Journal of Clinical Medicine

14 pages, 16757 KB

Open AccessArticle

Effects of Selective Retina Therapy on Central Serous Chorioretinopathy with Serous Pigment Epithelial Detachments

by Dayeong Kim, Seung Hee Jeon and Young-Jung Roh

J. Clin. Med. 2026, 15(10), 3905; https://doi.org/10.3390/jcm15103905 (registering DOI) - 19 May 2026

Background/Objective: This study’s aim is to evaluate the anatomical and functional effects of selective retina therapy (SRT) in patients with central serous chorioretinopathy (CSC) accompanied by serous pigment epithelial detachment (PED). Methods: This retrospective study included 32 eyes from 32 patients with CSC [...] Read more.

Background/Objective: This study’s aim is to evaluate the anatomical and functional effects of selective retina therapy (SRT) in patients with central serous chorioretinopathy (CSC) accompanied by serous pigment epithelial detachment (PED). Methods: This retrospective study included 32 eyes from 32 patients with CSC and serous PED treated with SRT. Pulse energy and micropulse number were adjusted based on test spot visibility on fundus photographs. Best-corrected visual acuity (BCVA; logMAR), central foveal thickness (CFT), subretinal fluid (SRF) height, PED height, and subfoveal choroidal thickness were assessed at baseline and at 1, 2, and 3 months post-treatment. Retinal sensitivity was evaluated using microperimetry at baseline and 3 months. Results: At 3 months after SRT, complete SRF resolution was achieved in 78.1% of eyes (25/32). Mean BCVA improved significantly from 0.29 ± 0.30 logMAR at baseline to 0.20 ± 0.29 logMAR (p = 0.006). Mean CFT decreased from 284.7 ± 91.3 µm to 165.7 ± 94.8 µm (p < 0.001). Mean SRF height decreased from 150.5 ± 74.6 µm to 20.9 ± 48.3 µm (p < 0.001), and mean PED height decreased from 101.7 ± 96.9 µm to 33.3 ± 37.6 µm (p < 0.001). Retinal sensitivity showed a non-significant improvement at 3 months (p = 0.108). Reduction in PED height was moderately correlated with reduction in SRF height (r = 0.446, p = 0.011). Conclusions: SRT was associated with reductions in PED and SRF in CSC. These findings should be interpreted cautiously given the absence of a control group and the potential for spontaneous changes in SRF and PED. Full article

(This article belongs to the Special Issue Clinical Management of Vitreous and Retinal Disorders)

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17 pages, 810 KB

Open AccessArticle

Visual and Patient-Reported Outcomes After Bilateral Implantation of Two Enhanced Monofocal IOLs

by Rosa Giglio, Serena Milan, Riccardo Leonelli, Elena Verdimonti, Alberto Grotto, Marianna Presotto, Giulia Soccio, Marco Zeppieri, Gianluca Turco and Daniele Tognetto

J. Clin. Med. 2026, 15(10), 3904; https://doi.org/10.3390/jcm15103904 (registering DOI) - 19 May 2026

Abstract

Background/Objectives: Enhanced monofocal intraocular lenses (IOLs) aim to extend functional vision into the intermediate range while preserving the distance visual quality of standard monofocal aspheric lenses. This study compared the clinical and patient-reported outcomes of two enhanced monofocal IOLs, TECNIS Eyhance™ and Evolux™, [...] Read more.

Background/Objectives: Enhanced monofocal intraocular lenses (IOLs) aim to extend functional vision into the intermediate range while preserving the distance visual quality of standard monofocal aspheric lenses. This study compared the clinical and patient-reported outcomes of two enhanced monofocal IOLs, TECNIS Eyhance™ and Evolux™, and characterised the anterior surface profile of the Evolux™ optic. Methods: This single-centre, retrospective comparative case series included consecutive patients who received bilateral implantation of either Evolux™ or TECNIS Eyhance™ between February and July 2023. Primary outcomes were monocular uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA). Secondary outcomes included monocular and binocular distance and near visual acuity, binocular intermediate visual acuity, spherical equivalent and patient-reported outcomes assessed using the Revised Heidelberg Daily Task Evaluation (DATE) questionnaire. Equivalence testing, Welch’s t-test, and covariate-adjusted ANCOVA were performed. Anterior surface profilometry of the Evolux™ IOL was conducted using an optical profilometer. Results: A total of 44 patients were included, 14 in the Evolux™ group and 30 in the TECNIS Eyhance™ group. Monocular and binocular UIVA and DCIVA were statistically equivalent between groups (TOST p = 0.028, 0.016, 0.008, and 0.005, respectively). Monocular and binocular distance outcomes were likewise equivalent. Binocular distance-corrected near visual acuity was significantly better in the Evolux™ group (0.164 ± 0.084 vs. 0.233 ± 0.112 logMAR; p = 0.030; Cohen’s d = 0.661), without a corresponding monocular difference. This isolated finding should be interpreted cautiously given the exploratory, multiple-outcome analysis and because it did not retain statistical significance after covariate adjustment for baseline biometric imbalances. Conclusions: In this exploratory study, both IOLs showed no statistically significant differences in intermediate and distance visual outcomes at one month after second eye surgery. The unadjusted binocular near vision finding for Evolux™, which did not retain significance after covariate adjustment, warrants further investigation in prospective, adequately powered, biometrically balanced studies. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery and Intraocular Lens Implantation: Clinical Advances and Perspectives)

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23 pages, 4737 KB

Open AccessReview

The History of the Precordial Early Repolarization and Sudden Death Syndrome, Lately Named Brugada Syndrome

by Bortolo Martini

J. Clin. Med. 2026, 15(10), 3903; https://doi.org/10.3390/jcm15103903 (registering DOI) - 19 May 2026

Abstract

This paper intends to go through the medical history of a new syndrome, beginning from its incidental observation to the nowadays ongoing reports quickly approaching 7000 published papers. This large number makes it difficult for the researcher to correctly quote the previous significant [...] Read more.

This paper intends to go through the medical history of a new syndrome, beginning from its incidental observation to the nowadays ongoing reports quickly approaching 7000 published papers. This large number makes it difficult for the researcher to correctly quote the previous significant published data, and the usual strategy is to copy and paste the last articles references. This review is mainly detailed historical research of the step-by-step journey mainly of the first three decades, with less attention to the ongoing and late scientific controversies that are indeed quoted. The new syndrome was early named “precordial early repolarization (PER) syndrome” but became popular after being renamed “Brugada syndrome” (BS). Nowadays it is classified as one of the “J wave syndromes” (JWSs). The main characteristic of this new entity was an unusual astonishing precordial coved ST segment elevation that gave rise since its first descriptions to two different pathophysiological theories, one organic and the second functional. The first theory ascribed the ST elevation to an unusual pattern of depolarization at the right ventricular outflow tract (RVOT), while the second favored an abnormal dynamic repolarization pattern. Both phenomena were sometimes linked to an ion channel genetic abnormality. In the following decades, many eminent scientists and also some excellent humble cardiologists made significant observations regarding epidemiology, laboratory, diagnostic techniques, genetic, clinical findings, histology, embryology, therapeutic approaches, and risk stratification. This rush “to be the first who” has created more confusion than certainty, and only in this last decade a more scientific and less emotional approach has led to a common acceptance of an underlying organic background that causes a strange conduction delay mainly at the epicardial level of the RVOT. “Next generation” cardiologists are in charge of further elucidating the genetic, the structural, and electrical pathophysiology, and the correct risk stratification needed to correctly identify the true patients who need a therapy and avoid unusual and dangerous treatments to healthy people with a benign strange ECG. Full article

(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)

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17 pages, 3796 KB

Open AccessArticle

REAMINAS—A Retrospective Study Evaluating the Completeness of the Emergency Department’s Admission Medication and Its Influence on Discharge Medication

by Ludwig vom Hofe, Maximilian Günther, Daniela Huttner, Ute Amann, Jan Rémi, Matthias Klein and Dorothea Strobach

J. Clin. Med. 2026, 15(10), 3902; https://doi.org/10.3390/jcm15103902 (registering DOI) - 19 May 2026

Abstract

Background: Documentation of admission medication is frequently insufficient, particularly in the emergency department (ED). This study analyses discrepancies between the admission medication by ED physicians and pharmaceutical medication reconciliation (PMR) at the emergency admission ward, their clinical relevance, and influence on discharge [...] Read more.

Background: Documentation of admission medication is frequently insufficient, particularly in the emergency department (ED). This study analyses discrepancies between the admission medication by ED physicians and pharmaceutical medication reconciliation (PMR) at the emergency admission ward, their clinical relevance, and influence on discharge medication. Methods: In a retrospective observational study (May 2022–April 2023) on an interdisciplinary emergency admission ward, unintended medication discrepancies (UMDs) between ED admission medication and PMR, as well as prescription discrepancies (PDs) between admission medication prescribed at the emergency admission ward and PMR, were analysed. Persistence of PDs up to discharge was evaluated. Drugs associated with discrepancies were classified for clinical relevance during hospitalisation as (A) relevant for documentation and prescription, (B) relevant for documentation but irrelevant for prescription, or (C) irrelevant for documentation and prescription. Additionally, a list of high-risk drugs was established. Results: For 256 patients, a median of three (Q1–Q3 0–6.75) and five (2–8) drugs were documented as admission medication in the ED and PMR, respectively, with a median of two (1–5) UMDs per patient. For Group A drugs, the admission medication prescribed at the emergency admission ward compared to the PMR resulted in a median of one (0–3) PD per patient. Drug omission was most common (60.0 and 61.0% of UMDs and PDs, respectively). A total of 22.8% of UMDs and 23.8% of PDs concerned high-risk drugs. Of 215 PDs eligible for discharge analysis, 137 (63.7%) persisted up to the discharge letter. Conclusions: A considerable number of discrepancies were found between the admission medication in the ED and PMR. A substantial proportion of these were caused by high-risk drugs, highlighting their potential to harm patients. Discrepancies tend to persist throughout hospitalisation up to the discharge letter. Full article

(This article belongs to the Section Pharmacology)

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13 pages, 918 KB

Open AccessArticle

Comparing 24 h Urine and Spot Urine Calcium Measurements in Clinical Routine: Accuracy and Limitations

by Antonia Mondorf, Rejane Golbach, Ludwig Hofbauer, Christine Koch, Christiana Graf, Anna Katharina Flügel, Nora Ackermann, Christian Vorländer, Matthias Pirlich, Christoph Terkamp, Katharina Holzer, Ulrich Mondorf, Alexander Mann and Jörg Bojunga

J. Clin. Med. 2026, 15(10), 3901; https://doi.org/10.3390/jcm15103901 (registering DOI) - 19 May 2026

Abstract

Background/Objectives: Urinary calcium excretion is a key parameter in assessing mineral metabolism and diagnosing conditions such as nephrolithiasis, osteoporosis, and hyperparathyroidism. The 24 h urine collection is the gold standard for evaluating calcium excretion, but it is often impractical due to patient [...] Read more.

Background/Objectives: Urinary calcium excretion is a key parameter in assessing mineral metabolism and diagnosing conditions such as nephrolithiasis, osteoporosis, and hyperparathyroidism. The 24 h urine collection is the gold standard for evaluating calcium excretion, but it is often impractical due to patient non-compliance and logistical challenges. As an alternative, the calcium-to-creatinine ratio (CCR) in spot urine has been proposed, although its reliability remains debated. This study aims to systematically compare the calcium levels in spot urine samples with those obtained from 24 h urine collections to assess their agreement and clinical applicability. Methods: This retrospective, multi-center study analyzed data from 201 patients who provided both 24 h and spot urine samples during routine diagnostic work-up between 1 January 2019 and 31 December 2024. Calcium excretion was normalized using the calcium-to-creatinine ratio (CCR). The agreement between the two methods was assessed using Bland–Altman analysis, Pearson and Spearman correlation coefficients, and receiver operating characteristic (ROC) curve analysis. Results: Hypercalciuria, defined as ≥6.25 mmol/24 h in women and ≥7.5 mmol/24 h in men, was detected in 52.7% of cases based on 24 h urine. ROC analysis showed that spot urine CCR had moderate diagnostic accuracy (AUC = 0.76). The optimal cut-off for predicting hypercalciuria was 4.4 mmol/g (sensitivity 70.8%, specificity 72.4%). Overall agreement between spot urine CCR and 24 h urine CCR was moderate, with a Bland–Altman geometric mean ratio of 1.06 and multiplicative limits of agreement of 0.59 to 1.91. A low spot urine CCR below 2 mmol/g showed high sensitivity but low specificity and had a negative predictive value of 82%. Conclusions: Spot urine CCR cannot replace 24 h urine collection for accurately assessing urinary calcium excretion, but very low values may have limited utility as an initial rule-out tool in selected patients. Very low spot urine CCR values may help rule out hypercalciuria in a limited subgroup of patients and may therefore support triage decisions in selected clinical situations. Further prospective studies are needed to validate these findings. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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13 pages, 899 KB

Open AccessArticle

Prognostic and Predictive Significance of Body Mass Index in Locally Advanced Gastric Cancer Receiving Neoadjuvant Chemotherapy: A Retrospective Multicenter Cohort Study

by Pervin Can Şancı, Mustafa Seyyar, Anil Karakayali, Murat Akyol, Yasemin Bakkal Temi, Devrim Çabuk, Kazım Uygun and Umut Kefeli

J. Clin. Med. 2026, 15(10), 3900; https://doi.org/10.3390/jcm15103900 (registering DOI) - 19 May 2026

Abstract

Background/Objectives: Gastric cancer remains a leading cause of cancer-related mortality worldwide, with a significant number of patients diagnosed at locally advanced stages. While perioperative chemotherapy and surgical resection are the standard treatments, patient outcomes remain heterogeneous. This study aimed to investigate the prognostic [...] Read more.

Background/Objectives: Gastric cancer remains a leading cause of cancer-related mortality worldwide, with a significant number of patients diagnosed at locally advanced stages. While perioperative chemotherapy and surgical resection are the standard treatments, patient outcomes remain heterogeneous. This study aimed to investigate the prognostic and predictive effects of Body Mass Index (BMI) on pathological response, progression-free survival (PFS), and overall survival (OS) in patients receiving neoadjuvant chemotherapy. Methods: This retrospective, observational cohort study included 192 patients with locally advanced gastric cancer who underwent curative gastrectomy and neoadjuvant chemotherapy between 2018 and 2023. Patients were categorized based on an optimal BMI cutoff value of 24.9 kg/m². Results: Patients with a BMI ≥ 24.9 kg/m² demonstrated a 41% lower 5-year mortality risk compared to those with a lower BMI (HR = 0.59; 95% CI: 0.35–0.99; p = 0.044). The high BMI group had a significantly longer average PFS (54.1 months) compared to the low BMI group (41.4 months). High BMI was associated with a significantly reduced risk of progression (HR: 0.61; 95%CI: 0.38–0.97; p = 0.038. Log-linear regression confirmed that the complete response rate was 73.7% lower in patients with low BMI. Conclusions: BMI threshold of ≥24.9 kg/m² is associated with improved pathological response and long-term survival in patients with locally advanced gastric cancer receiving neoadjuvant chemotherapy. These findings suggest that BMI potentially reflects the impact of nutritional status on treatment tolerability and oncological outcomes. Full article

(This article belongs to the Section Oncology)

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10 pages, 485 KB

Open AccessArticle

Cryotherapy-Driven Modulation of Postoperative Pain in Single-Visit Endodontic Treatment Across Different Obturation Materials: A Retrospective Study

by Kaan Ilıcalı, Ahter Şanal Çıkman and Özge Başar

J. Clin. Med. 2026, 15(10), 3899; https://doi.org/10.3390/jcm15103899 - 19 May 2026

Abstract

Background/Objectives: This study aimed to evaluate the effect of intracanal cryotherapy on postoperative pain across obturation materials with different chemical compositions and physical properties in single-visit root canal treatment. Methods: Patients diagnosed with irreversible pulpitis (n = 73), treated in [...] Read more.

Background/Objectives: This study aimed to evaluate the effect of intracanal cryotherapy on postoperative pain across obturation materials with different chemical compositions and physical properties in single-visit root canal treatment. Methods: Patients diagnosed with irreversible pulpitis (n = 73), treated in a single visit by the same operator, were categorized based on the obturation material used (AH Plus, TotalFill BC Sealer, and TotalFill BC RRM) and whether intracanal cryotherapy (20 mL of sterile saline at 4 °C for 5 min) was applied. Visual Analog Scale (VAS) scores obtained from patient follow-up forms at 24, 48, and 72 h were evaluated. Results: Cryotherapy (+) groups showed consistently lower pain scores at all time points compared with cryotherapy (−) groups (p < 0.001). Within the cryotherapy (+) groups, both TotalFill BC Sealer and TotalFill BC RRM exhibited significantly lower pain scores than AH Plus at 48 h (p < 0.05). In the cryotherapy (−) groups, TotalFill BC Sealer showed significantly lower pain scores on the third postoperative day (p < 0.05). Conclusions: Intracanal cryotherapy may serve as an effective adjunctive technique associated with lower early postoperative pain scores. Material-related differences became evident at 48 and 72 h, suggesting that obturation material selection may influence postoperative pain patterns and patient comfort during the later postoperative period. Full article

(This article belongs to the Special Issue Root Canal Treatment and Healing Outcomes: Clinical Application of Endodontic Biomaterials and Postoperative Management)

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14 pages, 1435 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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14 pages, 2113 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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10 pages, 205 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

17 pages, 529 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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19 pages, 1206 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

18 pages, 1095 KB

Open AccessReview

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

by Enshuo Liu and Fei Yang

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

Abstract

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

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

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

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14 pages, 471 KB

Open AccessSystematic Review

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

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

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

Abstract

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

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

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

18 pages, 3928 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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14 pages, 823 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Nephrology & Urology)

13 pages, 7312 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Obstetrics & Gynecology)

13 pages, 382 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

14 pages, 543 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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