Delsante, Umberto Maggiore, Enrico Fiaccadori and Lucio Manenti

J. Clin. Med. 2024, 13(9), 2594; https://doi.org/10.3390/jcm13092594 (registeringDOI) - 28 Apr 2024

Abstract

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide. IgAN causes end-stage kidney disease (ESKD) in 30–40% of all cases. The activation of the complement system by pathological circulating IgAs, which is often associated with low serum C3 levels (LowC3), seems to play a crucial role. Previous studies have shown an association between histological evidence of TMA, which is the result of alternative complement activation, and poor outcomes. However, it is not known to what extent the decrease in serum C3 levels reflects ongoing TMA injury. Our study aimed at assessing the association between LowC3 and ESKD and whether this association reflects ongoing TMA. Methods: We enrolled all patients with biopsy-proven IgAN and followed-up patients until their last visit, ESKD, or death. Results: Of the 56 patients included in the study, 12 (21%) presented low serum C3 (LowC3) at the time of renal biopsy. TMA was significantly more frequent in the LowC3 group [7/12 (58%) vs. 9/44 (20%), p = 0.02]. After adjusting for potential confounders, LowC3 was strongly associated with an increased hazard of ESKD (hazard ratio [HR]: 5.84 [95%CI: 1.69, 20.15; p = 0.005). The association was not affected by adjusting for TMA. The estimated overall proportion of the relation between C3 and ESKD mediated by TMA was low and not statistically significant. Conclusions: Our study provides evidence that C3 hypocomplementemia is associated with an increased risk of ESKD through mechanisms that are largely independent from TMA.Full article

(This article belongs to the Special Issue Glomerular Diseases: Advances in Diagnosis and Management)

►Show Figures

Figure 1

11 pages, 2088 KiB

Open AccessReview

The Ascyrus Medical Dissection Stent: A One-Fits-All Strategy for the Treatment of Acute Type A Aortic Dissection?

byLeonard Pitts, Michael C. Moon, Maximilian Luehr, Markus Kofler, Matteo Montagner, Simon Sündermann, Semih Buz, Christoph Starck, Volkmar Falk and Jörg Kempfert

J. Clin. Med. 2024, 13(9), 2593; https://doi.org/10.3390/jcm13092593 (registeringDOI) - 28 Apr 2024

Abstract

The treatment of DeBakey type I aortic dissection remains a major challenge in the field of aortic surgery. To upgrade the standard of care hemiarch replacement, a novel device called an “Ascyrus Medical Dissection Stent” (AMDS) is now available. This hybrid device composed of a proximal polytetrafluoroethylene cuff and a distal non-covered nitinol stent is inserted into the aortic arch and the descending thoracic aorta during hypothermic circulatory arrest in addition to hemiarch replacement. Due to its specific design, it may result in a reduced risk for distal anastomotic new entries, the effective restoration of branch vessel malperfusion and positive aortic remodeling. In this narrative review, we provide an overview about the indications and the technical use of the AMDS. Additionally, we summarize the current available literature and discuss potential pitfalls in the application of the AMDS regarding device failure and aortic re-intervention.Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

►Show Figures

Figure 1

---

Figure 3

---

Figure 4

21 pages, 826 KiB

Open AccessReview

Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts

byAndrea Tedeschi, Matteo Palazzini, Giancarlo Trimarchi, Nicolina Conti, Francesco Di Spigno, Piero Gentile, Luciana D’Angelo, Andrea Garascia, Enrico Ammirati, Nuccia Morici and Daniela Aschieri

J. Clin. Med. 2024, 13(9), 2592; https://doi.org/10.3390/jcm13092592 (registeringDOI) - 28 Apr 2024

Abstract

Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients’ deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence.Full article

(This article belongs to the Section Cardiovascular Medicine)

►Show Figures

Figure 1

attachment

12 pages, 1988 KiB

Open AccessFeature PaperArticle

The Clinical Efficacy of Different Relaxation Exercises on Intraocular Pressure Reduction: A Meta-Analysis

byBing-Qi Wu, Hou-Ting Kuo, Alan Y. Hsu, Chun-Ju Lin, Chun-Ting Lai and Yi-Yu Tsai

J. Clin. Med. 2024, 13(9), 2591; https://doi.org/10.3390/jcm13092591 (registeringDOI) - 28 Apr 2024

Abstract

Objective: The aim of this study was to synthesize the available evidence on the clinical efficacy of different relaxation exercises on intraocular pressure (IOP) reduction. Methods: A systemic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was undertaken from the earliest record to 10 April 2024. Peer-reviewed studies that reported on healthy individuals and glaucoma patients engaging in relaxation exercises for at least three weeks were included. The primary outcome was changes in IOP levels from baseline, before the commencement of relaxation exercises, to post-exercise. Our statistical analysis employed a random-effects model, with effect sizes reported using Hedges’ g. Results: Twelve studies were included, totaling 764 eyes (mean participant age ranging from 21.07 to 69.50 years). Relaxation exercises significantly reduced IOP, with Hedges’ g being −1.276 (95% CI: −1.674 to −0.879) and I² = 84.4%. Separate subgroup analyses showed that breathing exercises (Hedges’ g = −0.860, p < 0.0001), mindfulness-based stress reduction (MBSR) (Hedges’ g = −1.79, p < 0.0001), and ocular exercises (Hedges’ g = −0.974, p < 0.0001) were associated with reduced IOP levels. The reduction in IOP following the relaxation exercises was found to be associated with baseline IOP either greater than (Hedges’ g = −1.473, p < 0.0001) or less than 21 mmHg (Hedges’ g = −1.22, p < 0.0001). Furthermore, this effect persisted with follow-up durations of less than (Hedges’ g = −1.161, p < 0.0001) and more than one month (Hedges’ g = −1.324, p < 0.0001). Conclusions: The current meta-analysis indicates that relaxation exercises can significantly reduce IOP levels. Relaxation exercises are a potential class of novel treatments for glaucoma patients that deserve further evaluation.Full article

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

►Show Figures

Figure 1

---

Figure 3

---

Figure 4

8 pages, 469 KiB

Open AccessArticle

The Efficacy of Platelet-Rich Plasma Injection Therapy in Obese versus Non-Obese Patients with Knee Osteoarthritis: A Comparative Study

byJuho Aleksi Annaniemi, Jüri Pere and Salvatore Giordano

J. Clin. Med. 2024, 13(9), 2590; https://doi.org/10.3390/jcm13092590 (registeringDOI) - 28 Apr 2024

Abstract

Background/Objectives: Obesity is a common comorbidity in knee osteoarthritis (KOA) patients. Platelet-Rich Plasma (PRP) injection therapy may mitigate KOA. To further clarify potential patient selection for PRP injection therapy, we compared the outcomes in patients with different body mass index (BMI). Methods: A total of 91 patients with mild to moderate KOA were treated with three intra-articular PRP injections at 10 to 14-day intervals. Range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analogue Scale (VAS) were documented before and after the injections at 15 days, 6 months, 12 months, and at the last follow-up. Outcomes were compared between patients with a BMI over 30 kg/m² (obese, n = 34) and under 30 kg/m² (non-obese, n = 57). Results: Significant difference during the follow-up was detected in WOMAC score at the last follow-up favouring BMI under 30 group [17.8 ± 18.8 versus 10.5 ± 11.7, p = 0.023]. The odds ratio (OR) in BMI over 30 kg/m² group for total knee arthroplasty was 3.5 (95% CI 0.3–40.1, p = 0.553), and OR for any arthroplasty was 7.5 (95% CI 0.8–69.8, p = 0.085) compared to non-obese patients. Conclusions: Obese patients benefitted from PRP injections in KOA but there is a minimal difference favouring non-obese patients in symptom alleviation in follow-up stages after 12 months. The risk of arthroplasty is higher for obese KOA patients.Full article

(This article belongs to the Section Orthopedics)

►Show Figures

Figure 1

14 pages, 3472 KiB

Open AccessArticle

Endurant Stent Graft for Treatment of Abdominal Aortic Aneurysm Inside and Outside of the Instructions for Use for the Proximal Neck: A 14-Year, Single-Center Experience

byGiulio Accarino, Francesco De Vuono, Giancarlo Accarino, Giovanni Fornino, Aniello Enrico Puca, Rodolfo Fimiani, Valentina Parrella, Giovanni Savarese, Sergio Furgiuele, Carmine Vecchione, Gennaro Galasso and Umberto Marcello Bracale

J. Clin. Med. 2024, 13(9), 2589; https://doi.org/10.3390/jcm13092589 (registeringDOI) - 28 Apr 2024

Abstract

Aim: To assess the medium and long-term performance of the Endurant stent graft in a cohort of consecutive patients treated with this device for an abdominal aortic aneurysm (AAA) both inside and outside of the instructions for use (IFU) and to find factors influencing the outcomes. Methods: Our observational, retrospective, single-center study included all patients who consecutively underwent endovascular aneurysm repair with the Endurant stent graft from February 2009 to January 2023. Patients with an AAA to treat according to current guidelines were included. Patients were divided into two groups: Group 1 inside of the IFUs and Group 2 outside of the IFUs for the proximal aortic neck. Patients were followed up after the procedure with computed angiography tomography, ultrasound examination, and interviews. Aneurysm-related mortality, procedure-related reinterventions, and type IA and III endoleaks were considered primary endpoints. Secondary endpoints included aneurysmal sac variations and graft thrombosis. Results: A total of 795 patients were included, 650 in Group 1 and 145 in Group 2; 732 were males, and the mean age was 74 ± 8. Anamnestic baseline did not differ between the two groups. Neck length, width, and angulation were different between the two groups (all p < 0.001). A total of 40 patients had a ruptured AAA, while 56 were symptomatic. At a mean follow-up of 43 ± 39 months, aneurysm-related mortality was less than 1%, and 82 endoleak (10.5%) were observed. Overall endoleak rate and type 1A endoleak, as well as procedure-related reintervention, were significantly more frequent in Group 2. Sac regression of at least 5 mm was observed in 65.9% of cases. AAAs larger than 60.5 mm carried a higher risk of endoleak (HR: 1.025; 95% CI: 1.013–1.37; p < 0.001) and proximal necks shorter than 13.5 mm carried a higher type 1A risk (HR: 0.890; 95% CI: 0.836–0.948; p < 0.001). Patients without chronic obstructive pulmonary disease and taking lipid-lowering drugs had an overall more consistent sac-shrinking rate. Conclusions: The Endurant stent graft proves safe and reliable. Out-of-IFU treatment has poorer medium and long-term outcomes. Some conditions influence medium and long-term reintervention risk and sac behavior. Patients with bigger aneurysms, proximal necks shorter than 13.5 mm, and chronic obstructive pulmonary disease should be more carefully evaluated during follow-up. Consistent follow-up is in keeping low aneurysm-related mortality. Personalized risk profiles and peri and postoperative management strategies are needed.Full article

(This article belongs to the Special Issue Endovascular Management of Diseases of the Aorta: From the Aortic Valve to the Iliac Arteries)

►Show Figures