Journal of Clinical Medicine

15 pages, 540 KB

Open AccessArticle

Gender Differences Between Disability, Quality of Life, and Sedentary Behavior in Individuals with Chronic Non-Specific Neck Pain

by Anna Christakou, Alexandra Loizou and Dimitrios Chytas

J. Clin. Med. 2025, 14(22), 8155; https://doi.org/10.3390/jcm14228155 (registering DOI) - 17 Nov 2025

Abstract

Introduction: Chronic non-specific neck pain is a musculoskeletal disorder which may affect psychological well-being and work performance. Depression, anxiety, and limitations in daily and work activities may occur differently between genders in individuals with chronic non-specific pain. The main purpose of the present [...] Read more.

Introduction: Chronic non-specific neck pain is a musculoskeletal disorder which may affect psychological well-being and work performance. Depression, anxiety, and limitations in daily and work activities may occur differently between genders in individuals with chronic non-specific pain. The main purpose of the present cross-sectional study was to investigate the differences between men and women with chronic non-specific neck pain in disability due to pain, quality of life, and sedentary behavior. Secondly, we investigated the intercorrelations between the three above measured variables in the total sample. Methods: Eighty patients (44 men and 36 women), aged 20–55 years (Μ = 33.55, SD = 11.16) with chronic non-specific neck pain in the last 3 years participated. They completed three validated questionnaires which measured neck disability pain, quality of life, and sedentary behavior with (a) the Neck Disability Index (NDI), (b) the quality-of-life EuroQol-5D (EQ-5D), and (c) the International Physical Activity Questionnaire (IPAQ), respectively. Gender comparisons with Kruskal–Wallis H tests and correlation analysis with Spearman r tests were performed between the above variables using SPSS 29.00. Results: Men reported (a) better quality of life (H = 16.14, p < 0.001), (b) lower pain-related disability (H = 13.96, p < 0.001), (c) more time spending in vigorous physical activity (H = 3.37, p < 0.05), (d) more time spending in moderate physical activity (H = 5.17, p < 0.05), and (e) more time spending in walking (H = 11.24, p < 0.001). A strong positive correlation was found between the NDI and the EQ-5D Index (r = 0.74, p = 0.002) and a negative correlation was found between NDI and the EQ-5D VAS (r = −0.65, p = 0.003). Discussion: The present findings reported that men have more time walking, and have lower disability due to neck pain than women, thus they have better quality of life than women with chronic non-specific neck pain. Full article

(This article belongs to the Special Issue Neuromuscular Diseases and Musculoskeletal Disorders)

14 pages, 2730 KB

Open AccessArticle

Hidden Adaptations: Ultrasound Evidence of Intrinsic Foot and Tendon Changes in Basketball Players with Hallux Limitus

by Samuel Eloy Gutiérrez-Torre, Nerea Molina-Hernández, Álvaro García-Vázquez, César Calvo-Lobo, David Rodríguez-Sanz and Ricardo Becerro-de-Bengoa-Vallejo

J. Clin. Med. 2025, 14(22), 8154; https://doi.org/10.3390/jcm14228154 (registering DOI) - 17 Nov 2025

Abstract

Background: Hallux limitus (HL) is a restriction of first metatarsophalangeal joint dorsiflexion, commonly linked to foot biomechanics-related disorders or trauma, increasing sports injury risk. It involves plantar fascia tension, compensations, and tendon adaptations. Rehabilitative ultrasound imaging (RUSI) accurately assesses musculoskeletal changes, supporting physiotherapy [...] Read more.

Background: Hallux limitus (HL) is a restriction of first metatarsophalangeal joint dorsiflexion, commonly linked to foot biomechanics-related disorders or trauma, increasing sports injury risk. It involves plantar fascia tension, compensations, and tendon adaptations. Rehabilitative ultrasound imaging (RUSI) accurately assesses musculoskeletal changes, supporting physiotherapy evaluation and the study of HL-related structural adaptations. Objectives: Comparing the thickness and cross-sectional area (CSA) of flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), abductor hallucis (AbH), and quadratus plantae (QP) muscles, as well as the thickness of the plantar fascia (PF), Achilles tendon (AT), and plantar calcaneal fat pad (CFP), between participants with and without HL. Methods: Case–control study included 80 basketball players recruited from semi-professional teams by consecutive non-probabilistic sampling. Participants were divided into two groups: an HL group (n = 40) and a healthy group (n = 40). Musculotendinous parameters were assessed using RUSI. Results: The FDB, FHB, AB, and QP showed significant reductions in thickness and CSA at rest and at contraction in the HL group. PF thickness increased in participants with HL, while CFP thickness decreased significantly. Significance was established at (p < 0.05). Conclusions: HL participants exhibited reduced muscle size and CSA, increased PF, and lower CFP thicknesses, indicating adaptive tissue alterations. Full article

(This article belongs to the Special Issue Physiotherapy in Clinical Practice: From Assessment to Rehabilitation)

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13 pages, 480 KB

Open AccessArticle

De-Novo Stress Urinary Incontinence After Apical Prolapse Surgery: Potential Link with the Zone of Critical Elasticity

by Yaman Degirmenci, Ceren Efe Sayın, Ina Shehaj, Mona Wanda Schmidt and Gilbert Georg Klamminger

J. Clin. Med. 2025, 14(22), 8153; https://doi.org/10.3390/jcm14228153 (registering DOI) - 17 Nov 2025

Abstract

Background/Objectives: Pelvic organ prolapse (POP) surgery can lead to postoperative stress urinary incontinence (SUI) in previously continent women, termed de novo SUI. This study assessed the incidence and risk factors of de novo SUI after apical POP repair, hypothesizing that reduced bladder [...] Read more.

Background/Objectives: Pelvic organ prolapse (POP) surgery can lead to postoperative stress urinary incontinence (SUI) in previously continent women, termed de novo SUI. This study assessed the incidence and risk factors of de novo SUI after apical POP repair, hypothesizing that reduced bladder neck elasticity—particularly within the zone of critical elasticity (ZCE) described by the Integral Theory—contributes to its development. Methods: A retrospective single-center analysis was performed in 206 postmenopausal women (≥60 years) who underwent apical POP surgery without concomitant anti-incontinence procedures. Patients were classified by surgical approach as laparoscopic sacrocolpopexy (SCP) or vaginal native tissue repair. Results: The overall incidence of de novo SUI was 8.7%. Laparoscopic SCP for vaginal vault prolapse was significantly associated with a higher risk of postoperative SUI (OR 10.37, 95% CI 2.70–39.79, p = 0.001), whereas other procedures showed no significant association. Neither prior hysterectomy nor cystocele stage was an independent predictor of de novo SUI. Conclusions: These results suggest that surgical alteration of the ZCE—particularly excessive tension or reduced elasticity near the bladder neck—may impair urethral closure. Therefore, preserving ZCE integrity and carefully adjusting mesh tension during apical POP repair may reduce the risk of de novo SUI. Full article

(This article belongs to the Special Issue Pelvic Organ Prolapse: Clinical Advances and Challenges)

16 pages, 482 KB

Open AccessReview

Non-Invasive Ventilation Therapy Implementation in Medical Wards—A Scoping Review to Understand Hospitals’ Protocols and Procedures

by Catherine Buchan, Idinakachukwu Chukwu, Anne Walker, Eli Dabscheck and Natasha Smallwood

J. Clin. Med. 2025, 14(22), 8152; https://doi.org/10.3390/jcm14228152 (registering DOI) - 17 Nov 2025

Abstract

Background/Objectives: Non-invasive ventilation (NIV) is a highly effective and safe treatment for hypercapnic acute respiratory failure (ARF). This study aimed to identify and examine the content and recommendations within local health guidance documents (LHGDs) that facilitate ward-based implementation of NIV for the [...] Read more.

Background/Objectives: Non-invasive ventilation (NIV) is a highly effective and safe treatment for hypercapnic acute respiratory failure (ARF). This study aimed to identify and examine the content and recommendations within local health guidance documents (LHGDs) that facilitate ward-based implementation of NIV for the treatment of ARF in adults in Australian health services. Methods: A scoping review was conducted on 26 May 2023, updated on 11 January 2024 and 16 September 2025 to identify public health services NIV LHGDs. Data were extracted and analysed regarding NIV initiation, monitoring, maintenance and weaning, and management of clinical deterioration. Results: Twenty-two LHGDs were included, of which only six (27.3%) referenced international NIV guidelines. Most LHGDs (n = 17, 77.3%) required an arterial blood gas (ABG) measurement before NIV initiation, with eight (36.4%) specifying PaCO₂ > 45 mmHg and pH < 7.35 as a basis to consider NIV initiation. Most (n = 13, 59.1%) specified a target SpO₂ range to monitor NIV, but recommendations varied. NIV implementation recommendations general wards (n = 12, 54.5%) were most common, followed by respiratory wards (n = 5, 22.7%) and respiratory care units (n = 4, 18.2%). Most LHGDs did not specify criteria for medical review (n = 13, 59.1%), clinical escalation (n = 13, 59.1%) or palliation care (n = 13, 59.1%), and weaning guidance was rarely specified (n = 7, 31.8%). Conclusions: There was substantial variation in the structure and content of LHGDs for ward-based NIV across Australian hospitals, including inconsistencies in initiation, monitoring, weaning, and detection of patient deterioration. Variation and limited alignment with major clinical guidelines may impact care quality and safety. Full article

(This article belongs to the Section Respiratory Medicine)

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25 pages, 7213 KB

Open AccessReview

Psoriatic Arthritis: From Diagnosis to Treatment

by Renuka Kannappan, Sarah Kim, Arthur Lau and Lawrence H. Brent

J. Clin. Med. 2025, 14(22), 8151; https://doi.org/10.3390/jcm14228151 (registering DOI) - 17 Nov 2025

Abstract

Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory arthritis associated with psoriasis, affecting joints, entheses, and the axial skeleton. While primary care providers and dermatologists frequently encounter psoriasis (PsO), early recognition of PsA remains critical to preventing irreversible joint damage. This paper is [...] Read more.

Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory arthritis associated with psoriasis, affecting joints, entheses, and the axial skeleton. While primary care providers and dermatologists frequently encounter psoriasis (PsO), early recognition of PsA remains critical to preventing irreversible joint damage. This paper is written to provide a comprehensive overview of PsA, beginning with a clinical case that highlights diagnostic and therapeutic challenges. In this review, the epidemiology of PsA will be discussed, emphasizing its prevalence and risk factors among patients with PsO. The discussion extends to the underlying pathogenesis, focusing on genetic predisposition, environmental triggers, and key cytokines, including TNF-α, IL-17, and IL-23, that have become targets for advanced therapeutics. The clinical features of PsA are explored in detail, including peripheral and axial arthritis, enthesitis, dactylitis, and extra-articular manifestations. Diagnostic approaches are discussed, with a focus on the Classification Criteria for Psoriatic Arthritis (CASPAR) and Moll & Wright criteria. Additionally, we examine screening tools designed to facilitate early detection in dermatology clinics. Diagnostic modalities, including imaging and serologic markers, are reviewed. Finally, we explore the evolving landscape of PsA treatment, spanning conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic agents (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). Given the increasing availability of cytokine-targeted therapies, an interdisciplinary approach between dermatologists and rheumatologists is essential for optimizing outcomes in PsA patients. Patients with PsA are cared for by rheumatologists, dermatologists, and primary care providers who help manage the comorbidities associated with PsA. By bridging primary care, dermatology, and rheumatology in the care of PsA, this paper aims to enhance understanding of PsA for facilitating early identification and timely intervention for improved patient care. Full article

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

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16 pages, 759 KB

Open AccessArticle

Muscle Unloading During Exercise: Comparative Effects of Conventional Oxygen, NIV, and High-Flow Therapy on Neural Drive in Severe COPD

by Javier Sayas-Catalán, Victoria Villena Garrido, Cristina Lalmolda, Ana Hernández-Voth, Marta Corral-Blanco, Miguel Jiménez-Gómez, Laura González-Ramos and Manel Luján

J. Clin. Med. 2025, 14(22), 8150; https://doi.org/10.3390/jcm14228150 (registering DOI) - 17 Nov 2025

Abstract

Objectives: This study aimed to evaluate how non-invasive ventilation (NIV) and high-flow nasal cannula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We conducted an experimental, [...] Read more.

Objectives: This study aimed to evaluate how non-invasive ventilation (NIV) and high-flow nasal cannula therapy (HFT) versus conventional oxygen therapy (COT) affect neural ventilatory drive during exercise in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We conducted an experimental, controlled study with one arm and three different conditions for the same cohort. After initial testing on conventional oxygen therapy (COT), patients exercised under NIV and HFT in sequential days and a random order. Participants: Twenty patients (mean age 60 years old (SD 3.9), 6 female) with severe COPD (30% women) on home NIV as a bridge to lung transplantation were enrolled in this study, with a mean FEV₁ of 19.78% predicted and marked hyperinflation. Protocol: Participants performed constant-load cycling exercises at 75% maximum tolerated workload under three conditions: COT, NIV, and HFT. Neuro-respiratory drive (NRD) was measured using surface parasternal and sternocleidomastoid electromyography, and mixed ANOVA was performed to analyze repeated measures across conditions. Results: In total, 20 patients were included in this study. NIV demonstrated superior performance, with 60% lower NRD compared to COT (488.81 µV vs. 1180.63 µV, p < 0.05). HFT showed intermediate effects (807.8 µV). NIV also achieved greater reduction in respiratory rate (4.2 breaths/min), lower perceived exertion (Borg score decrease: 1.8 points), and more pronounced CO₂ reduction (5.3 mmHg) compared to both COT and HFT. Conclusions: NIV significantly reduces NRD during exercise in severe COPD patients compared to HFT and COT. This supports its use as a valuable adjunct to pulmonary rehabilitation in severe COPD. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Comorbidities in Chronic Obstructive Pulmonary Disease (COPD): 2nd Edition)

14 pages, 804 KB

Open AccessArticle

Long-Term Effect of a Structured Educational Program on Diabetic Foot on Major Adverse Limb and Cardiovascular Events in People with Type 1 Diabetes

by Núria Alonso-Carril, Maite Valverde, Jordi Anglada, Luis García-Pascual, Maria-José Barahona, Silvia Rodríguez-Rodríguez, Belén Berrocal, Carmen Quirós, Andreu Simó-Servat, Carlos Puig-Jové, Davinia Martínez, Carme Ferré, Antonio J. Amor and Verónica Perea

J. Clin. Med. 2025, 14(22), 8149; https://doi.org/10.3390/jcm14228149 (registering DOI) - 17 Nov 2025

Abstract

Background/Objectives: To evaluate the long-term impact of a structured diabetic foot education program on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in individuals with type 1 diabetes. Methods: Retrospective cohort study including 327 adults with type 1 [...] Read more.

Background/Objectives: To evaluate the long-term impact of a structured diabetic foot education program on major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) in individuals with type 1 diabetes. Methods: Retrospective cohort study including 327 adults with type 1 diabetes who participated in a structured diabetic foot education program between 1990 and 2014. The program included 10 h of education focused on diabetes self-management and foot care. Participants were encouraged to attend annual refresher sessions. The primary outcomes were the first occurrence of MALE (major amputation or lower-limb revascularization) and MACE (non-fatal stroke, non-fatal myocardial infarction, or all-cause death). Cox proportional hazards models were used to assess associations between the number of educational programs (EPs) attended (1, 2–3, >3) and outcomes. Results: Participants attended a median of two EPs during a median follow-up of 26.3 years. Of the total number of events, 21 were MALEs (crude incidence of 1.9 per 1000 person-years) and 108 were MACEs (incidence of 12.9 per 1000 person-years). Risk of MALE was not associated with the number of EPs attended (p = 0.384). In contrast, participants who attended >3 EPs had a significantly lower risk of MACE compared with those attending only one program (HR 0.48, 95% CI 0.24–0.99, p = 0.044), although this association was attenuated after adjusting for smoking status. Conclusions: Frequent participation in a structured diabetic foot education program was associated with fewer cardiovascular events, but this benefit was diminished by smoking. Integrating tobacco cessation into education programs may enhance their long-term impact. Full article

(This article belongs to the Special Issue Clinical Management of Type 1 Diabetes)

31 pages, 1325 KB

Open AccessReview

Research Progress on the Association Between Sarcopenic Obesity and Atherosclerosis: Current Status and Challenges

by Kai Yang, Wei Yang, Si-Cong Si, Jia Liu, Yi-Xin Ma and Huan Zhao

J. Clin. Med. 2025, 14(22), 8148; https://doi.org/10.3390/jcm14228148 (registering DOI) - 17 Nov 2025

Abstract

Sarcopenic obesity (SO) is a syndrome characterized by a gradual reduction in skeletal muscle mass, strength, and function coupled with excessive fat accumulation, which considerably increases the risk of metabolic disorders and atherosclerotic cardiovascular disease. Owing to its extensive influence on the health [...] Read more.

Sarcopenic obesity (SO) is a syndrome characterized by a gradual reduction in skeletal muscle mass, strength, and function coupled with excessive fat accumulation, which considerably increases the risk of metabolic disorders and atherosclerotic cardiovascular disease. Owing to its extensive influence on the health of elderly individuals and distinct pathophysiological mechanisms, SO should be considered an independent clinical condition. Atherosclerosis, the fundamental pathophysiological underpinning of atherosclerotic cardiovascular disease, has garnered increased interest because of its association with SO. Existing research indicates that SO may synergistically promote atherosclerosis development through multiple pathways, including hormonal dysregulation, adipo-myokine imbalance, insulin resistance, chronic low-grade inflammation, and lipid metabolic abnormalities. The current literature gaps predominantly encompass the absence of standardized diagnostic criteria for SO, inconsistent results in studies investigating the relationship between SO and atherosclerosis, and inadequate causal validation. Studies indicate associations between SO and carotid atherosclerosis, coronary atherosclerosis, arterial stiffness, and 10-year atherosclerotic cardiovascular disease risk; however, conclusions remain inconsistent, and most studies are cross-sectional. Additionally, this field has insufficient focus on peripheral atherosclerosis, such as in the lower extremities. Moreover, the pathophysiological mechanisms remain unclear. A complex vicious cycle potentially exists among decreased muscle mass and function, fat accumulation, and atherosclerosis, a relationship that has not received sufficient attention. Therefore, this review aims to integrate existing evidence, summarize advances in diagnostic criteria for SO, review the epidemiological association between sarcopenic obesity and atherosclerosis, and analyze the reasons for heterogeneity in conclusions. It further explores potential pathophysiological mechanisms, delving into the vicious cycle among declining muscle mass and function, fat accumulation, and atherosclerosis. Finally, this review proposes future research directions, including diagnostic standardization, in-depth mechanism exploration, conducting prospective cohort studies to validate causal relationships, and developing intervention targets for SO–Atherosclerosis comorbidity. Full article

(This article belongs to the Section Geriatric Medicine)

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71 pages, 3087 KB

Open AccessSystematic Review

Assessing Venous Congestion in Acute and Chronic Heart Failure: A Review of Splanchnic, Cardiac and Pulmonary Ultrasound: Part 1: Conventional B-Mode, Colordoppler, and Vexus Protocol

by Francesco Giangregorio, Ester Centenara, Samanta Mazzocchi, Luigi Gerra, Francesco Tursi, Davide Imberti and Daniela Aschieri

J. Clin. Med. 2025, 14(22), 8147; https://doi.org/10.3390/jcm14228147 (registering DOI) - 17 Nov 2025

Abstract

Background/Objectives: Heart failure (HF) causes systemic and regional haemodynamic alterations that extend beyond the heart, profoundly affecting splanchnic circulation. Venous congestion is a hallmark of heart failure (HF) and a major determinant of clinical deterioration and multiorgan dysfunction. The splanchnic venous system—comprising [...] Read more.

Background/Objectives: Heart failure (HF) causes systemic and regional haemodynamic alterations that extend beyond the heart, profoundly affecting splanchnic circulation. Venous congestion is a hallmark of heart failure (HF) and a major determinant of clinical deterioration and multiorgan dysfunction. The splanchnic venous system—comprising the portal, hepatic, and renal veins—acts as a key reservoir for intravascular volume redistribution. Conventional ultrasound (US), using grayscale and Doppler imaging, offers a direct, non-invasive approach to visualize these haemodynamic changes. This review, Part 1 of a two-part series, summarizes the current evidence and clinical applications of conventional US for assessing splanchnic, cardiac and pulmonary vascular alterations in patients with HF. Methods: A systematic review was performed in PubMed, Embase, and the Cochrane Library up to current date, following PRISMA 2020 guidelines. Eligible studies included adult human investigations evaluating splanchnic vascular changes in HF using B-mode, color Doppler, or pulsed Doppler ultrasonography. Exclusion criteria were pediatric, animal, or non-English studies and non-standard imaging methods. Data on ultrasonographic parameters, haemodynamic correlations, and prognostic value were extracted and qualitatively synthesized; Results: A total of 148 eligible studies (n ≈ 7000 patients) demonstrated consistent associations between HF severity and alterations in splanchnic, cardiac and pulmonary flow. Findings included increased bowel wall thickness, portal vein dilation with elevated pulsatility, and monophasic or reversed hepatic vein waveforms, all correlating with higher right atrial pressure and adverse clinical outcomes. The integration of these parameters into the Venous Excess Ultrasound (VExUS) framework enhanced detection of systemic venous congestion, in addition to the study of the cardiac and pulmonary circulation. Conclusions: Conventional ultrasound assessment of splanchnic vasculature provides valuable, reproducible insight into systemic congestion in HF. Incorporating hepatic and portal Doppler indices into standard evaluation protocols may improve risk stratification, optimize decongestion therapy, and guide management. Further prospective randomized and outcome-driven studies are required before VExUS-based therapeutic thresholds can be universally recommended and define prognostic thresholds. Full article

(This article belongs to the Special Issue Multiparametric Ultrasound Techniques for Liver Disease Assessments)

16 pages, 1586 KB

Open AccessArticle

Trick or Treat(ment): Should We Still Fear Reperfusion Therapy in Anticoagulated Stroke Patients?—Comparable 90-Day Outcomes in a Propensity-Score-Matched Registry Study

by Jessica Seetge, Balázs Cséke, Zsófia Nozomi Karádi, Edit Bosnyák, Eszter Johanna Jozifek and László Szapáry

J. Clin. Med. 2025, 14(22), 8146; https://doi.org/10.3390/jcm14228146 (registering DOI) - 17 Nov 2025

Abstract

Background: The management of acute ischemic stroke (AIS) in anticoagulated patients presents a clinical challenge, as concerns about safety and efficacy often limit access to recanalization therapies. Despite the widespread use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), their impact [...] Read more.

Background: The management of acute ischemic stroke (AIS) in anticoagulated patients presents a clinical challenge, as concerns about safety and efficacy often limit access to recanalization therapies. Despite the widespread use of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), their impact on functional recovery and mortality following intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) remains uncertain. Therefore, this study investigates the association between prior anticoagulation and 90-day outcomes in AIS patients undergoing reperfusion therapy. Methods: We conducted a retrospective cohort analysis using our institutional stroke registry, including AIS patients admitted to the Department of Neurology at our university between February 2023 and 2025. Anticoagulated patients were 1:1 propensity score-matched with non-anticoagulated controls (n = 126 per group) using Mahalanobis distance matching with a caliper, adjusting for age, sex, hypertension, diabetes, stroke severity (National Institutes of Health Stroke Scale [NIHSS] at admission and 72 h), and pre-stroke functional status (pre-morbid modified Rankin Scale [pre-mRS]). Primary endpoints at 90 days were functional independence (modified Rankin Scale [mRS] ≤ 2), mRS-shift, and mortality (mRS = 6). Predictors of outcome were assessed using multivariable logistic regression and generalized additive models (GAMs). Subgroup analyses evaluated the effects of anticoagulation type and treatment modality. Results: Among 866 AIS patients (DOAC n = 100, VKA n = 48, non-anticoagulated n = 718), 426 (49.2%) underwent reperfusion therapy (IVT n = 195, MT n = 163, IVT + MT n = 68). Before matching, anticoagulated patients were less likely to achieve functional independence (34.5% vs. 52.1%, odds ratio [OR] = 0.48, 95% confidence interval [CI] [0.33–0.70], p < 0.001), had a greater mRS-shift (2.53 vs. 1.79, p < 0.001), and higher mortality (30.4% vs. 14.5%, OR = 2.58, 95% CI [1.72–3.88], p < 0.001). However, after matching, these differences were no longer statistically significant. NIHSS, 72hNIHSS, and pre-mRS were the strongest independent predictors of outcome (p < 0.001), while anticoagulation status had no significant effect. Conclusions: Recanalization therapy was not associated with worse functional outcomes in selected anticoagulated AIS patients. These findings suggest that prior anticoagulation alone should not preclude reperfusion therapy in otherwise eligible patients, and underscore the importance of individualized, evidence-based decision-making in acute stroke care. Full article

(This article belongs to the Section Clinical Neurology)

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42 pages, 804 KB

Open AccessReview

The Conundrum of Medical Fracture Prevention in Chronic Kidney Disease—Summary of the Evidence and Pragmatic Clinical Guidance

by Simeon Schietzel and Uyen Huynh-Do

J. Clin. Med. 2025, 14(22), 8145; https://doi.org/10.3390/jcm14228145 (registering DOI) - 17 Nov 2025

Abstract

Fragility fractures are a major complication in chronic kidney disease (CKD), yet therapeutic strategies for their prevention remain highly controversial. The unique pathophysiology of CKD–mineral and bone disorder (CKD-MBD), coupled with the paucity of dedicated clinical trials, create substantial uncertainty regarding the efficacy [...] Read more.

Fragility fractures are a major complication in chronic kidney disease (CKD), yet therapeutic strategies for their prevention remain highly controversial. The unique pathophysiology of CKD–mineral and bone disorder (CKD-MBD), coupled with the paucity of dedicated clinical trials, create substantial uncertainty regarding the efficacy and safety of medical interventions established in the general osteoporosis population. This review summarizes the available evidence regarding fracture risk and bone mineral density including pragmatic clinical guidance for the use of calcium, vitamin D, phosphate binders, calcimimetics, bisphosphonates, denosumab, romosozumab, and teriparatide in patients with advanced non-dialysis CKD, on dialysis, and after kidney transplantation. For calcium, the conflicting balance between skeletal needs and risk of vascular calcification in the setting of declining kidney function and limited evidence for fracture prevention is outlined. For vitamin D, the gap between its widespread clinical use and the inconsistent data on fracture prevention is analyzed including a discussion of target levels in progressive kidney dysfunction. For phosphate binders, the evidence for fracture prevention, showing benefits in dialysis populations, is summarized together with a synthesis of data on potential risks of calcium-based agents. For calcimimetics, the available evidence on their role in fracture prevention, PTH, and calcium control is reviewed. For bisphosphonates, the unresolved question of benefit versus harm in advanced CKD stages are discussed and the evidence regarding efficacy and safety for various clinical settings is disentangled. For denosumab, the current data on fracture prevention is presented with emphasis on its renal-independent pharmacokinetics and strategies to mitigate hypocalcemia and rebound fracture risk. For romosozumab, the promising effects on bone health are reviewed alongside an analysis of cardiovascular safety data. For teriparatide, the limited evidence in patients with low bone turnover disease is evaluated. The review navigates the available evidence and unresolved controversies across therapeutic options, and provides pragmatic guidance to support individualized clinical decision-making. Full article

(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)

13 pages, 444 KB

Open AccessReview

Surgical Treatment for Localized Prostate Cancer: A Narrative Review of Literature

by Vincenzo Salamone, Luca Mazzola, Francesco Lupo Conte, Francesca Conte, Beatrice Giustozzi, Marco Saladino, Daniele Paganelli, Giulia Carli, Filippo Lipparini, Gianni Vittori, Rino Oriti, Matteo Salvi, Luca Lambertini, Fabrizio Di Maida, Andrea Mari, Andrea Minervini and Antonio Andrea Grosso

J. Clin. Med. 2025, 14(22), 8144; https://doi.org/10.3390/jcm14228144 (registering DOI) - 17 Nov 2025

Abstract

Introduction: Surgical management of prostate cancer has evolved significantly over more than a century, transitioning from open procedures to modern robot-assisted techniques. This narrative review traces the historical progression of surgical treatments for localized prostate cancer, from early approaches to the most [...] Read more.

Introduction: Surgical management of prostate cancer has evolved significantly over more than a century, transitioning from open procedures to modern robot-assisted techniques. This narrative review traces the historical progression of surgical treatments for localized prostate cancer, from early approaches to the most recent advancements. Materials and Methods: An extensive literature search was conducted from 1 April to 1 June 2025, using PubMed and cross-referencing citations. The search gathered studies on the evolution of prostate cancer surgery, technical aspects, and comparisons between surgical and non-surgical treatments. Keywords included “PROSTATE CANCER”, “PROSTATE CANCER SURGICAL TREATMENT”, “RADICAL PROSTATECTOMY EVOLUTION”, “ROBOT-ASSISTED RADICAL PROSTATECTOMY”, and “FOCAL THERAPY AND PROSTATE CANCER”. Results: A total of 65 manuscripts, including original articles, systematic reviews, meta-analyses, and clinical trials focusing on the surgical treatment of localized prostate cancer, were selected. The review begins with the history of prostatic surgery, chronicling its evolution through laparoscopic and, ultimately, robotic approaches. It highlights how improved visualization and new technologies have led to better functional outcomes and preservation of structures while maintaining oncological safety. A specific focus is placed on the technical evolution of robot-assisted radical prostatectomy, new robotic platforms, and the role of focal therapy as an ultra-minimally invasive technique for localized disease. Conclusions: Robot-assisted radical prostatectomy represents the current reference surgical technique for localized prostate cancer. However, it is crucial to acknowledge RALP’s elevated cost and the need for further long-term, randomized data to establish definitive oncological equivalence compared to non-surgical options. Full article

(This article belongs to the Special Issue Treatment Strategies for Prostate Cancer: An Update)

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21 pages, 1468 KB

Open AccessArticle

Changes in Speech Intelligibility, Health-Related Quality of Life, Depressive Symptoms, Anxiety, Perceived Stress, and Tinnitus-Induced Distress, in a Cohort of 227 Adults One Year After Cochlear Implantation: A Decade of Experience from a Single Tertiary Center

by Heidi Olze, Moritz Gröschel and Agnieszka J. Szczepek

J. Clin. Med. 2025, 14(22), 8143; https://doi.org/10.3390/jcm14228143 (registering DOI) - 17 Nov 2025

Abstract

Background/Objectives: The purpose of this study was to analyze changes in speech intelligibility, health-related quality of life, and the degree of comorbidities (depressive and anxiety symptoms and tinnitus-related distress) in a large cohort of 227 adults who underwent auditory rehabilitation with a cochlear [...] Read more.

Background/Objectives: The purpose of this study was to analyze changes in speech intelligibility, health-related quality of life, and the degree of comorbidities (depressive and anxiety symptoms and tinnitus-related distress) in a large cohort of 227 adults who underwent auditory rehabilitation with a cochlear implant (CI). The second goal was to identify the factors that influence the health-related quality of life in this cohort. Methods: Pre- and one-year post-CI data were collected on speech intelligibility (Freiburg Monosyllabic Test, FS), subjective hearing ability (Oldenburg Inventory, OI), health-related quality of life (Nijmegen Cochlear Implant Questionnaire, NCIQ), depressive symptoms (General Depression Scale, ADS-L), anxiety (Generalized Anxiety Disorder 7, GAD-7), perceived stress (Perceived Stress Questionnaire, PSQ), and tinnitus-related distress (Tinnitus Questionnaire, TQ). Results: The Wilcoxon matched-pairs signed-rank test showed significant improvements across the entire cohort in speech intelligibility, subjective hearing, and the quality of life. The scores indicating anxiety, depressiveness, perceived stress, and tinnitus-related distress decreased. The Spearman correlation showed that before implantation, quality of life positively related to subjective hearing, while depression, anxiety, stress, and tinnitus distress were negatively correlated. After a year, these links persisted but grew stronger. Regression analyses found subjective hearing (OI) as a positive predictor, and depression (ADS-L) and tinnitus distress (TQ) as negative predictors of life quality, especially in patients with low or median NCIQ scores. Conclusions: In a substantial cohort of adult patients with diverse CI indications, auditory rehabilitation enhances speech intelligibility and subjective hearing, improves health-related quality of life, and reduces the severity of depressive and anxiety symptoms, as well as tinnitus-related distress. Subjective hearing contributes positively to quality of life, whereas depressive symptoms and tinnitus distress negatively impact quality of life in patients with low NCIQ scores post-CI, highlighting the importance of monitoring and psychological intervention. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Cochlear Implantation)

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16 pages, 885 KB

Open AccessArticle

Effect of Mandibular Advancement Device Treatment on the Site-Specific Degree of Upper Airway Collapse During Drug-Induced Sleep Endoscopy

by Eldar Tukanov, Marijke Dieltjens, Annelies E. Verbruggen, Anneclaire V. Vroegop, Johan A. Verbraecken, Paul H. Van de Heyning, Marc J. Braem, Sara Op de Beeck and Olivier M. Vanderveken

J. Clin. Med. 2025, 14(22), 8142; https://doi.org/10.3390/jcm14228142 (registering DOI) - 17 Nov 2025

Abstract

Background: Mandibular advancement device (MAD) therapy is a non-invasive treatment for obstructive sleep apnea (OSA). Although the effect of MAD on OSA outcomes is widely known, its effect on the upper airway collapse degree remains poorly understood. This study aimed to assess the [...] Read more.

Background: Mandibular advancement device (MAD) therapy is a non-invasive treatment for obstructive sleep apnea (OSA). Although the effect of MAD on OSA outcomes is widely known, its effect on the upper airway collapse degree remains poorly understood. This study aimed to assess the impact of MAD therapy on site-specific airway collapse degree during drug-induced sleep endoscopy (DISE). Methods: One hundred participants were recruited and underwent a baseline polysomnography. Overall, 69 participants with OSA (AHI 5–50 events/h) underwent DISE at baseline and with MAD set to 75% of maximal mandibular protrusion. Collapse degree (none, partial, complete) was evaluated at the palate, oropharynx, tongue base, hypopharynx, and epiglottis without and with MAD. Ordinal logistic regression was used to analyze changes in degree of collapse. Results: MAD therapy reduced collapse degree at the palate (OR = 5.92 [3.28; 10.66], p < 0.001), oropharynx (OR = 2.70 [1.48; 4.92], p = 0.001), tongue base (OR = 1.83 [1.32; 2.53], p < 0.001), and hypopharynx (OR = 2.90 [1.53; 5.48, p = 0.001), with no effect at the epiglottis (OR = 0.65 [0.42; 1.02], p = 0.058). Conclusions: MAD therapy reduces upper airway collapse at most anatomical levels, except at the level of the epiglottis. These findings confirm its therapeutic efficacy while underscoring the importance of identifying patients with residual or worsening collapse who may benefit from combined or alternative treatments. Full article

(This article belongs to the Section Respiratory Medicine)

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14 pages, 889 KB

Open AccessArticle

Association Between the Blood Urea Nitrogen-to-Creatinine Ratio Trajectories and Clinical Outcomes in Critically Ill Hemorrhagic Stroke Patients: Insights from MIMIC-IV Database

by Xinyuejia Huang, Huixuan Luo, Hao Deng, Yang Wu, Mengqi Wang, Linglong Xiao, Xiaoman Shi, Wei Pan, Yuan Gao and Wei Wang

J. Clin. Med. 2025, 14(22), 8141; https://doi.org/10.3390/jcm14228141 (registering DOI) - 17 Nov 2025

Abstract

Background: Hemorrhagic stroke (HS) accounts for approximately 30% of all stroke cases and has high mortality in the intensive care unit (ICU). The blood urea nitrogen-to-creatinine ratio (BUNCR) is a potential biomarker of catabolic stress in critically ill patients. Meanwhile, its dynamic prognostic [...] Read more.

Background: Hemorrhagic stroke (HS) accounts for approximately 30% of all stroke cases and has high mortality in the intensive care unit (ICU). The blood urea nitrogen-to-creatinine ratio (BUNCR) is a potential biomarker of catabolic stress in critically ill patients. Meanwhile, its dynamic prognostic value in ICU-admitted HS patients remains unclear. This study utilized Group-based Trajectory Modeling (GBTM) to investigate associations between early BUNCR patterns and mortality. Methods: This study was conducted using data from the MIMIC-IV (v2.2) database. HS cases were identified via ICD-9/10. BUNCR trajectories were assessed by applying GBTM during the first 7 days. Outcomes were all-cause mortality (ACM) on day 28, on day 90, and at 1 year, with ICU and in-hospital mortality also evaluated. Kaplan–Meier survival curves and log-rank test compared survival across groups. Multivariable Cox proportional models adjusted for confounders and subgroup analysis assessed robustness. Results: Among 2559 patients (52.48% male), mortality was 10.16% (ICU), 14.07% (in-hospital), 17.00% (28-day), 22.43% (90-day), and 36.97% (1-year). Three BUNCR trajectories were identified: Group 1 (upward–downward, n = 655), Group 2 (stable upward, n = 1270), and Group 3 (downward–upward, n = 634). Group 2 had the highest ACM risk at 28-day, 90-day, and 1-year (p < 0.01), and was identified as a significant risk factor in multivariate Cox regression. Subgroup revealed significant interactions of BUNCR trajectories with age and sepsis. Conclusions: Distinct BUNCR trajectories were significantly associated with ACM in critically ill HS patients. Persistently increasing BUNCR predicted the poorest outcomes, underscoring its potential as a dynamic biomarker for timely risk stratification and informed ICU decisions. Full article

(This article belongs to the Special Issue Clinical Management and Long-Term Prognosis in Intensive Care)

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11 pages, 389 KB

Open AccessArticle

Impact of Lid Wipes and Tear Substitutes on Symptoms and Signs of Ocular Surface Disease After Cataract Surgery—A Real-Life Study

by Giulia Coco, Laura Antonia Meliante, Francesca Di Stefano, Livio Vitiello and Giuseppe Giannaccare

J. Clin. Med. 2025, 14(22), 8140; https://doi.org/10.3390/jcm14228140 (registering DOI) - 17 Nov 2025

Abstract

Objective: To evaluate the efficacy of lid wipes and tear substitutes, in addition to standard postoperative treatment, in alleviating signs and symptoms of ocular surface disease (OSD) following cataract surgery. Methods: Retrospective study on patients who underwent cataract surgery and received either standard [...] Read more.

Objective: To evaluate the efficacy of lid wipes and tear substitutes, in addition to standard postoperative treatment, in alleviating signs and symptoms of ocular surface disease (OSD) following cataract surgery. Methods: Retrospective study on patients who underwent cataract surgery and received either standard postoperative treatment (topical antibiotics, corticosteroids, and nonsteroidal anti-inflammatory drugs) or the same regimen supplemented with lid wipes and tear substitutes. Preoperatively and one month postoperatively, symptoms were evaluated using the 5-item Dry Eye Questionnaire (DEQ-5) and the Ocular Surface Disease Index (OSDI), while noninvasive keratograph break-up time (NIKBUT), tear meniscus height (TMH), conjunctival hyperemia, and infrared meibography were measured by the Oculus Keratograph. Results: A total of 63 patients (mean age 75.1 ± 6.3 years) were analyzed. Patients receiving standard treatment showed no significant changes in OSDI (+2 ± 32.7; p = 0.859) or DEQ-5 scores (+1.7 ± 5.4; p = 0.204). Conversely, those receiving the adjunct of lid wipes and tear substitutes demonstrated significant improvement in OSDI scores (−19.4 ± 15.9; p < 0.0001), a trend toward improvement in DEQ-5 scores (−1.9 ± 5.5; p = 0.059), and a reduction in the meibography score of the inferior eyelid (−0.24 ± 0.60; p = 0.023). Intergroup comparisons showed significantly greater improvements in both OSDI and DEQ-5 scores in patients receiving treatment for the ocular surface. Multivariate regression analysis confirmed the association between the use of wipes and tear substitutes and improvements in OSDI (p = 0.010) and DEQ-5 scores (p = 0.015). No significant postoperative changes in objective OSD parameters were observed in either group. Conclusions: The addition of lid wipes and tear substitutes to the standard postoperative regimen significantly improved patient-reported symptoms of ocular discomfort after cataract surgery, while no significant changes were observed in objective signs of ocular surface disease. These findings support the routine use of lid wipes and tear substitutes as an effective strategy for managing postoperative ocular surface discomfort. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Dry Eye Disease and Meibomian Gland Dysfunction)

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16 pages, 600 KB

Open AccessReview

Using Active Standing Orthostatic Stress Test to Assess Physiological Responses in Individuals with Long COVID: A Systematic Review

by Faith Olarinde, Albená Nunes-Silva, Diana C. Sanchez-Ramirez, Yannick Molgat-Seon and Rodrigo Villar

J. Clin. Med. 2025, 14(22), 8139; https://doi.org/10.3390/jcm14228139 (registering DOI) - 17 Nov 2025

Abstract

Background/Objectives: Individuals experiencing long COVID (LC) frequently report orthostatic intolerance symptoms, which may be linked to autonomic and cardiovascular dysfunction. The active standing test provides a simple, clinically relevant means to assess these impairments. This systematic review aims to determine the use [...] Read more.

Background/Objectives: Individuals experiencing long COVID (LC) frequently report orthostatic intolerance symptoms, which may be linked to autonomic and cardiovascular dysfunction. The active standing test provides a simple, clinically relevant means to assess these impairments. This systematic review aims to determine the use of the active standing orthostatic stress test in evaluating cardiovascular, autonomic, and respiratory responses in people experiencing LC. Methods: A systematic search, according to PRISMA guidelines, was conducted in PubMed, MEDLINE, EMBASE, CINAHL, and Scopus for articles published between 2020 and 2025. This study was registered in PROSPERO CRD-42024615872. Studies were included if they used the active standing test, enrolled adults (≥18 years), included both long COVID and healthy control groups, used continuous beat-to-beat measurements, and reported physiological outcomes. Risk of bias was assessed using the nine-point Newcastle–Ottawa Scale. Results: Three studies (216 participants experiencing LC and 186 controls) met the inclusion criteria. Across studies, LC individuals consistently exhibited elevated heart rate in both supine and standing positions. However, blood pressure findings were more variable: only one study reported 13% of participants met orthostatic hypotension criteria, while another found significant increases in diastolic blood pressure during standing. Long COVID groups also showed reduced heart rate variability compared to controls. Conclusions: Individuals experiencing LC show elevated heart rate and impaired autonomic function during active standing, with subgroup-specific blood pressure changes. These alterations may contribute to dizziness, fatigue, and reduced activity tolerance. Incorporating active standing into clinical assessment could aid early identification of autonomic dysfunction and inform rehabilitation strategies, though more research is urgently needed. Full article

(This article belongs to the Special Issue Understanding Syncope: Multidisciplinary Approaches to Diagnosis and Management)

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13 pages, 509 KB

Open AccessArticle

What Is the Most Effective Strategy for Acute Postoperative Pain in Total Knee Arthroplasty—Retrospective Observational Study

by Jin Joo, Man Soo Kim, Jeha Lee and Hyun Jung Koh

J. Clin. Med. 2025, 14(22), 8138; https://doi.org/10.3390/jcm14228138 (registering DOI) - 17 Nov 2025

Abstract

Background and Objectives: Effective early postoperative pain control is essential for optimal recovery following total knee arthroplasty (TKA). In addition to pharmacological pain management, the choice of anesthetic agents and surgical technique can significantly impact postoperative outcomes. Remimazolam and robotic-assisted TKA (RA-TKA) have [...] Read more.

Background and Objectives: Effective early postoperative pain control is essential for optimal recovery following total knee arthroplasty (TKA). In addition to pharmacological pain management, the choice of anesthetic agents and surgical technique can significantly impact postoperative outcomes. Remimazolam and robotic-assisted TKA (RA-TKA) have recently gained attention due to their potential advantages. This study aims to evaluate the effects of remimazolam and RA-TKA on acute postoperative pain compared with conventional TKA (C-TKA) and standard anesthetic protocols. Materials and Methods: In this retrospective observational study, 460 patients undergoing elective unilateral TKA were divided in to four groups based on surgical technique and anesthetic agents; RA-TKA with remimazolam (Group RR, n = 115), C-TKA with remimazolam (Group CR, n = 134), RA-TKA with conventional anesthesia (Group RC, n = 79), and C-TKA with conventional anesthesia (Group CC, n = 152). Remimazolam was administered at 6 mg/kg/h for induction and 1 mg/kg/h for maintenance, whereas conventional anesthesia was induced with propofol (1.5 mg/kg) and maintained with sevoflurane (1.5~2.0 vol%). The primary endpoint was acute postoperative pain, assessed via patient-controlled analgesia (PCA) consumption and supplemental analgesic use on the day of surgery. Secondary endpoints included total PCA consumption and additional analgesic use during the first 72 h, recovery room stay, discharge scores, and the incidence of postoperative nausea and vomiting (PONV). Results: Group RR required significantly fewer additional analgesics on the day of surgery than the other groups. Although group RR and group CR exhibited prolonged recovery room stay and lower discharge scores, these outcomes were not correlated with PCA consumption or supplementary analgesic use. RA-TKA was associated with approximately a 31% reduction in additional analgesic use compared with C-TKA, indicating a major contribution of the surgical technique to early postoperative pain control. Remimazolam alone did not demonstrate an independent effect on acute pain management. Conclusions: RA-TKA combined with remimazolam significantly reduced the need for additional analgesics on the day of surgery, highlighting a synergistic effect of the anesthetic and surgical approach. These findings support RA-TKA with remimazolam as an effective strategy for managing early postoperative pain following TKA. Full article

(This article belongs to the Special Issue Advances in Clinical Anesthesia and Analgesia: Novel Approaches for Optimal Patient Safety and Comfort)

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3 pages, 158 KB

Open AccessEditorial

Machine Learning and Artificial Intelligence in Clinical Medicine—Trends, Impact, and Future Directions

by Emmanuel Andrès, Carlos Escobar and Kent Doi

J. Clin. Med. 2025, 14(22), 8137; https://doi.org/10.3390/jcm14228137 (registering DOI) - 17 Nov 2025

Abstract

Over the past decade, the integration of machine learning (ML) and artificial intelligence (AI) into clinical medicine has accelerated dramatically, reshaping the ways in which clinicians collect, analyze, and interpret health data [...] Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Clinical Medicine)

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