Journal of Clinical Medicine

16 pages, 1931 KB

Open AccessArticle

Headless Screw Fixation Is Associated with Reduced Hardware Removal After Tibial Tubercle Osteotomy: A Retrospective Cohort Study

by Oguzhan Uslu and Ozkan Kose

J. Clin. Med. 2026, 15(1), 235; https://doi.org/10.3390/jcm15010235 (registering DOI) - 28 Dec 2025

Abstract

Background/Objectives: Symptomatic hardware removal remains the most frequent cause of reoperation after tibial tubercle osteotomy (TTO), with removal rates reported as high as 49%. Headless compression screws have been proposed as a low-profile alternative to conventional screws to reduce hardware-related morbidity, yet [...] Read more.

Background/Objectives: Symptomatic hardware removal remains the most frequent cause of reoperation after tibial tubercle osteotomy (TTO), with removal rates reported as high as 49%. Headless compression screws have been proposed as a low-profile alternative to conventional screws to reduce hardware-related morbidity, yet no study has directly compared their use with headed screws in TTO for patellofemoral instability. This study aimed to compare complication rates and the frequency of hardware removal between headless and headed screw fixation in TTO. Methods: A retrospective review was conducted on 84 patients (94 knees) who underwent TTO between 2014 and 2024. Patients were divided into two groups based on the type of fixation used: headless screws (56 knees) and headed screws (38 knees). Demographic characteristics, perioperative variables, functional outcomes (Kujala, Lysholm, and Tegner scores), complications, and reoperation rates were compared with a minimum one-year follow-up. Results: No significant differences were found between the groups in terms of baseline demographic and clinical characteristics. Symptomatic implant removal occurred in 13.2% of the headed screw group and in none of the patients in the headless screw group (p = 0.001). Reoperation for any reason was significantly lower in the headless group (3.6% vs. 26.3%, p = 0.002). Functional outcomes were similar between groups. Post-hoc power analysis confirmed sufficient statistical power (98.8%) to detect differences in implant removal rates. Conclusion: Headless screw fixation in TTO was associated with significantly lower rates of hardware-related reoperations and painful implant removal, while achieving functional outcomes similar to those with headed screws. Headless screws may represent a preferable fixation method for reducing implant-related complications in TTO. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 1288 KB

Open AccessArticle

Clinical Outcomes of Arthroscopic Treatment for Triangular Fibrocartilage Complex Lesions in Adolescent Elite Athletes

by Michele Davide Maria Lombardo, Min Cheol Chang and Loris Pegoli

J. Clin. Med. 2026, 15(1), 234; https://doi.org/10.3390/jcm15010234 (registering DOI) - 28 Dec 2025

Abstract

Objectives: The triangular fibrocartilage complex (TFCC) is critical for wrist stability. The incidence of TFCC injury among adolescent athletes is rising due to increased participation in high-demand sports. Here, we investigated the therapeutic outcomes of arthroscopic TFCC repair in adolescent elite athletes. [...] Read more.

Objectives: The triangular fibrocartilage complex (TFCC) is critical for wrist stability. The incidence of TFCC injury among adolescent athletes is rising due to increased participation in high-demand sports. Here, we investigated the therapeutic outcomes of arthroscopic TFCC repair in adolescent elite athletes. Methods: We retrospectively recruited 24 elite adolescent athletes (mean age 15.5 ± 1.3 years) treated arthroscopically for peripheral TFCC tears between March 2018 and January 2025. Clinical outcomes—including numeric rating scale (NRS) for pain, grip strength, wrist range of motion (ROM), DASH scores, and physical exam tests—were collected preoperatively and at 6-month follow-up. Statistical analysis included paired t-tests for continuous variables and chi-square tests for categorical comparisons. Results: At 6 months postoperatively, the mean NRS decreased from 6.9 ± 1.2 to 0.6 ± 0.7, grip strength increased from 26.3 ± 6.9 kg to 40.8 ± 5.6 kg, and all measured ROMs and DASH scores improved significantly. Positive findings on ballottement, Waiter’s, and piano key tests decreased significantly. There were no major complications. All athletes returned to their pre-injury sport levels. Conclusions: Arthroscopic peripheral TFCC repair in adolescent elite athletes is a safe, minimally invasive, and effective treatment, leading to rapid pain relief, functional recovery, and return to sport with their pre-injury sport levels. Full article

(This article belongs to the Special Issue Recent Advances in the Prevention, Treatment, and Rehabilitation of Sports Injuries)

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12 pages, 1115 KB

Open AccessArticle

Prognostic Value of STAS, Lymph Node Metastasis, and VPI in NSCLC ≤ 4 cm Treated with Lobectomy

by Esra Zeynelgil, Abdülkadir Koçanoğlu, Ata Türker Arıkök, Serdar Karakaya, Engin Eren Kavak and Tülay Eren

J. Clin. Med. 2026, 15(1), 233; https://doi.org/10.3390/jcm15010233 (registering DOI) - 28 Dec 2025

Abstract

Background/Objectives: This study aimed to evaluate the prognostic effects of tumor spread through air spaces (STAS) and other clinical and pathological risk factors on disease-free survival (DFS) in patients with non-small cell lung cancer (NSCLC) who underwent curative lobectomy and had tumors measuring [...] Read more.

Background/Objectives: This study aimed to evaluate the prognostic effects of tumor spread through air spaces (STAS) and other clinical and pathological risk factors on disease-free survival (DFS) in patients with non-small cell lung cancer (NSCLC) who underwent curative lobectomy and had tumors measuring 4 cm or less. Methods: NSCLC patients who underwent surgery between March 2015 and May 2024 and had at least 12 months of follow-up were retrospectively analyzed. Patients with tumors measuring 4 cm or less who underwent R0 resection, lobectomy, and STAS assessment on intraoperative frozen sections were included in the study. Clinicopathological features of all patients were restaged according to the 9th edition of the TNM staging system. The Kaplan–Meier method, log-rank test, and univariate Cox regression analysis were used to determine the factors affecting DFS. Results: 88 patients were included in the study. The median age of the patients was 61 years, 77.3% were male, and 72.7% had adenocarcinoma histology. According to TNM 9, 23.9% of the cases were staged T1b, 18.2% T1c, and 58.0% T2a. STAS positivity was detected in 45 patients (51.1%). The rates of lymphovascular invasion (LVI) (40.0% vs. 18.6%; p = 0.028) and visceral pleural invasion (VPI) (57.8% vs. 27.9%; p = 0.005) were significantly higher in the STAS-positive group than in the STAS-negative group. Recurrence was observed in a total of 31 patients (35.2%) during a median follow-up period of 68.1 months. In Kaplan–Meier analysis, the median DFS was not reached for the entire cohort. The estimated median DFS in STAS-positive patients was 52.7 months, while the median was not reached in the STAS-negative group (p = 0.001). The median DFS was 52.3 months in those with lymph node positivity, while the median was not reached in those with lymph node negativity (p = 0.031). According to TNM 9, the difference in DFS between stage IA/IB and stage IIAB groups was not statistically significant (p = 0.080). In univariate Cox analysis, STAS positivity (HR = 3.79; 95% CI: 1.69–8.51; p = 0.001), lymph node positivity (HR = 2.58; 95% CI: 1.05–6.31; p = 0.038) and VPI (HR = 2.28; 95% CI: 1.07–4.86; p = 0.032) were found to be significant prognostic factors adversely affecting DFS. Age, gender, histological type, tumor location, T stage, LVI, perineural invasion (PNI), and adjuvant chemotherapy had no significant effect on DFS. Conclusions: STAS is a strong negative prognostic indicator for recurrence in patients with operated NSCLC with tumor size ≤ 4 cm. It is believed that STAS should be integrated into risk-based staging and adjuvant treatment decision-making processes in early-stage NSCLC, particularly when evaluated in conjunction with VPI and lymph node positivity. Full article

(This article belongs to the Section Oncology)

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15 pages, 457 KB

Open AccessArticle

Conduction System Pacing Improved Cardiac Functions, Myocardial Work and Functional Capacity in Heart Failure with Reduced Ejection Fraction and Right Bundle Branch Block

by Anna Zsófia Tóth, László Nagy, Csaba Jenei, Arnold Péter Ráduly, Gábor Sándorfi, Krisztina Mária Szabó, Alexandra Kiss, László Tibor Nagy, Gergő István Szilágyi and Zoltán Csanádi

J. Clin. Med. 2026, 15(1), 232; https://doi.org/10.3390/jcm15010232 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Conduction system pacing (CSP) is a potential alternative to biventricular pacing (BVP) in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB) or non-LBBB. Available data also suggest that unlike BVP, CSP may improve clinical outcome in patients [...] Read more.

Background/Objectives: Conduction system pacing (CSP) is a potential alternative to biventricular pacing (BVP) in heart failure with reduced ejection fraction (HFrEF) and left bundle branch block (LBBB) or non-LBBB. Available data also suggest that unlike BVP, CSP may improve clinical outcome in patients with right bundle branch block (RBBB), although its effects on cardiac mechanics and energetics are ill-defined. Herein, we report on echocardiographic and clinical outcomes of CSP in this patient cohort. Methods: CSP either with His bundle pacing or LBB area pacing was attempted as a primary strategy in patients with RBBB, QRS duration ≥ 130 ms, LVEF < 35% and NYHA II-IV symptoms after optimized medical therapy for 6 months. Data on functional status, NT-proBNP and echocardiographic parameters were collected at baseline and 6 months after CSP. Results: CSP performed in 16 patients reduced QRS duration from 155.3 ± 12.8 ms to 130 ± 16.5 ms (p < 0.001), increased LVEF from 27 ± 7% to 33 ± 9% (p = 0.01), improved LV global longitudinal strain from −7 ± 3% to −10 ± 4% (p = 0.004) and improved LV peak strain dispersion from 126 ± 28 ms to 96 ± 23 ms (p = 0.004). Global myocardial work index increased from 582 ± 277 mmHg% to 840 ± 306 mmHg% (p = 0.003), as did global constructive work (900 ± 374 mmHg% to 1203 ± 393 mmHg%; p = 0.006) and global work efficiency (from 71 ± 7% to 77 ± 8%; p = 0.004). NYHA class (12.5% with NYHA II, 87.5% with NYHA III before vs. 25% with NYHA I, 50% with NYHA II and 25% with NYHA III at 6 months; p = 0.002) and 6 min walk distance (from 354 ± 88 m to 411 ± 95 m; p = 0.003) improved, while NT-proBNP decreased (from 4093 ± 7215 ng/L to 2087 ± 2872 ng/L, p = 0.003). Conclusions: CSP improved functional capacity and echocardiographic parameters related to cardiac functions and myocardial work in HFrEF patients with RBBB. Nevertheless, these results await further confirmation by large-scale, multi-center randomized trials. Full article

(This article belongs to the Special Issue Advances in Arrhythmia Diagnosis and Management)

14 pages, 629 KB

Open AccessArticle

Dream Patterns in Patients with Acute Myocardial Infarction: Data from the STEP-IN-AMI Trial

by Adriana Roncella, Vincenzo Pasceri, Christian Pristipino, Loreta Di Michele, Diego Irini, Robert Allan, Francesco Pelliccia and Giulio Speciale

J. Clin. Med. 2026, 15(1), 231; https://doi.org/10.3390/jcm15010231 (registering DOI) - 27 Dec 2025

Abstract

Background: Studies on the organization and structure of dreams before and after acute myocardial infarction (AMI) are lacking. Methods: We retrospectively studied dream patterns before and after AMI in the STEP-IN-AMI trial (Short-TErm Psychotherapy IN Acute Myocardial Infarction). We also performed [...] Read more.

Background: Studies on the organization and structure of dreams before and after acute myocardial infarction (AMI) are lacking. Methods: We retrospectively studied dream patterns before and after AMI in the STEP-IN-AMI trial (Short-TErm Psychotherapy IN Acute Myocardial Infarction). We also performed an analysis to describe how this pattern may change during ontopsychological short-term psychotherapy (STP) performed after AMI. Forty-seven patients (pts) aged 31–70 were studied. Results: At baseline, 21/47 (45%) pts remembered dreams, which increased to 43/47 (91%) with psychotherapy (p < 0.0001). Recurring dreams, described as a state of anguish, despair, perceived inability to complete an action, or grief over one’s mother’s early death, occurred before AMI in 16/47 pts (24%). After the third psychotherapy session, no pts reported recurring dreams (p < 0.001). In dreams that occurred during the year before AMI, 12 of 25 symbols referred to people known to pts and who had died of a cardiac disease; 9 of 25 symbols referred to an accident, danger, or distressing events. Overall, 21 of 25 symbols were associated with danger to an individual’s life (84%). The incidence of “negative” symbols was sharply reduced during psychotherapy, from 84% to 32% during the first three psychotherapy sessions and to 9% in the last phase of psychotherapy (p < 0.0001). Conclusions: Our study is the very first on dreams in pts with AMI, and it also examines how STP may change dream patterns in this cohort of pts. AMI pts frequently do not remember dreams that occurred before AMI or report distressing dreams. STP after AMI significantly increased their ability to remember dreams and sharply reduced the incidence of negative/distressing dreams. The results suggest that (1) dream symbols may be connected to the biological status of the dreamer, warning the dreamer of their cardiac condition; (2) ontopsychological STP may act as a stimulus for inner personal change for AMI pts. Full article

(This article belongs to the Section Mental Health)

14 pages, 711 KB

Open AccessArticle

A Vanished Association Between Proton Pump Inhibitors and Clostridioides Difficile Infection After Minimizing Bias

by Bin Wu, Zhiyao He and Ting Xu

J. Clin. Med. 2026, 15(1), 230; https://doi.org/10.3390/jcm15010230 (registering DOI) - 27 Dec 2025

Abstract

Background: The gut microbiome might be affected by proton-pump inhibitors (PPIs), increasing the risk of Clostridioides difficile infection (CDI); however, the association between PPIs and Clostridioides difficile infection (CDI) remains controversial. Aim: The aim of this study is to reevaluate the association [...] Read more.

Background: The gut microbiome might be affected by proton-pump inhibitors (PPIs), increasing the risk of Clostridioides difficile infection (CDI); however, the association between PPIs and Clostridioides difficile infection (CDI) remains controversial. Aim: The aim of this study is to reevaluate the association between PPIs and CDI based on pharmacovigilance data, taking competition bias into account. Methods: PPI-related CDI adverse event reports, based on the Food and Drug Administration adverse event reporting system database from 2004 to 2023, were analyzed. Included PPI cases were stratified into CDI and non-CDI groups. Disproportionality analysis was performed using the reporting odds ratio (ROR) and information component (IC). The effect of competition bias on signal detection was quantitatively investigated. Age-stratified analyses were conducted to assess residual confounding. Results: A total of 238,470 PPI reports were included, with 1268 cases in the CDI group and 237,202 cases in the non-CDI group. Initial analysis revealed a significant PPI-CDI association (ROR = 2.36, 95% confidence interval (95%CI) 2.19 to 2.53; IC = 1.21, 95%CI 0.97 to 1.45), with CDI signals detected for five PPI agents, including pantoprazole, omeprazole, lansoprazole, rabeprazole, and dexlansoprazole. After excluding competition from antibacterial drugs, CDI signal strength decreased substantially (ROR = 1.47, 95%CI 1.34 to 1.62; IC = 0.55, 95%CI 0.23 to 0.87), retaining a significant CDI signal only for rabeprazole and pantoprazole. Upon further exclusion of antibacterial or immunosuppressive drug users and renal injury event cases, CDI signal strength decreased (ROR = 1.48, 95%CI 1.32 to 1.66; IC = 0.56, 95%CI 0.18 to 0.94), with pantoprazole as the sole CDI signal drug. Age-stratified analyses demonstrated complete signal loss after antibacterial drug adjustment across all age groups. Conclusions: The current large-scale pharmacovigilance study indicated that the observed PPI-CDI association may be mediated predominantly by antibacterial drug co-exposure rather than PPI direct causation. Full article

(This article belongs to the Topic Drug Use and Patient Safety in Primary and Secondary Care Settings)

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9 pages, 402 KB

Open AccessArticle

Hemorrhagic Complications in Patients with Atrial Fibrillation Treated with Novel Oral Anticoagulants: Results from the CRAFT Study

by Marek Styczkiewicz, Mateusz Wawrzeńczyk, Adam Sukiennik, Bartosz Krzowski, Cezary Maciejewski, Piotr Lodziński, Leszek Kraj, Grzegorz Opolski, Marcin Grabowski, Paweł Balsam and Michał Peller

J. Clin. Med. 2026, 15(1), 229; https://doi.org/10.3390/jcm15010229 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Hemorrhagic complications are among the most common adverse events of anticoagulant therapy in patients with atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (DOACs) are known to be more effective than vitamin K antagonists (VKAs) in preventing thromboembolism. The aim was [...] Read more.

Background/Objectives: Hemorrhagic complications are among the most common adverse events of anticoagulant therapy in patients with atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (DOACs) are known to be more effective than vitamin K antagonists (VKAs) in preventing thromboembolism. The aim was to identify clinical factors associated with hemorrhagic events in AF patients treated with DOACs and to develop a simple, clinically applicable bleeding risk score. Methods: Data were derived from the multicenter CRAFT trial (NCT02987062). We conducted a retrospective analysis of hospital records of 1435 AF patients (median age: 67 years; 44.8% female) treated with dabigatran or rivaroxaban. The main study endpoints were the occurrence of a bleeding episode, thromboembolic episode, or all-cause death during a mean four-year follow-up (1531 [1062–2140] days). Results: The rates of bleeding episodes, thromboembolic episodes, and all-cause death were 17.4%, 13.5%, and 23.9%, respectively. Nine factors were identified as predictors of bleeding complications: male sex, history of major bleeding, history of cancer, COPD, CRT, rivaroxaban therapy, statin therapy, age, and absence of heart failure. Based on these, the CRAFT bleeding score was developed to predict the risk of hemorrhagic events in individual patients. Conclusions: The CRAFT bleeding score may be implemented in AF patients as an additional tool for evaluating DOACs safety prior to initiating anticoagulant therapy, and for guiding closer monitoring of high-risk individuals to minimize bleeding complications. Full article

(This article belongs to the Section Cardiology)

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14 pages, 247 KB

Open AccessReview

AI-Powered Predictive Models in Implant Dentistry: Planning, Risk Assessment, and Outcomes

by Ghada Neji, Roberta Gasparro, Mohamed Tlili, Aya Dhahri, Faten Khanfir, Gilberto Sammartino, Angelo Aliberti, Maria Domenica Campana and Faten Ben Amor

J. Clin. Med. 2026, 15(1), 228; https://doi.org/10.3390/jcm15010228 (registering DOI) - 27 Dec 2025

Abstract

Artificial intelligence (AI) is rapidly transforming the landscape of dental implantology by enhancing every stage of treatment, from diagnostics and digital planning to intraoperative navigation, outcome prediction, and long-term follow-up. This narrative review explores the current and emerging applications of AI technologies in [...] Read more.

Artificial intelligence (AI) is rapidly transforming the landscape of dental implantology by enhancing every stage of treatment, from diagnostics and digital planning to intraoperative navigation, outcome prediction, and long-term follow-up. This narrative review explores the current and emerging applications of AI technologies in implant dentistry, with a focus on machine learning, neural networks, and computer vision. It examines how AI is utilized in digital implant planning, surgical navigation, peri-implant disease monitoring, risk assessment, and the prediction of treatment outcomes such as peri-implantitis and implant failure. These innovations contribute to more efficient workflows, more personalized treatment strategies, and improved cost-effectiveness of care. Finally, future perspectives and educational implications of AI integration in clinical implantology are discussed. Full article

(This article belongs to the Special Issue Dental Implantology: Clinical Updates and Perspectives—2nd Edition)

15 pages, 815 KB

Open AccessArticle

Differing Definitions of Outpatient Surgery May Influence Study Outcomes Related to ACL Reconstruction

by Ryan Hoang, Junho Song, Arthur W. Cowman, Timothy Hoang, Alexander Yu, Justin Tiao, Haiyue Jin and Robert L. Parisien

J. Clin. Med. 2026, 15(1), 227; https://doi.org/10.3390/jcm15010227 (registering DOI) - 27 Dec 2025

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR), one of the most frequently performed orthopedic procedures, has experienced rising demand and escalating costs, driving efforts to reduce expenses through shorter hospital stays and an increased shift toward outpatient settings. This study aims to evaluate how [...] Read more.

Background: Anterior cruciate ligament reconstruction (ACLR), one of the most frequently performed orthopedic procedures, has experienced rising demand and escalating costs, driving efforts to reduce expenses through shorter hospital stays and an increased shift toward outpatient settings. This study aims to evaluate how differing definitions of “outpatient” surgery influence the interpretation of outcomes following ACLR. Methods: ACS-NSQIP was queried for patients undergoing primary ACL reconstruction between 2014 and 2023. Patients ≥ 18 years with CPT code 29888 were included. Patients with missing hospital length of stay (LOS) data or a LOS > 2 days (≥99th percentile) were excluded. Two definitions of “outpatient” surgery were evaluated: hospital-defined outpatient (HDO) and same-day discharge (SDD, LOS = 0). Propensity score matching of baseline demographics and comorbidities was used to compare HDO and SDD cohorts to their respective inpatient counterparts. Primary outcomes analyzed included 30-day readmission, reoperation, and postoperative complications. Univariate and multivariate analyses were performed to compare risks of complications for HDO and SDD cohorts compared to their inpatient counterparts. Results: A total of 37,546 patients were included in this study, with 35,334 HDO (94.1%) and 34,801 (92.7%) SDD cases. 1021 (2.9%) of the 35,334 HDO patients had an inpatient hospital stay of at least 1 night. In propensity-matched cohorts, hospital-defined inpatient ACLR was associated with significantly greater risk of 30-day reoperation (odds ratio [OR] 3.167, 95% CI 1.267–7.915, p = 0.009) and superficial surgical site infection (SSI) (OR 5.0, 95% CI 1.712–14.604 p = 0.001), while HDO ACLR was associated with increased risk of deep vein thrombosis (DVT) (OR 0.333, 95% CI 0.121–0.916, p = 0.025). Compared to the propensity-matched SDD cohort, inpatient ACLR was significantly associated with greater rates of 30-day readmission (OR 1.988, 95% CI 1.088–3.630, p < 0.001), reoperation (OR 3.222, 95% CI 1.528–6.794, p = 0.001), and superficial SSI (OR 3.286, 95% CI 1.412–7.644, p = 0.003). Conclusions: This study found differences in readmission and deep vein thrombosis between HDO and SDD cohorts when compared to inpatient ACLR. A standardized definition of outpatient surgery should be created to clearly distinguish same-day discharge from other outpatient categories, considering discharge timing and patient monitoring practices. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 225 KB

Open AccessArticle

Determinants of Ultra-Early Aspiration Pneumonia in Acute Intracerebral Hemorrhage Presenting to the Emergency Department

by Giancarlo Ceccarelli, Luca Bortolani, Francesco Branda, Mattia Albanese, Maria Civita Cedrone, Francesco Baratta, Riccardo Renna, Giovanni Giordano, Anne Falcou, Antonio Sili Scavalli, Luigi Petramala, Gabriella d’Ettorre and Gioacchino Galardo

J. Clin. Med. 2026, 15(1), 226; https://doi.org/10.3390/jcm15010226 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Aspiration pneumonia is among the most frequent medical complications after intracerebral hemorrhage (ICH), yet its role during the ultra-early emergency department (ED) phase remains poorly understood. This study aimed to identify clinical and neurological factors independently associated with radiologically confirmed aspiration [...] Read more.

Background/Objectives: Aspiration pneumonia is among the most frequent medical complications after intracerebral hemorrhage (ICH), yet its role during the ultra-early emergency department (ED) phase remains poorly understood. This study aimed to identify clinical and neurological factors independently associated with radiologically confirmed aspiration pneumonia in patients presenting with acute spontaneous ICH and to evaluate its association with early clinical outcomes. Methods: A retrospective observational cohort study was conducted in the neuro-emergency department of a large tertiary university hospital. All consecutive adults with spontaneous ICH confirmed by neuroimaging between January 2020 and December 2023 were included. Univariable and multivariable logistic regression models were used to identify independent predictors of pneumonia. Results: A total of 184 patients were analyzed (median age 74 years; 46% female). Radiologically confirmed aspiration pneumonia occurred in 37 patients (22.0%). Pneumonia was significantly associated with lower GCS, higher National Institutes of Health Stroke Scale (NIHSS) and ICH scores, shorter ED stay, and more frequent endotracheal intubation (ETI). In multivariable analysis, ETI (OR 5.42, 95% CI 1.57–18.63, p = 0.007), higher NIHSS score (OR 1.09, 95% CI 1.01–1.20, p = 0.047), and shorter ED stay (OR 0.97, 95% CI 0.95–0.99, p = 0.035) were independently associated with pneumonia. Aspiration pneumonia was not independently associated with neurosurgical referral (p = 0.082) or low GCS at discharge (p = 0.650). Conclusions: In this neuro-emergency cohort, aspiration pneumonia was common and strongly associated with neurological severity, particularly with endotracheal intubation and higher NIHSS scores. Although it did not independently predict early neurological deterioration or neurosurgical transfer, it identifies a critical period in which preventive measures—such as dysphagia screening, oral hygiene, and careful airway management—should be systematically applied. Larger multicenter studies with longer follow-up are needed to better define its long-term clinical consequences after ICH. Full article

(This article belongs to the Section Brain Injury)

16 pages, 1533 KB

Open AccessSystematic Review

Does Continuous Positive Airway Pressure Improve Liver Outcomes in MASLD with Obstructive Sleep Apnea? A Systematic Review

by Theja V. Channapragada, Clinton R. Brenner, Keven Guruswamy, Rewanth Katamreddy, Alwyn T. Pandian, Vyshnavi Pendala, Jaydon J. Sam, Jonathan G. Stine, Michael J. Brenner and Vinciya Pandian

J. Clin. Med. 2026, 15(1), 225; https://doi.org/10.3390/jcm15010225 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) often coexists with obstructive sleep apnea (OSA) due to overlapping metabolic risk factors. Whether continuous positive airway pressure (CPAP) influences hepatic outcomes in MASLD remains uncertain. This systematic review, using updated criteria for MASLD, evaluated the [...] Read more.

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) often coexists with obstructive sleep apnea (OSA) due to overlapping metabolic risk factors. Whether continuous positive airway pressure (CPAP) influences hepatic outcomes in MASLD remains uncertain. This systematic review, using updated criteria for MASLD, evaluated the effects of OSA treatment on liver and metabolic outcomes. Methods: PubMed, Web of Science, and CINAHL were searched for randomized controlled trials (RCTs) and observational studies in adults with MASLD and OSA treated with CPAP, lifestyle interventions, pharmacotherapy, or surgery. Outcomes included liver stiffness, fat content, enzymes, fibrosis scores, HbA1c, lipids, and anthropometrics. Risk of bias was assessed with RoB 2 (RCTs) and ROBINS-I (non-randomized studies) and certainty of evidence with GRADE. Results: Eight studies (three RCTs, five observational; n = 1006; 73.5% male) met criteria. Studies evaluated CPAP for from 4 weeks to 3 years, with adherence ≥ 4 h/night in most. CPAP produced modest, inconsistent reductions in alanine aminotransferase and aspartate aminotransferase, small improvements in HbA1c and triglycerides, and minimal changes in liver stiffness, steatosis, weight, or anthropometrics. No RCT demonstrated significant improvement in fibrosis or steatosis. Risk of bias was low in one RCT, “some concerns” in two, and moderate in observational studies; one study had serious confounding risk. Conclusions: CPAP may modestly improve liver enzymes and select metabolic parameters in MASLD with OSA, but evidence for salutary effects on steatosis, fibrosis, and body composition is limited. Level of evidence was low due to methodological limitations, heterogeneity, and imprecision. High-quality, longitudinal trials are needed. Full article

(This article belongs to the Section Otolaryngology)

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12 pages, 234 KB

Open AccessArticle

Associations of ADHD and Borderline Personality Disorder with Suicidality in Adolescents: Additive and Interactive Effects

by Bartłomiej Sporniak, Przemysław Zakowicz and Monika Szewczuk-Bogusławska

J. Clin. Med. 2026, 15(1), 224; https://doi.org/10.3390/jcm15010224 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Suicidal behaviors are a major clinical concern in adolescents, particularly among those with disorders marked by emotion dysregulation and impulsivity. Although attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) each heighten suicide risk, little is known about whether their occurrence confers [...] Read more.

Background/Objectives: Suicidal behaviors are a major clinical concern in adolescents, particularly among those with disorders marked by emotion dysregulation and impulsivity. Although attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) each heighten suicide risk, little is known about whether their occurrence confers additive or interactive effects in youth. This study examined whether ADHD and BPD diagnoses show additive or interactive associations with the suicide risk in adolescents. Methods: In this cross-sectional observational clinical study, the sample included 108 Polish adolescents (66.7% female; aged 13–17 years) recruited from inpatient and outpatient psychiatric settings (Independent Public Healthcare Facility, Children and Youth Treatment Center in Zabór, the Youth Sociotherapy Center No. 2 in Wrocław, and the District Educational Center in Jerzmanice-Zdrój (Poland)). The data collection for our study was conducted between May 2024 and July 2025. Diagnoses and suicide risk were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID 7.02). Associations of ADHD and BPD with suicide risk were tested using linear and logistic regression models while accounting for age, sex, the current depressive episode, and the use of psychiatric medications. Results: Unadjusted analyses revealed significant main, but not interactive, associations of BPD and ADHD with suicide risk. When covariates were included in the model, BPD remained strongly associated with suicidality severity and with the presence of any suicide risk (adjusted OR = 7.00, 95% CI [1.55–31.57]), whereas the association between ADHD and suicidality was attenuated and did not reach conventional levels of statistical significance (adjusted OR = 3.48, 95% CI [0.93–13.08]). No statistically detectable ADHD × BPD interaction was observed. Estimates for ADHD were directionally consistent across models but characterized by wide confidence intervals. Conclusions: Adolescents with BPD appear to be at particularly high risk of suicide and should receive focused assessment, safety planning, and early intervention as part of routine care. In contrast, suicidality among adolescents with ADHD appears to be influenced by co-occurring clinical conditions, and its independent association with suicide risk remains statistically uncertain after adjustment. Clinicians should therefore remain alert to suicidality in youth with ADHD, while paying particular attention to accompanying symptoms and comorbid diagnoses that may further increase risk. Full article

(This article belongs to the Section Mental Health)

26 pages, 4081 KB

Open AccessArticle

Citicoline Oral Solution Induces Functional Enhancement and Synaptic Plasticity in Patients with Open-Angle Glaucoma

by Vincenzo Parisi, Lucia Ziccardi, Lucia Tanga, Lucilla Barbano, Emanuele Tinelli, Gianluca Coppola, Antonio Di Renzo, Manuele Michelessi, Gloria Roberti, Carmela Carnevale, Sara Giammaria, Carmen Dell’Aquila, Mattia D’Andrea, Gianluca Manni and Francesco Oddone

J. Clin. Med. 2026, 15(1), 223; https://doi.org/10.3390/jcm15010223 (registering DOI) - 27 Dec 2025

Abstract

Objectives: To evaluate the changes in retinal function and neural conduction along the visual pathways after 12 months of treatment with Citicoline oral solution in patients with open-angle glaucoma (OAG). Methods: In this randomized, prospective, double-blind study, 29 OAG patients were enrolled. Fifteen [...] Read more.

Objectives: To evaluate the changes in retinal function and neural conduction along the visual pathways after 12 months of treatment with Citicoline oral solution in patients with open-angle glaucoma (OAG). Methods: In this randomized, prospective, double-blind study, 29 OAG patients were enrolled. Fifteen patients (Citicoline Group, 15 eyes) received Citicoline oral solution (Neurotidine^®, 500 mg/day), and 14 patients (Placebo Group, 14 eyes) received placebo for 12 months. Visual field (VF), pattern electroretinogram (PERG), visual evoked potentials (VEP), and Retinocortical Time (RCT) were assessed at baseline and after 6 and 12 months. Brain Diffusion Tensor Imaging (DTI)-Magnetic Resonance Imaging (MRI) was performed at baseline and at 12 months. Results: PERG, VEP, and RCT baseline values were comparable between groups (p > 0.01) at baseline. After 12 months of Citicoline treatment, significant (p < 0.01) increases in PERG P50-N95 and VEP N75-P100 amplitudes, and significant shortening of PERG P50, VEP P100 implicit times and RCT were observed. VEP implicit times shortening significantly correlated with the changes in VF Mean Deviation, and RCT shortening was associated with changes in DTI-MRI metrics in the lateral geniculate nucleus and on optic radiations, without reaching the level of significance. No significant changes were found in the Placebo Group. Conclusions: In OAG, Citicoline oral solution enhances retinal function likely through neuromodulation processes and changes post-retinal visual pathway connectivity. This could explain the improvement of visual field defects. Full article

(This article belongs to the Section Ophthalmology)

14 pages, 255 KB

Open AccessArticle

Clinical Outcomes Associated with the Use of a Family-Based Digital Support Program in Patients with Pharmacologic Treatment for Obesity

by Antonio de Arriba Muñoz, Oscar Eduardo Rodríguez-Montes, Ana Rocío Conde-Moro, María Teresa Garcia Castellanos, José Andrés Martínez García and Luis Fernández-Luque

J. Clin. Med. 2026, 15(1), 222; https://doi.org/10.3390/jcm15010222 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: The Adhera^® Caring Digital Program (ACDP) is a digitally delivered intervention aimed at enhancing the mental and physical well-being of family caregivers of children with chronic conditions. Tailored for the context of childhood obesity, ACDP leverages the Adhera AI Precision Digital [...] Read more.

Background/Objectives: The Adhera^® Caring Digital Program (ACDP) is a digitally delivered intervention aimed at enhancing the mental and physical well-being of family caregivers of children with chronic conditions. Tailored for the context of childhood obesity, ACDP leverages the Adhera AI Precision Digital Companion to support caregivers in promoting effective treatment adherence and healthy behaviors at home. While children in this study received GLP-1 receptor agonist treatment as part of their obesity management, the ACDP was designed to empower caregivers through educational, behavioral, and emotional support tools. The aim of this study was to determine the relationship between engagement with the ACDP as a DHI and clinical outcomes in participants receiving GLP-1 receptor agonist treatment for obesity. Methods: This study analyzed data from approximately 40 pediatric patients receiving GLP-1-based pharmacological treatment for obesity and their caregivers enrolled in the ACDP. Caregiver engagement was assessed through a composite score derived from digital activity metrics and classified as low, medium, or high. Children’s clinical parameters (BMI, weight, fat mass %, muscle mass %, and waist circumference) were collected at baseline and Day 150. Biometric, physical activity, and sleep data were also collected through a wearable device, enabling continuous and objective monitoring of participants’ physiological and behavioral patterns in real-world conditions. Statistical analyses included paired comparisons, Pearson correlations, and group comparisons by engagement level. Results: Data from 40 pediatric participants and their caregivers were analyzed over 150 days. Observed changes over the time in children showed a reduction in waist circumference (−6.0%, p = 0.0056) and a modest decrease in BMI. Higher levels of caregiver engagement with the Adhera^® Caring Digital Program correlated with reduction in body fat (ΔFat% r ≈ 0.5, p = 0.091) representing the strongest correlation observed in the study, albeit not reaching statistical significance. From baseline to Day 150, significant improvements were observed across all clinical outcomes, including reductions in BMI (−4.51 kg/m²), body weight (−11.42 kg), body fat percentage (−5.63%), and waist circumference (−8.69 cm), alongside an increase in muscle mass (+4.47%) (all p < 0.0001). Conclusions: At the mid-point of the intervention, combined GLP-1 pharmacotherapy and the Adhera^® Caring Digital Program led to meaningful improvements in BMI, adiposity, and central obesity. While caregiver engagement was not significantly associated with short-term outcomes, observed trends suggest that digital support may provide complementary benefits to pharmacological treatment, warranting further evaluation at Day 300. Full article

(This article belongs to the Special Issue Clinical Management for Metabolic Syndrome and Obesity)

34 pages, 7736 KB

Open AccessArticle

The Influence of PAR 1 and Endothelin 1 on the Course of Specific Kidney Diseases

by Maciej Szymczak, Marcelina Żabińska, Katarzyna Kościelska-Kasprzak, Dorota Bartoszek, Harald Heidecke, Kai Schulze-Forster, Łucja Janek, Krzysztof Kujawa, Jakub Wronowicz, Karolina Marek-Bukowiec, Tomasz Gołębiowski and Mirosław Banasik

J. Clin. Med. 2026, 15(1), 221; https://doi.org/10.3390/jcm15010221 (registering DOI) - 27 Dec 2025

Abstract

Background: PAR 1 (protease-activated receptor 1) and endothelin 1 are biomarkers that could be of significance in kidney diseases. Methods: We measured the plasma levels of PAR1 and endothelin 1 in patients with membranous nephropathy (n = 19), focal and [...] Read more.

Background: PAR 1 (protease-activated receptor 1) and endothelin 1 are biomarkers that could be of significance in kidney diseases. Methods: We measured the plasma levels of PAR1 and endothelin 1 in patients with membranous nephropathy (n = 19), focal and segmental glomerulosclerosis (FSGS) (n = 30), systemic lupus erythematosus (SLE) (n = 22), IgA nephropathy (n = 16), mesangial proliferative (non-IgA) glomerulonephritis (n = 7), chronic kidney disease (CKD) (n = 27), and hemodialysis (n = 26), as well as a healthy control group (n = 22). Then, for two years, we tracked the patients’ clinical progress (creatinine, total protein, and albumin levels) and compared the outcomes with their initial PAR 1 and endothelin 1 levels. Moreover, we checked the correlations between PAR 1 and endothelin 1 and the results of anti-PAR1 and anti-ETAR (endothelin A receptor) evaluations. Results: Membranous nephropathy, FSGS, IgA nephropathy, CKD, and hemodialysis patients had higher PAR 1 levels than the control group. PAR 1 correlated with total protein, albumin in SLE, total protein in IgA nephropathy, and creatinine in CKD. Endothelin 1 correlated with albumin in membranous nephropathy, total protein, albumin, creatinine in FSGS, total protein in IgA nephropathy, total protein, and albumin in CKD. PAR 1 correlated with anti-PAR 1 in FSGS. Anti-ETAR correlated with anti-PAR 1 in membranous nephropathy, FSGS, and IgA nephropathy. Conclusions: PAR 1 levels are elevated in some kidney diseases compared to the healthy population. Both PAR 1 and endothelin 1 are supposed to be related to the clinical course of specific kidney diseases. Full article

(This article belongs to the Section Nephrology & Urology)

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18 pages, 472 KB

Open AccessSystematic Review

A Systematic Review of Rehabilitation Interventions for Athletes with Chronic Ankle Instability

by Marlena Skwiot

J. Clin. Med. 2026, 15(1), 220; https://doi.org/10.3390/jcm15010220 (registering DOI) - 27 Dec 2025

Abstract

Background: Ankle sprains affect approximately 8% of the general population, and recurrence occurs in as many as 80% of patients participating in high-risk sports. The aim of this review was to assess the impact of physiotherapy interventions on chronic ankle stability (CAI), providing [...] Read more.

Background: Ankle sprains affect approximately 8% of the general population, and recurrence occurs in as many as 80% of patients participating in high-risk sports. The aim of this review was to assess the impact of physiotherapy interventions on chronic ankle stability (CAI), providing evidence for the effectiveness of clinical treatment and care for patients with CAI. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) evaluating the effectiveness of physiotherapy interventions in athletes with CAI following injury were analyzed. PubMed, Embase, PEDro, and Cochrane electronic databases were searched. A modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the included studies, in accordance with the guidelines. Results: The literature search yielded 316 results, of which 13 articles met all required eligibility criteria and were included in the study. The RCTs included 490 athletes with CAI. Interventions included various types of exercises, including balance training (BT), plyometric training, CrossFit, and neuromuscular training. The duration of the intervention was 4–12 weeks. Both subjective and objective measures were used to assess the effectiveness of the therapy in the following seven domains: Dynamic Balance, Static Balance, Patient-Reported Outcomes, Kinematic Outcomes, Proprioception, Body-Composition, and Strength Assessment. Conclusions: The evidence supports the effectiveness of rehabilitation interventions in athletes with CAI. Further large-scale randomized controlled trials, incorporating control groups and long-term follow-up, are needed to better determine the robust impact of conservative management on improving both the physical and psychological health of patients with CAI. Full article

(This article belongs to the Section Sports Medicine)

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14 pages, 8886 KB

Open AccessArticle

Comparative Analysis of Implant Placement Accuracy Using Augmented Reality Technology Versus 3D-Printed Surgical Guides: A Controlled In Vitro Study

by Adam Aleksander Nowicki and Marek Markiewicz

J. Clin. Med. 2026, 15(1), 219; https://doi.org/10.3390/jcm15010219 (registering DOI) - 27 Dec 2025

Abstract

Purpose: The objective of this study was to evaluate and compare the precision of dental implant placements using augmented reality (AR)-iPhone (Apple, Cupertino, CA, USA) navigation technology versus conventional 3D-printed surgical guides. The accuracy was assessed by comparing the actual implant positions [...] Read more.

Purpose: The objective of this study was to evaluate and compare the precision of dental implant placements using augmented reality (AR)-iPhone (Apple, Cupertino, CA, USA) navigation technology versus conventional 3D-printed surgical guides. The accuracy was assessed by comparing the actual implant positions to their predefined three-dimensional (3D) locations in surgical plans using the Exocad software (Exocad, Dormstadt, Germany). Materials and Methods: Fourteen standardized mandibular models were divided into two groups: AR-guided (AR1-AR7) and 3D-printed surgical guide-assisted (Group 1–7). Each model received four implants in positions 35, 32, 42, and 45. Postoperative CBCT scans were aligned with the preoperative plans in the Exocad software to measure three-dimensional deviations, including total entry error, total apex error, and angular error. Statistical analysis was performed using the Statistica 12 software (StatSoft, Tulsa, OK, USA), incorporating Shapiro–Wilk normality tests, ANOVA, and post hoc LSD tests (where applicable). Results: The in vitro comparative experiment demonstrated AR group superior accuracy with mean deviations of 0.42 ± 0.12 mm at the entry point and 0.51 ± 0.18 mm at the apex, compared to 0.48 ± 0.15 mm and 0.58 ± 0.22 mm, respectively, in the 3D-printed guide group (p < 0.05). Angular deviation was significantly lower in the AR group (1.8° ± 0.6°) versus the guide group (2.1° ± 0.7°, p = 0.009). Descriptive statistics revealed the median apex error was 0.49 mm (IQR: 0.38–0.61) for AR versus 0.56 mm (IQR: 0.45–0.72) for guides. Conclusions: AR iPhone navigation technology achieved clinically acceptable accuracy compared to static 3D-printed guides, particularly in controlling angular deviations. While both methods produced clinically acceptable results, AR technology represents a significant advancement for precision-sensitive cases. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Advances and Future Directions)

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19 pages, 1089 KB

Open AccessArticle

The Role of Aldosterone in Detecting Resistance-Driven Hypoaldosteronism and Deficit-Driven Hypoaldosteronism

by Jorge Gabriel Ruiz-Sánchez, Alfonso Luis Calle-Pascual, Miguel Ángel Rubio-Herrera, Paz De Miguel Novoa, Emilia Gómez-Hoyos and Isabelle Runkle

J. Clin. Med. 2026, 15(1), 218; https://doi.org/10.3390/jcm15010218 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Hypoaldosteronism is classified into “aldosterone deficit” (Aldo-D) and “aldosterone/mineralocorticoid resistance” (Aldo-R) based on etiopathogenic mechanisms. This distinction could be useful for guiding the treatment. However, no reliable methods have been established to differentiate these subtypes. We first aimed to assess whether [...] Read more.

Background/Objectives: Hypoaldosteronism is classified into “aldosterone deficit” (Aldo-D) and “aldosterone/mineralocorticoid resistance” (Aldo-R) based on etiopathogenic mechanisms. This distinction could be useful for guiding the treatment. However, no reliable methods have been established to differentiate these subtypes. We first aimed to assess whether aldosterone levels could help identify them when assessed in the setting of hyperkalemia or hyperreninemia. Methods: We conducted a retrospective analysis of eighty-four cases of hypoaldosteronism. Aldo-D and Aldo-R classification was based on the presence of clinical factors associated with aldosterone deficit and mineralocorticoid resistance, respectively. The accuracy of plasma aldosterone (PAC) to identify each type of hypoaldosteronism individually was evaluated using AUC-ROC analysis. Results: Aldo-D was identified in 66 (78.6%), and Aldo-R in 41 (48.8%) cases. Factors related to both subtypes were observed in forty-seven (56%) cases. AUC-ROC analysis of PAC measured during hyperkalemia showed low accuracy for detecting either subtype. During hyperreninemia, PAC accuracy was adequate for identifying Aldo-D but unsatisfactory for Aldo-R. Nevertheless, a PAC ≤ 60 pg/mL (6 ng/dL, ~166 pmol/L) during hyperkalemia and hyperreninemia yielded positive predictive values (PPV) of 94% and 100%, respectively, for Aldo-D, while a PAC value > 160 pg/mL (~443 pmol/L), particularly ≥ 200 pg/mL (20 ng/dL, ~550 pmol/L) in either condition had a PPV of 100% for Aldo-R. Conclusions: Although overall diagnostic accuracy was limited, extreme low and high PAC values (≤ 60 pg/mL or ≥ 200 pg/mL) may be suggestive of Aldo-D or Aldo-R, respectively, while intermediate values remain difficult to interpret due to substantial overlap. Full article

(This article belongs to the Special Issue From Hyperfunction to Insufficiency: A Comprehensive Look at Adrenal Disorders)

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14 pages, 1609 KB

Open AccessArticle

Socially Assistive Robot Hyodol for Depressive Symptoms of Community-Dwelling Older Adults in Medically Underserved Areas: A Preliminary Study

by Han Wool Jung, Yujin Kim, Hyojung Kim, Min-kyeong Kim, Hyejung Lee, Jin Young Park, Woo Jung Kim and Jaesub Park

J. Clin. Med. 2026, 15(1), 217; https://doi.org/10.3390/jcm15010217 (registering DOI) - 27 Dec 2025

Abstract

Background/Objectives: Socially assistive robots effectively support elderly care when they incorporate personalization, person-centered principles, rich interactions, and careful role setting with psychosocial alignment. Hyodol, a socially assistive robot designed for elderly people, embodies a grandchild’s persona, emulating the grandparent–grandchild relationship. Based [...] Read more.

Background/Objectives: Socially assistive robots effectively support elderly care when they incorporate personalization, person-centered principles, rich interactions, and careful role setting with psychosocial alignment. Hyodol, a socially assistive robot designed for elderly people, embodies a grandchild’s persona, emulating the grandparent–grandchild relationship. Based on the behavioral activation principles and a human-centered approach, this robot continuously supports users’ emotional well-being, health management, and daily routines. Methods: The current study evaluated Hyodol’s impact on depressive symptoms and other quality of life factors among older adults living in medically underserved areas. A total of 278 participants were assessed for depressive symptoms, loneliness, medication adherence, and user acceptance. Results: After six months of use, participants showed significant reductions in overall depressive symptoms, with a 45% decrease in the proportion of individuals at high risk of depression. Significant improvements were also observed in loneliness and medication adherence. Participants reported high levels of user acceptance and satisfaction, exceeding 70% of the total score. Participants who engaged more frequently in free chat with Hyodol showed greater improvements in depressive symptoms. Conclusions: These results highlight Hyodol’s potential as a promising tool for enhancing mental healthcare and overall well-being in this population. This at-home mental-healthcare framework can complement primary care and, if its effects are confirmed in controlled trials, could contribute to reducing healthcare burden and preventing the onset and escalation of depressive symptoms. Full article

(This article belongs to the Special Issue Innovations in the Treatment for Depression and Anxiety)

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