Journal of Clinical Medicine

14 pages, 1435 KB

Open AccessArticle

Compliance with Home-Based Prehabilitation and Length of Stay After Total Hip Arthroplasty: A Prospective Cohort Study

by Paweł Hereć, Jakub Mazur, Robert Fiut, Weronika Wasyluk, Alicja Wójcik-Załuska and Jacek Gągała

J. Clin. Med. 2026, 15(10), 3898; https://doi.org/10.3390/jcm15103898 (registering DOI) - 19 May 2026

Abstract

Background/Objectives: Patients awaiting total hip arthroplasty (THA) may have a preoperative period for home-based exercise. However, the benefit of prehabilitation may depend on programme completion. This study assessed the association between compliance with home-based prehabilitation and postoperative course after THA, particularly hospital stay [...] Read more.

Background/Objectives: Patients awaiting total hip arthroplasty (THA) may have a preoperative period for home-based exercise. However, the benefit of prehabilitation may depend on programme completion. This study assessed the association between compliance with home-based prehabilitation and postoperative course after THA, particularly hospital stay and self-assessed health status at discharge, and explored associations between compliance and changes in clinical and functional outcomes. Methods: In this prospective single-centre observational cohort pilot study, 40 adults scheduled for elective THA were included in a planned 60-day home-based prehabilitation programme as standard preoperative care. Assessments were performed before prehabilitation, preoperatively, and at discharge. Compliance was recorded using a daily checklist and expressed as a compliance index. Associations were analysed using non-parametric tests and Spearman correlation. Results: Median compliance index was 32.41%. Higher compliance was observed in participants reporting improvement or marked improvement at discharge than in those reporting slight improvement or no improvement (p = 0.0076). Compliance was inversely correlated with postoperative length of stay, median 6 days (rho = −0.593, p < 0.001). Compliance was lower in participants who reported pain during exercise (p = 0.0127). No significant associations were found between compliance and postoperative symptoms or changes in hip muscle strength, mechanical muscle properties, pain intensity, or functional test performance between baseline and preoperative assessments. Conclusions: Greater compliance with home-based prehabilitation was associated with shorter postoperative hospitalization and more favorable self-assessed health status at discharge. These findings support strategies to improve programme completion and minimize exercise-related pain. Full article

(This article belongs to the Special Issue Advanced Approaches in Hip and Knee Arthroplasty)

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14 pages, 2113 KB

Open AccessArticle

Temporomandibular Disorder-like Pain in Parkinson’s Disease Is Associated with Motor Symptom Severity and Disability Levels

by Nontawat Chuinsiri, Krittima Rungrattrakul, Piyamitr Mungngam, Prachnasatee Hongboon, Ratchaphon Phromrueangrit, Natthapol Thinsathid and Sarawut Suksuphew

J. Clin. Med. 2026, 15(10), 3897; https://doi.org/10.3390/jcm15103897 (registering DOI) - 19 May 2026

Abstract

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterised by motor and non-motor symptoms, including pain. Temporomandibular disorder (TMD)-like pain, defined as self-reported pain modified by jaw activities, has been suggested to be more prevalent in PD, but its association with [...] Read more.

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterised by motor and non-motor symptoms, including pain. Temporomandibular disorder (TMD)-like pain, defined as self-reported pain modified by jaw activities, has been suggested to be more prevalent in PD, but its association with PD severity remains unclear. This study aimed to investigate the association between pain modified by jaw activities and PD severity and the temporal stability of such pain in PD. Methods: This prospective study recruited 28 individuals with PD. Motor symptom severity and disability levels were evaluated using the modified Hoehn and Yahr (mHY) staging and modified Rankin Scale (mRS), respectively. Based on the diagnostic criteria for TMD, a questionnaire assessing pain modified by jaw activities and clinical examination were utilised. Pain modified by jaw activities was reassessed at one, two, and three months. Statistical analyses included Spearman’s rank correlation test and Friedman test, with p < 0.05 considered significant. Results: The participants’ mean age was 69.2 ± 9.6 years; 53.6% were male. Eight participants reported pain modified by jaw activities. Clinical examination identified painful palpation sites in 14 participants, most commonly in the masseter muscle body. Pain modified by jaw activity count showed significant positive correlations with mHY stage (rho = 0.48, p = 0.015) and mRS score (rho = 0.41, p = 0.04). Twenty-four participants completed follow-up, with no significant changes in pain reports over three months. Conclusions: Some individuals with PD may experience persistent TMD-like pain, which is correlated with motor symptom severity and disability levels, highlighting the importance of routine TMD screening in PD. Full article

(This article belongs to the Special Issue Musculoskeletal Pain: Clinical Management Updates)

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10 pages, 205 KB

Open AccessArticle

The Quality of AI-Generated CABG Counseling: A Blinded Comparison of Two Language Models

by Alper Özbakkaloğlu, Ömer Faruk Rahman, Ercan Keleş, Ahmet Daylan, Dağlar Cansu and Şahin Bozok

J. Clin. Med. 2026, 15(10), 3896; https://doi.org/10.3390/jcm15103896 (registering DOI) - 19 May 2026

Abstract

Objectives: Coronary artery bypass grafting (CABG) remains a fundamental surgical treatment for advanced coronary artery disease. With the increasing use of large language models to obtain health information, patients are increasingly turning to these systems to understand surgical options. However, their performance in [...] Read more.

Objectives: Coronary artery bypass grafting (CABG) remains a fundamental surgical treatment for advanced coronary artery disease. With the increasing use of large language models to obtain health information, patients are increasingly turning to these systems to understand surgical options. However, their performance in generating patient-oriented CABG information has not been sufficiently evaluated. Therefore, this study aimed to compare the responses generated by ChatGPT and DeepSeek-R1 to patient questions about CABG in terms of scientific accuracy, comprehensibility, and level of unnecessary detail. Methods: Forty patient-oriented questions were developed based on online sources and clinical experience. Responses were obtained from ChatGPT and DeepSeek under standardized conditions. A blinded panel of four cardiovascular surgeons evaluated the responses using a five-point Likert scale across three domains. Statistical analyses were performed using paired tests. Results: DeepSeek generated significantly longer responses than ChatGPT (212.88 ± 48.13 vs. 188.7 ± 50.34 words; p < 0.001). Accuracy scores were higher for DeepSeek (median 4.5 vs. 4.25; p = 0.004), whereas comprehensibility and unnecessary detail scores were similar between the models. Overall scores were high for both models (4.32 ± 0.28 vs. 4.27 ± 0.30; p = 0.34). Conclusions: The responses generated by both models were generally evaluated favorably by the expert panel, with only limited differences observed between them. DeepSeek demonstrated higher accuracy, whereas ChatGPT tended to produce shorter and more concise responses. However, given the variability observed at the individual-question level, these findings should be interpreted with caution. Large language models may support patient information delivery but should not be considered reliable stand-alone sources for clinical decision-making or patient counseling. Full article

(This article belongs to the Special Issue Coronary Artery Disease in the Era of Artificial Intelligence: Clinical Insights and Therapeutic Challenges)

17 pages, 529 KB

Open AccessArticle

Enhanced Recovery Pathway and Postoperative Ileus After Elective Minimally Invasive Colorectal Surgery

by Codruta Craciun, Jenel Marian Patrascu, Jr., Danut Dejeu, Ana-Maria Davidoiu-Salavastru, Adrian Cosmin Ilie, Patricia Octavia Mazilu, Lavinia Craciun and Stelian Pantea

J. Clin. Med. 2026, 15(10), 3895; https://doi.org/10.3390/jcm15103895 (registering DOI) - 19 May 2026

Abstract

Background: Postoperative ileus (POI) remains a leading driver of delayed recovery and prolonged length of stay (LOS) after colorectal surgery. Although ERAS is well established, less is known about how pathway adherence and implementation fidelity relate to bowel recovery in pragmatic minimally invasive [...] Read more.

Background: Postoperative ileus (POI) remains a leading driver of delayed recovery and prolonged length of stay (LOS) after colorectal surgery. Although ERAS is well established, less is known about how pathway adherence and implementation fidelity relate to bowel recovery in pragmatic minimally invasive practice. Objectives: To evaluate whether a structured ERAS pathway, delivered in routine care, was associated with lower POI and improved early recovery compared with contemporaneous standard care after elective minimally invasive colorectal surgery. Methods: In a prospective, non-randomized pragmatic comparative study conducted from January 2022 to September 2024, 123 adults undergoing elective laparoscopic colorectal resection were managed with either an ERAS pathway (n = 62) or standard care (n = 61). POI was operationalized prospectively using predefined clinical criteria and daily team assessment. Primary outcome was POI. Secondary outcomes included time to flatus, LOS, 48 h opioid use (morphine milligram equivalents, MME), complications (Clavien–Dindo), 30-day readmission, and Quality of Recovery (QoR-15). Multivariable logistic regression and propensity score–adjusted sensitivity analyses were performed to address baseline imbalance. Results: POI occurred in 7/62 (11.3%) in ERAS vs. 22/61 (36.1%) in standard care (p = 0.002). ERAS patients had earlier flatus (38.6 ± 15.2 h vs. 60.0 ± 20.1 h, p < 0.001), shorter LOS (4.2 [3.4–5.0] vs. 5.4 [4.5–6.8] days, p < 0.001), lower 48 h opioids (35.4 [25.2–47.8] vs. 61.1 [41.5–88.6] MME, p < 0.001), and higher QoR-15 at POD2 (113.9 ± 14.9 vs. 104.8 ± 15.5, p = 0.001). In the primary multivariable model, ERAS was independently associated with lower POI odds (adjusted OR 0.2; 95% CI 0.1–0.7; p = 0.013); the association remained directionally similar in propensity-adjusted sensitivity analysis (adjusted OR 0.31; 95% CI 0.12–0.79; p = 0.015). Higher adherence was associated with lower POI and lower opioid exposure. Conclusions: In this prospective cohort, ERAS implementation was associated with lower POI incidence and faster early recovery; however, findings should be interpreted as observational and hypothesis-generating rather than causal. Full article

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

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19 pages, 1206 KB

Open AccessArticle

The Impact of Aspirin Use on In-Hospital Outcomes and Metastatic Disease in Colorectal Cancer: An Evaluation of the National Inpatient Sample

by Omar A. Oudit, Temitayo Adebowale, Abdulrahman Atasi, Kibwey Peterkin, Jamal Perry, Chidiebele E. Omaliko and Jamil Shah

J. Clin. Med. 2026, 15(10), 3894; https://doi.org/10.3390/jcm15103894 (registering DOI) - 18 May 2026

Abstract

Background: Aspirin, initially recognized for its anti-inflammatory, antipyretic and analgesic properties, holds a prominent role in the treatment of cardiovascular disease. The utility of aspirin in cancer therapeutics has been explored and stratified into COX-dependent and -independent mechanisms. COX2 gene expression has [...] Read more.

Background: Aspirin, initially recognized for its anti-inflammatory, antipyretic and analgesic properties, holds a prominent role in the treatment of cardiovascular disease. The utility of aspirin in cancer therapeutics has been explored and stratified into COX-dependent and -independent mechanisms. COX2 gene expression has been demonstrated to be significantly upregulated in colorectal cancer and various other gastrointestinal malignancies including pancreatic, esophageal, and gastric cancer. This study investigates the relationship of aspirin use and outcomes in patients with colorectal cancer. Methods: The Nationwide Inpatient Sample (NIS) database from 2017 to 2022 was analyzed for patients age > 18 who were hospitalized for colorectal cancer and its decompensations using ICD-10 diagnostic codes. These patients were further stratified based on the long-term use of aspirin. The principal outcome of this investigation are the odds of in-hospital mortality, with secondary outcomes including odds of pulmonary embolism, portal vein thrombosis, acute kidney injury, septic shock, requiring an ICU level of care and odds of hepatic, pulmonary, gastrointestinal and peritoneal or retroperitoneal metastatic disease. Multivariate logistic regression accounting for hospital and patient characteristics was implemented for analysis, with the Charlson Comorbidity Index used to adjust for coexisting comorbidity burden; a p-value (p) of <0.05 was considered statistically significant. Results: In our analysis of the NIS, 596,160 patients were identified with colorectal cancer and 11.7% (69,750) of this population were identified with long-term use of aspirin. Aspirin use was identified to have a significantly reduced odds of in-patient mortality (adjusted odds ratio) [aOR] 0.530, p value < 0.001 95% CI (confidence interval): 0.460–0.617. Patients with aspirin use also demonstrated significantly reduced odds of adverse outcomes and gastrointestinal, hepatic, pulmonary and retroperitoneal/peritoneal metastasis; (aOR 0.606, 95% CI: 0.564–0.653, p < 0.001), (aOR 0.628, 95% CI: 0.582–0.678, p < 0.001), (aOR 0.676, 95% CI: 0.605–0.755, p < 0.001) and (aOR 0.751, 95% CI: 0.685–0.825, p < 0.001) respectively. Conclusions: In recent years, there has been an alarming increase in incidence of colorectal cancer, particularly amongst younger individuals with increased associated mortality. This mortality increase, albeit alarming, is a driving force for treatment innovation with continual examination of our repertoire of medications for possible repurposed applications. COX2-mediated signaling serves as a key promotor of tumorigenic molecular signaling that directly contributes to tumor cell proliferation, angiogenesis and metastasis in colorectal cancer. Aspirin use and its inhibitory action on COX2 demonstrated a significantly reduced odds of in-hospital mortality. Aspirin use is also associated with significantly reduced odds of developing metastatic disease to the liver, gastrointestinal system, lungs and peritoneum in patients with colorectal cancer. These findings convey that aspirin use reduces the likelihood of in-hospital mortality, major comorbid conditions and of developing metastatic disease as compared to those who do not use aspirin. Full article

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

18 pages, 1095 KB

Open AccessReview

EUS-Anchored Multimodal Evaluation of Pancreatic Cystic Lesions: Toward a Conceptual Diagnostic Framework

by Enshuo Liu and Fei Yang

J. Clin. Med. 2026, 15(10), 3893; https://doi.org/10.3390/jcm15103893 (registering DOI) - 18 May 2026

Abstract

Pancreatic cystic lesions (PCLs) represent a growing clinical challenge due to their diverse biological behaviors and the substantial overlap in imaging features between benign, premalignant, and malignant entities. Traditional diagnostic approaches relying on cross-sectional imaging or isolated morphologic criteria frequently fail to achieve [...] Read more.

Pancreatic cystic lesions (PCLs) represent a growing clinical challenge due to their diverse biological behaviors and the substantial overlap in imaging features between benign, premalignant, and malignant entities. Traditional diagnostic approaches relying on cross-sectional imaging or isolated morphologic criteria frequently fail to achieve adequate risk discrimination. Advances in endoscopic ultrasound (EUS) now permit detailed morphologic assessment complemented by cyst-fluid biochemical markers, proteomic signatures, and comprehensive genomic profiling using next-generation sequencing. Parallel progress in artificial intelligence (AI) further strengthens diagnostic precision by integrating EUS features with multimodal biomarker data to reduce subjectivity and support individualized clinical decision-making. This review introduces an EUS-based multimodal diagnostic framework of PCLs that integrates morphological evaluation, cyst-fluid biochemical testing, molecular profiling, and AI-assisted analysis. By synthesizing current evidence, we outline how the integrative approach enhances diagnostic accuracy, biological interpretability, and individualized risk stratification for PCLs. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Management of Pancreatobiliary Disorders—2nd Edition)

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14 pages, 471 KB

Open AccessSystematic Review

Functional Biomechanical Tests of the Foot and Ankle in Physiotherapy and Sports—Outcome Measures, Wearable Sensor Integration, and Psychometric Properties: A Systematic Review

by Guna Semjonova, Rodrigo Vallejo-Martínez, Luis Ceballos-Laita, Sandra Jiménez-del-Barrio, Sergejs Davidovics and Anna Davidovica

J. Clin. Med. 2026, 15(10), 3892; https://doi.org/10.3390/jcm15103892 - 18 May 2026

Abstract

Objectives: To systematically synthesize existing evidence on functional biomechanical tests of the foot and ankle in physiotherapy and sports, focusing on their outcome measures, compatibility with wearable sensor technologies, and psychometric properties. Methods: We performed a systematic review (PRISMA-guided) of PubMed, [...] Read more.

Objectives: To systematically synthesize existing evidence on functional biomechanical tests of the foot and ankle in physiotherapy and sports, focusing on their outcome measures, compatibility with wearable sensor technologies, and psychometric properties. Methods: We performed a systematic review (PRISMA-guided) of PubMed, Web of Science, PEDro, and SPORTDiscus from inception to December 2025. Eligible studies evaluated functional foot/ankle biomechanics in athletes, healthy adults, or adults with musculoskeletal foot/ankle conditions using wearable sensors (e.g., IMUs, wireless pressure insoles). Two reviewers independently screened, extracted data, and appraised methodological quality using the COSMIN Risk of Bias tool, applying property-specific ratings. Heterogeneity precluded meta-analysis; findings were narratively synthesized and tabulated. Results: Twenty full texts were reviewed; four studies (n = 83 participants) met the inclusion criteria. Wearable devices included foot- or trunk-mounted IMUs and wireless pressure insoles. Reported outcomes spanned temporal gait events and inner-stance phases, vertical ground reaction force (vGRF) and centre-of-pressure trajectories, running step rate/stride length, and jump counts in competition. Validity was most frequently assessed: foot-worn IMUs showed millisecond-level agreement with in-shoe pressure references for stance and inner-stance events; pressure insoles demonstrated acceptable agreement with force plates for vGRF/COP alongside fair-to-excellent test–retest reliability; foot- vs. shank-mounted IMUs provided strong agreement for running step rate and stride length; and competition-based jump detection using IMUs achieved high sensitivity. Across studies, reliability indices were inconsistently reported, measurement error (SEM/MDC) was sparse, and MCID was not reported. The COSMIN appraisal ranged from very good/adequate to inadequate, driven primarily by small sample sizes, non-gold-standard comparators, and incomplete psychometric reporting. Full article

(This article belongs to the Special Issue Physiotherapy and Therapeutic Exercise in Modern Clinical Practice)

18 pages, 3928 KB

Open AccessArticle

Evaluating the Tissue Optical Perfusion Pressure Method in Diabetic Patients with and Without Media Arterial Calcification

by Igli Kalaja, Max Maria Meertens, Volker Hubert Schmitt, Birgit Linnemann, Gerhard Weißer, Melanie Schwaderlapp, Sarah Schneider, Leoni Hoffmann and Christine Espinola-Klein

J. Clin. Med. 2026, 15(10), 3891; https://doi.org/10.3390/jcm15103891 - 18 May 2026

Abstract

Background: The ankle-brachial index (ABI) is a popular method for evaluating peripheral artery disease (PAD). However, it is unreliable in patients with diabetes mellitus (DM), particularly in cases of media arterial calcification (MAC), where falsely elevated or unreliable values may be produced. [...] Read more.

Background: The ankle-brachial index (ABI) is a popular method for evaluating peripheral artery disease (PAD). However, it is unreliable in patients with diabetes mellitus (DM), particularly in cases of media arterial calcification (MAC), where falsely elevated or unreliable values may be produced. The toe-brachial index (TBI) is therefore recommended in such cases, but has its limitations. The tissue optical perfusion pressure (TOPP) method is another automated diagnostic protocol combining oscillometric ABI measurement (oABI) and photo-plethysmographic pulse-wave assessment using the pulse wave index (PWI). The study evaluated TOPP-derived parameters in diabetic patients with or without MAC, in comparison with established functional vascular examinations. Methods: PAD patients with DM presenting in our outpatient clinic were enrolled prospectively from January to August 2024. Patients with peripheral bypasses or deemed unsuitable for the TOPP method were excluded. All patients received an ABI, TBI and TOPP measurement. Results: A total of 107 patients with DM were included in the present study. 38 patients presented with MAC and 69 patients without. The majority were male. Most patients presented with claudication (20 Fontaine stage IIa, 30 stage IIb), 9 presented with rest pain (Fontaine stage III), and 31 with wounds (Fontaine stage IV). 17 patients were free of symptoms (Fontaine stage I). The two parameters of the TOPP method, oABI and PWI, both correlated with the TBI and ABI. In patients with MAC, the oABI did not correlate with any other measurement, but the PWI did weakly correlate with the TBI. MAC is an important factor in influencing measurement accuracy. Despite their limitations, the TBI showed a significant correlation to the clinical symptoms (correlation coefficient = −0.387, p < 0.001). Conclusions: In patients without MAC, oABI and PWI correlated with ABI and TBI. TBI was the most reliable parameter in those with MAC. PWI correlated with TBI, but the correlation was weak. TBI should not be replaced by PWI. PWI may provide complementary information in a diagnostic protocol. oABI did not correlate with clinical symptom severity in DM patients, independently of the presence of MAC, and is unsuitable as a stand-alone parameter. A combination of TBI and TOPP-derived parameters may help to assess the severity of peripheral artery disease in diabetic patients with MAC. Larger multicentre studies are required. Full article

(This article belongs to the Topic Diabetic Foot Disease: Current Challenges, Emerging Concepts and Future Directions)

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14 pages, 823 KB

Open AccessArticle

Comparison of Long-Term Oncological Outcomes of Intravesical Bacillus Calmette–Guérin Versus Gemcitabine in Treatment-Naïve Non-Muscle-Invasive Bladder Cancer with Intermediate and High Risk: A Multicenter Retrospective Analysis

by Kyung Hwan Kim, Byeong Jin Kang, Chan Ho Lee, Soodong Kim, Ja Yoon Ku and Hong Koo Ha

J. Clin. Med. 2026, 15(10), 3890; https://doi.org/10.3390/jcm15103890 - 18 May 2026

Abstract

Background/Objectives: Although intravesical Bacillus Calmette–Guérin (BCG) is an established adjuvant therapy for non-muscle-invasive bladder cancer (NMIBC), chronic global shortages and adverse events (AEs) can occur. Thus, intravesical gemcitabine has been used as an alternative. We compared the long-term oncological outcomes and safety profiles [...] Read more.

Background/Objectives: Although intravesical Bacillus Calmette–Guérin (BCG) is an established adjuvant therapy for non-muscle-invasive bladder cancer (NMIBC), chronic global shortages and adverse events (AEs) can occur. Thus, intravesical gemcitabine has been used as an alternative. We compared the long-term oncological outcomes and safety profiles of BCG and gemcitabine in treatment-naïve patients with intermediate- and high-risk NMIBC. Methods: Patients with intermediate- and high-risk NMIBC (n = 477) received adjuvant intravesical induction and maintenance therapy with intravesical BCG (n = 361) or gemcitabine (n = 116) and their data were collected retrospectively. Results: Compared with the gemcitabine group, the BCG group had significantly higher proportions of patients with T1 stage, high-grade tumors, high-risk tumors, and longer median follow-up duration. Over a median 36-month observation period, the BCG group exhibited significantly better recurrence-free survival (RFS) and high-grade RFS (HG-RFS) than the gemcitabine group. In the propensity score–matched high-risk population, BCG also outperformed gemcitabine in RFS and HG-RFS. BCG therapy was identified as a potent protective predictor, reducing the risk of recurrence and high-grade recurrence by 65% and 66%, respectively, in the total cohort, and by 69% and 71%, respectively, in the propensity score-matched high-risk subgroup. No significant differences were observed in the frequency of grade ≥3 AEs between BCG and gemcitabine. Conclusions: Intravesical BCG is strongly associated with superior oncological outcomes over gemcitabine in intermediate- and high-risk NMIBC. The results of this study offer pivotal practice-based insights to guide clinical strategies for managing NMIBC. Full article

(This article belongs to the Section Nephrology & Urology)

13 pages, 7312 KB

Open AccessArticle

Uncommon Presentations of Endometriosis: Clinicopathological Features of Abdominal Wall and Extrapelvic Lesions

by Ismet Hortu, Mert Acar, Cagdas Sahin, Ali Akdemir, Levent Akman, Fatih Sendag and Murat Ulukus

J. Clin. Med. 2026, 15(10), 3889; https://doi.org/10.3390/jcm15103889 - 18 May 2026

Abstract

Background/Objectives: Abdominal wall and extrapelvic endometriosis are uncommon entities that may mimic other surgical conditions and delay diagnosis. This study evaluated their clinicopathological, diagnostic, and surgical features in a single-center case series. Methods: This retrospective study included 29 patients with histopathologically [...] Read more.

Background/Objectives: Abdominal wall and extrapelvic endometriosis are uncommon entities that may mimic other surgical conditions and delay diagnosis. This study evaluated their clinicopathological, diagnostic, and surgical features in a single-center case series. Methods: This retrospective study included 29 patients with histopathologically confirmed abdominal wall or extrapelvic endometriosis treated at a tertiary referral center between 2009 and 2025. Demographic and clinical characteristics, surgical history, CA-125 levels, imaging findings, lesion size, and surgical features were analyzed. Abdominal wall cases were further evaluated based on the presence of muscle or fascial invasion. Results: Abdominal wall lesions comprised 93.1% of cases, while extrapelvic lesions (6.9%) were all vaginal. Most cases had a history of cesarean section; however, one patient had no prior abdominal surgery, consistent with spontaneous disease, with concomitant endometrioma and deep infiltrating endometriosis. Muscle or fascial invasion was observed in 63.0% of cases. Both CA-125 levels (p = 0.005) and CA-125 positivity (≥35 U/mL) (p = 0.029) were significantly higher in patients with invasion. Cyclic symptoms were present in 89.7% of patients, and mesh repair was required in two cases with large lesions. Conclusions: Abdominal wall endometriosis should be suspected in patients with cyclic pain or swelling at surgical sites, particularly after cesarean delivery, although it may occur without prior surgery. Deep muscle and fascial invasion may be associated with elevated CA-125 levels and increased CA-125 positivity, sometimes requiring wider excision and mesh repair. These findings may support earlier diagnosis and surgical planning. Full article

(This article belongs to the Section Obstetrics & Gynecology)

13 pages, 382 KB

Open AccessArticle

Branched Endovascular Aneurysm Repair (BEVAR) to Rescue Failed Complex EVAR (C-EVAR): Technical Challenges and Outcomes in a 12-Case Series

by Marco Virgilio Usai, Blanca Expósito-Camacho, Philipp Franke, Imam T. P. Ritonga, Jorge Balaguer-Germán and Martin J. Austermann

J. Clin. Med. 2026, 15(10), 3888; https://doi.org/10.3390/jcm15103888 - 18 May 2026

Abstract

Background: Complex EVAR is a well-established option for treating complex aortic pathologies. However, depending on the type of it, long-term effectiveness is often compromised. For example, chimney EVAR is related to type IA endoleaks related to the gutter and proximal neck degeneration, late [...] Read more.

Background: Complex EVAR is a well-established option for treating complex aortic pathologies. However, depending on the type of it, long-term effectiveness is often compromised. For example, chimney EVAR is related to type IA endoleaks related to the gutter and proximal neck degeneration, late failures after fenestrated or branched EVAR are rare. Although redo-endovascular procedures are recommended for failed repairs, the use of branched endoprostheses (BEVAR) to address failed Complex EVAR (C-EVAR) cases is rarely documented. This study aims to evaluate the technical feasibility and 30-day outcomes of using BEVAR as a definitive rescue strategy for these patients. Methods: A retrospective single-center analysis was conducted on a series of twelve patients who had previously undergone failed C-EVAR. Clinical and procedure-related variables were collected. Statistical analysis was performed using Stata v18.0 software. Results: The reasons for reintervention were type Ia endoleak (ten patients), type Ib (one patient), and type III + Ia (one patient). Branched devices were used: eleven patients received the Zenith t-Branch (Cook Medical, Bloomington, IN, USA), and one received the G-Branch device (Lifetech Scientific, Shenzhen, China). Technical and clinical success was achieved in 11 out of 12 patients (91.7%). One perioperative death (due to haemothorax and sepsis) and three major complications were recorded in the first 30 days following repair. No patient of this cohort was deemed fit enough for open conversion. Imaging follow-up at 30 days revealed two type I leaks and seven type II leaks, with no type III leaks recorded. Patency was maintained in all treated visceral vessels (the celiac trunk, the superior mesenteric artery, and the renal arteries) in survivors. Conclusions: Repairing failed C-EVAR using branched endovascular aneurysm repair is a feasible and effective technique. This approach can resolve complex issues such as proximal sealing and component integrity failures, successfully excluding the aneurysmal sac while avoiding the morbidity and mortality associated with open surgery in high-risk patients. Full article

(This article belongs to the Special Issue Aortic Aneurysms: Recent Advances in Diagnosis and Treatment)

14 pages, 543 KB

Open AccessArticle

Salvage Posterior C1–C2 Fusion for Odontoid Nonunion After Failed Nonoperative Management: A Propensity Score-Matched Comparison with Primary Fusion

by Sapan Patel, Hershil A. Patel, Rohan I. Suresh, Jake Carbone, Gerald Kidd, Abel K. Lindley, Ethan Yang, Antoan Koshar, Ryan Curto, Husni Alasadi, Usman Zareef, Evan Honig, Alexander Padovano, Louis Bivona, Daniel Cavanaugh, Eugene Koh, Steven C. Ludwig and Julio J. Jauregui

J. Clin. Med. 2026, 15(10), 3887; https://doi.org/10.3390/jcm15103887 - 18 May 2026

Abstract

Background/Objectives: Posterior C1–C2 fusion is commonly used for unstable traumatic odontoid injuries, but it is less commonly used for patients who initially undergo nonoperative management and later require salvage fusion. This study compared hospital length of stay, short-term complications, and postoperative radiographic [...] Read more.

Background/Objectives: Posterior C1–C2 fusion is commonly used for unstable traumatic odontoid injuries, but it is less commonly used for patients who initially undergo nonoperative management and later require salvage fusion. This study compared hospital length of stay, short-term complications, and postoperative radiographic alignment between salvage posterior C1–C2 fusion after failed nonoperative management and primary posterior C1–C2 fusion. Materials and Methods: A retrospective cohort study was performed of 106 adult patients who underwent posterior C1–C2 instrumented fusion for traumatic cervical spine injuries from 2011 to 2023. Patients were stratified into the salvage fusion group after radiographic nonunion following attempted nonoperative management with external immobilization or the primary fusion group, who underwent initial surgical management. The primary outcome was hospital length of stay. Secondary outcomes included postoperative radiographic alignment, screw loosening, hardware failure, revision surgery, and 30-day emergency department visits. Propensity score matching and full-cohort augmented inverse probability weighting were used to account for baseline differences between groups. Results: Twenty-seven patients underwent salvage fusion and 79 underwent primary fusion. Propensity score matching produced 25 matched pairs. In the matched cohort, salvage fusion was associated with significantly shorter length of stay than primary fusion, with a median of 2 versus 5 days, respectively (p < 0.001). This remained significant in the full-cohort augmented inverse probability weighting analysis, where salvage fusion was associated with a 2.41-day reduction in length of stay (95% CI, −3.63 to −1.19; p < 0.001). Short-term complications were uncommon in both groups, and no clear sign of increased screw loosening, hardware failure, revision surgery, or 30-day emergency department visits was observed in the salvage cohort. Salvage fusion was also associated with lower postoperative C2–C7 lordosis and a greater C1 lamina–occiput distance. Conclusions: Salvage posterior C1–C2 fusion for radiographic nonunion after attempted nonoperative management was not associated with higher short-term complication rates compared with primary fusion. While surgical-admission length of stay was shorter in the salvage cohort, this difference should be interpreted cautiously because salvage and primary fusion occur in different admission contexts and do not reflect the total episode-of-care burden. Early postoperative alignment differences were observed, but these were not correlated with clinical outcomes or longitudinal imaging, and their long-term significance remains unclear. Future multicenter studies should evaluate total healthcare utilization, fusion status, longitudinal alignment, and patient-reported outcomes after salvage C1–C2 fusion. Full article

(This article belongs to the Special Issue Advances in the Management of Cervical Spine Trauma)

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23 pages, 427 KB

Open AccessSystematic Review

Association Between E-Cigarette Use (Vaping) and Oral Health in Adolescents and Young Adults: A Systematic Review

by Carmen Machuca-Portillo, Carolina Caleza-Jiménez, Cira Suárez-Marchena, Lucy Chandler-Gutiérrez, Pablo Relimpio-Pérez, María José Barra-Soto, Lydia López-del Valle and Juan J. Segura-Egea

J. Clin. Med. 2026, 15(10), 3886; https://doi.org/10.3390/jcm15103886 - 18 May 2026

Abstract

Background: Vaping has become one of the most prevalent risk behaviors among adolescents and young adults worldwide. Although electronic cigarettes (ECs) are often perceived as safer than conventional tobacco, concerns regarding their impact on oral health are increasing. This systematic review aimed to [...] Read more.

Background: Vaping has become one of the most prevalent risk behaviors among adolescents and young adults worldwide. Although electronic cigarettes (ECs) are often perceived as safer than conventional tobacco, concerns regarding their impact on oral health are increasing. This systematic review aimed to critically evaluate and synthesize the available evidence regarding the association between e-cigarette use and oral health outcomes in adolescents and young adults. Methods: A systematic search of PubMed/MEDLINE, EMBASE, Scopus, and EBSCOhost databases was conducted for observational studies published within the last ten years. Studies evaluating oral health outcomes among adolescents and young adults were included. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies, and certainty of evidence was graded using the GRADE approach. Results: Eight observational studies met the inclusion criteria and were included in the qualitative synthesis. E-cigarette use was associated with increased caries risk, higher prevalence of gingival inflammation, alterations in salivary flow and pH, changes in oral microbiota—including increased levels of Porphyromonas gingivalis—and elevated frequencies of micronuclei in oral mucosal cells. Four studies were rated as having low risk of bias and four as moderate risk. The overall certainty of evidence was low for all outcomes due to methodological limitations, heterogeneity in outcome assessment, and inadequate control of confounding factors, including dual use of combustible tobacco products. Conclusions: Current evidence may suggest a possible association between e-cigarette use and adverse oral health alterations in adolescents and young adults. However, given the low certainty of evidence, residual confounding, and the predominance of cross-sectional designs, causal relationships cannot be established. Well-designed longitudinal studies that clearly differentiate exclusive e-cigarette users from dual users and adequately adjust for behavioral confounders are required to clarify the independent impact of vaping on oral health in this vulnerable population. Full article

(This article belongs to the Special Issue Dental Care and Oral Health in Adolescents and Children)

17 pages, 605 KB

Open AccessSystematic Review

Comparative Prognostic Accuracy of Objective Nutritional Indices in Critically Ill Patients with Sepsis: A Systematic Review and Meta-Analysis

by Yan-Wu Yang, Yan Zhang, Tian-Yi Qu, Mei-Ling Ge and Zhi Wan

J. Clin. Med. 2026, 15(10), 3885; https://doi.org/10.3390/jcm15103885 - 18 May 2026

Abstract

Background: Nutritional indices are increasingly studied as prognostic tools in sepsis, but their comparative value remains uncertain. We conducted a systematic review and meta-analysis to evaluate associations between major nutritional indices and mortality in adult sepsis. Methods: PubMed, Embase, and Web of Science [...] Read more.

Background: Nutritional indices are increasingly studied as prognostic tools in sepsis, but their comparative value remains uncertain. We conducted a systematic review and meta-analysis to evaluate associations between major nutritional indices and mortality in adult sepsis. Methods: PubMed, Embase, and Web of Science were searched for eligible studies. Pooled odds ratios (ORs), hazard ratios (HRs), and diagnostic accuracy measures were synthesized using random-effects models. Subgroup and sensitivity analyses explored heterogeneity and tested robustness. Results: Twenty-two studies comprising 51,769 patients were included. Higher modified Nutrition Risk in the Critically Ill (mNUTRIC) and Nutrition Risk in the Critically Ill (NUTRIC) scores were associated with increased mortality (OR 3.10, 95% CI 1.39–6.89; OR 4.54, 95% CI 2.13–9.66, respectively). In contrast, a higher Prognostic Nutritional Index (PNI) was consistently associated with lower mortality (OR 0.64, 95% CI 0.50–0.83; HR 0.66, 95% CI 0.54–0.81), and a higher Geriatric Nutritional Risk Index (GNRI) was associated with improved survival (HR 0.66, 95% CI 0.44–0.98). Controlling Nutritional Status (CONUT) showed a non-significant trend toward higher mortality (OR 1.83, 95% CI 0.94–3.54). In diagnostic analyses, mNUTRIC demonstrated better discrimination than PNI (AUC 0.84 vs. 0.74). Heterogeneity in mNUTRIC analyses decreased markedly after stratification by mortality endpoint. Conclusions: Nutritional indices are prognostically informative in sepsis, but performance is context-dependent. mNUTRIC/NUTRIC show stronger short-term signals in ICU cohorts, likely reflecting illness-severity components, and cross-index comparisons remain indirect due to heterogeneous thresholds and endpoints. Full article

(This article belongs to the Special Issue Sepsis and Septic Shock: Diagnosis, Treatment, and Prognosis)

21 pages, 940 KB

Open AccessArticle

Does the Type of Electrotherapy Impact the Effectiveness of Complex Physiotherapy Administered to Individuals with Neck Pain?

by Jolanta Zwolińska, Aleksandra Kielar and Marta Kasprzak

J. Clin. Med. 2026, 15(10), 3884; https://doi.org/10.3390/jcm15103884 - 18 May 2026

Abstract

Background: The widespread prevalence of neck pain (NP) is a serious healthcare and social problem, and the question of which components of physiotherapy are most effective is still valid. Objectives: The objective of this study was to assess the effect of [...] Read more.

Background: The widespread prevalence of neck pain (NP) is a serious healthcare and social problem, and the question of which components of physiotherapy are most effective is still valid. Objectives: The objective of this study was to assess the effect of the type of electrotherapy applied on the outcomes of complex physiotherapy administered to individuals with NP. Methods: In line with the study protocol, 100 individuals with NP were enrolled and randomly divided into four groups. All groups received kinesiotherapy and phototherapy. Additionally, each group also received electrotherapy treatment, which was a differentiating factor. Participants were assessed at baseline, post-intervention, and after six months. The examination involved evaluation of pain using VAS and measurement of the cervical range of motion (ROM). Overall, seven parameters were assessed during each examination. Results: Pain intensity decreased in all individuals across the three study periods. A large effect size and changes exceeding the Minimal Clinically Important Difference (MCID) were observed only in the electrotherapy groups. The improvement in cervical spine ROM was comparable in the HF and LF TENS groups in the short- and long-term perspectives; however, a greater number of effects (p < 0.05) was observed in the HF TENS group. TC resulted only in large and moderate short-term effects reflected by improvements in cervical spine ROM. In the PLACEBO group, moderate long-term effects were observed. Conclusions: Low-frequency currents appear to improve the analgesic effectiveness of complex physiotherapy implemented in individuals with NP. TC may provide better short-term effects compared to long-term effects reflected by improvements in cervical spinal ROM. The effects in the PLACEBO group may suggest that phototherapy and kinesiotherapy are more effective due to the continuation of exercise and the education in ergonomics of work. Full article

(This article belongs to the Special Issue Rehabilitation Strategies for Chronic Musculoskeletal Pain)

12 pages, 1079 KB

Open AccessArticle

Accuracy of Intraocular Lens Power Calculation in Cataract Surgery Combined with Trabeculectomy in Open Angle Glaucoma

by Giulia Coco, Giulia Piccotti, Federica Genova, Lucrezia Leucci, Danilo Iannetta, Gloria Roberti and Carlo Nucci

J. Clin. Med. 2026, 15(10), 3883; https://doi.org/10.3390/jcm15103883 - 18 May 2026

Abstract

Background/Objectives: To assess the accuracy of several intraocular lens power calculation formulas in phacotrabeculectomy for open angle glaucoma. Methods: Patients who underwent phacotrabeculectomy for open angle glaucoma were included. Refraction and biometry measurements were repeated at 3, 6 and ≥12 months. [...] Read more.

Background/Objectives: To assess the accuracy of several intraocular lens power calculation formulas in phacotrabeculectomy for open angle glaucoma. Methods: Patients who underwent phacotrabeculectomy for open angle glaucoma were included. Refraction and biometry measurements were repeated at 3, 6 and ≥12 months. Prediction error (PE) and absolute error (AE) were calculated using the SRK/T, Holladay 1, Hoffer Q, Haigis, Kane, Emmetropia Verifying Optical (EVO) and Barrett Universal II formulas at ≥12 months, and their accuracy was compared using linear mixed-effects models accounting for repeated measurements within the same eye and inter-eye correlation. Results: Sixty eyes from 40 patients were included. The linear mixed-effects model showed a significant overall effect of formula on PE (χ²(6) = 119.14, p < 0.001). Most formulas showed a tendency toward a hyperopic refractive shift, whereas Haigis showed a negative PE. Based on estimated marginal mean AE, the formulas were ranked as follows: EVO (0.548 D), Barrett Universal II (0.551 D), Holladay and SRK/T (0.561 D), Haigis (0.572 D), Kane (0.577 D) and Hoffer Q (0.617 D). However, the AE did not significantly differ among the formulas (χ²(6) = 3.75, p = 0.711). The percentage of eyes within ± 1.00D of PE ranged from 81.7% to 90% across the formulas (p > 0.05). Significant axial length shortening, anterior chamber deepening and mean keratometry reduction were detected postoperatively at ≥12 months (p < 0.05). Conclusions: Despite postoperative ocular anatomic changes, all formulas showed acceptable refractive accuracy after phacotrabeculectomy. Although no significant difference in the AE was detected among the formulas, the PE differed significantly, with most formulas showing a tendency toward a hyperopic shift and Haigis showing a myopic shift. This inter-formula difference should be considered when selecting the refractive target, particularly when using formulas that tend toward hyperopic PE. Full article

(This article belongs to the Special Issue Recent Advances in Refractive Surgery and Intraocular Lens Implantation)

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22 pages, 366 KB

Open AccessSystematic Review

Multimodal Hand Hygiene Interventions and Clinical Healthcare-Associated Infection Outcomes in Acute Care Hospitals: A Systematic Review of Quasi-Experimental Studies

by Emilia Doaga Pruna, Lavinia Davidescu, Maria Sorop-Florea, Ioan Demeter, Stela Iurciuc, Norberth-Istvan Varga, Vlad Laurentiu David, Florina Buleu and Florin George Horhat

J. Clin. Med. 2026, 15(10), 3882; https://doi.org/10.3390/jcm15103882 - 18 May 2026

Abstract

Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand [...] Read more.

Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand hygiene interventions and clinical HAI outcomes in acute care hospitals. Methods: A structured literature search was conducted in PubMed, Scopus, Embase, and Google Scholar using a combination of Medical Subject Headings (MeSH) and free-text terms related to hand hygiene, healthcare-associated infections, hospital settings, and intervention strategies. Eligible studies were quasi-experimental designs, including before–after, controlled before–after, and interrupted time-series studies, evaluating multimodal hand hygiene interventions implemented at hospital-wide or multi-ward level and reporting clinical HAI outcomes. Two reviewers independently assessed risk of bias using the ROBINS-I tool, and certainty of evidence across major outcome categories was summarized using GRADE. Results: twelve studies met the inclusion criteria. Overall, multimodal hand hygiene interventions were generally associated with favorable directional trends in clinical outcomes. Reductions were most consistent for broader institutional HAI measures and some device-associated infections, particularly central line-associated bloodstream infections. In contrast, organism-specific outcomes, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, were more heterogeneous across studies and settings. All included studies were judged to be at serious or critical overall risk of bias, primarily because of confounding, lack of contemporaneous controls, co-interventions, and phased implementation. Conclusions: Multimodal hand hygiene programs in acute care hospitals may be associated with improvement in selected clinically relevant HAI outcomes, particularly at the institutional level. However, the overall certainty of evidence remains low to very low, and the strength of inference is limited by the non-randomized nature of the available studies and the difficulty of isolating the independent effect of hand hygiene within complex infection-prevention strategies. Full article

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

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24 pages, 1854 KB

Open AccessArticle

Genetic Causes and Ankle Instability in Hypermobile Ehlers–Danlos Syndrome (hEDS): An Integrated Analysis Using Whole-Exome Sequencing and Stress Imaging

by Jae-Yoon Kim, Ho-Yeon Lee, Seon-Yeop Kim, Sun-Woo Lee, Minjoo Cho, Jeong Woen Shin, Yeo-Gyeong Yoon, Jinhyuk Lee, Yea Eun Kang, Da Hyun Kang, Seong Kyeong Jo, Chan Kang, Namshin Kim and Jae Hwang Song

J. Clin. Med. 2026, 15(10), 3881; https://doi.org/10.3390/jcm15103881 - 18 May 2026

Abstract

Background: Hypermobile Ehlers–Danlos syndrome (hEDS), the most common EDS subtype, is characterized by chronic pain and joint laxity, yet no definitive causative genes or imaging-based diagnostic criteria have been established. This study investigated the genetic basis of hEDS using whole-exome sequencing (WES) and [...] Read more.

Background: Hypermobile Ehlers–Danlos syndrome (hEDS), the most common EDS subtype, is characterized by chronic pain and joint laxity, yet no definitive causative genes or imaging-based diagnostic criteria have been established. This study investigated the genetic basis of hEDS using whole-exome sequencing (WES) and objectively evaluated ankle instability. Methods: We conducted an observational cohort study with a case–control comparison, including 22 patients and a three-generation Korean family (six individuals, four affected) diagnosed with hEDS by the 2017 criteria. WES was performed; ankle laxity was assessed by the anterior drawer test (ADT), stress ultrasonography, and stress radiography. Healthy young adults (n = 24, Beighton score < 5) from our previous study served as controls. Results: The hEDS cohort had a mean Beighton score of 8.5, with all participants reporting a family history of hypermobility and musculoskeletal complications. Family-based WES identified variants in CD44 (c.1516 + 1G > A), ITIH2 (c.783C > G), and ADAM21 (c.397C > T) in all affected individuals. In 22 unrelated patients, 114 variants in 103 candidate genes were identified; 17 patients harbored variants in genes from the same pathways as the family-derived causative genes. Compared with controls, the hEDS group showed significantly greater manual ADT grade, anterior talofibular ligament (ATFL) length at rest and under stress, dynamic ATFL change, anterior talar translation, and talar tilt. Conclusions: These findings provide molecular evidence that hEDS is a multifactorial disorder involving interconnected biological pathways, and confirm ankle instability as a clinically meaningful diagnostic feature. These complementary approaches may improve diagnostic accuracy and provide insights into the prognosis and therapeutic strategies for hEDS. Full article

(This article belongs to the Special Issue Foot and Ankle Surgery: Clinical Challenges and New Insights: 2nd Edition)

24 pages, 770 KB

Open AccessSystematic Review

Digital Health Strategies in Heart Failure: Effects of Telemedicine and Remote Monitoring on Clinical Outcomes—A Systematic Review and Meta-Analysis

by Dan Alexandru Surducan, Madalin-Marius Margan, Dragos-Mihai Gavrilescu, Andrei Marginean, Diana-Maria Mateescu, Ioana Cotet, Cristina Tudoran, Roxana Folescu, Mihaela-Diana Popa, Sorin Ursoniu, Costela Serban and Adrian-Cosmin Ilie

J. Clin. Med. 2026, 15(10), 3880; https://doi.org/10.3390/jcm15103880 - 18 May 2026

Abstract

Background/Objectives: Telemedicine and remote patient monitoring have emerged as promising strategies to improve outcomes in heart failure (HF), but prior meta-analyses reported conflicting results, partly due to insufficient differentiation between intervention modalities. This systematic review and meta-analysis evaluated the impact of distinct [...] Read more.

Background/Objectives: Telemedicine and remote patient monitoring have emerged as promising strategies to improve outcomes in heart failure (HF), but prior meta-analyses reported conflicting results, partly due to insufficient differentiation between intervention modalities. This systematic review and meta-analysis evaluated the impact of distinct telemedicine strategies on clinically relevant outcomes in HF. Methods: Conducted according to PRISMA 2020 and a prospectively registered PROSPERO protocol (CRD420261355507), this analysis included randomized controlled trials (RCTs) comparing telemedicine-based strategies—non-invasive telemonitoring, structured remote patient management (RPM), or haemodynamic-guided monitoring—against standard care, identified through searches of PubMed/MEDLINE, Embase, and CENTRAL (inception to 15 March 2026). Random-effects meta-analyses (DerSimonian–Laird) were performed, with predefined subgroup, sensitivity, and publication bias analyses. Results: Sixteen RCTs (n = 8618) were included. Telemedicine significantly reduced all-cause mortality (RR 0.82, 95% CI 0.73–0.92; I² = 34%; GRADE: moderate), all-cause hospitalization (RR 0.79, 95% CI 0.71–0.88; GRADE: moderate), HF-related hospitalization (RR 0.68, 95% CI 0.59–0.78; GRADE: high), and composite outcomes (RR 0.75, 95% CI 0.67–0.84; GRADE: moderate). A prespecified subgroup analysis revealed a significant mechanistic gradient (p for interaction = 0.008): haemodynamic-guided monitoring conferred the largest mortality reduction (RR 0.71), followed by structured RPM (RR 0.79), whereas non-invasive telemonitoring alone did not reach statistical significance (RR 0.93; p = 0.14). Conclusions: Telemedicine-based strategies yield clinically meaningful reductions in mortality and hospitalization in HF, but benefit is contingent upon intervention intensity and physiological specificity. Haemodynamic-guided monitoring and structured RPM provide robust outcome reductions, whereas passive telemonitoring alone is insufficient. These findings support consideration of structured remote patient management and haemodynamic-guided monitoring in appropriately selected patients and settings, while implementation and comparative effectiveness research remains necessary. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure: 3rd Edition)

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