Exploration of Medicine

Open Access

Review

Angiotensin peptides in the regulation of adrenal cortical function

The adrenal cortex plays a key role in the regulation of metabolism, salt and water homeostasis and sex differentiation by synthesizing glucocorticoid, mineralocorticoid and androgen hormones. Evidence exists that angiotensin II r [...] Read more.

Gian Paolo Rossi ... Teresa Maria Seccia

Published: June 30, 2021 Explor Med. 2021;2:294–304
DOI: https://doi.org/10.37349/emed.2021.00047
This article belongs to the special issue Angiotensins—A Century of Progress

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Commentary

An engineered mayhem: YAP/TAZ mechanosignaling and hepatocarcinogenesis in NAFLD

Gyorgy Baffy

Published: August 31, 2021 Explor Med. 2021;2:305–310
DOI: https://doi.org/10.37349/emed.2021.00048
This article belongs to the special issue Exploring Chronic Liver Disease

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Review

Sex hormones abnormalities in non-alcoholic fatty liver disease: pathophysiological and clinical implications

Obesity and metabolic syndrome are conditions at high risk for the development of complications such as type 2 diabetes mellitus, atherosclerotic cardiovascular disease, and non-alcoholic fatty liver disease (NAFLD). The growing p [...] Read more.

Angelo Di Vincenzo ... Marco Rossato

Published: August 31, 2021 Explor Med. 2021;2:311–323
DOI: https://doi.org/10.37349/emed.2021.00049
This article belongs to the special issue Exploring NAFLD/NASH

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Case Report

Central pontine myelinolysis secondary to glycemic variability in type 1 diabetes: a case report and a systematic review of the literature

Central pontine myelinolysis (CPM) is a rare manifestation of osmotic demyelination syndrome (ODS) which involves the pons and causes significant morbidity and mortality. CPM usually occurs in the setting of rapid correction of se [...] Read more.

Stefania Di Agostino ... Mauro Maurantonio

Published: August 31, 2021 Explor Med. 2021;2:324–332
DOI: https://doi.org/10.37349/emed.2021.00050

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Review

Pediatric vs. adult NAFLD to MAFLD transition: a welcome but tangled path

The term non-alcoholic fatty liver disease (NAFLD) appears unfitting both in adults and in children. As obesity and metabolic syndrome play a relevant pathogenic role, an international group of adults’ liver disease experts has [...] Read more.

Angelo Colucci ... Claudia Mandato

Published: August 31, 2021 Explor Med. 2021;2:333–342
DOI: https://doi.org/10.37349/emed.2021.00051
This article belongs to the special issue Exploring NAFLD/NASH

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Open Access

Case Report

Submucosal esophageal hematomas in a critically ill patient on anticoagulation

Submucosal esophageal hematoma is an uncommon clinical complication of anticoagulation. Current literature is scarce regarding presentation and management in acute submucosal hematomas in critically ill patients. Patients often pr [...] Read more.

Hassam Ali, Maliha Naseer

Published: August 31, 2021 Explor Med. 2021;2:343–347
DOI: https://doi.org/10.37349/emed.2021.00052

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Review

Role of angiotensin II in the development of subcellular remodeling in heart failure

The development of heart failure under various pathological conditions such as myocardial infarction (MI), hypertension and diabetes are accompanied by adverse cardiac remodeling and cardiac dysfunction. Since heart function is ma [...] Read more.

Sukhwinder K. Bhullar ... Naranjan S. Dhalla

Published: August 31, 2021 Explor Med. 2021;2:352–371
DOI: https://doi.org/10.37349/emed.2021.00054
This article belongs to the special issue Angiotensins—A Century of Progress

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Times Cited: 16

Open Access

Original Article

High prevalence of false positive SARS-CoV2 serology in a cohort of patients with liver autoimmune diseases

Aim: Monitoring the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) immunization in patients with autoimmune diseases is of particular concern to understand their response to the infection and to the v [...] Read more.

Aim: Monitoring the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) immunization in patients with autoimmune diseases is of particular concern to understand their response to the infection and to the vaccine. In fact, the immunological disorder and the immunosuppressive therapies could affect the serological response. SARS-CoV2 serological tests potentially provide this information, although they were rapidly commercialized with internal verifications. Here, we analysed the seroprevalence to SARS-CoV2 in a cohort of patients with liver autoimmune diseases. Methods: From May to December 2020, a cohort of patients affected by primary biliary cholangitis (PBC), autoimmune hepatitis (AIH) and PBC/AIH overlap syndrome were screened with reverse transcription-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs, rapid antigenic test and chemiluminescent serological test during routine follow-up. Results: The analysis of 42 patients was carried out: 18 (42.85%) PBC, 12 (28.57%) AIH and 12 (28.57%) PBC/AIH overlap syndromes. Only 2 patients (4.76%) resulted positive to the RNA, antigen and antibody detection tests, hence affected by SARS-CoV2 infection. 14 subjects out of 40 negative cases presented a positive serology for SARS-CoV2 antibodies, hence with a false positivity in the 35% of cases without infection. Notably, among these, 6 (42.86%) patients presented only immunoglobulin (Ig)M positivity, 6 (42.86%) patients presented positivity for only IgG and 2 (14.28%) patients were positive to both IgM and IgG. Notably, the presence of autoantibodies did not correlate with the serological false positivity, highlighting that there is no cross-reactivity with autoantibodies. Moreover, the presence of polyclonal hypergammaglobulinemia did not interfere with the serological test as its prevalence is not different between negative and false positive cases. Interestingly, the patients with false positive serology showed higher levels of gamma-glutamyltransferase (GGT) and C-reactive protein (CRP). Conclusions: Patients with liver autoimmune diseases present a high rate of false positive SARS-CoV2 serology. Therefore, new strategies are needed to study the serological response in this patient category.

Maria Giulia Cornacchia ... Gaetano Serviddio

Published: August 31, 2021 Explor Med. 2021;2:372–377
DOI: https://doi.org/10.37349/emed.2021.00055
This article belongs to the special issue Exploring Chronic Liver Disease

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Aim: Monitoring the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) immunization in patients with autoimmune diseases is of particular concern to understand their response to the infection and to the vaccine. In fact, the immunological disorder and the immunosuppressive therapies could affect the serological response. SARS-CoV2 serological tests potentially provide this information, although they were rapidly commercialized with internal verifications. Here, we analysed the seroprevalence to SARS-CoV2 in a cohort of patients with liver autoimmune diseases. Methods: From May to December 2020, a cohort of patients affected by primary biliary cholangitis (PBC), autoimmune hepatitis (AIH) and PBC/AIH overlap syndrome were screened with reverse transcription-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs, rapid antigenic test and chemiluminescent serological test during routine follow-up. Results: The analysis of 42 patients was carried out: 18 (42.85%) PBC, 12 (28.57%) AIH and 12 (28.57%) PBC/AIH overlap syndromes. Only 2 patients (4.76%) resulted positive to the RNA, antigen and antibody detection tests, hence affected by SARS-CoV2 infection. 14 subjects out of 40 negative cases presented a positive serology for SARS-CoV2 antibodies, hence with a false positivity in the 35% of cases without infection. Notably, among these, 6 (42.86%) patients presented only immunoglobulin (Ig)M positivity, 6 (42.86%) patients presented positivity for only IgG and 2 (14.28%) patients were positive to both IgM and IgG. Notably, the presence of autoantibodies did not correlate with the serological false positivity, highlighting that there is no cross-reactivity with autoantibodies. Moreover, the presence of polyclonal hypergammaglobulinemia did not interfere with the serological test as its prevalence is not different between negative and false positive cases. Interestingly, the patients with false positive serology showed higher levels of gamma-glutamyltransferase (GGT) and C-reactive protein (CRP). Conclusions: Patients with liver autoimmune diseases present a high rate of false positive SARS-CoV2 serology. Therefore, new strategies are needed to study the serological response in this patient category.

Open Access

Perspective

Why the aortic dissection detection risk score is problematic in emergency departments

Acute aortic syndromes, including aortic dissection (AD), are rare. The AD detection risk score (ADDRS) and associated investigation pathway were developed to reduce missed diagnosis of AD. The methodology for its development was [...] Read more.

Anne-Maree Kelly

Published: August 31, 2021 Explor Med. 2021;2:348–351
DOI: https://doi.org/10.37349/emed.2021.00053
This article belongs to the special issue Exploring Aortic Disease

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Open Access

Commentary

Breastfeeding duration and reduced risk of NAFLD in midlife of parous women

Alessandro Mantovani ... Andrea Dalbeni

Published: October 31, 2021 Explor Med. 2021;2:378–381
DOI: https://doi.org/10.37349/emed.2021.00056
This article belongs to the special issue Exploring Chronic Liver Disease

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Open Access

Original Article

Objective measurement of sleep by smartphone application: comparison with actigraphy and relation to self-reported sleep

Aim: Smartphone technology is increasingly used by the public to assess sleep. Specific features of some sleep-tracking applications are comparable to actigraphy in objectively monitoring sleep. The clinical utility of smartpho [...] Read more.

Taylor Maynard ... Sandy Neargarder

Published: October 31, 2021 Explor Med. 2021;2:382–391
DOI: https://doi.org/10.37349/emed.2021.00057
This article belongs to the special issue Digital Biomarkers: The New Frontier for Medicine and Research

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Review

Exploring evidence-based innovative therapy for the treatment of chronic HBV infection: experimental and clinical

With the advent of various vaccines and antimicrobial agents during the 20th century, the control and containment of infectious diseases appeared to be a matter of time. However, studies unveiled the diverse natures of microbes, t [...] Read more.

Sheikh Mohammad Fazle Akbar ... Yoichi Hiasa

Published: October 31, 2021 Explor Med. 2021;2:392–409
DOI: https://doi.org/10.37349/emed.2021.00058
This article belongs to the special issue Exploring Chronic Liver Disease

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Open Access

Meta-Analysis

A review of aortic thrombosis in COVID-19 infection

Aim: As the novel coronavirus disease 2019 (COVID-19) pandemic impacts the global healthcare system, evolving data show increased frequency of arterial and venous thromboembolism among patients with COVID-19 infection. Aortic t [...] Read more.

Aim: As the novel coronavirus disease 2019 (COVID-19) pandemic impacts the global healthcare system, evolving data show increased frequency of arterial and venous thromboembolism among patients with COVID-19 infection. Aortic thrombus is a rare thrombotic event with a wide spectrum of clinical manifestations and potential catastrophic complications. This study aimed to elucidate the clinical manifestations, diagnosis and treatment dilemmas of aortic thrombus with COVID-19 infection and raise awareness among frontline medical providers. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise. Methods: Literature review was conducted between November 1, 2019, and November 14, 2020, on PubMed and Embase to identify publications regarding aortic thrombosis among COVID-19 cases. Results: Most of the patients were male with a median age of 67 years, and had comorbidities (most commonly hypertension, dyslipidemia and diabetes mellitus). In our study, underlying atherosclerosis, a common risk factor for aortic thrombus, was identified among 56% of the patients. Aortic thrombus was symptomatic in 62% of these patients and most commonly manifested itself as acute limb ischemia (46%), whereas 30% of cases were found incidentally during the investigation of elevated inflammatory markers or increased oxygen requirement. Treatment was individualized given the lack of established guidelines for aortic thrombus, including anticoagulation, systemic and catheter directed thrombolysis, and surgical thrombectomy. Overall mortality was found to be 30% in our study. Conclusions: Although rare, aortic thrombus has high morbidity and mortality, and can present without any symptoms or underlying aortic disease. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise.

Korin Karabulut ... James Morgan

Published: October 31, 2021 Explor Med. 2021;2:410–422
DOI: https://doi.org/10.37349/emed.2021.00059
This article belongs to the special issue Exploring Aortic Disease

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Aim: As the novel coronavirus disease 2019 (COVID-19) pandemic impacts the global healthcare system, evolving data show increased frequency of arterial and venous thromboembolism among patients with COVID-19 infection. Aortic thrombus is a rare thrombotic event with a wide spectrum of clinical manifestations and potential catastrophic complications. This study aimed to elucidate the clinical manifestations, diagnosis and treatment dilemmas of aortic thrombus with COVID-19 infection and raise awareness among frontline medical providers. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise. Methods: Literature review was conducted between November 1, 2019, and November 14, 2020, on PubMed and Embase to identify publications regarding aortic thrombosis among COVID-19 cases. Results: Most of the patients were male with a median age of 67 years, and had comorbidities (most commonly hypertension, dyslipidemia and diabetes mellitus). In our study, underlying atherosclerosis, a common risk factor for aortic thrombus, was identified among 56% of the patients. Aortic thrombus was symptomatic in 62% of these patients and most commonly manifested itself as acute limb ischemia (46%), whereas 30% of cases were found incidentally during the investigation of elevated inflammatory markers or increased oxygen requirement. Treatment was individualized given the lack of established guidelines for aortic thrombus, including anticoagulation, systemic and catheter directed thrombolysis, and surgical thrombectomy. Overall mortality was found to be 30% in our study. Conclusions: Although rare, aortic thrombus has high morbidity and mortality, and can present without any symptoms or underlying aortic disease. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise.

Open Access

Review

Aortic complications in pregnancy: the less remembered chapter—a narrative review

Pregnancy increases the risk of common vascular events and also the rarer events like aortic dissection (AD)/aortic rupture and this is even more pronounced in patients with predisposing aortopathies. AD was found to occur in 0.00 [...] Read more.

Preetha Rajasekaran ... Bashi V. Velayudhan

Published: October 31, 2021 Explor Med. 2021;2:423–434
DOI: https://doi.org/10.37349/emed.2021.00060
This article belongs to the special issue Exploring Aortic Disease

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Commentary

Separating the apples from the oranges: from NAFLD heterogeneity to personalized medicine

Recently, Arrese and Colleagues have published a review article entitled, “Insights into Nonalcoholic Fatty-Liver Disease (NAFLD) Heterogeneity” (Semin Liver Dis. 2021;41:421–34. doi: 10.1055/s-0041-1730927). This milestone [...] Read more.

Amedeo Lonardo

Published: October 31, 2021 Explor Med. 2021;2:435–442
DOI: https://doi.org/10.37349/emed.2021.00061
This article belongs to the special issue Exploring Chronic Liver Disease

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Perspective

Reactive oxygen species may influence on the crossroads of stemness, senescence, and carcinogenesis in a cell via the roles of APRO family proteins

Excessive reactive oxygen species (ROS) may cause oxidative stress which is involved in aging and in the pathogenesis of various human diseases. Whereas unregulated levels of the ROS may be harmful, regulated basal level of ROS is [...] Read more.

Yuka Ikeda ... Satoru Matsuda

Published: October 31, 2021 Explor Med. 2021;2:443–454
DOI: https://doi.org/10.37349/emed.2021.00062
This article belongs to the special issue Reactive Oxygen Species (ROS) in Pathophysiological Conditions

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Times Cited: 5

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Review

Future incidence and mortality of colorectal carcinoma in the United States: an updated overview of risk factors and preventative measures

According to the Global Cancer Observatory (GLOBOCAN) 2020, colorectal carcinoma (CRC) was the second leading cause of cancer death globally. Current literature utilizes reported databases such as Surveillance, Epidemiology, and E [...] Read more.

Hassam Ali

Published: December 31, 2021 Explor Med. 2021;2:455–467
DOI: https://doi.org/10.37349/emed.2021.00063

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Review

Obstetric implications of maternal chronic hepatitis B virus infection

Antenatal screening for hepatitis B surface antigen seropositivity is widely adopted to identify pregnant women with chronic hepatitis B virus (HBV) infection in order to target their newborn infants for combined passive-active ne [...] Read more.

Antenatal screening for hepatitis B surface antigen seropositivity is widely adopted to identify pregnant women with chronic hepatitis B virus (HBV) infection in order to target their newborn infants for combined passive-active neonatal immunization to prevent the maternal-to-child transmission of HBV. It is less certain whether the presence of chronic HBV infection in these largely asymptomatic women could impact their pregnancy outcome. There is now gathering information in the literature, though sometimes conflicting, on the obstetric implications of chronic HBV infection. The conflicting data is most probably related to confounding factors such as the immunological phase of chronic HBV infection, viral genotype and activity, presence of hepatic inflammation and other co-existing liver disorders such as non-alcoholic fatty liver disease, and coinfection with other virus such as hepatitis C virus and micro-organisms, which are usually not examined, but which could have made significant influence on the occurrence of many of the pregnancy complications and adverse fetal and neonatal outcome. For pregnancy complications, the evidence suggests association with increased gestational diabetes mellitus, preterm birth, intrahepatic cholestasis of pregnancy, caesarean delivery, and postpartum haemorrhage, probably increased placental abruption and prelabour rupture of the membranes, and no effect or a reduction in the hypertensive disorders of pregnancy, especially preeclampsia. For perinatal outcome, there may be increased miscarriage and fetal malformations, and increase in both low birthweight and large-for-gestational age/macrosomic infants, as well as increased intrauterine fetal demise/stillbirth and fetal distress. However, most studies have not elaborated on the mechanisms or explanations of many of the adverse outcomes. Taken together, maternal chronic HBV infection increases the risk of adverse obstetric outcome overall, but further prospective studies are warranted to elucidate the reasons and mechanisms of, and with a view to mitigating, these adverse obstetric outcomes.

Terence T. Lao

Published: December 31, 2021 Explor Med. 2021;2:468–482
DOI: https://doi.org/10.37349/emed.2021.00064

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Antenatal screening for hepatitis B surface antigen seropositivity is widely adopted to identify pregnant women with chronic hepatitis B virus (HBV) infection in order to target their newborn infants for combined passive-active neonatal immunization to prevent the maternal-to-child transmission of HBV. It is less certain whether the presence of chronic HBV infection in these largely asymptomatic women could impact their pregnancy outcome. There is now gathering information in the literature, though sometimes conflicting, on the obstetric implications of chronic HBV infection. The conflicting data is most probably related to confounding factors such as the immunological phase of chronic HBV infection, viral genotype and activity, presence of hepatic inflammation and other co-existing liver disorders such as non-alcoholic fatty liver disease, and coinfection with other virus such as hepatitis C virus and micro-organisms, which are usually not examined, but which could have made significant influence on the occurrence of many of the pregnancy complications and adverse fetal and neonatal outcome. For pregnancy complications, the evidence suggests association with increased gestational diabetes mellitus, preterm birth, intrahepatic cholestasis of pregnancy, caesarean delivery, and postpartum haemorrhage, probably increased placental abruption and prelabour rupture of the membranes, and no effect or a reduction in the hypertensive disorders of pregnancy, especially preeclampsia. For perinatal outcome, there may be increased miscarriage and fetal malformations, and increase in both low birthweight and large-for-gestational age/macrosomic infants, as well as increased intrauterine fetal demise/stillbirth and fetal distress. However, most studies have not elaborated on the mechanisms or explanations of many of the adverse outcomes. Taken together, maternal chronic HBV infection increases the risk of adverse obstetric outcome overall, but further prospective studies are warranted to elucidate the reasons and mechanisms of, and with a view to mitigating, these adverse obstetric outcomes.

Open Access

Original Article

Cross-cultural adaptation of Delphi definitions of low back pain prevalence in French (Delphi DOLBaPP-F)

Aim: The high heterogeneity in the definitions of low back pain encountered in the literature has led to the development of standardized definitions of this condition called “Delphi definitions of low back pain prevalence (D [...] Read more.

Antarou Ly ... Clermont E. Dionne

Published: December 31, 2021 Explor Med. 2021;2:483–493
DOI: https://doi.org/10.37349/emed.2021.00065

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Review

Molecular targets regulating endoplasmic reticulum-mitochondria crosstalk for NAFLD treatment

Non-alcoholic fatty liver disease (NAFLD) as the most common chronic liver disease poses a significant impact on public healthcare and economic risk worldwide. As a multifactorial disease, NAFLD is usually associated with many com [...] Read more.

Chunye Zhang, Ming Yang

Published: December 31, 2021 Explor Med. 2021;2:494–510
DOI: https://doi.org/10.37349/emed.2021.00066
This article belongs to the special issue Exploring Chronic Liver Disease

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