Journal of Clinical Medicine

18 pages, 2377 KB

Open AccessArticle

Impact of Patients, Nurses, and Workload on the Use of a Nurse-Initiated Pain Protocol at Triage in the Emergency Department: A Single-Center Retrospective Observational Study

by Yvan Fournier, Patrick Taffe, Corrado Corradi-Dell’Acqua and Olivier Hugli

J. Clin. Med. 2026, 15(2), 782; https://doi.org/10.3390/jcm15020782 (registering DOI) - 18 Jan 2026

Abstract

Background: Nurse-initiated pain protocols (NIPPs) at emergency department (ED) triage remain underused. This study investigated factors associated with patient refusal and nurse use of NIPP, accounting for triage operational context. Methods: This retrospective observational study combined prospectively collected nurse characteristics with [...] Read more.

Background: Nurse-initiated pain protocols (NIPPs) at emergency department (ED) triage remain underused. This study investigated factors associated with patient refusal and nurse use of NIPP, accounting for triage operational context. Methods: This retrospective observational study combined prospectively collected nurse characteristics with retrospective data on NIPP use over 15 months in a tertiary university hospital ED. Outcomes included rates of NIPP refusal and use, documented reasons for refusal, and associations with patient characteristics, nurse characteristics, crowding, and operational pressure. Results: Sixty-three triage nurses managed 16,137 adult patients; 6.2% refused the NIPP. Among consenting patients, NIPP was used in one-third of encounters. Multi-level logistic regression revealed significant variation between nurses in both refusal and use. Refusal was more likely in patients with lower acuity and among nurses trained in Europe or concerned about prescribing responsibility, but less frequent with severe pain or longer triage duration. NIPP use was more frequent with lower acuity, higher pain intensity, longer triage duration, crowding, and among nurses with European training, but decreased in older patients and those arriving by ambulance. Conclusions: NIPP refusal and use at triage were both low, with marked variability between nurses. Patient characteristics and triage operational factors were most strongly associated with outcomes, while nurse-related factors contributed less. These findings support prospective implementation studies to clarify drivers of practice variation and optimize analgesia delivery at triage. Full article

(This article belongs to the Section Emergency Medicine)

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18 pages, 2835 KB

Open AccessArticle

Comparing the Effect of Spinal Versus General Anesthesia on Postoperative Opioid Use in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Patient Matched Study

by Harshvardhan G. Iyer, Jesus E. Sanchez-Garavito, Jorge Rios-Zermeno, Andrew P. Roberts, Juan P. Navarro Garcia de Llano, Loizos Michaelides, Jimena Gonzalez-Salido, Benjamin F. Gruenbaum, Elird Bojaxhi, Oluwaseun O. Akinduro, Ian A. Buchanan and Kingsley O. Abode-Iyamah

J. Clin. Med. 2026, 15(2), 781; https://doi.org/10.3390/jcm15020781 (registering DOI) - 18 Jan 2026

Abstract

Background/Objectives: Postoperative opioid exposure after lumbar fusion remains a key clinical concern. Understanding which perioperative factors are associated with lower postoperative opioid use may help optimize recovery after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). This study aimed to determine if [...] Read more.

Background/Objectives: Postoperative opioid exposure after lumbar fusion remains a key clinical concern. Understanding which perioperative factors are associated with lower postoperative opioid use may help optimize recovery after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). This study aimed to determine if patients undergoing MIS-TLIF under spinal anesthesia (SA) showed lower postoperative opioid use compared to those undergoing MIS-TLIF under general anesthesia (GA). Methods: We retrospectively studied all adult patients (>18 years) undergoing 1- and contiguous 2-level MIS-TLIFs performed by a single surgeon. Patients undergoing the procedure under GA were compared to those undergoing the procedure under SA. Postoperative oral opioid use, up to 3 months post discharge, was collected. A 1:1 propensity score matching (PSM) protocol was implemented. Each outcome variable was initially assessed using univariate regression. Predictor variables with a p-value < 0.2 were included in the multivariate regression model. This was a retrospective, non-randomized study, and residual confounding cannot be excluded despite PSM. Results: The matched groups (n = 50 in each group) did not differ significantly depending on demographics or levels fused. Before regression, mean number of postoperative opioid prescriptions (p = 0.03), mean total operating room (OR) time in minutes (p < 0.01), and median length of stay (LOS) in days (p = 0.03) were significantly different. Multivariate regression showed that the GA group received 216.5 more total morphine milligram equivalents than the SA group (95% CI = 0.7–432.2, p = 0.049). The days of opioid use were higher in the GA group by 3.8 days (95% CI = 0.5 to 7.1, p = 0.025). On multivariate regression, LOS in hours was greater in the GA group by 14.1 h (p = 0.042). Conclusions: SA is an effective anesthetic modality for spinal surgery with the advantages of reduced postoperative opioid use, reduced OR time, and shorter LOS compared to GA. Full article

(This article belongs to the Special Issue Spine Surgery: Clinical Advances and Future Directions)

14 pages, 829 KB

Open AccessArticle

Topical and Mucoadhesive Administration of Capsaicin in the Burning Mouth Syndrome Treatment

by Jacek Zborowski, Bożena Karolewicz, Arleta Dołowacka-Jóźwiak, Dawid Bursy, Krzysztof Słotwiński and Tomasz Konopka

J. Clin. Med. 2026, 15(2), 780; https://doi.org/10.3390/jcm15020780 (registering DOI) - 18 Jan 2026

Abstract

Background/Objectives: Burning Mouth Syndrome (BMS) is a common oral condition in older women and is characterized by a multifactorial etiology. To date, no standardized treatment strategy has been established. The aim of this study was to evaluate the effectiveness of topical application of [...] Read more.

Background/Objectives: Burning Mouth Syndrome (BMS) is a common oral condition in older women and is characterized by a multifactorial etiology. To date, no standardized treatment strategy has been established. The aim of this study was to evaluate the effectiveness of topical application of capsaicin (0.025 mg/cm²) in the form of a mucoadhesive bilayer polymer reducing burning sensations in BMS. The study assessed levels of depression, sleep disturbances, and quality of life. Material and Methods: The proof-of-concept study included 29 patients with symptoms of BMS. The peripheral origin of BMS was confirmed by lingual nerve block. Pain intensity was assessed using the Numeric Rating Scale (NRS-11) and the Short-Form McGill Pain Questionnaire (SF-MPQ). Depression, sleep disturbances, and quality of life were evaluated using the Beck Depression Inventory (BDI), Athens Insomnia Scale (AIS), and WHO Quality of Life Questionnaire (WHOQoL). Results: A reduction in pain was observed in over 86% patients. Decrease in burning at treatment sites was recorded immediately after treatment and also at the 3-month follow-up. Gender, taste disturbances, depression, and age were found to have a significant effect on final NRS-11 scores. Conclusions: Significant reduction in pain intensity was achieved in nearly all treated patients, with adverse effects being rare. Full article

(This article belongs to the Special Issue Advances in Periodontitis and Other Periodontal Diseases)

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21 pages, 3239 KB

Open AccessReview

Management of Surgical Complications in Pediatric Kidney Transplantation

by Maria P. Corzo, Sara K. Rasmussen and Jaimie D. Nathan

J. Clin. Med. 2026, 15(2), 779; https://doi.org/10.3390/jcm15020779 (registering DOI) - 18 Jan 2026

Abstract

Introduction: Graft and patient survival after kidney transplantation in children has increased in the past decade; however, post-transplant surgical complications occur in up to 15.4% of recipients and pose a significant threat to graft survival. Due to anatomic discrepancies in children, kidney transplantation [...] Read more.

Introduction: Graft and patient survival after kidney transplantation in children has increased in the past decade; however, post-transplant surgical complications occur in up to 15.4% of recipients and pose a significant threat to graft survival. Due to anatomic discrepancies in children, kidney transplantation in this population is nuanced and requires meticulous planning. This narrative review summarizes the most common postoperative surgical complications following kidney transplantation in children. Methods: PubMed and Google Scholar were queried for full-text articles that reported pediatric kidney transplantation surgical complications and their management following kidney transplantation. Results: Vascular complications can occur in approximately 1.3–13.8% of cases and are the leading cause of graft nephrectomy, with arterial stenosis and venous thrombosis being the most common. Urologic complications occur in 1.3–30% of patients and are more frequent in children due to pre-existing genitourinary abnormalities prior to transplantation. Vesicoureteral reflux is the most common urologic complication. Discussion: Surgical complications following kidney transplantation in children continue to significantly affect graft viability. Ultimately, meticulous surgical techniques and close postoperative surveillance are critical to mitigating the risk of allograft nephrectomy. Prospective studies focused on best surgical practice, techniques, prevention, and postoperative care in pediatric kidney transplant recipients are needed. Full article

(This article belongs to the Special Issue Clinical Management of Complications Following Kidney Transplant Surgery)

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13 pages, 3780 KB

Open AccessArticle

CT-Based Analysis of Rod Trace Length Changes During Posterior Spinal Correction in Adult Spinal Deformity

by Takumi Takeuchi, Takafumi Iwasaki, Kaito Jinnai, Yosuke Kawano, Kazumasa Konishi, Masahito Takahashi, Hitoshi Kono and Naobumi Hosogane

J. Clin. Med. 2026, 15(2), 778; https://doi.org/10.3390/jcm15020778 (registering DOI) - 18 Jan 2026

Abstract

Background: In adult spinal deformity (ASD) surgery, appropriate rod length determination is crucial, as excessive cranial rod length can lead to skin problems, especially in thin elderly patients if proximal junctional kyphosis (PJK) develops. In adolescent idiopathic scoliosis (AIS), correction is primarily [...] Read more.

Background: In adult spinal deformity (ASD) surgery, appropriate rod length determination is crucial, as excessive cranial rod length can lead to skin problems, especially in thin elderly patients if proximal junctional kyphosis (PJK) develops. In adolescent idiopathic scoliosis (AIS), correction is primarily performed in the coronal plane, and rod length changes are relatively predictable. Moreover, PJK is uncommon in AIS, making excess rod length rarely a clinical concern. In contrast, ASD correction involves more complex three-dimensional realignment, including restoration of lumbar lordosis (LL), which makes it challenging to predict postoperative changes in rod trace length (RTL). Furthermore, because PJK occurs more frequently in ASD surgery, appropriate rod length selection becomes clinically important. This study aimed to quantitatively evaluate changes in RTL before and after posterior correction. Method: Thirty patients with ASD who underwent staged lateral lumbar interbody fusion (LLIF) followed by posterior corrective fusion from T9 to the pelvis were retrospectively analyzed. RTL before posterior correction (Pre-RTL) was estimated from the planned screw insertional point on axial CT after LLIF, and postoperative RTL (Post-RTL) was measured from screw head centers on post-operative CT. LL and Cobb angle were assessed before and after posterior correction. Correlations between RTL change and alignment change were evaluated. Results: Postoperative RTL was shortened in all patients, with an average reduction of approximately 16–17 mm. RTL shortening demonstrated significant correlations with LL correction (R = 0.51, p = 0.003) and Cobb angle correction (R = 0.70, p = 0.00001). Greater shortening of RTL was observed on the convex side in patients with preoperative Cobb angle ≥ 10° (p = 0.04). Conclusions: Greater coronal deformity, particularly on the convex side, was associated with increased RTL shortening. These findings suggest that routine preparation of excessively long rods may be unnecessary. Consideration of anticipated RTL shortening may help avoid excessive cranial rod length and potentially reduce the risk of skin complications associated with PJK, particularly in thin elderly patients. Full article

(This article belongs to the Special Issue Current Challenges and Innovations in Spine Deformity: Biomechanics, Imaging and AI-Driven Analysis)

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17 pages, 2787 KB

Open AccessArticle

Machine Learning Model for Sepsis Prediction in Prolonged and Chronic Critical Illness: Development and Validation Using Retrospective Real-World ICU Data

by Mikhail Ya. Yadgarov, Olga Yu. Rebrova, Levan B. Berikashvili, Petr A. Polyakov, Kristina K. Kadantseva, Alexey A. Yakovlev, Andrey V. Grechko and Valery V. Likhvantsev

J. Clin. Med. 2026, 15(2), 777; https://doi.org/10.3390/jcm15020777 (registering DOI) - 18 Jan 2026

Abstract

Background: No machine learning (ML) models for sepsis prediction have been specifically developed for patients with prolonged or chronic critical illness (PCI/CCI). Objective: This study aimed to develop and validate an ML-based sepsis prediction model for this cohort. Methods: We analyzed ICU admissions [...] Read more.

Background: No machine learning (ML) models for sepsis prediction have been specifically developed for patients with prolonged or chronic critical illness (PCI/CCI). Objective: This study aimed to develop and validate an ML-based sepsis prediction model for this cohort. Methods: We analyzed ICU admissions from the Russian Intensive Care Dataset (RICD, 575 patients with PCI/CCI) and two public ICU datasets from the PhysioNet (>40,000 patients with acute critical illness). Models were trained within a right-aligned prediction framework using a case–crossover–control sampling approach and a 6 h prediction window. Two strategies were evaluated: (1) a PCI/CCI-focused model trained on RICD with external testing on PhysioNet data and (2) a universal model trained on combined RICD and PhysioNet cohorts. Models were developed with tree-based algorithms (XGBoost, LightGBM, Random Forest, AdaBoost), with internal and external validation. Primary outcome was model discrimination (AUROC). Subgroup analyses were performed for sepsis phenotypes. Results: The PCI/CCI-focused XGBoost model achieved an AUROC of 0.82 in the RICD cohort but failed to generalize to external ICU populations (AUROC 0.47). A universal model trained on mixed data demonstrated reduced discrimination in PCI/CCI patients (AUROC mean difference 0.02, p = 0.0012). Respiratory rate, heart rate, body temperature, and age were among the most important features. Predictive performance was higher in hypoinflammatory sepsis phenotype (AUROC 0.84 vs. 0.81 for hyperinflammatory, p < 0.001). Despite worthless positive predictive value (up to 21%) for PCI/CCI-focused model, negative predictive value exceeded 97%. Conclusions: A right-aligned ML model tailored to PCI/CCI demonstrated strong internal performance for sepsis exclusion but limited cross-population generalizability, underscoring the need for population-specific prediction models and prospective validation before clinical application. Full article

(This article belongs to the Section General Surgery)

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18 pages, 2108 KB

Open AccessArticle

Association Between Bone Density and Maxillary Canine Impaction: A CBCT-Based Study

by Gianna Dipalma, Angelo Michele Inchingolo, Roberta Morolla, Francesco Inchingolo, Daniela Di Venere, Cinzia Maspero, Andrea Palermo, Grazia Marinelli and Alessio Danilo Inchingolo

J. Clin. Med. 2026, 15(2), 776; https://doi.org/10.3390/jcm15020776 (registering DOI) - 18 Jan 2026

Abstract

Background/Objective: Maxillary canine impaction is a frequent orthodontic challenge. Three-dimensional CBCT assessment allows precise evaluation of periradicular bone density, which may play a role in eruption failure. This study aimed to compare bone density (HU) around impacted canines with that of the contralateral [...] Read more.

Background/Objective: Maxillary canine impaction is a frequent orthodontic challenge. Three-dimensional CBCT assessment allows precise evaluation of periradicular bone density, which may play a role in eruption failure. This study aimed to compare bone density (HU) around impacted canines with that of the contralateral erupted tooth and to assess correlations with age and sex. Methods: A total of 26 patients (10 males, 16 females; 13–19 years) with unilateral maxillary canine impaction were examined. Pre-treatment CBCT scans acquired were analyzed. Bone density was measured in HU at three root levels (cervical, middle, apical) and in four regions (buccal, palatal, mesial, distal). Statistical analyses included Student’s t-tests, linear regression, and correlation coefficients, with significance set at p < 0.05. Results: Tooth 2.3 was the most frequently impacted (61.5%), with a slight predominance of palatal impactions (53.8%). Bone density was significantly higher around impacted canines than around the contralateral erupted teeth in all regions and levels (p = 0.000), with values increasing from the cervical portion toward the apex. In impacted canines, bone density increased significantly with age, whereas no meaningful differences were found between males and females. Conclusions: Higher bone density surrounding impacted canines supports its potential role in eruption failure. The age-related increase highlights the clinical importance of early diagnosis and timely orthodontic–surgical intervention. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

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12 pages, 649 KB

Open AccessArticle

Short-Term Effects of Dupilumab in Eosinophilic COPD

by Chiara Lupia, Daniela Pastore, Giuseppina Marrazzo, Giada Procopio, Antonio Giacalone, Federica Marrelli, Mariarosanna De Fina, Adele Emanuela Di Francesco, Alessandro Vatrella, Santi Nolasco, Raffaele Campisi, Nunzio Crimi, Claudia Crimi, Girolamo Pelaia and Corrado Pelaia

J. Clin. Med. 2026, 15(2), 775; https://doi.org/10.3390/jcm15020775 (registering DOI) - 18 Jan 2026

Abstract

Background/Objectives: Patients with eosinophilic chronic obstructive pulmonary disease (COPD) often remain symptomatic despite optimized triple inhaled therapy. Dupilumab is a fully human monoclonal antibody that blocks the IL-4 receptor alpha subunit, thereby inhibiting IL-4 and IL-13 signaling. Evidence from randomized trials supports dupilumab [...] Read more.

Background/Objectives: Patients with eosinophilic chronic obstructive pulmonary disease (COPD) often remain symptomatic despite optimized triple inhaled therapy. Dupilumab is a fully human monoclonal antibody that blocks the IL-4 receptor alpha subunit, thereby inhibiting IL-4 and IL-13 signaling. Evidence from randomized trials supports dupilumab for add-on treatment of type 2-high COPD, but data referring to short-term effectiveness in clinical practice are quite limited. Methods: We conducted an observational, compassionate-use study enrolling 13 consecutive outpatients with eosinophilic COPD (blood eosinophils ≥ 300 cells/µL) receiving add-on biologic therapy with dupilumab 300 mg every two weeks. Clinical (CAT, mMRC), functional (spirometry and body plethysmography), and inflammatory parameters (blood eosinophils/basophils, fibrinogen, FeNO) were evaluated at baseline and after four weeks of treatment. Safety was monitored after injection in a clinical setting, as well as via weekly phone follow-up. Results: Participants (84.6% male; mean age 67.08 ± 11.42 years) experienced rapid and clinically meaningful improvements at four weeks. CAT score decreased from baseline 21.40 ± 6.22 to 14.00 ± 5.58 (p < 0.001) and mMRC scale from 2.90 ± 0.73 to 1.80 ± 0.63 (p < 0.0001), respectively. Pre-bronchodilator FEV₁ increased from baseline 1.35 ± 0.65 L to 1.59 ± 0.84 L (p < 0.05), and FVC from 2.36 ± 0.92 L to 2.83 ± 1.11 L (p < 0.01). A marked lung deflation was observed: indeed, residual volume declined from baseline 4.17 ± 1.98 L to 3.47 ± 2.07 L (p < 0.05), with a concomitant reduction in specific effective airway resistance (from baseline 3.15 ± 1.77 to 2.43 ± 1.44 kPa·s; p < 0.05) associated with significant increases in mid-expiratory flow (FEF₂₅₋₇₅: from baseline 0.62 ± 0.38 to 0.86 ± 0.71 L/s; p < 0.05) and peak expiratory flow (3.80 ± 1.40 to 4.48 ± 1.79 L/s; p < 0.01). Type 2 inflammatory biomarkers changed as follows: blood eosinophil count fell from baseline 390.0 ± 43.75 to 190.0 ± 65.47 cells/µL (p < 0.001); blood basophil number decreased from baseline 37.50 ± 13.89 to 26.25 ± 13.02 cells/µL (p < 0.001); plasma fibrinogen lowered from baseline 388.4 ± 54.81 to 334.9 ± 72.36 mg/dL (p < 0.01); FeNO levels dropped from baseline 23.95 ± 18.10 to 14.00 ± 2.04 ppb (p < 0.0001). Dupilumab was well tolerated, and no treatment-related serious adverse events or discontinuations were detected. Conclusions: Within an exploratory context of daily medical activity referring to eosinophilic COPD already treated with maximal inhaled therapy, we found relevant therapeutic effects of a four-week add-on treatment with dupilumab. In particular, our patients manifested rapid improvements in symptoms, airflow limitation, and lung hyperinflation, paralleled by significant decrements of type 2 inflammatory signatures. Such encouraging results were associated with a favorable short-term safety profile. However, larger and longer studies are necessary to corroborate these preliminary findings. Full article

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

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18 pages, 622 KB

Open AccessArticle

Insulin Resistance in Systemic Sclerosis: Decoding Its Association with Severe Clinical Phenotype

by Eugenio Capparelli, Luca Clerici, Giusy Cinzia Moltisanti, Francesco Lapia, Eleonora Zaccara, Francesca Capelli, Daniela Bompane, Maria Sole Chimenti, Sergio Finazzi, Paola Maria Luigia Faggioli and Antonino Mazzone

J. Clin. Med. 2026, 15(2), 774; https://doi.org/10.3390/jcm15020774 (registering DOI) - 17 Jan 2026

Abstract

Background/Objectives: Insulin resistance (IR) is a relevant metabolic concern in patients with rheumatic diseases; however, data regarding its clinical influence on the systemic sclerosis (SSc) phenotype is lacking. This study aimed to evaluate the characteristics of patients exhibiting IR in a monocentric [...] Read more.

Background/Objectives: Insulin resistance (IR) is a relevant metabolic concern in patients with rheumatic diseases; however, data regarding its clinical influence on the systemic sclerosis (SSc) phenotype is lacking. This study aimed to evaluate the characteristics of patients exhibiting IR in a monocentric SSc cohort. Methods: We conducted a cross-sectional study on 178 SSc patients, stratified according to the presence of IR, defined as a HOMA-IR value >1.85 for men and >2.07 for women, based on thresholds previously validated in the Estudio Epidemiológico de la Insuficiencia Renal en España (EPIRCE) cross-sectional study. The rationale for applying the current cut-offs is based on its discriminative potential when using sex- and age-specific thresholds in a nondiabetic population. This approach is particularly applicable to SSc, where the prevalence of diabetes is very low and the median ages of the two cohorts are comparable. Data collected included demographic-, clinical-, laboratory-, pulmonary function-, capillaroscopic-, and treatment-related parameters. A multivariable logistic regression model was used to identify independent predictors of IR. Results: Patients with IR (n = 76) had a significantly higher prevalence of diffuse cutaneous subset (26.3% vs. 11.8%, p = 0.012) and interstitial lung disease (39.5% vs. 17.6%, p = 0.001), along with the positivity for anti-Scl70 antibodies and the current presence of musculoskeletal symptoms (p = 0.021) and digital ulcers (p = 0.037). As expected, body mass index (BMI) was significantly higher in the IR population (24.6 ± 5.2 vs. 22.9 ± 4.1, p = 0.012), along with fasting glucose, insulin, HOMA-IR, and HbA1c levels. IR patients exhibited higher percentages of dyslipidemia and liver steatosis. Medications such as hydroxychloroquine, statins, and Iloprost were more frequently used in the IR group; as for corticosteroids usage (21.1% vs. 5.9%, p = 0.002), however, cumulative glucocorticoid dosage did not differ between the groups. In multivariable analysis, BMI (OR 1.09; p = 0.038) and interstitial lung disease (ILD) (OR 3.03; p = 0.034) were independent predictors of IR. Conclusions: In SSc, IR is associated with ILD, digital ulcers, musculoskeletal involvement, and anti-Scl70 autoantibodies. Full article

(This article belongs to the Special Issue Innovative Approaches to the Epidemiology, Diagnosis, and Treatment of Systemic Sclerosis: Bridging Gaps in Early Detection and Personalized Therapy)

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14 pages, 6217 KB

Open AccessArticle

A Multimodal Analysis of Serum and Tear Crystallization Patterns in Patients with Obesity

by Cosmin Victor Ganea, Anisia Iuliana Alexa, Nicoleta Anton, Calina Anda Sandu, Madalina Ioana Bilha, Vlad Constantin Donica, Irina Andreea Pavel, Roxana Elena Ciuntu and Camelia Margareta Bogdanici

J. Clin. Med. 2026, 15(2), 773; https://doi.org/10.3390/jcm15020773 (registering DOI) - 17 Jan 2026

Abstract

Objectives: The study examined tear and serum alterations using the ferning test and quantified the number of branches formed during the controlled drying of these biological fluids (tears and serum), in order to identify a potential diagnostic patterning test in individuals with [...] Read more.

Objectives: The study examined tear and serum alterations using the ferning test and quantified the number of branches formed during the controlled drying of these biological fluids (tears and serum), in order to identify a potential diagnostic patterning test in individuals with obesity. Methods: A total of 61 patients aged between 25 and 72 years were enrolled (median age [interquartile range] = 39.0 [26] years). BMI values ranged from 19.1 to 47.5 kg/m², with a median BMI (interquartile range) of 29.3 (12.1) kg/m². Results: The Kruskal–Wallis test showed statistically significant differences among at least two Schirmer classes with respect to the number of branches observed in dried tears at a brightness threshold of 220 (H(2) = 8.485, p = 0.014). According to the Dunn post hoc test, Schirmer Class 1 showed a markedly lower number of branches compared with Classes 2 and 3 (p < 0.031 and p < 0.021), whereas no significant difference was found between Classes 2 and 3. The Kruskal–Wallis test further suggested the presence of statistically significant differences in the number of branches in dried serum, quantified using ImageJ2 at a brightness threshold of 190, across visceral fat classes (H(2) = 9.583, p = 0.008). Dunn’s post hoc tests revealed that the number of branches in serum analyzed at a brightness threshold of 190 was significantly higher in visceral fat class 3 compared to class 1 (p_holm = 0.006), while no statistically significant differences were observed between classes 1 and 2 or between classes 2 and 3 (p_holm > 0.05). Conclusions: In addition to other obesity-specific complications patients with obesity exhibit an increased risk of developing dry eye syndrome. The combined assessment of DPT in both the tear film and serum may represent a new method for analyzing obesity-associated biomarkers. Further studies are required to determine the sensitivity and specificity of these approaches in diagnosing systemic alterations induced by excess adipose tissue. Full article

(This article belongs to the Special Issue Latest Advances in Ocular Surface Diseases)

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15 pages, 666 KB

Open AccessArticle

Serum Chemerin Levels in Polish Women with PCOS-Phenotype D

by Justyna Kuliczkowska-Płaksej, Jowita Halupczok-Żyła, Łukasz Gojny, Agnieszka Zembska, Aneta Zimoch, Monika Skrzypiec-Spring, Marek Bolanowski and Aleksandra Jawiarczyk-Przybyłowska

J. Clin. Med. 2026, 15(2), 772; https://doi.org/10.3390/jcm15020772 (registering DOI) - 17 Jan 2026

Abstract

Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder with diverse pathogenetic mechanisms and clinical manifestations. Phenotype D PCOS is characterized by oligomenorrhoea and polycystic ovaries without hyperandrogenism. Altered adipokine profiles may contribute to reproductive and metabolic disturbances. Chemerin is an adipokine involved [...] Read more.

Objectives: Polycystic ovary syndrome (PCOS) is a heterogeneous disorder with diverse pathogenetic mechanisms and clinical manifestations. Phenotype D PCOS is characterized by oligomenorrhoea and polycystic ovaries without hyperandrogenism. Altered adipokine profiles may contribute to reproductive and metabolic disturbances. Chemerin is an adipokine involved in inflammatory and metabolic processes. It remains unclear whether altered chemerin levels in PCOS reflect metabolic dysfunction alone or are directly associated with hyperandrogenism. The aim of this study was to compare serum chemerin levels in women with normoandrogenic PCOS and a control group. Methods: This cross-sectional preliminary study included 49 women with phenotype D PCOS and 40 healthy, age- and body mass index (BMI)-matched controls. Anthropometric, biochemical, hormonal parameters, and serum chemerin concentrations were assessed. Results: Serum chemerin concentrations did not differ significantly between the groups. In the PCOS group, the 95% confidence interval ranged from 198.61 to 234.37, while in the controls, it ranged from 187.13 to 216.21. In women with PCOS, chemerin showed significant positive correlations with weight, BMI, waist and hip circumference, total adipose tissue, and both gynoid and android fat content. Positive correlations were also observed with highly sensitive C-reactive protein (hs-CRP), insulin, glucose, triglycerides, and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), and a negative correlation was found with high-density lipoprotein (HDL) cholesterol. Chemerin was weakly negatively correlated with sex hormone binding globulin (SHBG) and positively correlated with the free androgen index (FAI). In the control group, chemerin correlated positively with CRP, insulin, triglycerides, total and gynoid adipose tissue, and negatively correlated with HDL cholesterol and SHBG. Conclusions Although chemerin levels did not differ from controls, chemerin was associated with metabolic and inflammatory markers in both groups. These findings should be considered preliminary due to the limited sample size. Chemerin may reflect metabolic and inflammatory status rather than hyperandrogenism in normoandrogenic PCOS. Full article

(This article belongs to the Topic Gynecological Endocrinology Updates)

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13 pages, 1574 KB

Open AccessArticle

Bridging the Compatibility Gap in Revision Hip Arthroplasty with 14/16 Tapers: Long-Term Outcomes of the Bioball™ System

by Marek Drobniewski, Bartosz Gonera, Łukasz Olewnik, Adam Borowski, Kacper Ruzik, George Triantafyllou and Andrzej Borowski

J. Clin. Med. 2026, 15(2), 771; https://doi.org/10.3390/jcm15020771 (registering DOI) - 17 Jan 2026

Abstract

Purpose: Revision total hip arthroplasty (RTHA) in the presence of a well-fixed femoral stem is associated with increased risk, as stem removal often results in bone loss, prolonged operative time, and greater blood loss. This problem is particularly relevant for older implants with [...] Read more.

Purpose: Revision total hip arthroplasty (RTHA) in the presence of a well-fixed femoral stem is associated with increased risk, as stem removal often results in bone loss, prolonged operative time, and greater blood loss. This problem is particularly relevant for older implants with a 14/16 taper, which is incompatible with most modern femoral heads. The Bioball™ System, a modular head–neck adapter, allows for acetabular or head-only revision while preserving the femoral stem. This study aimed to evaluate long-term clinical and radiological outcomes of RTHA using the Bioball™ System in patients with 14/16 tapers. Methods: A total of 38 patients (23 women, 15 men; mean age 73.5 years) met the inclusion criteria. All procedures were carried out with a well-fixed femoral stem and a 14/16 taper. Revisions were limited to exchange of the acetabular component, liner, or both, avoiding stem removal. The primary indication was acetabular cup loosening (n = 29, 76.3%); liner-only exchange was performed in 9 patients (23.7%). Clinical outcomes were assessed using the modified Merle d’Aubigné and Postel (MAP) score, and radiological evaluation focused on fixation, migration, and loosening. Mean follow-up was 8.44 years. Results: Both the acetabular component and liner were replaced in 76.3% of patients, while 23.7% underwent liner and head exchange only. Longer adapter sizes were most frequently used, and a 7.5° offset adapter was applied in 57.9% of cases. The modified MAP score improved by a mean of 5.7 points (p < 0.05), and VAS pain scores decreased from 7.4 to 2.6 (p < 0.05). No radiological signs of loosening were observed at final follow-up. Conclusions: The Bioball™ System enables effective restoration of hip stability and offset without femoral stem removal, offering favorable long-term clinical and radiological outcomes in revisions involving older 14/16 tapers. Full article

(This article belongs to the Section Orthopedics)

13 pages, 816 KB

Open AccessSystematic Review

Reduced Versus Full-Dose Direct Oral Anticoagulants for Long-Term Management of Venous Thromboembolism: A Systematic Review

by Manar Al Arifi, Walaa A. Alshahrani, Abdulmajeed M. Alshehri and Majed S. Al Yami

J. Clin. Med. 2026, 15(2), 770; https://doi.org/10.3390/jcm15020770 (registering DOI) - 17 Jan 2026

Abstract

Background: Venous thromboembolism (VTE) is still a serious clinical problem because many patients still have a significant chance of having it happen again after their first course of anticoagulation is over. In recent years, reduced-dose direct oral anticoagulants (DOACs) have been investigated as [...] Read more.

Background: Venous thromboembolism (VTE) is still a serious clinical problem because many patients still have a significant chance of having it happen again after their first course of anticoagulation is over. In recent years, reduced-dose direct oral anticoagulants (DOACs) have been investigated as a means to ensure prolonged protection while diminishing the risk of bleeding complications. This systematic review aims to summarize the available evidence comparing reduced-dose and full-dose DOAC regimens during the extended phase of VTE treatment. Methods: A systematic search of PubMed and the Cochrane Library (January 2010–November 2025) identified randomized trials and one ambispective cohort study evaluating reduced-dose apixaban (2.5 mg BID), rivaroxaban (10 mg OD), dabigatran (110 mg BID), or edoxaban (30 mg OD). Methodological quality was assessed using RoB-2 for trials and the Newcastle–Ottawa Scale for observational data. Because of differences in study designs and outcome definitions, a narrative synthesis was applied. Results: Five studies met the inclusion criteria. Across trials, reduced-dose DOACs maintained consistently low rates of recurrent VTE: 1.7% in AMPLIFY-EXT versus 8.8% with placebo; 1.2–1.5% in EINSTEIN CHOICE versus 4.4% with aspirin; 2.2% in RENOVE versus 1.8% with full-dose therapy; and 1.3% in HI-PRO versus 10% with placebo. Real-world data from Valeriani et al. showed only a single recurrence (0.7%) over nearly three years. Major bleeding remained uncommon, ranging from 0.1 to 0.5% in randomized trials and 2.1–2.9% in longer-term observational cohorts. Conclusions: In summary, reduced-dose DOACs appear to offer a favorable balance of safety and efficacy, providing durable protection against recurrence with a lower bleeding burden. These findings support their role as a practical extended-treatment strategy in clinical practice. Full article

(This article belongs to the Section Vascular Medicine)

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18 pages, 557 KB

Open AccessSystematic Review

Diagnostic, Prognostic, and Predictive Molecular Biomarkers in Head and Neck Squamous Cell Carcinoma: A Comprehensive Review

by Adam Michcik, Barbara Wojciechowska, Jakub Tarnawski, Piotr Choma, Adam Polcyn, Łukasz Garbacewicz, Maciej Sikora, Paolo Iacoviello, Tomasz Wach and Barbara Drogoszewska

J. Clin. Med. 2026, 15(2), 769; https://doi.org/10.3390/jcm15020769 (registering DOI) - 17 Jan 2026

Abstract

Background: Head and neck squamous cell carcinoma (HNSCC) remains the seventh most common cancer worldwide, characterized by late-stage diagnosis and poor 5-year survival rates. Oral squamous cell carcinoma (OSCC) is the most prevalent subtype. The identification of robust diagnostic, prognostic, and predictive [...] Read more.

Background: Head and neck squamous cell carcinoma (HNSCC) remains the seventh most common cancer worldwide, characterized by late-stage diagnosis and poor 5-year survival rates. Oral squamous cell carcinoma (OSCC) is the most prevalent subtype. The identification of robust diagnostic, prognostic, and predictive markers is essential for personalized treatment monitoring. Methods: Following PRISMA and PICO standards, we conducted a comprehensive review of studies published over the past 10 years across PubMed/MEDLINE, Scopus, and Web of Science. The selection process was facilitated by AI-powered tools (Rayyan QCRI), and study quality was assessed using NOS or QUIPS. Results: 34 articles (including meta-analyses and original trials) were identified. Established clinical markers, such as p16-positivity (HR ≈ 0.55) and PD-L1 (CPS), remain significant. However, the molecular landscape is expanding to include high-risk lncRNA signatures (HR ≈ 2.50), immune checkpoints such as TIGIT (HR ≈ 1.85), and genomic alterations, including IL-10 promoter polymorphisms. We highlight that epigenetic silencing of p16 affects only about 25% of patients, while metabolic regulators (e.g., GLUT-1) and protein markers (e.g., MASPIN) offer critical predictive value for therapy response. Conclusions: The diagnostic and predictive paradigm is shifting toward a multi-omic approach that integrates DNA, RNA, proteins, and metabolic indicators. Future clinical use will rely on AI-driven multimarker panels and non-invasive liquid biopsies to enable real-time monitoring and de-escalation of treatment strategies. Full article

(This article belongs to the Special Issue Advances in Maxillofacial Surgery—Historical and Future Perspectives and Controversies)

20 pages, 3536 KB

Open AccessCase Report

A New Histology-Based Prognostic Index for Acute Lymphoblastic Leukemia: Preliminary Results of the “ALL Urayasu Classification”

by Toru Mitsumori, Hideaki Nitta, Haruko Takizawa, Hiroko Iizuka-Honma, Chiho Furuya, Suiki Maruo, Maki Fujishiro, Shigeki Tomita, Akane Hashizume, Tomohiro Sawada, Kazunori Miyake, Mitsuo Okubo, Yasunobu Sekiguchi and Masaaki Noguchi

J. Clin. Med. 2026, 15(2), 768; https://doi.org/10.3390/jcm15020768 (registering DOI) - 17 Jan 2026

Abstract

Background/Objectives: Mechanisms underlying treatment resistance in hematopoietic malignancies such as acute lymphoblastic leukemia (ALL) include (1) enhanced activity of anticancer drug efflux mechanisms (MRP1); (2) suppressed activity of anticancer drug influx mechanisms (ENT-1); (3) enhanced drug detoxification activity (AKR1B10, AKR1C3, CYP3A4); (4) [...] Read more.

Background/Objectives: Mechanisms underlying treatment resistance in hematopoietic malignancies such as acute lymphoblastic leukemia (ALL) include (1) enhanced activity of anticancer drug efflux mechanisms (MRP1); (2) suppressed activity of anticancer drug influx mechanisms (ENT-1); (3) enhanced drug detoxification activity (AKR1B10, AKR1C3, CYP3A4); (4) influence of the tumor microenvironment (GRP94), etc. We conducted this study to comprehensively and clinically examine treatment resistance due primarily to a decrease in the tumor intracellular anticancer drug concentrations. Methods: The subjects were 19 ALL patients who underwent initial induction therapy with alternating Hyper CVAD/MA therapy. Antibodies against 23 types of treatment resistance-associated proteins were used for immunohistochemical analysis of tumor specimens obtained from the patients, and correlations between the results of immunohistochemistry and the overall survival (OS) were retrospectively analyzed using the Kaplan–Meier method. Results: Based on the patterns of expression of the enzymes involved in treatment resistance, we classified the patients (Urayasu classification for ALL, which we believe would be very useful for accurately stratifying patients with ALL according to the predicted prognosis), as follows: Good prognosis group, n = 1, 5%: AKR1B1(+)/AKR1B10(−), 5-year overall survival (OS), 100%; Intermediate prognosis-1 group, n = 9, 5%: AKR1B1(−)/AKR1B10(−) plus MRP1(−), 5-year OS, 68%; Intermediate-2 prognosis group, n = 6.3%: AKR1B1(−)/AKR1B10(−) plus MRP1(+), median survival, 17 months, 5-year OS, 20%; and Poor prognosis group, n = 3, 16%: AKR1B1(−)/AKR1B10(+), median survival, 18 months, 5-year OS, 0%. n = 2. Conclusions: The Urayasu classification for ALL is considered reliable for predicting the prognosis of patients with ALL after the initial Hyper CVAD/MA remission induction therapy. Full article

(This article belongs to the Special Issue Hematologic Malignancies: Treatment Strategies and Future Challenges: 2nd Edition)

11 pages, 784 KB

Open AccessArticle

Implementation of a Sepsis Code Protocol at an Academic Institution in Colombia: A Pilot Study

by German Devia Jaramillo, Laura María Castillo Morales and Camilo Antonio Vega Useche

J. Clin. Med. 2026, 15(2), 767; https://doi.org/10.3390/jcm15020767 (registering DOI) - 17 Jan 2026

Abstract

Background/Objectives: Sepsis is a critical medical emergency with significant morbidity and mortality, particularly in resource-limited countries. Effective strategies are essential to lower the high death rate. The sepsis code protocol recommends coordinated, structured, and prompt interventions for thorough patient care. This study aimed [...] Read more.

Background/Objectives: Sepsis is a critical medical emergency with significant morbidity and mortality, particularly in resource-limited countries. Effective strategies are essential to lower the high death rate. The sepsis code protocol recommends coordinated, structured, and prompt interventions for thorough patient care. This study aimed to compare in-hospital mortality rates after implementing the Sepsis Code protocol with those of a cohort of patients previously treated according to standard institutional guidelines. Methods: A pilot quasi-experimental study using a historical cohort design was conducted, involving patients with sepsis treated in an emergency department. Bivariate and multivariate analyses, as well as survival analysis, were conducted to evaluate the effectiveness of the intervention. Results: A total of 342 patients were analyzed. Among those who received the intervention, mortality was 13.4%, while in the control group, it was 22.5% (p = 0.042). Additionally, a protective association was found between the intervention and mortality (OR, 0.53; 95% CI, 0.29–0.94). Factors associated with increased mortality risk included lactate levels, SOFA score, septic shock presence, and history of diabetes. Conclusions: The implementation of the Sepsis Code in the emergency area showed an association with lower in-hospital mortality, especially in patients with septic shock. However, due to the study’s design, further research is needed to employ more robust methodologies and confirm the protocol’s applicability in the region. Full article

(This article belongs to the Special Issue Current Advances and Future Perspectives of Sepsis and Septic Shock)

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18 pages, 1088 KB

Open AccessReview

Excimer Laser Coronary Atherectomy: Current Evidence, Clinical Applications, and Future Directions

by Mohsen Mohandes, Alberto Pernigotti, Mauricio Torres, Cristina Moreno Ambroj, Francisco Fernández, Roberto Bejarano-Arosemena, Pablo Moreno, Anna Vidal-Romero, Jordi Guarinos and Jose Luis Ferreiro

J. Clin. Med. 2026, 15(2), 766; https://doi.org/10.3390/jcm15020766 (registering DOI) - 17 Jan 2026

Abstract

Excimer Laser Coronary Atherectomy (ELCA) has re-emerged as a valuable adjunctive modality in percutaneous coronary intervention (PCI), particularly in the context of increasingly complex coronary anatomy and rising procedural expectations. By delivering pulsed ultraviolet energy at 308 nm through flexible fiber-optic catheters, ELCA [...] Read more.

Excimer Laser Coronary Atherectomy (ELCA) has re-emerged as a valuable adjunctive modality in percutaneous coronary intervention (PCI), particularly in the context of increasingly complex coronary anatomy and rising procedural expectations. By delivering pulsed ultraviolet energy at 308 nm through flexible fiber-optic catheters, ELCA enables precise photochemical, photothermal, and photomechanical ablation of atherosclerotic, fibrotic, calcified, and thrombotic tissue while minimizing thermal injury to surrounding structures. Recent technical refinements, simplified catheter designs, and improved safety profiles have enhanced its feasibility and utility across a range of challenging lesion subsets. This review summarizes the fundamental principles underlying excimer laser–tissue interaction, discusses available equipment and key procedural considerations, and examines the expanding clinical evidence supporting ELCA in contemporary practice. Data from observational studies and multicenter registries suggest that ELCA may enhance device crossability, restore coronary flow, and reduce distal embolization in thrombus-rich lesions, particularly during primary PCI. In device-uncrossable lesions, ELCA facilitates plaque modification and improves procedural success, including in chronic total occlusions. Furthermore, ELCA—especially when performed with simultaneous contrast injection—has demonstrated efficacy in treating stent underexpansion refractory to high-pressure balloon dilation, improving minimal stent area and enabling optimal post-dilatation. As lesion complexity continues to increase, ELCA is gaining recognition as an important tool within the interventional armamentarium. While generally safe in experienced hands, ELCA carries a risk of procedural complications that must be carefully considered. Ongoing investigations are expected to further define its optimal use and reinforce its relevance in modern interventional cardiology. Full article

(This article belongs to the Special Issue Advances and Future Directions in Percutaneous Coronary Intervention (PCI))

11 pages, 740 KB

Open AccessArticle

Intra-Procedural Real-Time Predictors of Failure in Patients with Roux-en-Y Gastric Bypass Undergoing Double-Balloon Assisted ERCP: Is There an Optimal Time to Cross-Over to EUS-Directed Transgastric ERCP? A Prospective Single-Center Study

by Kambiz Kadkhodayan, Azhar Hussain, Saurabh Chandan, Shayan Irani, Almujarkesh Mohamad Khaled, Abdullah Abbasi, Mustafa Arain, Natalie Cosgrove, Maham Hayat, Deepanshu Jain, Sagar Pathak, Dennis Yang, Zubair Khan, Armando Rosales and Hasan K. Muhammad

J. Clin. Med. 2026, 15(2), 765; https://doi.org/10.3390/jcm15020765 (registering DOI) - 17 Jan 2026

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) remains technically challenging. Device-assisted ERCP (DAE-ERCP) is widely used for uncomplicated pancreaticobiliary disease but is associated with prolonged procedure times and high failure rates. Endoscopic ultrasound-directed transgastric ERCP (EDGE) offers high [...] Read more.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) remains technically challenging. Device-assisted ERCP (DAE-ERCP) is widely used for uncomplicated pancreaticobiliary disease but is associated with prolonged procedure times and high failure rates. Endoscopic ultrasound-directed transgastric ERCP (EDGE) offers high technical success but introduces additional cost and the risk of a persistent fistula. We aimed to prospectively identify intra-procedural predictors of DAE-ERCP failure and define an actionable, real-time threshold for early cross-over to EDGE. Methods: We prospectively evaluated consecutive RYGB patients undergoing DAE-ERCP at a tertiary referral center. Patients with established pre-procedural features associated with complex or low-yield DAE-ERCP were triaged directly to EDGE and excluded. Intra-procedural variables were recorded in real time. Univariate and multivariable logistic regression identified predictors of DAE-ERCP failure. Received operating characteristic (ROC) analysis determined optimal cutoffs for cross-over. Results: A total of 94 patients with RYGB underwent ERCP. Amongst these, 42 patients (11 males, 31 females) were included in the analysis and underwent DAE-ERCP with a success rate of 73.8% (n = 31). Significant risk factors of DAE-ERCP failure included excessive resistance to scope advancement (p < 0.0001), failure to reach the ampulla (p < 0.0001), patient position (p = 0.009), BMI (p = 0.004), and time to reach the jejuno-jejunal (J-J) anastomosis (p < 0.0001). Additionally, time needed to reach the J-J anastomosis of ≥23 min [OR 1.360 (95% CI: 1.079–1.713), p = 0.009], excess resistance to scope advancement [OR 2.223 (95% CI: 2.001–4.167)], and failure to reach the ampulla [OR 9.929 (95% CI: 2.004–4.033)] were statistically significant predictors of DAE-ERCP failure. When ≥2 predictors of BA-ERCP failure were present, the likelihood of DAE-ERCP failure was 2.370 with 95.50% sensitivity and 90% specificity with AUC= 0.929 (p = 0.0001). Conclusions: DAE-ERCP remains an effective first-line strategy in appropriately selecting RYGB patients without pre-procedural high-risk features. Real-time intra-procedural predictors can reliably identify impending failure. A structured algorithm incorporating both pre-procedural triage and intra-procedural checkpoints supports timely transition to EDGE, optimizing efficiency, safety, and resource utilization. Full article

(This article belongs to the Section General Surgery)

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11 pages, 504 KB

Open AccessArticle

Clinical Parameters Associated with Achieving Negative Fluid Balance in Critically Ill Patients: A Retrospective Cohort Study

by Dekel Stavi, Amir Gal Oz, Nimrod Adi, Roy Rafael Dayan, Yoel Angel, Andrey Nevo, Nardeen Khoury, Itay Moshkovits, Yael Lichter, Ron Wald and Noam Goder

J. Clin. Med. 2026, 15(2), 764; https://doi.org/10.3390/jcm15020764 (registering DOI) - 17 Jan 2026

Abstract

Background/Objectives: Fluid overload in critically ill patients is linked to adverse outcomes. While resuscitation strategies are well established, guidance for the de-resuscitation phase remains limited. This study aimed to identify clinical factors associated with diuretic response and achieving negative fluid balance (FB) in [...] Read more.

Background/Objectives: Fluid overload in critically ill patients is linked to adverse outcomes. While resuscitation strategies are well established, guidance for the de-resuscitation phase remains limited. This study aimed to identify clinical factors associated with diuretic response and achieving negative fluid balance (FB) in critically ill patients. Methods: We conducted a single-center, retrospective cohort study of ICU patients who received intravenous furosemide between 2017 and 2023. A CHAID (Chi-square Automatic Interaction Detector) decision tree identified clinical variables associated with fluid removal after the first dose, and a mixed-effects model analyzed repeated measurements. Results: The cohort comprised 1764 patients over 6632 ICU days. Mean arterial pressure (MAP) was the strongest predictor of negative FB. MAP ≤ 75 mmHg yielded minimal negative FB (−33 ± 1054 mL/24 h); MAP 75–90 mmHg yielded intermediate negative FB (−467 ± 1140 mL/24 h); and MAP > 90 mmHg produced the greatest negative FB (−899 ± 1415 mL/24 h; p < 0.001). Secondary associations varied by MAP: creatinine at low MAP, blood urea nitrogen at mid-range MAP, and SOFA score at high MAP, all inversely related to negative FB. In mixed-effects analyses, each 1 mmHg MAP increase was associated with 23.3 mL greater fluid removal (p < 0.001). Independent factors linked to reduced negative FB included vasopressor use (noradrenaline), elevated creatinine, and higher SOFA scores. Conclusions: In this cohort, MAP was significantly associated with the likelihood of achieving a negative fluid balance during de-resuscitation. Conversely, vasopressor use, renal dysfunction, and higher illness severity were linked to reduced diuretic responsiveness. These findings support individualized de-resuscitation strategies. Full article

(This article belongs to the Section Intensive Care)

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