Journal of Clinical Medicine

2 pages, 135 KiB

Open AccessReply

Reply to Del Riccio, M.; Lastrucci, V. Comment on “Maglione et al. Changes in Respiratory Viruses’ Activity in Children During the COVID-19 Pandemic: A Systematic Review. J. Clin. Med. 2025, 14, 1387”

by Marco Maglione, Vincenzo Tipo, Emiliano Barbieri, Roberta Ragucci, Agnese Sara Ciccarelli, Chiara Esposito, Ludovica Carangelo and Antonietta Giannattasio

J. Clin. Med. 2025, 14(9), 2960; https://doi.org/10.3390/jcm14092960 (registering DOI) - 25 Apr 2025

Abstract

We would like to thank Dr [...] Full article

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

25 pages, 1858 KiB

Open AccessArticle

Validation of the Polish Version of the Keratoconus Outcomes Research Questionnaire: Tool for Vision-Related Quality of Life in Patients with Keratoconus

by Magdalena Nandzik, Adam Wylęgała, Magdalena Kijonka, Dominika Szkodny, Bartłomiej Markuszewski and Edward Wylęgała

J. Clin. Med. 2025, 14(9), 2959; https://doi.org/10.3390/jcm14092959 - 24 Apr 2025

Abstract

Background/Objectives: Keratoconus is a progressive corneal disorder that significantly impairs visual quality and daily functioning. This study aimed to translate, culturally adapt, and validate the Polish version of the Keratoconus Outcomes Research Questionnaire (KORQ), a tool designed to assess keratoconus-related vision problems and [...] Read more.

Background/Objectives: Keratoconus is a progressive corneal disorder that significantly impairs visual quality and daily functioning. This study aimed to translate, culturally adapt, and validate the Polish version of the Keratoconus Outcomes Research Questionnaire (KORQ), a tool designed to assess keratoconus-related vision problems and their impact on quality of life. Methods: This study involved three phases: translation, validation, and optimization. The translation followed cross-cultural adaptation guidelines, including forward translation, back translation, and pretesting. In the validation phase, 100 patients with keratoconus completed the Polish KORQ. Psychometric properties were assessed using Rasch analysis to evaluate item fit, reliability, unidimensionality, and targeting. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to examine the latent structure of the questionnaire. Regression analysis examined the demographic and clinical factors influencing keratoconus severity and vision-related quality of life, with the total KORQ score as the dependent variable. Results: The Polish KORQ demonstrated excellent psychometric properties. Internal consistency was high (α = 0.95 for activity limitation, α = 0.87 for symptoms). Rasch analysis confirmed good item fit and measurement reliability. EFA identified a two-factor structure consistent with the original questionnaire, explaining 53% of the total variance. CFA supported this model, with good fit indices (CFI = 0.981, TLI = 0.980), despite slightly elevated RMSEA (0.104) and SRMR (0.109). The two latent factors were moderately correlated (r = 0.729). Regression analysis showed that uncorrected visual acuity and disease severity significantly predicted lower quality of life. Conclusions: The Polish KORQ is a reliable and valid tool for assessing the impact of keratoconus in clinical and research settings. Full article

(This article belongs to the Section Ophthalmology)

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12 pages, 1917 KiB

Open AccessArticle

Real-World Evaluation of 12-Month Romosozumab Treatment in Korean Women with Severe Osteoporosis: Potential Synergy with Hormone Therapy

by Jung Yoon Park, Hyoung Moo Park, Jae-Yen Song, Kyung Jin Hwang, Mee-Ran Kim and Youn-Jee Chung

J. Clin. Med. 2025, 14(9), 2958; https://doi.org/10.3390/jcm14092958 - 24 Apr 2025

Abstract

Background/Objectives: Osteoporosis is a major public health concern, due to its high risk of fractures and disability and associated medical costs. Romosozumab, an anabolic agent, has been approved for the treatment of osteoporosis in postmenopausal women at high risk of fractures. However, limited [...] Read more.

Background/Objectives: Osteoporosis is a major public health concern, due to its high risk of fractures and disability and associated medical costs. Romosozumab, an anabolic agent, has been approved for the treatment of osteoporosis in postmenopausal women at high risk of fractures. However, limited data exist on its long-term effects in the Korean population, particularly regarding its impact on bone mineral density (BMD), bone turnover markers, and body composition. This study aimed to evaluate the 12-month effects of romosozumab treatment on BMD, bone turnover markers, and body composition in postmenopausal Korean women with high-fracture-risk osteoporosis (T-scores ≤ −3.0). Additionally, the impact of concomitant postmenopausal hormone therapy (MHT) on BMD changes was assessed. Methods: This multicenter, retrospective observational study included 50 postmenopausal women diagnosed with osteoporosis (T-scores ≤ −3.0) who received 12 monthly doses of romosozumab (210 mg) at two hospitals in Korea. Changes in BMD in the lumbar spine, femoral neck, and total hip were assessed using dual-energy X-ray absorptiometry (DXA). Bone turnover markers, including procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX), were measured at baseline and at 3, 6, and 12 months. Changes in body composition, including the skeletal muscle index (SMI), body mass index (BMI), and visceral adipose tissue (VAT), were also analyzed. Results: After 12 months of romosozumab treatment, BMD significantly increased at the lumbar spine (14.65%), femoral neck (6.58%), and total hip (4.19%) (p < 0.05). P1NP levels increased significantly at 3 months (+37.9%), but returned to baseline at 6 months, while CTX levels continuously decreased (−27.8%) over 12 months. No significant changes were observed in SMI or BMI, but the VAT showed a slight decreasing trend (p < 0.05). Additionally, patients receiving concomitant MHT demonstrated a significantly greater increase in lumbar spine BMD compared to those receiving romosozumab alone (p < 0.05), while no significant differences were observed in femoral neck and total hip BMD. Conclusions: This study demonstrated that 12 months of romosozumab treatment significantly improved BMD and bone turnover markers in postmenopausal Korean women with severe osteoporosis. The combination of romosozumab and MHT further enhanced lumbar spine BMD gains. These findings support the use of romosozumab as an effective treatment for high-risk osteoporotic fractures in postmenopausal Korean women, and suggest potential benefits of a combined therapeutic approach. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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19 pages, 1295 KiB

Open AccessArticle

Diagnostic and Prognostic Evaluation of Novel Biomarkers Compared to ESC 0/1 h and 0/3 h Algorithms in Patients with Suspected Non-ST-Elevation Myocardial Infarction

by Mustafa Yildirim, Christian Salbach, Matthias Mueller-Hennessen, Norbert Frey and Evangelos Giannitsis

J. Clin. Med. 2025, 14(9), 2957; https://doi.org/10.3390/jcm14092957 - 24 Apr 2025

Abstract

(1) Background: Prompt acute coronary syndrome (ACS) recognition remains challenging. This study evaluated the diagnostic and prognostic performance of novel biomarkers for non-ST-elevation myocardial infarction (NSTEMI). (2) Methods: Patients with suspected ACS presenting to Heidelberg University Hospital’s Emergency Department between August 2014 and [...] Read more.

(1) Background: Prompt acute coronary syndrome (ACS) recognition remains challenging. This study evaluated the diagnostic and prognostic performance of novel biomarkers for non-ST-elevation myocardial infarction (NSTEMI). (2) Methods: Patients with suspected ACS presenting to Heidelberg University Hospital’s Emergency Department between August 2014 and February 2023 were analyzed. The biomarker panel included high-sensitivity cardiac troponin T (hs-cTnT), cardiac myosin-binding protein C (cMyBP-C), pro-B-type natriuretic peptide (proBNP), total N-terminal pro-B-type natriuretic peptide (t-NtproBNP), Angiotensin II (Ang2), Bone morphogenetic protein 10 (BMP10), Endothelial cell-specific molecule 1 (ESM1), fatty acid-binding protein 3 (FABP3), Fibroblast growth factor 23 (FGF23), Growth differentiation factor 15 (GDF15), and Copeptin. Negative predictive values (NPVs), sensitivities, and area under the curve (AUC) values were calculated for NSTEMI discrimination. Effectiveness and prognostic performance were assessed based on cardiovascular events at 30 days and 1 year. (3) Results: Of 1765 patients, 212 (12%) were diagnosed with NSTEMI. The European Society of Cardiology (ESC) 0/1 h and 0/3 h algorithms achieved sensitivities of 100% and 96.8%, NPVs of 100% and 99.3%, and effectiveness values of 54.8% and 66.0%. Hs-cTnT (AUC: 0.922) and cMyBP-C (AUC: 0.917) exhibited the highest diagnostic accuracy, followed by FABP3 (AUC: 0.759) and Copeptin (AUC: 0.624). Other biomarkers had lower performance (AUC: 0.516–0.617). At 1 year, event rates ranged from 0.0% to 3.4%, with the ESC algorithms demonstrating superior prognostic performance (0.8%, 2.4%). (4) Conclusions: The ESC 0/1 h and 0/3 h algorithms remain the most effective NSTEMI diagnostic strategies, balancing high sensitivity, prognostic reliability, and effectiveness. Among novel biomarkers, only cMyBP-C demonstrated comparable accuracy to hs-cTnT, supporting its potential as an adjunct to troponin assays. Full article

(This article belongs to the Section Cardiology)

21 pages, 730 KiB

Open AccessSystematic Review

Photodynamic Therapy in Primary Cutaneous Skin Lymphoma—Systematic Review

by Adam Zalewski, Witold Musiał and Alina Jankowska-Konsur

J. Clin. Med. 2025, 14(9), 2956; https://doi.org/10.3390/jcm14092956 - 24 Apr 2025

Abstract

Background/Objectives: Primary cutaneous lymphomas (CLs) are a group of skin-limited lymphoproliferative disorders, including cutaneous T-cell (CTCLs) and B-cell lymphomas (CBCLs). Photodynamic therapy (PDT), a non-invasive, light-activated treatment, has gained attention as a skin-directed therapy for early-stage CLs due to its selectivity and favorable [...] Read more.

Background/Objectives: Primary cutaneous lymphomas (CLs) are a group of skin-limited lymphoproliferative disorders, including cutaneous T-cell (CTCLs) and B-cell lymphomas (CBCLs). Photodynamic therapy (PDT), a non-invasive, light-activated treatment, has gained attention as a skin-directed therapy for early-stage CLs due to its selectivity and favorable safety profile. This systematic review evaluates the current evidence on the clinical use of PDT in managing CLs. Methods: A systematic literature search was conducted in PubMed, Scopus, and Embase through 1 September 2024 following PRISMA guidelines. Search terms included “primary cutaneous skin lymphoma”, “CTCL”, “CBCL”, “mycosis fungoides”, “lymphomatoid papulosis”, and “photodynamic therapy”. After screening 1033 records, 30 studies were included. Data were extracted and categorized by lymphoma subtype and clinical outcomes. Results: Of the included studies, 23 focused on mycosis fungoides (MF), 5 on lymphomatoid papulosis (LyP), and 2 on CBCL. PDT demonstrated notable clinical efficacy in early-stage and localized disease, particularly MF, using methyl aminolevulinate (MAL) or 5-aminolevulinic acid (5-ALA) as photosensitizers. Adjunctive techniques like microneedling and laser-assisted delivery improved treatment outcomes. PDT was generally well tolerated, with mild, transient side effects; rare complications such as localized neuropathy were reported. Conclusions: PDT is a promising, non-invasive treatment for early-stage CLs, especially MF and indolent CBCL variants. While current evidence supports its safety and effectiveness, further comparative and prospective studies are needed to refine protocols, evaluate long-term efficacy, and compare different photosensitizers. Full article

(This article belongs to the Special Issue Skin Diseases: From Diagnosis to Treatment)

13 pages, 655 KiB

Open AccessArticle

How to Evaluate Kidney Function in Elite Endurance Athletes: Pros and Cons of Different Creatinine-Based Formulas

by Giuseppe Di Gioia, Armando Ferrera, Andrea Serdoz, Alessandro Spinelli, Roberto Fiore, Lorenzo Buzzelli, Domenico Zampaglione and Maria Rosaria Squeo

J. Clin. Med. 2025, 14(9), 2955; https://doi.org/10.3390/jcm14092955 - 24 Apr 2025

Abstract

Background: Various creatinine-based equations are used to estimate the glomerular filtration rate (eGFR) in athletes, but each has limitations. The aim of our study was to identify the most suitable formula for use in athletes. Methods: We evaluated 490 Olympic athletes (27 ± [...] Read more.

Background: Various creatinine-based equations are used to estimate the glomerular filtration rate (eGFR) in athletes, but each has limitations. The aim of our study was to identify the most suitable formula for use in athletes. Methods: We evaluated 490 Olympic athletes (27 ± 5.3 yo) with normal values of serum creatinine and no history of kidney diseases. Athletes were divided into those practicing skills and endurance disciplines. The EGFR was calculated with Cockcroft–Gault (CG), MDRD, MCQE and CKD-EPI, and classified as stages G1–G5 according to the Kidney Disease Improving Global Outcomes (KDIGO) GFR categories. Results: Endurance athletes showed higher serum creatinine (0.91 ± 0.14 mg/dL vs. 0.88 ± 0.13 mg/dL in skills, p = 0.014). The eGFR calculated with the CKD-EPI and MCQE formulas showed no differences between the groups. The CG formula produced a lower eGFR for endurance athletes (113.6 ± 27 mL/min/1.73 m²) compared to skills athletes (122.6 ± 30.8, p = 0.008), while MDRD produced higher values for endurance athletes (129.3 ± 25.8 vs. 122.6 ± 24 mL/min/1.73 m², p = 0.004). According to CKD-EPI, all athletes were in G1, while with MCQE, 0.5% of skills athletes and 1% of endurance athletes were in G2. With the CG formula, a significant percentage of athletes were in G2 (13.2% of skills athletes and 18.5% of endurance athletes, p = 0.125). With the MDRD formula, 29 athletes (5.9%) were in G2 (6% for skills athletes and 5.8% for endurance athletes, p = 0.927). Conclusions: CKD-EPI and MCQE showed better stability and reliability, making them the most suitable for kidney function evaluation in athletes. Full article

(This article belongs to the Special Issue Advancements in Diagnostic Innovations in Sports Cardiology)

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9 pages, 933 KiB

Open AccessArticle

Evaluation of the New Robotic Platform “HINOTORI™” in Urologic Robot-Assisted Surgery: From a Comparison with da Vinci^® Surgical System in Sacrocolpopexy

by Tetsuya Fukumoto, Takatora Sawada, Keigo Nishida, Tomoya Onishi, Ryuta Watanabe, Kenichi Nishimura, Noriyoshi Miura, Yuki Miyauchi, Tadahiko Kikugawa and Takashi Saika

J. Clin. Med. 2025, 14(9), 2954; https://doi.org/10.3390/jcm14092954 - 24 Apr 2025

Abstract

Background/Objectives: HINOTORI™ is a robotic-assisted surgical platform developed in Japan. It has been applied in urologic procedures such as robot-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN). This study aimed to evaluate the clinical performance of HINOTORI™ compared with the da Vinci^® [...] Read more.

Background/Objectives: HINOTORI™ is a robotic-assisted surgical platform developed in Japan. It has been applied in urologic procedures such as robot-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN). This study aimed to evaluate the clinical performance of HINOTORI™ compared with the da Vinci^® surgical system by analyzing outcomes of robot-assisted sacrocolpopexy (RSC) performed by a single skilled surgeon using a uniform surgical procedure. Methods: A total of 125 patients who underwent RSC for pelvic organ prolapse (POP) were analyzed. Surgical outcomes were compared between the HINOTORI™ (h-RSC group) and da Vinci^® (d-RSC group) platforms. Evaluated parameters included operative time, robotic console time, anterior compartment dissection time, suture time per stitch, perioperative complications, hospital stay, and POP recurrence. Results: Operative and robotic console times were significantly longer in the h-RSC group (148 vs. 139 min, p < 0.005; 109 vs. 95 min, p < 0.001). Anterior compartment dissection time showed no significant difference (p = 0.58), but suture time per stitch was longer in the h-RSC group (76 vs. 60 s, p < 0.005), possibly due to limited suture-cutting functionality, requiring manual assistance. No significant differences were observed in perioperative complications, hospital stay, and POP recurrence. Conclusions: HINOTORI™ demonstrated surgical precision and safety comparable to the da Vinci^® surgical system. It may serve as a viable alternative robotic platform, supporting broader adoption of robot-assisted surgical technologies. Full article

(This article belongs to the Special Issue The Current State of Robotic Surgery in Urology)

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14 pages, 1233 KiB

Open AccessArticle

Real-World Effectiveness and Safety of Upadacitinib and Abrocitinib in Moderate-to-Severe Atopic Dermatitis: A 52-Week Retrospective Study

by Luciano Ibba, Costanza Falcidia, Sara Di Giulio, Matteo Bianco, Mario Valenti, Paola Facheris, Alessandra Narcisi, Antonio Costanzo and Luigi Gargiulo

J. Clin. Med. 2025, 14(9), 2953; https://doi.org/10.3390/jcm14092953 - 24 Apr 2025

Abstract

Background: Atopic dermatitis (AD) is a chronic pruritic inflammatory disease affecting children and adults. Upadacitinib and abrocitinib are selective Janus kinase 1 inhibitors approved for the treatment of moderate-to-severe AD. Although their efficacy and safety are described in phase 3 clinical trials, real-world [...] Read more.

Background: Atopic dermatitis (AD) is a chronic pruritic inflammatory disease affecting children and adults. Upadacitinib and abrocitinib are selective Janus kinase 1 inhibitors approved for the treatment of moderate-to-severe AD. Although their efficacy and safety are described in phase 3 clinical trials, real-world data are limited. Objectives: We aimed to evaluate the effectiveness and safety of upadacitinib and abrocitinib treatment in a real-life adult population with moderate-to-severe AD throughout an extended observation period. Methods: This retrospective observational study was conducted by analyzing data from the electronic records of IRCCS Humanitas Research Hospital from January 2023 to December 2024. Patients were administered either upadacitinib (15 or 30 mg) or abrocitinib (100 or 200 mg). Effectiveness was evaluated by using clinician-reported scores (Investigator Global Assessment [IGA] and Eczema Area and Severity Index [EASI]) and patient-reported outcomes (peak pruritus numerical rating scale [PP-NRS]) at weeks 8, 16, 32 and 52. Statistical significance was set at a probability value (p-value) < 0.05. Adverse events were also collected. Results: In total, 129 patients were included in the study, and 84 of them reached 52 weeks. At week 52, the EASI 75, 90, and 100 responses were 88.9%, 70.8%, and 54.2% for upadacitinib, and 100%, 91.7%, and 75% for abrocitinib. An IGA score equal to 0 or 1 at 52 weeks was achieved by 84.7% of patients treated with upadacitinib and 100% of those receiving abrocitinib. A four-point reduction from baseline PP-NRS was reported by 86.1% for upadacitinib and by 83.3% of patients for abrocitinib after one year of follow-up. Conclusions: Our study showed comparable or even higher effectiveness outcomes in terms of EASI 75, EASI 90, and EASI 100 at week 52 compared to phase-3 clinical trials, with no new safety concerns, supporting the real-world effectiveness of abrocitinib and upadacitinib in moderate-to-severe AD. Full article

(This article belongs to the Special Issue Innovative Systemic Treatments for Atopic Dermatitis)

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12 pages, 952 KiB

Open AccessArticle

Evaluating Variations in Spinopelvic Parameters from Sitting to Standing: A Comparative Analysis of 1447 Older Adults Across Age, BMI, and Gender Subgroups

by Atahan Durbas, Tejas Subramanian, Chad Simon, Myles R. J. Allen, Justin Samuel, Luis Felipe Colón, Michael R. Mazzucco, Cale Pagan, Theofilos Karasavvidis, Jonathan Vigdorchik, Matthew E. Cunningham, Han Jo Kim and Francis C. Lovecchio

J. Clin. Med. 2025, 14(9), 2952; https://doi.org/10.3390/jcm14092952 - 24 Apr 2025

Abstract

Background/Objectives: Sagittal spinal alignment goals for adult spinal deformity (ASD) surgery are predominantly derived from standing radiographs, despite the biomechanical relevance of sitting posture. Existing studies on sitting alignment involve young, healthy cohorts, which poorly represent ASD patients. This study assessed posture-dependent [...] Read more.

Background/Objectives: Sagittal spinal alignment goals for adult spinal deformity (ASD) surgery are predominantly derived from standing radiographs, despite the biomechanical relevance of sitting posture. Existing studies on sitting alignment involve young, healthy cohorts, which poorly represent ASD patients. This study assessed posture-dependent changes in spinopelvic parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL), and examined how age, BMI, and gender influence these changes. Methods: In this retrospective cohort study, sitting and standing lateral radiographs of 1447 patients were evaluated. Spinopelvic parameters were measured, and changes (ΔPI, ΔPT, ΔSS, and ΔLL) were calculated. Multiple regression analysis was used to determine associations between these changes and age, BMI, and gender. Results: All parameters differed significantly between positions (p < 0.001); PT and PI increased in sitting (ΔPT = −19.20°; ΔPI = −4.52°), while SS and LL increased in standing (ΔSS = 14.67°; ΔLL = 18.44°). Older age correlated with increased ΔPT (p < 0.001) and ΔPI (p = 0.049) but reduced ΔLL and ΔSS (p < 0.001). Higher BMI was associated with decreased ΔPI, ΔPT, and ΔLL (p < 0.001, 0.003, and 0.025). Females showed greater ΔPT (p = 0.013) but smaller ΔPI, ΔSS, and ΔLL (p = 0.043, <0.001, and 0.001). Conclusions: Spinopelvic parameters vary significantly between sitting and standing positions, affected by age, BMI, and gender. The observed PI change suggests SIJ involvement, highlighting the need for posture-specific and demographic-adjusted alignment goals in ASD surgery to optimize outcomes. Full article

(This article belongs to the Section Orthopedics)

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14 pages, 1055 KiB

Open AccessArticle

Perspectives on Matrix Metalloproteinase-8 and Salivary Osteoprotegerin in Orthodontic Strategy in Children with Chronic Kidney Disease

by Natalia Sergeevna Morozova, Alina Alekseevna Elovskaya, Ekaterina Andreevna Maslikova, Andrey Vladimirovich Sevbitov, Maria Dmitrievna Timoshina, Malkan Abdrashidovna Amkhadova, Larisa Dmitrievna Maltseva, Ellina Valerievna Velichko, Elena Yur’evna Danilova and Olga Leonidovna Morozova

J. Clin. Med. 2025, 14(9), 2951; https://doi.org/10.3390/jcm14092951 - 24 Apr 2025

Abstract

Background/Objectives: This study aimed to establish the regularities of changes in the content of matrix metalloproteinase 8 (MMP-8) and osteoprotegerin (OPG), the most well-known indicators of bone metabolism disorders, in the saliva of children with different severities of chronic kidney disease (CKD) who [...] Read more.

Background/Objectives: This study aimed to establish the regularities of changes in the content of matrix metalloproteinase 8 (MMP-8) and osteoprotegerin (OPG), the most well-known indicators of bone metabolism disorders, in the saliva of children with different severities of chronic kidney disease (CKD) who need orthodontic treatment. Methods The study of MMP-8 and OPG content in saliva was carried out in 76 children in need of orthodontic treatment, who were divided into equal groups (G) of 19 people: G1—children with congenital malformations of the urinary tract, acquired renal pathology, and CKD stage 1 and 2, receiving medical therapy, as well as more having a deep distal bite formed by mandibular micrognathia; G2—children with a terminal stage of CKD, receiving renal replacement therapy in the volume of hemodialysis, with a characteristic distal bite of different etiology; G3—children one year after kidney transplantation, with a tendency to form an open distal bite, associated to a greater extent with maxillary macrognathia. G4—practically healthy children without renal pathology stratified by sex and age. Results: It was found that the content of MMP-8 and OPG in the saliva of children with different CKD stages who needed orthodontic treatment was significantly higher than the G4. The maximum values of MMP-8 were registered in G2. An increase in OPG content in saliva was observed in the G1 and G3. Conclusions: The identified changes in markers of mineral and bone disorders in the saliva of children with different stages of CKD show the possibility of their use as non-invasive predictive and prognostic markers for the diagnosis of preclinical stages of bone metabolic disorders. Full article

(This article belongs to the Special Issue Current Challenges in Clinical Dentistry: 2nd Edition)

14 pages, 558 KiB

Open AccessReview

Compliance of Physiotherapeutic Scoliosis-Specific Exercise in Adolescent Idiopathic Scoliosis: A Scoping Review

by Azharuddin Fazalbhoy, Jeb McAviney and Rosemary Mirenzi

J. Clin. Med. 2025, 14(9), 2950; https://doi.org/10.3390/jcm14092950 - 24 Apr 2025

Abstract

Background: Non-surgical management of adolescent idiopathic scoliosis (AIS) includes physiotherapeutic scoliosis-specific exercise (PSSE). Determining the efficacy of PSSE in AIS has been challenging as the clinical effect is closely linked to exercise compliance (a dose–response relationship), with home exercise programs (HEPs) showing [...] Read more.

Background: Non-surgical management of adolescent idiopathic scoliosis (AIS) includes physiotherapeutic scoliosis-specific exercise (PSSE). Determining the efficacy of PSSE in AIS has been challenging as the clinical effect is closely linked to exercise compliance (a dose–response relationship), with home exercise programs (HEPs) showing a general trend for decreased participation over time. The existing literature reports contradictory definitions and parameters of appropriate PSSE compliance in AIS. As such, this scoping review is necessary for therapists to identify PSSE prescription consistency, enabling clear guidelines for improved PSSE compliance. Methods: A scoping review of the literature was conducted to synthesize original research from inception to November 2024 and reference lists were examined for studies reporting compliance, adherence, or motivational strategies for PSSE in AIS. Results: Fifteen articles with a focus on PSSE in AIS were included in this review. The results demonstrate that compliance (C) and adherence (A) are terms commonly used interchangeably, only half of the studies clearly define compliance and/or adherence, and some utilize motivational strategies; however, outcomes of compliance/adherence were often not reported in the Results section or reflected in the discussion of results. Conclusions: Compliance and/or adherence are inconsistently reported within studies and numerous variations exist in (1) the section of the paper it is mentioned, (2) whether the inclusion criteria hinged on patient compliance/adherence, and (3) whether motivational strategies were employed and outcomes reported. Notably, there was a lack of compliance or adherence reporting in Results and Discussion sections of papers. The definition of appropriate compliance and any effective motivational strategies to improve compliance to achieve the desired results for treatment of AIS remain undetermined. Full article

(This article belongs to the Section Orthopedics)

13 pages, 1194 KiB

Open AccessArticle

Translation and Validation of the Gothenburg Trismus Questionnaire-2 into Italian Language

by Andrea Frosolini, Lisa Tuomi, Olindo Massarelli, Caterina Finizia, Simone Benedetti, Lisa Catarzi, Andrea Lovato, Guido Gabriele and Paolo Gennaro

J. Clin. Med. 2025, 14(9), 2949; https://doi.org/10.3390/jcm14092949 - 24 Apr 2025

Abstract

Objectives: This study aimed to translate and validate the Gothenburg Trismus Questionnaire-2 for Italian-speaking patients (I-GTQ2). Methods: A cross-sectional study was conducted with 200 participants. The translation process adhered to international standards. Patients completed the I-GTQ2 along with the European Organization for Research [...] Read more.

Objectives: This study aimed to translate and validate the Gothenburg Trismus Questionnaire-2 for Italian-speaking patients (I-GTQ2). Methods: A cross-sectional study was conducted with 200 participants. The translation process adhered to international standards. Patients completed the I-GTQ2 along with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) and the Hospital Anxiety and Depression Scale (HADS) to evaluate construct validity. Reliability was assessed using internal consistency and test–retest reliability (ICC). Known-group validity was also analyzed. Results: The I-GTQ2 showed high reliability, with Cronbach’s alpha ranging from 0.61 to 0.94 and ICC between 0.79 and 0.96. Known-group comparisons confirmed discriminative validity, with significant differences between patients with and without trismus in jaw-related problems (p = 0.005, d = 0.575) and large differences between patients and controls in most domains (p < 0.001, d > 0.65) except for muscular tension. Convergent validity was supported by strong correlations between GTQ-2 domains and EORTC QLQ-C30 (e.g., r = −0.54 for facial pain and global health status; r = 0.64 for jaw-related problems and pain) as well as moderate correlations with HADS anxiety (r = 0.39–0.52) and depression (r = 0.37–0.46). Conclusions: The I-GTQ2 is a reliable and valid tool for assessing the impact of trismus on the quality of life in Italian-speaking patients, and it is recommended for clinical and research use. Future studies should investigate its relationship with objective trismus measurements. Full article

(This article belongs to the Section Otolaryngology)

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19 pages, 396 KiB

Open AccessArticle

Impact of Living Arrangements on Delirium in Older ED Patients

by Andrea Russo, Sara Salini, Luigi Carbone, Andrea Piccioni, Francesco Pio Fontanella, Fiorella Ambrosio, Claudia Massaro, Davide Della Polla, Giuseppe De Matteis, Francesco Franceschi, Francesco Landi and Marcello Covino

J. Clin. Med. 2025, 14(9), 2948; https://doi.org/10.3390/jcm14092948 - 24 Apr 2025

Abstract

Background: The purpose of this study is to assess how the socio–family demographic status of patients is related to the onset of delirium in a large cohort of older adults aged ≥65 years evaluated in the emergency department (ED) using a comprehensive geriatric [...] Read more.

Background: The purpose of this study is to assess how the socio–family demographic status of patients is related to the onset of delirium in a large cohort of older adults aged ≥65 years evaluated in the emergency department (ED) using a comprehensive geriatric assessment (CGA). Methods: This is a cross-sectional, observational, retrospective study conducted in the ED of a teaching hospital. We enrolled 2770 geriatric patients admitted to the ED from January 2019 to December 2023 and evaluated them using CGA. Clinical variables assessed in the ED were evaluated for associations with delirium onset and in-hospital mortality. Results: Delirium was statistically related to frailty statuses as measured via the Clinical Frailty Scale (CFS) (OR 1.47 [1.39–1.56]; p < 0.001). The occurrence of delirium was also associated with living arrangements: “living with other relatives” condition (OR 1.43 [1.12–1.83]; p = 0.004) and residence in a nursing home (OR 1.72 [1.30–2.31]; p < 0.001). In addition, compared to patients in emergency conditions (NEWS > 5), it emerges that patients with better clinical stability have a lower risk of developing delirium (NEWS 3–5 OR 0.604 [0.48–0.75]; p < 0.001—NEWS < 3 OR 0.42 [0.34–0.53]; p < 0.001). In-hospital mortality was associated with age, male sex, frailty status, clinical instability, and the onset of delirium in the ED. Conclusions: Delirium is a multifactorial and acute syndrome representing a negative prognostic factor of in-hospital mortality, especially in elderly patients. Independent of the clinical condition, the patient’s living arrangement could be of relevance to the onset of delirium in the ED. Early comprehensive geriatric assessments in the ED could allow the early detection of all predisposing risk factors, resulting in the timely implementation of supportive strategies to prevent the onset of delirium in EDs. Full article

(This article belongs to the Section Emergency Medicine)

13 pages, 1557 KiB

Open AccessArticle

Skeletal Muscle Density as a Predictor of Prognosis and Physical Reserve in Patients with Cancer of Unknown Primary

by Kwonjae Lee, Se Jun Park, Joori Kim, Sook Hee Hong, In-Ho Kim, Jieun Lee, Myung Ah Lee, Kabsoo Shin and Han Song Mun

J. Clin. Med. 2025, 14(9), 2947; https://doi.org/10.3390/jcm14092947 - 24 Apr 2025

Abstract

Introduction: The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) is widely used to assess patient status but relies on subjective judgment and may not fully reflect their physical reserve. While studies have shown that skeletal muscle quality and quantity are associated with [...] Read more.

Introduction: The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) is widely used to assess patient status but relies on subjective judgment and may not fully reflect their physical reserve. While studies have shown that skeletal muscle quality and quantity are associated with patient prognosis, their role in cancers of unknown primary (CUP) remains unclear. Therefore, this study aimed to investigate whether computed tomography (CT)-based skeletal muscle indicators reflect physical reserve and their prognostic value in patients with CUP. Methods: This study enrolled 184 patients with CUP, comprising both inpatients and outpatients, who were diagnosed at Seoul St. Mary’s Hospital between 1 January 2008, and 30 June 2024. Overall survival (OS) was evaluated using the Kaplan–Meier method and analyzed using the log-rank test. Univariate and multivariate analyses were performed using Cox proportional hazard models. Statistical significance was defined as p < 0.05. Correlation analyses were conducted to evaluate the relationships between skeletal muscle density (SMD), skeletal muscle index (SMI), and other prognostic factors. Results: SMD was positively correlated with SMI and negatively correlated with age, neutrophil-to-lymphocyte ratio, Charlson Comorbidity Index (CCI), and ECOG-PS. Jonckheere’s trend test revealed that SMD decreased significantly as CCI and ECOG-PS increased (p < 0.001), indicating that a higher comorbidity burden and poorer performance status were associated with lower SMD. Both ECOG-PS and SMD were identified as prognostic factors in the univariate analysis of survival; however, only SMD demonstrated statistical significance regarding prognostic value in the multivariate analysis (p = 0.004) Conclusions: SMD, as a measure of muscle quality, demonstrates superior prognostic value compared to the subjective ECOG-PS and may serve as a reliable objective tool for assessing physical reserve in patients with CUP. Full article

(This article belongs to the Section Oncology)

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22 pages, 5081 KiB

Open AccessArticle

Exploring the Connection Between Depression, Inflammatory Biomarkers, and Atherosclerotic Coronary Artery Disease

by Marius Rus, Cristian Nicolae Sava, Adriana Ioana Ardelean, Georgeta Pasca, Felicia Liana Andronie-Cioara, Simina Crisan, Claudia Teodora Judea Pusta and Madalina Ioana Guler

J. Clin. Med. 2025, 14(9), 2946; https://doi.org/10.3390/jcm14092946 - 24 Apr 2025

Abstract

Background/Objectives: Depression is associated with an increased risk for the development and progression of cardiovascular disease. This research investigated the association between depressive symptoms and inflammation in the development of atherosclerotic coronary events. Methods: This retrospective observational study included 276 patients who were [...] Read more.

Background/Objectives: Depression is associated with an increased risk for the development and progression of cardiovascular disease. This research investigated the association between depressive symptoms and inflammation in the development of atherosclerotic coronary events. Methods: This retrospective observational study included 276 patients who were not previously diagnosed with atherosclerotic coronary artery disease at the beginning of the research. Participants were categorized using the Hamilton Depression Rating Scale (HDRS) and the Structured Clinical Interview for DSM-5 (SCID) into two groups: the depression group and the control group. Inflammatory biomarkers (C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and cortisol) were measured at the beginning of the study, as well as at six months, one year, and two years. Results: Among patients with mild depression (17.3% vs. 4.2%) or moderate depression (15.4% vs. 6.7%), there were significantly more men than women, while among patients with very severe depression, there were significantly more women than men (21.7% vs. 11.5%). Participants with depression showed significantly higher increases at 2 years compared to baseline for all investigated parameters (p < 0.001). Depressed patients were significantly associated with an acute coronary syndrome (p = 0.038). Conclusions: This research highlights that individuals with depression face a greater risk of developing an acute coronary syndrome than those without depression. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 3350 KiB

Open AccessArticle

The T-Top Technique for Tandem Lesions: A Single-Center Retrospective Study

by Daniele Giuseppe Romano, Raffaele Tortora, Matteo De Simone, Giulia Frauenfelder, Alfredo Siani, Ettore Amoroso, Gianpiero Locatelli, Francesco Taglialatela, Gianmarco Flora, Francesco Diana and Renato Saponiero

J. Clin. Med. 2025, 14(9), 2945; https://doi.org/10.3390/jcm14092945 - 24 Apr 2025

Abstract

Background: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant [...] Read more.

Background: Tandem Lesions (TLs) or Tandem Occlusions (TOs) are characterized by simultaneous high-grade stenosis or occlusion of the proximal extracranial internal carotid artery and the intracranial terminal internal carotid artery or its branches. These lesions can result in stroke and pose significant challenges to endovascular treatment. This study introduces and evaluates the “T-Top technique” as an innovative approach to address TLs, assessing its safety and technical efficacy. Methods: Data from acute ischemic stroke (AIS) patients treated with the T-Top technique between September 2022 and September 2023 were retrospectively analyzed. The technique involves using the pusher wire of a stent retriever as a microwire to guide a monorail angioplastic balloon to the extracranial carotid stenosis, performing angioplasty simultaneously with stent retriever anchorage. Clinical outcomes, procedural data, and safety were assessed. Results: Successful reperfusion (mTICI > 2b) was achieved in 91% of cases, with a median groin puncture to final recanalization time of 50 min. Favorable clinical outcomes (mRS < 3) were observed in 69% of patients, with a low mortality rate of 6% after 90 days. Conclusions: The T-Top technique offers a rapid and reliable strategy for TL treatment, improving reperfusion rates and clinical outcomes. Further studies are warranted to validate its efficacy in larger cohorts. This technique holds promise for enhancing endovascular treatment outcomes in patients with Tandem Lesions. Full article

(This article belongs to the Special Issue Neurosurgery: Recent Advances and New Perspectives in Skull Base Approaches)

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15 pages, 1428 KiB

Open AccessSystematic Review

Oral Manifestations of Multiple Sclerosis: A Systematic Review

by Paula García-Rios, Francisco Javier Rodríguez-Lozano and Miguel Ramón Pecci-Lloret

J. Clin. Med. 2025, 14(9), 2944; https://doi.org/10.3390/jcm14092944 - 24 Apr 2025

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by diverse clinical manifestations, including the potential involvement of the oral cavity. Oral symptoms in MS patients may arise both as direct consequences of the disease and as [...] Read more.

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system characterized by diverse clinical manifestations, including the potential involvement of the oral cavity. Oral symptoms in MS patients may arise both as direct consequences of the disease and as side effects of pharmacological treatments. These manifestations, such as xerostomia, periodontal disease, and dental sensitivity, can significantly affect quality of life and may be underrecognized in clinical practice. Aim: To systematically assess the presence and relevance of oral manifestations in patients with MS, and to identify correlations between these symptoms and clinical parameters such as MS phenotype, disease duration, and disability level. Materials and Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A database search was conducted in PubMed and Scopus on 17 March 2025, using terms related to “multiple sclerosis” and “oral manifestations”. Inclusion criteria were limited to observational studies published in the last ten years, focusing on oral symptoms in MS patients. Furthermore, the quality of the studies was assessed following the Newcastle–Ottawa Scale (NOS) for cohort and case–control studies, and the JBI Critical Appraisal checklist for analytical cross-sectional studies. Results: Ten studies met the inclusion criteria. The most frequently reported oral manifestations were hyposalivation, gingival inflammation, increased DMFT and plaque indices, dental sensitivity, and oral pain. Several studies found statistically significant associations between oral dryness and MS phenotype (p < 0.05), and between periodontal health and degree of disability (p < 0.05). However, heterogeneity in methodology and lack of longitudinal studies were noted as limitations. Conclusions: This review highlights a clear relationship between MS and several oral health disturbances, particularly xerostomia and periodontal disease. The findings underscore the need for multidisciplinary care approaches and further studies with standardized protocols to better understand oral-systemic interactions in MS. Full article

(This article belongs to the Special Issue Multiple Sclerosis: Advances in Therapeutic Approaches)

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16 pages, 5835 KiB

Open AccessArticle

Chronic Ulcers Healing Prediction through Machine Learning Approaches: Preliminary Results on Diabetic Foot Ulcers Case Study

by Elisabetta Spinazzola, Guillaume Picaud, Sara Becchi, Monica Pittarello, Elia Ricci, Marc Chaumont, Gérard Subsol, Fabio Pareschi, Luc Teot and Jacopo Secco

J. Clin. Med. 2025, 14(9), 2943; https://doi.org/10.3390/jcm14092943 - 24 Apr 2025

Abstract

Background: Chronic diabetic foot ulcers are a global health challenge, affecting approximately 18.6 million individuals each year. The timely and accurate prediction of wound healing paths is crucial for improving treatment outcomes and reducing complications. Methods: In this study, we apply predictive modeling [...] Read more.

Background: Chronic diabetic foot ulcers are a global health challenge, affecting approximately 18.6 million individuals each year. The timely and accurate prediction of wound healing paths is crucial for improving treatment outcomes and reducing complications. Methods: In this study, we apply predictive modeling to the case study of diabetic foot ulcers, analyzing and comparing multiple models based on Deep Neural Networks (DNNs) and Machine Learning (ML) algorithms to enhance wound prognosis and clinical decision making. Our approach leverages a dataset of 1766 diabetic foot wounds, each monitored for at least three visits, incorporating key clinical wound features such as WBP scores, wound area, depth, and tissue status. Results: Among the 12 models evaluated, the highest accuracy (80%) was achieved using a three-layer LSTM recurrent DNN trained on wound instances with four visits. The model performance was assessed through AUC (0.85), recall (0.80), precision (0.79), and F1-score (0.80). Our findings indicate that the wound depth and area at the first visit followed by the wound area and granulated tissue percentage at the second visit are the most influential factors in predicting the wound status. Conclusions: As future developments, we started building a weakly supervised semantic segmentation model that classifies wound tissues into necrosis, slough, and granulation, using tissue color proportions to further improve model performance. This research underscores the potential of predictive modeling in chronic wound management, specifically in the case of diabetic foot ulcers, offering a tool that can be seamlessly integrated into routine clinical practice. Full article

(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)

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12 pages, 549 KiB

Open AccessArticle

Evaluation of ChatGPT Responses About Sexual Activity After Total Hip Arthroplasty: A Comparative Study with Observers of Different Experience Levels

by Batuhan Gencer, Ufuk Arzu, Serdar Satılmış Orhan, Turgut Dinçal and Mehmet Ekinci

J. Clin. Med. 2025, 14(9), 2942; https://doi.org/10.3390/jcm14092942 - 24 Apr 2025

Abstract

Background/Objectives: Despite the rising tendency to depend on ChatGPT for medical counselling, it is imperative to evaluate ChatGPT’s capacity to address sensitive subjects that patients often hesitate to discuss with their physicians. The objective of this study was to evaluate the recommendations [...] Read more.

Background/Objectives: Despite the rising tendency to depend on ChatGPT for medical counselling, it is imperative to evaluate ChatGPT’s capacity to address sensitive subjects that patients often hesitate to discuss with their physicians. The objective of this study was to evaluate the recommendations provided by ChatGPT for sexual activity subsequent to total hip arthroplasty (THA) by orthopaedic surgeons with varying degrees of experience, as well as using standardized scoring systems. Methods: Four patient scenarios were developed, reflecting different ages and indications for THA. Twenty-four questions were asked to ChatGPT 4.0, and responses were evaluated by three different orthopaedic surgeons. All responses were also scored using defined standardized scales. Results: No response was found to be ‘faulty’ or ‘partial’ by any of the observers. While the lowest mean score was attributed by the orthopaedic surgeon with less than five years of experience, the highest mean score was attributed by the orthopaedic surgeon with more than 15 years of experience but not actively working in the field of arthroplasty. An analysis of the data across scenarios revealed that in general, the scores decreased in the more specialized scenarios (p > 0.05). Conclusions: ChatGPT shows potential as a supplementary resource for addressing sensitive postoperative questions such as sexual activity after THA. However, its limitations in providing nuanced, patient-specific recommendations highlight the need for further refinement. While ChatGPT can support general patient education, expert clinical guidance remains essential for addressing complex or individualized concerns. Full article

(This article belongs to the Special Issue Applications of Artificial Intelligence and Digital Therapeutics in Clinical Medicine)

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17 pages, 290 KiB

Open AccessArticle

Evaluation of Prescription Patterns of Antipsychotics in Schizophrenia Patients—A Single-Center Prospective Study

by Ahmed Adel Mohamed, Abdulaziz Saleh Almulhim, Abdulrahman Abdullah Alnijadi, Fatimatuzzahra’ binti Abd Aziz, Khuloud Khaled Alajmi, Ahmed Abdullah Al-Mudhaffar and Mohammad Salem Almutairi

J. Clin. Med. 2025, 14(9), 2941; https://doi.org/10.3390/jcm14092941 - 24 Apr 2025

Abstract

Inappropriate prescription patterns and polypharmacy are critical challenges facing the optimal management of schizophrenia patients, especially in regard to patient safety. Background/Objectives: The purpose of this study was to examine the relationship between patient safety and the existence of incorrect prescription patterns [...] Read more.

Inappropriate prescription patterns and polypharmacy are critical challenges facing the optimal management of schizophrenia patients, especially in regard to patient safety. Background/Objectives: The purpose of this study was to examine the relationship between patient safety and the existence of incorrect prescription patterns and/or polypharmacy in the medications prescribed to individuals with schizophrenia. This issue is addressed in a broad context, highlighting the purpose of this study. Methods: A cross-sectional study was adopted, involving a prospective analysis of the prescriptions of schizophrenia patients receiving treatment. Prescription patterns deemed inappropriate were evaluated based on evidence-based guidelines. Antipsychotic maximum allowable daily doses were calculated using the British National Formulary Maximum Daily Dose (BNFmax), an online tool. Patient safety outcomes were assessed using the Glasgow Antipsychotic Side-effect Scale (GASS). Results: A total of 198 patients diagnosed with schizophrenia and receiving treatment consented to participate in the GASS survey. A total of 116 (58.6%) males participated. The mean age of patients was 40.1 (±12.7). Thirty-one (66.2%) reported mild side effects, while 67 (33.8%) reported moderate side effects. Polypharmacy was detected in 103 (52%) patients’ prescriptions. The correlation between GASS and BNFmax was positive and statistically significant (p < 0.001). The elevation in GASS score was associated with polypharmacy prescriptions (OR 3.21; 95% CI 1.64–6.29), the presence of first-generation antipsychotics (FGAP) (OR 2.79; 95% CI 0.236–5.951), any combination of antipsychotics containing haloperidol (OR 3.22; 95% CI 1.11–9.32), and olanzapine (OR 3.46; 95% CI 1.36–8.79). Conclusions: The safety of patients with schizophrenia has been proven to be impacted by the improper use of psychotropic drugs. Following evidence-based guidelines is a cornerstone to ensuring optimal, effective, and safe patient treatment plans. Full article

(This article belongs to the Section Mental Health)

19 pages, 1003 KiB

Open AccessReview

Decreasing Preoperative Anxiety in Patients with Newly Available Multimodal Approaches—A Narrative Review

by Weronika Kisielewska, Michał Kościółek, Weronika Kowalczyk, Bernard Mitura, Lidia Mitura, Sylwester Rogula, Piotr Konrad Leszczyński, Katarzyna Antosik and Kryspin Mitura

J. Clin. Med. 2025, 14(9), 2940; https://doi.org/10.3390/jcm14092940 - 24 Apr 2025

Abstract

Preoperative anxiety affects approximately 80% of adult patients; thus, identifying patients with excessive anxiety and implementing appropriate interventions can significantly reduce the risk of deterioration during the perioperative period. This narrative review presents current knowledge about pharmacological and nonpharmacological methods for reducing preoperative [...] Read more.

Preoperative anxiety affects approximately 80% of adult patients; thus, identifying patients with excessive anxiety and implementing appropriate interventions can significantly reduce the risk of deterioration during the perioperative period. This narrative review presents current knowledge about pharmacological and nonpharmacological methods for reducing preoperative anxiety. Commonly used pharmacological options include benzodiazepines, ketamine, or fentanyl. Antidepressants have also been shown to be effective in alleviating symptoms, but they typically require four weeks to take effect. Establishment of supportive relationships with medical staff to help patients express their feelings have been shown to have a positive impact on anxiety reduction. Other nonpharmacological methods include the provision of information through informed consent forms, video materials, virtual reality, or the use of psychotherapeutic interventions such as breathing techniques, music therapy, or cognitive–behavioural therapy. Some studies suggest that essential oils may have a role in reducing perioperative anxiety. Nonpharmacological interventions can be used in patients of different ages. An increasing number of researchers advocate for a holistic approach that integrates less invasive and cost-effective interventions with conventional medicine. While various interventions have been proposed to manage preoperative anxiety, more research is needed to establish the most effective and feasible interventions for different patient populations. Full article

(This article belongs to the Section General Surgery)

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13 pages, 857 KiB

Open AccessReview

Positron Emission Tomography in Takayasu Arteritis: A Review Including Patterns of Vascular Involvement Across Modalities and Regions

by Tokio Katakura and Tsuyoshi Shirai

J. Clin. Med. 2025, 14(9), 2939; https://doi.org/10.3390/jcm14092939 - 24 Apr 2025

Abstract

Takayasu arteritis (TAK) is a rare, chronic large-vessel vasculitis that predominantly affects the aorta and its major branches. Early and accurate diagnosis remains essential to prevent irreversible vascular damage and organ dysfunction. Positron emission tomography/computed tomography (PET/CT) has emerged as a valuable imaging [...] Read more.

Takayasu arteritis (TAK) is a rare, chronic large-vessel vasculitis that predominantly affects the aorta and its major branches. Early and accurate diagnosis remains essential to prevent irreversible vascular damage and organ dysfunction. Positron emission tomography/computed tomography (PET/CT) has emerged as a valuable imaging modality for detecting active vascular inflammation in TAK. Using 18F-fluorodeoxyglucose (18F-FDG), PET/CT enables the assessment of metabolic activity in inflamed arterial walls, supporting both initial diagnosis and disease monitoring. Compared with conventional imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), PET/CT provides functional data correlated with inflammatory activity rather than solely anatomical changes. Recent studies have highlighted its utility in distinguishing active from chronic disease, predicting relapse, and evaluating treatment response. This review summarizes the role of PET/CT in TAK, addressing its advantages, patterns of vascular involvement, limitations, and future perspectives. Vascular lesions identified using PET/CT do not always align with those detected by other imaging modalities, with PET/CT demonstrating superiority in revealing aortic inflammation potentially overlooked by alternative techniques. Further research is needed to establish whether PET/CT-based vascular involvement patterns, rather than conventional angiographic findings, can help identify disease subtypes of TAK. Full article

(This article belongs to the Special Issue Systemic Vasculitis: Advancement in Pathogenesis, Clinical Features, Management and Therapeutic Strategies)

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13 pages, 2454 KiB

Open AccessArticle

Prognostic Value of Single Nodal Zone Metastasis in Non-Small-Cell Lung Cancer—A Multi-Institutional Study

by Samanta Nicosia, Paraskevas Lyberis, Stefano Rudella, Paolo Olivo Lausi, Simona Sobrero, Riccardo Carlo Cristofori, Matteo Roffinella, Elisa Carla Fontana, Francesco Leo, Enrico Ruffini and Francesco Guerrera

J. Clin. Med. 2025, 14(9), 2938; https://doi.org/10.3390/jcm14092938 - 24 Apr 2025

Abstract

Objectives: Lung cancer is the leading cause of cancer-related deaths worldwide and mediastinal lymph node involvement is an important negative prognostic factor. Nevertheless, the involvement of a single mediastinal nodal zone has been reported to have favorable outcomes. This study aims to [...] Read more.

Objectives: Lung cancer is the leading cause of cancer-related deaths worldwide and mediastinal lymph node involvement is an important negative prognostic factor. Nevertheless, the involvement of a single mediastinal nodal zone has been reported to have favorable outcomes. This study aims to assess whether the prognosis of non-small-cell lung cancer (NSCLC) with single-zone lymph node involvement varies by the affected lymph node zone. Methods: We retrospectively analyzed patients affected by NSCLC with a single lymph node zone involvement who underwent anatomical resection. The prognosis of patients was statistically compared based on the different affected lymph node zones. Results: A total of 135 patients were enrolled. All patients underwent anatomical lung resection and systematic lymph node dissection. Lymph node involvement was observed in 50 cases (37%) for the upper zone, 36 cases (27%) for the aorto-pulmonary (AP) zone, 41 cases (30%) for the subcarinal zone and 8 cases (6%) for the lower zone. The median follow-up was 37 months [ranging from 1 to 115 months]. Cancer recurrence was reported in 64 cases (52%) during this period. The 2-year and 4-year overall survival (OS) were 69% and 49%, respectively. The 2-year and 4-year relapse-free survival (RFS) were 55% and 41%. The OS and RFS change relating to the different involved lymph node zones (p < 0.01). Lower zone involvement predicts worse prognosis, upper zone and subcarinal zone better outcomes, and the AP zone involvement intermediate survival. Conclusions: The location of the affected lymph nodes appears to be an important prognostic factor in patients with NSCLC, with significant impacts on both OS and RFS. It may play a key role in the disease progression and patient survival by providing more personalized therapy. Full article

(This article belongs to the Special Issue Clinical and Surgical Insights on Lung Cancer Treatment)

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12 pages, 600 KiB

Open AccessArticle

Clinical Outcomes in Early-Stage HER2-Low and HER2-Zero Breast Cancer: Single-Center Experience

by Jamshid Hamdard, Mehmet Haluk Yücel, Harun Muğlu, Özgür Açıkgöz, Aslı Çakır, Ahmet Bilici and Ömer Fatih Ölmez

J. Clin. Med. 2025, 14(9), 2937; https://doi.org/10.3390/jcm14092937 - 24 Apr 2025

Abstract

Background/Objectives: The goal of this study is to characterize the survival patterns and outcomes of women with early-stage breast cancer, with a particular emphasis on the distinction between HER2-low and HER2-zero expression. There is limited real-world data on how patients with HER2-negative or [...] Read more.

Background/Objectives: The goal of this study is to characterize the survival patterns and outcomes of women with early-stage breast cancer, with a particular emphasis on the distinction between HER2-low and HER2-zero expression. There is limited real-world data on how patients with HER2-negative or HER2-low metastatic or recurrent breast cancer are treated. Methods: We retrospectively analyzed the medical records of 1500 breast cancer patients diagnosed between January 2020 and December 2024. From this cohort, 99 patients with HER2-low and 34 patients with HER2-zero early-stage breast cancer were included in our analysis. HER2 low was defined as Immunohistochemistry (IHC) 1+ or IHC 2+ with negative Silver In situ Hybridization (SISH), while HER2 zero was defined as IHC 0. Statistical analyses, including Kaplan–Meier survival analyses and log-rank tests for group comparisons, were performed using IBM SPSS Statistics. Results: The median age of patients was 55 years. The HER2-zero group exhibited a higher incidence of brain, liver, bone, and lung metastases (p < 0.001 for all) and increased use of CDK4/6 inhibitors (p < 0.001). In univariate analyses, younger age, an HER2-zero status, and the absence of metastases were associated with improved disease-free survival (DFS) and overall survival (OS). However, in multivariate analyses, an HER2-zero status independently predicted longer DFS (HR = 0.14, 95% CI: 0.05–0.41, p < 0.001) and OS (HR = 0.16, 95% CI: 0.042–0.6, p = 0.007). Conclusions: Our study revealed distinct metastatic patterns and survival outcomes between HER2-low and HER2-zero early-stage breast cancers. Despite a higher metastatic burden in univariate analyses, HER2 zero status was independently associated with longer DFS and OS in multivariate analyses, highlighting their biological heterogeneity and the need for further research to inform tailored strategies. Full article

(This article belongs to the Special Issue Breast Cancer: Clinical Diagnosis and Personalized Therapy)

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13 pages, 1239 KiB

Open AccessArticle

Impact of Urethroplasty on Erectile Function: A Multicenter Analysis of the International Index of Erectile Function Score Changes Across Different Etiologies of Urethral Stricture

by Mikołaj Frankiewicz, Łukasz Białek, Marta Rydzińska, Michał Skrzypczyk, Rafał Pęksa, Marcin Folwarski, Adam Kaftan, Jakub Krukowski, Adam Kałużny, Marcin Matuszewski and Trauma and Reconstructive Urology Working Party of the European Association of Urology Young Academic Urologists

J. Clin. Med. 2025, 14(9), 2936; https://doi.org/10.3390/jcm14092936 - 24 Apr 2025

Abstract

Background/Objectives: Urethral stricture disease, characterized by narrowing of the urethra due to scar tissue, affects urinary and sexual health. While urethroplasty is the standard treatment, its impact on erectile function is less understood. This study examines changes in International Index of Erectile [...] Read more.

Background/Objectives: Urethral stricture disease, characterized by narrowing of the urethra due to scar tissue, affects urinary and sexual health. While urethroplasty is the standard treatment, its impact on erectile function is less understood. This study examines changes in International Index of Erectile Function (IIEF) scores post-urethroplasty across various stricture etiologies, identifies predictors of erectile function outcomes, and explores recovery trajectories following surgery. Methods: This multicenter retrospective study included 103 patients who underwent urethroplasty between 2017 and 2023. Preoperative and postoperative IIEF scores at 3 and 6 or 12 months were analyzed. Stricture etiologies included pelvic fracture urethral injury, transurethral resection, catheterization, idiopathic, and hypospadias. The Wilcoxon signed-rank test and multivariate regression models were used to assess changes in IIEF scores and identify significant predictors. Results: Preoperative erectile function and patient age were significant predictors of postoperative outcomes. Younger patients and those with higher baseline IIEF scores experienced better erectile function post-surgery. Long-term outcomes (6 to 12 months) were significantly worse for strictures involving both penile and bulbar regions. Multivariate analysis showed higher pre-surgery IIEF scores and younger age were associated with better outcomes both short-term (R² = 0.562) and long-term (R² = 0.507). Diabetes was associated with worse erectile function outcomes at 3 months post-surgery. Conclusions: Younger patients and those with higher baseline IIEF scores have better erectile function outcomes following urethroplasty. Complex strictures involving both penile and bulbar regions adversely affect long-term outcomes. Additionally, the presence of diabetes is correlated with diminished erectile function in the short-term postoperative period. Full article

(This article belongs to the Special Issue Advancements and Challenges in Reconstructive Urology and Urethral Surgery)

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13 pages, 761 KiB

Open AccessArticle

Fragility Fractures of the Pelvic Ring: Analysis of Epidemiology, Treatment Concepts, and Surgical Strategies from the Registry of the German Pelvic Multicenter Study Group

by David B. Osche, Emmanouil Liodakis, Stefan Huber, Tim Pohlemann, Christian Kleber, Steven C. Herath and Andreas Höch

J. Clin. Med. 2025, 14(9), 2935; https://doi.org/10.3390/jcm14092935 - 24 Apr 2025

Abstract

Background: Fragility fractures of the pelvic ring (FFPs) represent a fast-growing entity in geriatric traumatology with increasing incidence worldwide. This study aimed to analyze the epidemiology, treatment concepts, and surgical strategies for FFPs based on data collected by the German Pelvic Multicenter Study [...] Read more.

Background: Fragility fractures of the pelvic ring (FFPs) represent a fast-growing entity in geriatric traumatology with increasing incidence worldwide. This study aimed to analyze the epidemiology, treatment concepts, and surgical strategies for FFPs based on data collected by the German Pelvic Multicenter Study Group documented in the German Pelvic Fracture Registry. It is the largest cohort study of its kind. Methods: This retrospective cohort study included patients aged 65 years or older after FFPs, as classified according to the Rommens and Hofmann classification. Data were collected from July 2018 onward and analyzed for demographics; fracture classifications; treatment modalities (operative vs. non-operative); and details of surgery, including timing and choice of implants. Patients after high-energy trauma were excluded. Statistical analyses included descriptive metrics and subgroup comparisons. Results: Among 1242 patients (84% female; median age 83.4 years), FFP Type II was the most common fracture type (50.8%), followed by Type IV (21.1%). Non-operative management was employed in 68.8% of cases, while 30.9% underwent surgery. Surgical intervention was more frequent in higher-grade FFPs (e.g., 72.1% in Type IV). The most common surgical technique for the posterior pelvic ring was percutaneous screw fixation (61.3%), with navigation used in 47.4% of cases. Conclusions: This study highlights the variability in treatment strategies for FFPs, with conservative management predominating in lower-grade fractures and surgical approaches increasingly utilized for more complex cases. The findings underscore the need for standardized, evidence-based guidelines and further research to optimize treatment and long-term outcomes for geriatric patients with FFPs. Full article

(This article belongs to the Special Issue Osteoporotic Fractures of the Pelvis, Hip and Femur: Current Challenges and New Perspectives)

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20 pages, 1226 KiB

Open AccessReview

Iron Deficiency Treatment in Heart Failure—Challenges and Therapeutic Solutions

by Lucreția Anghel, Ciprian Dinu, Diana Patraș, Anamaria Ciubară and Iulia Chiscop

J. Clin. Med. 2025, 14(9), 2934; https://doi.org/10.3390/jcm14092934 - 24 Apr 2025

Abstract

Iron deficiency (ID) is a common comorbidity in heart failure (HF), affecting nearly 50% of patients and worsening symptoms, exercise capacity, and prognosis. This review summarizes recent evidence from meta-analyses, clinical trials, and guidelines on the pathophysiology, diagnosis, and treatment of ID in [...] Read more.

Iron deficiency (ID) is a common comorbidity in heart failure (HF), affecting nearly 50% of patients and worsening symptoms, exercise capacity, and prognosis. This review summarizes recent evidence from meta-analyses, clinical trials, and guidelines on the pathophysiology, diagnosis, and treatment of ID in HF. ID in HF results from chronic inflammation, intestinal congestion, and impaired iron metabolism. Diagnosis is based on serum ferritin and transferrin saturation (TSAT) levels. While oral iron therapy has limited efficacy, intravenous iron, particularly ferric carboxymaltose and ferric derisomaltose, improves symptoms and exercise tolerance and reduces hospitalizations. Timely diagnosis and treatment of ID in HF are essential. Intravenous iron is the preferred therapeutic approach, but further research is needed to optimize long-term management. Full article

(This article belongs to the Section Cardiology)

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9 pages, 703 KiB

Open AccessArticle

Enhancing Adult Autism Diagnostic Pathways: The Role of Clinical Triage in Efficient Service Provision

by Marios Adamou, Sarah L. Jones, Tim Fullen, Bronwen Alty, Jennifer Ward and Joanne Nixon Mills

J. Clin. Med. 2025, 14(9), 2933; https://doi.org/10.3390/jcm14092933 - 24 Apr 2025

Abstract

Background: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition affecting 1.1% of adults. The increasing incidence of ASD has led to pressurised diagnostic services. Objective: We aimed to determine the number needed to harm (NNH) of criteria-informed triage assessment in [...] Read more.

Background: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition affecting 1.1% of adults. The increasing incidence of ASD has led to pressurised diagnostic services. Objective: We aimed to determine the number needed to harm (NNH) of criteria-informed triage assessment in an adult autism diagnostic service in the UK. Methods: The study was conducted at a specialist adult Autism Service in West Yorkshire, UK, from November 2021 to August 2022. All eligible referrals were accepted, with criteria requiring service users to be over 18 years old and without an intellectual disability. The evaluation consisted of 60 cases. Results: None of the evaluation cases resulted in a clinical diagnosis of ASD, yielding an infinite number needed to harm (NNH), demonstrating that every case benefited from the triage process without significant risk of harm. Conclusions: Triage enables services to gather comprehensive information about individual presentations and clinical needs, facilitating informed decision-making and better service utilisation. The evaluation demonstrates the safety and effectiveness of the triage process, with directions for further research discussed. Full article

(This article belongs to the Special Issue Autism Spectrum Disorder: Diagnosis, Treatment, and Management)

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13 pages, 1151 KiB

Open AccessArticle

Continuous Monitoring with Implantable Loop Recorders After Cryoballoon Ablation: Impact on Atrial Fibrillation Recurrence and Therapeutic Management in Era of Artificial Intelligence

by Rosario Foti, Michele Di Silvestro, Giuseppe Campisi, Sergio Conti, Giuseppe Picciolo, Carlo Cardì, Marco Barbanti, Giulia Rapisarda, Antonio Parlavecchio and Giuseppe Sgarito

J. Clin. Med. 2025, 14(9), 2932; https://doi.org/10.3390/jcm14092932 - 24 Apr 2025

Abstract

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia associated with stroke, heart failure, and increased mortality. Due to its efficacy and safety, cryoballoon ablation (CBA) is widely accepted for rhythm control; however, long-term AF recurrence remains a challenge. Continuous monitoring [...] Read more.

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia associated with stroke, heart failure, and increased mortality. Due to its efficacy and safety, cryoballoon ablation (CBA) is widely accepted for rhythm control; however, long-term AF recurrence remains a challenge. Continuous monitoring with implantable loop recorders (ILRs) enhanced by artificial intelligence (AI) can detect both symptomatic and asymptomatic episodes, potentially optimizing patient management. This analysis assessed the long-term effectiveness of CBA in maintaining sinus rhythm and investigated the role of ILR-guided monitoring in enhancing therapeutic decisions. Methods: Data from 91 patients with paroxysmal or persistent atrial fibrillation (AF) who underwent pulmonary vein isolation using cryoballoon ablation at four Italian centers between April 2022 and April 2024 were analyzed. All patients received an insertable loop recorder (ILR) before or during hospitalization for ablation, allowing for the continuous remote monitoring of arrhythmias. Baseline demographics, procedural details, AF occurrence, AF burden (calculated as the total duration of all AF episodes occurring within a day and categorized by episode duration), therapeutic adjustments, and the effect of artificial intelligence (AI) on data processing were evaluated. Results: The cohort’s average age was 62.4 years, with 24.2% of participants being female. Physician-confirmed AF recurrence was noted in 26.7% of patients at 12 months and 49.5% at 24 months. The device data indicated a daily AF burden of ≥6 min in 47.2% at 12 months, with 25.9% surpassing 1 h. AI algorithms decreased false-positive alerts by 21%, resulting in an estimated saving of 19 clinician hours. In patients with pre-ablation ILR data, the median AF burden significantly decreased from 7% to 0.2% (p = 0.017). ILR-guided monitoring affected treatment adjustments, leading to the discontinuation of antiarrhythmic therapy in 36 patients and redo ablations in 8. Conclusions: Continuous ILR monitoring, combined with AI-driven analysis, enables the detection of AF recurrences and burden, thereby facilitating timely therapeutic adjustments. Full article

(This article belongs to the Special Issue Atrial Arrhythmias: Diagnosis, Management and Future Opportunities)

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11 pages, 1068 KiB

Open AccessArticle

Postoperative C-Reactive Protein Trend Is a More Accurate Predictor of Anastomotic Leak than Absolute Values Alone

by Britney R. Niemann, Jeevan Murthy, Connor Breinholt, Jacob Swords, Alyson Stevens, Mary Garland-Kledzik, Keri Mayers, Emily Groves, Kevin Train and Douglas Murken

J. Clin. Med. 2025, 14(9), 2931; https://doi.org/10.3390/jcm14092931 - 24 Apr 2025

Abstract

Background/Objectives: An anastomotic leak (AL) following colorectal surgery is one of the most feared complications due to its associated morbidity and mortality. Early detection of ALs remains difficult, as the development of clinical signs of deterioration can be a late finding. This [...] Read more.

Background/Objectives: An anastomotic leak (AL) following colorectal surgery is one of the most feared complications due to its associated morbidity and mortality. Early detection of ALs remains difficult, as the development of clinical signs of deterioration can be a late finding. This is particularly problematic in patients with poor access to care after discharge. C-reactive protein (CRP) is a systemic marker of inflammation that has been proposed as an early AL screening. However, absolute cut-off values have been shown to have limited sensitivity and specificity. We propose the use of CRP trends for early AL detection. Methods: A retrospective chart review of patients undergoing surgery requiring at least one anastomosis at a single tertiary care center was performed. Patients with two or fewer postoperative CRP values were excluded. Postoperative CRP trends were compared between control and AL patients using a mixed model with a Geisser–Greenhouse correction. Results: CRP trends differed significantly between AL and control patients, with a 10% CRP increase after postoperative day two showing 100% sensitivity and 84% specificity for an AL as well as a 100% negative predictive value. Accepted CRP cut-off values on postoperative days three and four had sensitivities of only 71.4% and 80% and specificities of 70.0% and 76.5%, respectively. CRP trends differed in AL versus control patients despite the surgical approach or presence of additional procedures. Conclusions: Daily monitoring of CRP trends (versus absolute cut-offs) may enhance early anastomotic leak detection and aid in discharge decision-making, particularly important in rural settings with limited healthcare access. Full article

(This article belongs to the Section General Surgery)

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J. Clin. Med., Volume 14, Issue 9 (May-1 2025) – 102 articles

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