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J. Clin. Med., Volume 14, Issue 12 (June-2 2025) – 376 articles

Cover Story (view full-size image): Alcohol use disorder (AUD) in patients with heroin use disorder (HUD) represents a major clinical challenge. While methadone is effective for HUD, many patients fail to respond to approved anti-craving agents for AUD. Sodium oxybate (SMO), a GHB salt approved for alcohol relapse prevention in Europe, may represent the closest option to substitution therapy for AUD. This retrospective study compared treatment outcomes in patients receiving methadone plus SMO either as detoxification only or as ongoing maintenance. Our aim was to assess the six-month efficacy of SMO co-maintenance in reducing alcohol use and improving treatment retention among patients with co-occurring HUD and AUD. View this paper
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18 pages, 1493 KiB  
Systematic Review
Visualization of the Glymphatic System Through Brain Magnetic Resonance in Human Subjects with Neurodegenerative Disorders: A Systematic Review and Meta-Analysis
by Jana Hamzeh, Hayat Harati, Farah Ayoubi, Marie-belle Saab, Lea Saab, Elie Al Ahmar and Elias Estephan
J. Clin. Med. 2025, 14(12), 4387; https://doi.org/10.3390/jcm14124387 - 19 Jun 2025
Viewed by 670
Abstract
Background: One of the major contributors to homeostasis at the level of the central nervous system, specifically the brain, is the glymphatic system, which is described as an exchange occurring at the level of and between the interstitial fluid and cerebrospinal fluid that [...] Read more.
Background: One of the major contributors to homeostasis at the level of the central nervous system, specifically the brain, is the glymphatic system, which is described as an exchange occurring at the level of and between the interstitial fluid and cerebrospinal fluid that has been linked to neurodegenerative processes. Methods: Fourteen studies were included after PROSPERO registration and a literature search. Screening, reviewing, and data extraction were performed by two reviewers. Quality assessment scales were used. General continuous and subgroup analysis, heterogeneity tests, and random effect models were run using SPSS. Forest plots were constructed based on subgroup analysis. Results: Significant correlations (p < 0.05) were detected between MRI indices and outcomes quantifying neurodegenerative diseases. Studies on Alzheimer’s disease showed a positive correlation between diffusivity indices and cognitive scores. Studies on Parkinson’s disease showed negative correlations between diffusivity indices and disease severity, progression, and motor function (p < 0.05). As for other conditions, the conclusions remain uncertain, yet positive results were detected (p < 0.05). Conclusions: Positive significant correlations were deduced between the ALPS index and cognitive scores, indicating that low cognition is correlated with a low ALPS index and enlarged PVSs. Negative significant correlations were deduced between ALPS indices and UPDRS scores, indicating motor dysfunction is correlated with lower ALPS indices and enlarged PVSs. Finally, MRI parameters may help to deduce disease progression across subgroups. Despite the presence of heterogeneity between studies, significant correlations with moderate to large effect sizes were detected. Glymphatic dysfunction measured through MRI indices is correlated with neurodegenerative changes across various neurological conditions. Full article
(This article belongs to the Section Clinical Neurology)
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14 pages, 840 KiB  
Article
Efficacy and Safety of Fosfomycin Disodium in Patients with Bacterial Infections: A Single-Center, Real-Life Clinical Study
by Fabio Luciano, Lorenzo Bertolino, Fabian Patauner, Filomena Boccia, Raffaella Gallo, Pino Sommese, Anna Maria Carolina Peluso, Oriana Infante, Silvia Mercadante, Augusto Delle Femine, Arta Karruli, Roberto Andini, Rosa Zampino and Emanuele Durante-Mangoni
J. Clin. Med. 2025, 14(12), 4386; https://doi.org/10.3390/jcm14124386 - 19 Jun 2025
Viewed by 505
Abstract
Objectives: Fosfomycin is an old antibiotic that has recently gained attention owing to its preserved activity against multidrug-resistant (MDR) bacteria. Data on its use in real life are limited. Thus, we evaluated the efficacy and safety of fosfomycin disodium in the context of [...] Read more.
Objectives: Fosfomycin is an old antibiotic that has recently gained attention owing to its preserved activity against multidrug-resistant (MDR) bacteria. Data on its use in real life are limited. Thus, we evaluated the efficacy and safety of fosfomycin disodium in the context of our hospital clinical practice. Methods: Single-center, retrospective, observational study on 56 patients who received fosfomycin disodium from September 2016 to July 2023, focusing on clinical and microbiological outcomes and adverse events. Results: Included in this study were 56 patients. Fosfomycin disodium was administered for a median duration of 10 days [5–13.5] and was always used in combination with other antibiotics, more frequently with meropenem (16 cases, 28.6%) and colistin (11 cases, 19.6%). It was mostly used for treating pneumonia (41%), followed by bloodstream infections (19.6%), urinary tract infections (16.1%), bone infections (16.1%), and surgical site infections (7.1%). The most common isolated pathogen was Pseudomonas aeruginosa (17%), and polymicrobial infections were detected in 18 patients (32%). Among the isolated bacteria, 36 (44.4%) were MDR. The complete resolution, defined as the disappearance of symptoms, eradication of the causative microorganism, and decrease in CRP levels, was achieved in 39% of cases. During treatment, we observed electrolyte imbalances, in particular a decrease in serum potassium (0.6 mEq/L [0.3–1.1]), calcium (0.7 mEq/L [0.3–1.1]) and magnesium levels (0.3 mg/dL [0.20–0.48]), and an increase in serum sodium levels (4 mEq/dL [2–7]). Changes in potassium and sodium levels were more pronounced in patients with prior kidney dysfunction and heart failure, respectively, and in patients receiving fosfomycin diluted with saline compared with 5% glucose solution (p = 0.04). Conclusions: Fosfomycin is effective in treating complicated infections in comorbid patients when combined with other antimicrobials. During treatment, major electrolyte imbalances occur that require careful monitoring and correction, especially in patients with prior kidney disease. Full article
(This article belongs to the Section Infectious Diseases)
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12 pages, 2458 KiB  
Systematic Review
Recurrence Pattern of Left Upper Lobectomies and Trisegmentectomies: Systematic Review and Meta-Analysis
by Borja Aguinagalde, Juan A. Ferrer-Bonsoms, Iker López, Jon Ander Lizarbe, Arantza Fernandez-Monge, Maria Mainer, Raul Embun and Jon Zabaleta
J. Clin. Med. 2025, 14(12), 4385; https://doi.org/10.3390/jcm14124385 - 19 Jun 2025
Viewed by 351
Abstract
Background: Surgical resection remains the standard treatment for early-stage non-small-cell lung cancer (NSCLC). Traditionally, lobectomy has been considered the procedure of choice; however, emerging evidence suggests that trisegmentectomy may offer comparable outcomes. This meta-analysis evaluates whether left upper lobe trisegmentectomy provides non-inferior or [...] Read more.
Background: Surgical resection remains the standard treatment for early-stage non-small-cell lung cancer (NSCLC). Traditionally, lobectomy has been considered the procedure of choice; however, emerging evidence suggests that trisegmentectomy may offer comparable outcomes. This meta-analysis evaluates whether left upper lobe trisegmentectomy provides non-inferior or superior oncologic outcomes compared to left upper lobectomy, with particular attention to recurrence patterns. Methods: Following PRISMA guidelines, we included comparative studies evaluating left upper lobectomy versus trisegmentectomy. Outcomes assessed included recurrence (locoregional and distant), morbidity, and the length of hospital stay. A meta-analysis was conducted using the metabin function from the R meta package. Results: Of 14 identified articles, 9 met the inclusion criteria. No significant differences were observed in locoregional recurrence. However, distant recurrence was significantly lower in the trisegmentectomy group (OR 0.58; 95% CI 0.41–0.82). While overall morbidity showed no significant difference (OR 0.95), analysis of matched studies favored trisegmentectomy (OR 0.73; 95% CI 0.56–0.96). Hospital stay was significantly shorter in the trisegmentectomy group (OR –0.94; 95% CI –1.26 to –0.63). Conclusions: Trisegmentectomy and lobectomy exhibit distinct recurrence patterns, with lobectomy associated with a higher rate of distant recurrence. Trisegmentectomy may provide oncologic and perioperative advantages in appropriately selected patients. The systematic review and meta-analysis are registered in PROSPERO (registration number: CRD420251066445). Full article
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19 pages, 1043 KiB  
Article
A Multicentre, Double-Blind, Randomised, Non-Inferiority Trial of a Novel Single-Injection Intra-Articular HMDA-Cross-Linked Hyaluronate Gel for Knee Osteoarthritis
by Kang-Il Kim, Yong In, Hyung-Suk Choi, Ju-Hong Lee, Jae-Ang Sim, Han-Jun Lee, Young-Wan Moon, Oog-Jin Shon, Jong-Keun Seon, Young-Mo Kim, Sang-Jun Song, Chong-Bum Chang and Hyuk-Soo Han
J. Clin. Med. 2025, 14(12), 4384; https://doi.org/10.3390/jcm14124384 - 19 Jun 2025
Viewed by 515
Abstract
Background/Objectives: This Phase 3, randomised, double-blind, multicentre trial evaluated the efficacy and safety of a novel hyaluronic acid hydrogel cross-linked with hexamethylenediamine (HMDA-HA) compared to a conventional 1,4-butanediol diglycidyl ether cross-linked HA (BDDE-HA) in patients with mild-to-moderate knee osteoarthritis (OA). Methods: [...] Read more.
Background/Objectives: This Phase 3, randomised, double-blind, multicentre trial evaluated the efficacy and safety of a novel hyaluronic acid hydrogel cross-linked with hexamethylenediamine (HMDA-HA) compared to a conventional 1,4-butanediol diglycidyl ether cross-linked HA (BDDE-HA) in patients with mild-to-moderate knee osteoarthritis (OA). Methods: A total of 223 adults (mean age 63.5 years; 167 women) with Kellgren–Lawrence (KL) grade I–III knee OA were randomised 1:1 to receive two intra-articular injections of HMDA-HA or BDDE-HA at baseline and at 24 weeks. The primary endpoint was changes from baseline in weight-bearing pain (WBP) on a 100 mm visual analogue scale (VAS) at Week 12, assessed in the per-protocol population. A non-inferiority margin of 10 mm was predefined. Secondary outcomes included global assessments, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index scores, responder rates, and rescue medication use [ClinicalTrials.gov: NCT06307847]. Results: At Week 12, least squares mean change (standard error [SE]) in WBP was −23.72 (1.88) mm in the HMDA-HA group (n = 83) and −25.99 (1.76) mm in the BDDE-HA group (n = 95), yielding a difference of 2.26 mm (95% confidence interval [CI]: −2.83 to 7.34; p = 0.3825), thus demonstrating the non-inferiority of HMDA-HA to BDDE-HA. Secondary outcomes were comparable between groups. A total of 136 adverse events were reported: 44 (41.1%) in the HMDA-HA group and 32 (28.1%) in the BDDE-HA group, with no treatment-related adverse drug reactions. Conclusions: A single-injection intra-articular regimen of HMDA-HA was effective and safe for the treatment of adult patients with mild-to-moderate knee OA. Full article
(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)
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11 pages, 485 KiB  
Article
Understanding the Perioperative Perception of Pain in Patients with Crohn’s Disease: Epidural Versus Non-Epidural Analgesia
by Regina Pistorius, Anna Widder, Marleen Sabisch, Christian Markus, Michael Meir, Imad Maatouk, Christoph-Thomas Germer, Patrick Meybohm, Nicolas Schlegel, Matthias Kelm and Sven Flemming
J. Clin. Med. 2025, 14(12), 4383; https://doi.org/10.3390/jcm14124383 - 19 Jun 2025
Viewed by 346
Abstract
Background: Patients with Crohn’s disease (CD) suffer from a relevant burden of abdominal pain and psychological distress that can aggravate postoperatively. While systematic strategies for postoperative pain management are lacking, the potential benefit of perioperative epidural analgesia (EDA) in CD patients is unclear. [...] Read more.
Background: Patients with Crohn’s disease (CD) suffer from a relevant burden of abdominal pain and psychological distress that can aggravate postoperatively. While systematic strategies for postoperative pain management are lacking, the potential benefit of perioperative epidural analgesia (EDA) in CD patients is unclear. Methods: All patients receiving an ileocecal resection due to CD at a tertiary hospital were included. The impact of epidural versus non-epidural analgesia on postoperative pain perception was evaluated by analyzing the numeric rating scale (NRS), analgesic consumption, and clinical outcomes. Results: In this monocentric study, 172 patients receiving ileocecal resection due to CD were included, with 122 receiving EDA. The epidural pain catheters were kept for an average of 4.4 days (±1.3) before being removed. EDA resulted in significantly decreased pain as well as a decreased amount of analgesic consumption (adjuvant analgesics: 16.4% vs. 32%, p = 0.021; strong opioids: 30.3% vs. 72.0%, p < 0.001) at the early postoperative course (1 vs. 3 at rest and 2 vs. 4 movement-evoked, p < 0.001). No difference in pain perception was detected on day 5 between EDA and non-EDA patients. Patients with EDA had a significantly longer length of hospital stay (7.5 versus 6 days, p = 0.002) and an increased intake of weak opioids at discharge (p = 0.024). Conclusions: While EDA in CD patients resulted in significantly decreased pain and decreased amounts of analgesic adjuvants and strong opioids at the early postoperative course, intravenous and oral analgesia provide sufficient postoperative pain control after surgery and earlier patient autonomy. Full article
(This article belongs to the Section General Surgery)
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11 pages, 819 KiB  
Article
Effectiveness of Endovascular Treatment in Native Hemodialysis Fistula Dysfunction: Long-Term Outcomes
by Mehmet Beyazal and Esat Kaba
J. Clin. Med. 2025, 14(12), 4382; https://doi.org/10.3390/jcm14124382 - 19 Jun 2025
Viewed by 309
Abstract
Objectives: This study aimed to present our single-center experience on the efficacy of endovascular treatment for the dysfunction of hemodialysis arteriovenous fistulas (AVF). Methods: This retrospective study analyzed 110 patients with hemodialysis AVF dysfunction who underwent endovascular treatment. Patients were evaluated with Doppler [...] Read more.
Objectives: This study aimed to present our single-center experience on the efficacy of endovascular treatment for the dysfunction of hemodialysis arteriovenous fistulas (AVF). Methods: This retrospective study analyzed 110 patients with hemodialysis AVF dysfunction who underwent endovascular treatment. Patients were evaluated with Doppler ultrasound, and those with significant stenosis or thrombosis were treated using balloon angioplasty, tissue plasminogen activator (t-PA), and/or thrombectomy, or a combination of both. A transvenous approach was performed in all cases, and post-procedural patency was assessed with fistulography. The primary outcome was defined as achieving stenosis reduction below 30%, with follow-up patency recorded at 3 and 6 months. Long-term fistula patency times and the frequency of repeat interventions were also evaluated. Statistical analysis was conducted to evaluate patency outcomes and procedural success rates. Results: Primary patency was achieved in 90.9% of patients, with balloon angioplasty significantly improving patency rates (p = 0.0077), while t-PA and thrombectomy showed no significant impact. At the 3-month follow-up, 83% of patients maintained patency; at 6 months, this rate decreased to 72.7%. ANOVA analysis showed no significant differences between treatment groups in long-term patency time (p = 0.322). The mean fistula patency duration was most prolonged in patients treated with balloon angioplasty alone (21.8 months), followed by those who received combination therapy (19.2 months), and shortest in those treated with only t-PA or thrombectomy (14.7 months). However, differences were not statistically significant (p > 0.05). A total of 21 patients required repeat interventions, with an average patency duration of 25.13 months after reintervention. Conclusions: This study suggests that endovascular treatment, especially balloon angioplasty, plays a key role in maintaining fistula patency. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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16 pages, 1516 KiB  
Article
Comparison of the Trabecular Titanium Acetabular Shell with Burch–Schneider Cages in Revision Hip Arthroplasty
by Pawel Kamiński, Jarosław Ambroży and Rafał Obuchowicz
J. Clin. Med. 2025, 14(12), 4381; https://doi.org/10.3390/jcm14124381 - 19 Jun 2025
Viewed by 314
Abstract
Objective: In recent years, a significant increase in the incidence of both total hip arthroplasty and acetabular revision surgery has been observed. A substantial proportion of patients requiring these revision procedures present with major bone deficits and extensive osteolysis. In light of these [...] Read more.
Objective: In recent years, a significant increase in the incidence of both total hip arthroplasty and acetabular revision surgery has been observed. A substantial proportion of patients requiring these revision procedures present with major bone deficits and extensive osteolysis. In light of these challenges, this study aims to provide a comprehensive comparison between two commonly utilized methods: trabecular titanium shell implants and Burch–Schneider acetabular reinforcement cages. Methods: Participants of both sexes were included through a retrospective review of medical records. The sole inclusion criterion was that the patient had undergone revision hip arthroplasty using either Burch–Schneider acetabular reinforcement cages or Regenerex trabecular titanium shell within the past 18 years. No exclusion criteria were applied concerning patient age, laterality, ethnicity, or post-operative status. Each patient was evaluated based on nine predictive factors, including the Paprosky classification, duration of surgery, perioperative blood loss, number of bone grafts and screws used, as well as pre- and post-operative Harris Hip Score (HHS) and Visual Analogue Scale (VAS). Results: A total of 220 patients were included in the analysis, with 75% (n = 165) comprising the group treated with trabecular titanium implants and 25% (n = 55) treated with Burch–Schneider cages. The use of Regenerex trabecular titanium was associated with a 32.40% (n = 23.13 mL) reduction in bone graft tissue required and a 13.7% (n = 0.59) increase in the number of screws needed. Additionally, the trabecular titanium group experienced a 15.93% (n = 179.64 mL) reduction in perioperative blood loss compared to the Burch–Schneider cage group. The other parameters analyzed in the study did not demonstrate statistical significance. Conclusions: The use of a trabecular titanium acetabular shell may be an effective option, particularly in patients with severe acetabular deficits, as it provides favorable clinical and radiological outcomes. Additionally, it reduces the number of bone grafts required and allows for faster and more immediate partial weight-bearing on the operated limb. Full article
(This article belongs to the Section Orthopedics)
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Graphical abstract

23 pages, 1947 KiB  
Systematic Review
Oral Findings Linked to Chronic Kidney Disease: A Comprehensive Systematic Review
by Paula García-Rios, Francisco Javier Rodríguez-Lozano and Nuria Pérez-Guzmán
J. Clin. Med. 2025, 14(12), 4380; https://doi.org/10.3390/jcm14124380 - 19 Jun 2025
Viewed by 445
Abstract
Background\Objectives: Chronic kidney disease (CKD) is defined as a clinical syndrome secondary to a permanent change in kidney function or structure, making it irreversible. Most patients at the onset of the disease are asymptomatic or present nonspecific symptoms, including signs and symptoms at [...] Read more.
Background\Objectives: Chronic kidney disease (CKD) is defined as a clinical syndrome secondary to a permanent change in kidney function or structure, making it irreversible. Most patients at the onset of the disease are asymptomatic or present nonspecific symptoms, including signs and symptoms at the oral level. These manifestations, such as hyposalivation, increased calculus index, enamel defects, or changes in saliva composition, contribute to the diagnosis of this pathology and can also significantly affect the patient’s quality of life. The aim is to systematically assess the presence and relevance of oral manifestations in patients with CKD, and to identify correlations between these symptoms and clinical parameters such as glomerular filtration rate or concomitant conditions of the patient. Materials and Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was carried out in the PubMed, Scopus, Scielo, and The Cochrane Library databases on 7 April 2025, using terms related to “chronic kidney disease” and “oral manifestations”. Inclusion criteria referred to observational studies published in the last ten years that reported oral symptoms in patients with CKD. The quality of cohort and case-control studies was assessed using the Newcastle–Ottawa Scale (NOS), while for cross-sectional studies, the Joanna Briggs Institute (JBI) critical appraisal checklist was used. Results: A total of 27 studies met the inclusion criteria, primarily cross-sectional in design. The most frequently reported oral manifestations included hyposalivation, increased calculus and plaque indices, enamel defects, periodontal disease, and oral candidiasis. Significant associations were identified between the duration of dialysis and severity of periodontal disease, as well as between CKD stage and taste dysfunction. Findings varied by age group and CKD stage, with children showing distinct salivary profiles and adults presenting more pronounced periodontal and mucosal conditions. Conclusions: This review highlights a clear relationship between CKD and various oral health disturbances, although more studies are needed to better understand oral–systemic interactions in CKD. What is necessary is the establishment of multidisciplinary care approaches. Full article
(This article belongs to the Special Issue Interaction Between Systemic Diseases and Oral Diseases)
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13 pages, 769 KiB  
Article
Impact of Age at Narcolepsy Onset on Sleep-Onset REM Periods in the Multiple Sleep Latency Test
by Jun-Sang Sunwoo, Ki-Hwan Ji, Daeyoung Kim, Kyung Min Kim, Yun Ho Choi, Jae Wook Cho, Hyeyun Kim, Wonwoo Lee, Yu Jin Jung, Dae Lim Koo, Hee-Jin Im and Kwang Ik Yang
J. Clin. Med. 2025, 14(12), 4379; https://doi.org/10.3390/jcm14124379 - 19 Jun 2025
Viewed by 417
Abstract
Background/Objectives: This study aimed to investigate the effect of age at symptom onset on rapid eye movement (REM) sleep latency and sleep-onset REM period (SOREMP) distribution in multiple sleep latency tests (MSLTs) in patients with narcolepsy. Methods: This was a retrospective multicenter [...] Read more.
Background/Objectives: This study aimed to investigate the effect of age at symptom onset on rapid eye movement (REM) sleep latency and sleep-onset REM period (SOREMP) distribution in multiple sleep latency tests (MSLTs) in patients with narcolepsy. Methods: This was a retrospective multicenter chart review of 135 newly diagnosed drug-naïve patients with narcolepsy who underwent MSLT and fulfilled the diagnostic criteria for narcolepsy. The age at onset was defined as the first occurrence of excessive daytime sleepiness or cataplexy. We investigated sleep onset latency, REM sleep latency, and the presence of SORMEP in each nap trial of the MSLT. The clinical, polysomnography, and MSLT findings were compared between the early- and late-onset groups. Correlation and linear regression analyses were used to assess the effect of age at onset as a continuous variable, and survival analyses confirmed its impact on the MSLT parameters. Results: The mean age at onset was 18.3 ± 8.8 years. Patients with early onset had a higher rate of SOREMPs than late-onset patients in the first MSLT nap (81.9% vs. 63.3%, p = 0.031). However, the severity of the narcolepsy symptoms did not differ between the groups. In linear regression analysis, age at onset was significantly associated with MSLT REM sleep latency (β = 0.049, p = 0.033) after adjusting for confounders. Survival analysis confirmed that an early onset of narcolepsy was associated with a higher probability of SOREMPs in the first MSLT nap (hazard ratio 0.955, p = 0.001). Conclusions: A younger age at narcolepsy onset was associated with shorter REM sleep latency and higher SOREMP probability in MSLT. These findings indicate that the early onset of narcolepsy may be linked to greater disease severity in terms of REM sleep dysregulation. Full article
(This article belongs to the Section Clinical Neurology)
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13 pages, 1113 KiB  
Article
Implantation of Sutureless Scleral-Fixated Carlevale Intraocular Lens (IOL) in Patients with Insufficient Capsular Bag Support: A Retrospective Analysis of 100 Cases at a Single Center
by Jan Strathmann, Sami Dalbah, Tobias Kiefer, Nikolaos E. Bechrakis, Theodora Tsimpaki and Miltiadis Fiorentzis
J. Clin. Med. 2025, 14(12), 4378; https://doi.org/10.3390/jcm14124378 - 19 Jun 2025
Viewed by 334
Abstract
Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale IOL provides a sutureless and scleral fixated treatment method. Methods: In [...] Read more.
Background/Objectives: Different surgical techniques are available in cases of missing or insufficient capsular bag support. Next to the anterior chamber or iris-fixated intraocular lenses (IOL), the implantation of the Carlevale IOL provides a sutureless and scleral fixated treatment method. Methods: In a retrospective single-center study, the perioperative data of 100 patients who consecutively received a scleral fixated Carlevale IOL combined with a 25 gauge (G) pars plana vitrectomy between September 2021 and June 2024 were investigated. The intraoperative and postoperative results were analyzed in terms of complication rates and refractive outcomes. Results: IOL dislocation was the most common surgical indication (50%) for sutureless Carlevale IOL implantation, followed by postoperative aphakia in 35 patients (35%). Nearly every fourth patient (24%) had a preoperative traumatic event, and 21% had pseudoexfoliation (PEX) syndrome. The average surgery time was 60.2 (±20.1) min. Intraoperative intraocular hemorrhage occurred in seven cases, and IOL haptic breakage in two patients. Temporary intraocular pressure fluctuations represented the most common postoperative complications (28%). Severe complications such as endophthalmitis or retinal detachment were not observed in our cohort. The mean refractive prediction error was determined in 67 patients and amounted to an average of −0.7 ± 2.0 diopters. The best corrected visual acuity (BCVA) at the last postoperative follow-up showed an improvement of 0.2 ± 0.5 logMAR (n = 76) compared to the preoperative BCVA (p = 0.0002). The postoperative examination was performed in 72% of the patients, and the mean follow-up period amounted to 7.2 ± 6.4 months. Conclusions: Overall, sutureless and scleral fixated implantation of the Carlevale IOL represents a valuable therapeutic option in the treatment of aphakia and lens as well as IOL dislocation in the absence of capsular bag support with minor postoperative complications and positive refractive outcomes. Full article
(This article belongs to the Section Ophthalmology)
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8 pages, 677 KiB  
Article
Transperineal Prostate Biopsy Under Local Anaesthesia, Tolerability, and Functional Outcomes: A Prospective, Monocentric, and Single-Operator Study
by Gilles Adans-Dester, Mathieu Bourguignon and Guillaume Krings
J. Clin. Med. 2025, 14(12), 4377; https://doi.org/10.3390/jcm14124377 - 19 Jun 2025
Viewed by 407
Abstract
Background: Prostate cancer (PCa) remains a major health concern worldwide, although improved screening and treatments have reduced its incidence and mortality. MRI-targeted biopsies, especially using MRI–ultrasound fusion, enhance detection of clinically significant prostate cancer (CsPCa) and reduce unnecessary procedures. Transperineal biopsies offer [...] Read more.
Background: Prostate cancer (PCa) remains a major health concern worldwide, although improved screening and treatments have reduced its incidence and mortality. MRI-targeted biopsies, especially using MRI–ultrasound fusion, enhance detection of clinically significant prostate cancer (CsPCa) and reduce unnecessary procedures. Transperineal biopsies offer the same diagnostic performance and reduce the risk of infection while limiting the need for antibiotic prophylaxis. However, they tend to be more painful under local anaesthesia and require greater operator experience. Methods: This study prospectively assessed the tolerability and effectiveness of transperineal targeted biopsies under local anaesthesia in a monocentric cohort of 51 patients. Results: Immediate pre-biopsy anxiety showed a clinically significant association with pain experienced during biopsies, and greater expected pain resulted in greater experienced pain. Overall patient tolerability was high. Local anaesthesia provided procedural flexibility, reduced resource utilisation, was cost-effective, and did not compromise precision. Conclusions: The results support local anaesthesia as a viable option, offering precision, patient satisfaction, and reduced healthcare resource utilisation. These results emphasise the importance of personalising the choice of anaesthesia modality for transperineal prostate biopsies, tailoring it to the patient’s anxiety. Larger studies are required to confirm these findings and validate the observed trends. Full article
(This article belongs to the Section Oncology)
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14 pages, 873 KiB  
Article
Assessing Gait Function in Lower Limb Rehabilitation: The Role of the Gait Analysis and Motion Score (GAMS)
by Walter Bily, Ferdinand Prüfer, Klemens Adamer, Roman Lederwasch, Špela Matko, Michael J. Fischer and Vincent Grote
J. Clin. Med. 2025, 14(12), 4376; https://doi.org/10.3390/jcm14124376 - 19 Jun 2025
Viewed by 402
Abstract
Background: Assessment of gait function is crucial for optimising rehabilitation outcomes. The gait analysis and motion score (GAMS) summarises qualitative and quantitative gait parameters from treadmill-based analyses to evaluate functional walking status. Objectives: To assess the sensitivity of the GAMS for detecting short-term [...] Read more.
Background: Assessment of gait function is crucial for optimising rehabilitation outcomes. The gait analysis and motion score (GAMS) summarises qualitative and quantitative gait parameters from treadmill-based analyses to evaluate functional walking status. Objectives: To assess the sensitivity of the GAMS for detecting short-term changes, its test–retest reliability, and its correlation with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and Go (TUG) test. Methods: A retrospective analysis of 94 inpatient rehabilitation patients with hip, knee, or ankle impairments was performed. Changes in GAMS, WOMAC, and TUG scores and their interrelationships were assessed at both admission and discharge. Results: GAMS, WOMAC, and TUG showed significant improvements over time, with medium effect sizes (η2 = 0.303 to 0.434; p < 0.001). No significant differences in outcome measures were observed between groups. Moderate to strong correlations were found between pre- and post-rehabilitation scores for GAMS, TUG, and WOMAC (r = 0.58 to r = 0.90), indicating good test–retest reliability. A significant low negative correlation between GAMS and TUG was observed for all patients at admission (r = −0.30, p = 0.003) and discharge (r = −0.26, p = 0.030). No significant correlations were observed between GAMS and WOMAC in any patient group. Baseline GAMS scores significantly influenced change scores. Conclusions: GAMS is a sensitive and reliable tool for detecting short-term changes in gait parameters. GAMS and TUG assess related but distinct constructs, with GAMS and WOMAC assessing different domains of gait function. Therefore, GAMS provides complementary information not captured by WOMAC or TUG. Full article
(This article belongs to the Section Clinical Rehabilitation)
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16 pages, 254 KiB  
Review
Enhancing Patient Education for Colonoscopy Preparation: Strategies, Tools, and Best Practices
by Roba Ganayem, Osama Alamour, Daniel L. Cohen, Nour Ealiwa and Naim Abu-Freha
J. Clin. Med. 2025, 14(12), 4375; https://doi.org/10.3390/jcm14124375 - 19 Jun 2025
Viewed by 513
Abstract
Background: Colonoscopy is an important and essential diagnostic and screening tool for colorectal cancer and other pathologies in the colon. High-quality bowel preparation (BP) is a key quality measure of colonoscopy and is critical for maximizing its effectiveness, including enhancing adenoma detection [...] Read more.
Background: Colonoscopy is an important and essential diagnostic and screening tool for colorectal cancer and other pathologies in the colon. High-quality bowel preparation (BP) is a key quality measure of colonoscopy and is critical for maximizing its effectiveness, including enhancing adenoma detection rates. However, inadequate bowel preparation (IBP) remains a frequent challenge and is influenced by multiple factors. This review aims to summarize and evaluate educational and technological interventions implemented before colonoscopy to improve BP quality. Methods: The methodology comprised a structured narrative review of studies published in English, including randomized controlled trials, prospective studies, observational cohorts, and meta-analyses. Interventions were categorized by their delivery mode and impact on BP adequacy. Interventions included written materials, internet-based education modules, short message service (SMS) reminders, visual aids, instructional videos, verbal communication, telephone support, smartphone applications, and virtual reality (VR) platforms. Results: Most studies reported significant improvements in BP quality with enhanced patient education, particularly with the use of instructional videos and smartphone applications. Verbal communication and telephone support also demonstrated positive outcomes but were limited by resource availability. VR represents a promising emerging technology, though its implementation remains costly and complex. Conclusions: Enhanced educational interventions are proven methods to optimize BP quality. The selection of an appropriate modality should consider patient characteristics, technological accessibility, and institutional resources. Personalized strategies targeting high-risk populations can further reduce IBP rates and improve overall colonoscopy outcomes. Full article
(This article belongs to the Special Issue Clinical Applications of Endoscopic Technology in Gastroenterology)
13 pages, 1135 KiB  
Article
The Relationship Between Neuromuscular Block Depth and Airway Retroglossal Area: A Prospective, Nonrandomized, Observational Clinical Trial
by László Asztalos, Mena Boktor, Miklós Kukuly, Dorka Sólyom, Adrienn Pongrácz, Sorin J. Brull and Béla Fülesdi
J. Clin. Med. 2025, 14(12), 4374; https://doi.org/10.3390/jcm14124374 - 19 Jun 2025
Viewed by 370
Abstract
Background: Tracheal intubation and mechanical ventilation are facilitated by neuromuscular blocking agents. We investigated the effectiveness of subjective clinical evaluation of neuromuscular function on retroglossal area size, since it determines spontaneous ventilation adequacy following tracheal extubation. Secondarily, we correlated changes in retroglossal [...] Read more.
Background: Tracheal intubation and mechanical ventilation are facilitated by neuromuscular blocking agents. We investigated the effectiveness of subjective clinical evaluation of neuromuscular function on retroglossal area size, since it determines spontaneous ventilation adequacy following tracheal extubation. Secondarily, we correlated changes in retroglossal area and depth of neuromuscular block assessed during both respiratory phases using quantitative neuromuscular monitoring. Methods: Once mechanical ventilation was no longer needed, antagonists were used to reverse the neuromuscular block in 21 consenting patients; adequacy of reversal was assessed subjectively by delivering a sequence of four rapid (2 Hz) electrical stimuli (train-of-four, TOF) to a peripheral nerve and assessing attainment of four equal muscle contractions (TOF ratio = 1.0), signifying normal neuromuscular function. Retroglossal area during both inhalation and exhalation were measured pharyngoscopically at various phases of neuromuscular recovery, including at baseline after anesthesia induction but before neuromuscular block onset and at recovery before tracheal extubation; area changes were correlated with depth of quantitatively measured neuromuscular block. Results: Clinicians’ subjective evaluation of readiness for tracheal extubation failed to identify significant residual block in most patients who required rescue antagonism. Markedly decreased retroglossal areas (inhalation: 39.5% of baseline; exhalation: 20.1% of baseline) were present at extubation, and 11 out of 21 (52.4%) patients needed rescue antagonism. In contrast, in patients with neuromuscular recovery to the currently recommended threshold determined quantitatively (TOF ratio > 0.90), retroglossal areas were only 80% recovered but returned to near baseline values when the TOF ratio ≥ 0.95. Conclusions: Quantitative monitoring should guide the timing of tracheal extubation. Current definitions of the minimal threshold for adequate neuromuscular recovery (TOF ratio > 0.90) after mechanical ventilation in postoperative patients should be re-evaluated. A TOF ratio > 0.95 better correlates with return to normal (baseline) retroglossal area during both inhalation and exhalation. Full article
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12 pages, 1362 KiB  
Article
Automated Volumetric Assessment of Hounsfield Units Using a Deep-Reasoning and Learning Model: Correlations with DXA Metrics
by Hans K. Nugraha, Vaida Goplin, Linjun Yang, Jonathan M. Morris, Paul M. Huddleston III, Mimi C. Sammarco and A. Noelle Larson
J. Clin. Med. 2025, 14(12), 4373; https://doi.org/10.3390/jcm14124373 - 19 Jun 2025
Viewed by 395
Abstract
Background/Objectives: Accurate assessment of spinal bone density is essential for evaluating bone health, particularly in preoperative planning. Conventional manual methods for Hounsfield unit (HU) measurements rely on single-slice measurements within the region of interest, limiting their precision and reproducibility in patients with [...] Read more.
Background/Objectives: Accurate assessment of spinal bone density is essential for evaluating bone health, particularly in preoperative planning. Conventional manual methods for Hounsfield unit (HU) measurements rely on single-slice measurements within the region of interest, limiting their precision and reproducibility in patients with severe vertebral deformities. We hypothesize that a novel deep-reasoning and learning model (DR-AI) can fully automate spinal bone density assessment volumetrically, with high correlations to spinal bone mineral density (BMD) obtained from dual-energy X-ray absorptiometry (DXA), as well as to the T- and Z-scores. Methods: A cross-sectional study was conducted on patients who had BMD assessment of their lumbar spine and lumbar CT scans within 1 year. The fully-automated DR model was utilized to analyze the soft-tissue window of the lumbar vertebrae CT scans. Spearman correlation coefficients were calculated to assess the strength of relationships between the computed volumetric HUs and the BMD, T-, and Z-scores from each vertebra. Results: 84 patients (67 females, mean age 74.1 ± 10.3 years; 17 males, mean age 68.1 ± 12.4 years) meeting inclusion criteria. Correlation analyses for L1 to L4 showed significant positive relationships (p < 0.0001), with the strongest correlation at L2 between HU and BMD (ρ = 0.75). Conclusions: the DR model for automated assessment of volumetric HUs offers a highly reliable, efficient, and precise alternative to DXA measurements. Full article
(This article belongs to the Section Orthopedics)
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12 pages, 733 KiB  
Article
Clinical Significance of Prognostic Nutritional Index in Patients Who Underwent Palliative Surgery for Spine Metastasis
by Young-Hoon Kim, Kee-Yong Ha, Hyung-Youl Park, Kihyun Kwon, Yunseong Kim, Hyun W. Bae and Sang-Il Kim
J. Clin. Med. 2025, 14(12), 4372; https://doi.org/10.3390/jcm14124372 - 19 Jun 2025
Viewed by 317
Abstract
Background/Objectives: Malnutrition is common in patients with metastatic spine tumors (MSTs) and may adversely affect surgical outcomes. The Prognostic Nutritional Index (PNI) reflects both nutritional and immune status, but its role in palliative MST surgery is not well defined. The aim of [...] Read more.
Background/Objectives: Malnutrition is common in patients with metastatic spine tumors (MSTs) and may adversely affect surgical outcomes. The Prognostic Nutritional Index (PNI) reflects both nutritional and immune status, but its role in palliative MST surgery is not well defined. The aim of this study was to investigate the association between preoperative the PNI and postoperative outcomes, including functional recovery and survival, in patients undergoing palliative surgery for MSTs. Methods: A brief description of the main methods or treatments applied. This can include any relevant preregistration or specimen information. Results: Patients with a higher PNI (≥42.8) demonstrated significantly better postoperative ambulation and longer overall survival compared to those with a lower PNI (<42.8). The higher PNI group showed earlier ambulation (p = 0.017) and longer median survival (30.7 vs. 7.0 months; p = 0.002). Multivariate analysis confirmed that a PNI ≥ 42.8 was an independent predictor of early ambulation (HR = 1.516; 95% CI: 1.010–2.277; p = 0.045) and prolonged survival (HR = 0.955; 95% CI: 0.927–0.985; p = 0.003). No significant association was found between the PNI and postoperative infections. Conclusions: The PNI is a simple and effective predictor of postoperative functional recovery and survival in patients undergoing palliative surgery for MSTs. Its routine preoperative assessment may help stratify surgical risk, guide nutritional interventions, and optimize clinical outcomes in this vulnerable population. Full article
(This article belongs to the Special Issue Recent Advances in Spine Tumor Diagnosis and Treatment)
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26 pages, 1412 KiB  
Systematic Review
Effectiveness of the Er:YAG Laser in Snoring Treatment Based on Systematic Review and Meta-Analysis Results
by Diana Dembicka-Mączka, Magdalena Gryka-Deszczyńska, Jacek Sitkiewicz, Aleksander Makara, Jakub Fiegler-Rudol and Rafał Wiench
J. Clin. Med. 2025, 14(12), 4371; https://doi.org/10.3390/jcm14124371 - 19 Jun 2025
Viewed by 530
Abstract
Background: Snoring and mild to moderate obstructive sleep apnoea (OSA) are common sleep-related breathing disorders with increasing demand for minimally invasive treatment options. This study aimed to systematically evaluate the efficacy and safety of erbium:yttrium–aluminium–garnet (Er:YAG) laser therapy for these conditions. Methods [...] Read more.
Background: Snoring and mild to moderate obstructive sleep apnoea (OSA) are common sleep-related breathing disorders with increasing demand for minimally invasive treatment options. This study aimed to systematically evaluate the efficacy and safety of erbium:yttrium–aluminium–garnet (Er:YAG) laser therapy for these conditions. Methods: A systematic review and meta-analysis were conducted in line with PRISMA guidelines. Studies published between 2015 and 2025 were retrieved from major biomedical databases based on predefined inclusion criteria. Data were extracted on treatment outcomes, laser parameters, patient characteristics, and adverse effects. Results: Fifty-six studies were included. Er:YAG laser treatment, particularly in non-ablative SMOOTH and long-pulse modes, significantly reduced snoring intensity and improved subjective sleep quality. High patient satisfaction (65–85%) and a favourable safety profile were observed, with adverse effects generally mild and transient. Therapeutic effects typically lasted 12–24 months, though 25–40% of patients required maintenance sessions. Treatment success was associated with BMI, oropharyngeal anatomy, smoking status, and baseline apnoea-hypopnoea index scores (AHI 5–30 events/hour). Conclusions: Er:YAG laser therapy appears to be a safe and effective short- to medium-term treatment for selected patients with snoring or mild to moderate OSA. Optimising patient selection and treatment protocols may enhance long-term outcomes. Based on moderate-quality evidence for the immediate effects and safety profile, but low to very low quality evidence for long-term outcomes, erbium:yttrium–aluminium–garnet laser treatment appears to be a potentially effective and well-tolerated option for achieving short- to medium-term improvement in carefully selected patients with primary snoring or mild to moderate obstructive sleep apnoea. The practical significance of these findings lies in the refinement of candidate selection criteria, laser parameter settings, and the development of optimal protocols for long-term snoring control. Full article
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
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10 pages, 776 KiB  
Article
Diabetes Is Associated with Lower In-Hospital Mortality in Patients Undergoing Surgical Repair for Aortic Aneurysm Rupture
by Hamza Chaudhry, Soha Dargham, Ziyad Mahfoud, Amin Jayyousi, Jassim Al Suwaidi and Charbel Abi Khalil
J. Clin. Med. 2025, 14(12), 4370; https://doi.org/10.3390/jcm14124370 - 19 Jun 2025
Viewed by 379
Abstract
Background: Previous studies reported a protective effect of type 2 diabetes on the progression of aortic aneurysms. We aimed to investigate whether this paradoxical phenomenon remained in patients with diabetes undergoing repair of ruptured aortic aneurysms. Methods: Data from the US [...] Read more.
Background: Previous studies reported a protective effect of type 2 diabetes on the progression of aortic aneurysms. We aimed to investigate whether this paradoxical phenomenon remained in patients with diabetes undergoing repair of ruptured aortic aneurysms. Methods: Data from the US Nationwide Readmission Database from 2016 to 2019 were analyzed. Patients admitted for surgical repair of ruptured abdominal or thoracic aortic aneurysms were included. Patients discharged alive were followed for 30 days. The co-primary outcomes were in-hospital and 30-day mortality. Results: A total of 9858 patients hospitalized for surgical repair of ruptured abdominal or thoracic aortic aneurysm were included, of whom 16.4% had diabetes. A lower adjusted risk of in-hospital mortality in abdominal and thoracic aneurysms was observed in diabetes patients (aOR = 0.76 [0.67–0.87], 0.61 [0.46–0.810], respectively). However, atrial fibrillation and acute renal failure were more likely to occur in the presence of diabetes (aOR = 1.25 [1.11–1.42]; 1.17 [1.05–1.32], respectively). Within 30 days, diabetes was not associated with a difference in the incidence of mortality or readmission (aHR = 1.47 [95% CI 0.98–2.22]; 1.15 [95% CI 0.99–1.34], respectively). Cardiovascular system-related pathologies were the most prevalent etiologies in all readmitted patients. Infections were more likely to occur in the diabetes group (16.0% vs. 11.0%, respectively, p = 0.042). Conclusions: The paradoxical effect of diabetes is also observed in ruptured aneurysms treated surgically, as type 2 diabetes patients have a lower in-hospital mortality. However, this protective effect does not extend to 30-day readmission or survival. Full article
(This article belongs to the Special Issue New Insights into Diabetes and Cardiovascular Diseases)
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21 pages, 1156 KiB  
Review
Renal Involvement in Mixed Cryoglobulinemic Vasculitis: Current Perspectives
by Annalisa Villa, Antonietta Gigante, Chiara Pellicano, Klara Radovic, Konstantinos Giannakakis, Milvia Casato and Marcella Visentini
J. Clin. Med. 2025, 14(12), 4369; https://doi.org/10.3390/jcm14124369 - 19 Jun 2025
Viewed by 613
Abstract
Cryoglobulinemia is a rare disorder characterized by the presence of abnormal proteins (cryoglobulins) in the blood that precipitate at low temperatures. It presents with a wide clinical spectrum, from mild symptoms to severe, life-threatening disease. In mixed cryoglobulinemia (MC), vascular damage results from [...] Read more.
Cryoglobulinemia is a rare disorder characterized by the presence of abnormal proteins (cryoglobulins) in the blood that precipitate at low temperatures. It presents with a wide clinical spectrum, from mild symptoms to severe, life-threatening disease. In mixed cryoglobulinemia (MC), vascular damage results from immune complexes—typically monoclonal IgM with rheumatoid factor activity and polyclonal IgG (Type II), or polyclonal/oligoclonal IgM and IgG (Type III). These complexes can obstruct small blood vessels, leading to ischemia and leukocytoclastic vasculitis. Renal involvement occurs in about 30% of MC patients and it is a manifestation with poor prognosis. Nowadays, types II and III MC are the most common forms, often linked to autoimmune diseases like Sjögren’s syndrome and systemic lupus erythematosus, or to viral infections such as hepatitis B or persisting despite hepatitis C eradication. This review explores renal involvement in MC, offering a comprehensive perspective on current knowledge, including recent advances in pathophysiological understanding, evolving diagnostic strategies, and novel therapeutic approaches. In this context, “perspectives” refers to the growing recognition of the shifting epidemiology of MC—particularly the changing etiological landscape following hepatitis C virus eradication—as well as the integration of emerging clinical and pathological entities such as cryofibrinogenemia and monoclonal gammopathy of renal significance into diagnostic and management frameworks. Furthermore, the review highlights current therapeutic strategies recognized as most effective, emphasizing the importance of a multidisciplinary and multimodal approach that combines etiological treatment, B-cell–targeted therapy (notably rituximab), plasma exchange in selected cases, and comprehensive supportive care for renal and systemic complications. Moreover, the landscape of management could be enriched in future years, since clinical trials are ongoing to explore novel therapies for refractory or relapsing cases of MC with renal involvement. Full article
(This article belongs to the Section Nephrology & Urology)
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11 pages, 233 KiB  
Article
Particularities of the Post-Pandemic Hepatitis A Outbreak in a Tertiary Infectious Diseases Hospital in Romania
by Georgiana Neagu, Violeta Molagic, Serban Nicolae Benea, Irina Ianache, Eliza Militaru, Iulia Nedelcu, Gabriel Maxim, Gabriela Andreea Dumitru, Cristiana Oprea and Ruxandra Moroti
J. Clin. Med. 2025, 14(12), 4368; https://doi.org/10.3390/jcm14124368 - 19 Jun 2025
Viewed by 407
Abstract
Background/Objectives: In addition to classical transmission routes, hepatitis A (HA) outbreaks were, for the first time, linked to sexual activity in the late 1970s, particularly among men who have sex with men (MSM). Since then, outbreaks have continued to emerge globally among adults [...] Read more.
Background/Objectives: In addition to classical transmission routes, hepatitis A (HA) outbreaks were, for the first time, linked to sexual activity in the late 1970s, particularly among men who have sex with men (MSM). Since then, outbreaks have continued to emerge globally among adults engaging in high-risk sexual behaviors, reinforcing the ongoing public health significance of this transmission route. Although the COVID-19 pandemic temporarily reduced HA cases, outbreaks reemerged following the relaxation of pandemic measures. This study aims to report the HA outbreak registered at Romania’s tertiary infectious diseases hospital during the first half of 2022. Methods: We retrospectively analyzed all HA cases admitted to the National Institute for Infectious Diseases from 1 January to 1 August 2022. Results: Among 51 cases, eight children (under 14) were excluded from further analyses. Of the 43 remaining cases, 37 (86%) were male, with 20/37 (54.05%) identified as MSM. Twenty-two of the males (59.45%) were previously or concomitantly diagnosed with sexually transmitted diseases (STDs), notably syphilis and HIV. A marginal finding: 14 out of 29 patients screened for hepatitis E tested positive for IgM. The MSM patients exhibited significantly higher transaminase levels (ALT median level 3404 U/L [IQR 2608–5448] vs. 2066 U/L [IQR 1393–3682]) and more severe liver impairment (INR median level 1.37 [IQR 1.18–1.78] vs. 1.18 [IQR 1.11–1.43] compared to non-MSM patients. While direct bilirubin levels were higher in MSM (7.4 mg/dL vs. 5.5 mg/dL), the difference was not statistically significant. Conclusions: An HA outbreak occurred at the beginning of 2022 among Romanian young MSM, with a more severe acute liver injury. High-risk sexual practices may be a potential risk factor for severe HA. This emphasizes the need to screen for STDs in young males with HA and review vaccination policies for at-risk individuals. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
13 pages, 212 KiB  
Article
Perceptions and Practice of Urologists in Saudi Arabia Regarding Sexual Complications Related to LUTS/BPH Management
by Saad Alshahrani, Abdulrahman Binsaleh, Ahmed Othman Alghamdi, Saad Alqasem, Ali Al-Gonaim and Ashraf El-Metwally
J. Clin. Med. 2025, 14(12), 4367; https://doi.org/10.3390/jcm14124367 - 19 Jun 2025
Viewed by 319
Abstract
Objectives: This study aimed to evaluate perceptions and practices of urologists in Saudi Arabia regarding discussions of erectile dysfunction (ED) and ejaculatory dysfunction (EjD) with patients before initiating BPH treatments. Methods: A cross-sectional survey was conducted using a structured questionnaire distributed [...] Read more.
Objectives: This study aimed to evaluate perceptions and practices of urologists in Saudi Arabia regarding discussions of erectile dysfunction (ED) and ejaculatory dysfunction (EjD) with patients before initiating BPH treatments. Methods: A cross-sectional survey was conducted using a structured questionnaire distributed during the 36th Saudi Urological Annual Conference held in Riyadh in February 2025 among urologists in Saudi Arabia. A binary outcome variable, “frequent and open discussion,” was created based on a scoring system using the median score of these responses. Data analysis included descriptive statistics and univariate (p < 0.25) and multivariate (p < 0.05) logistic regression using SPSS version 27. Results: Discussions about ED risks were most frequent before prescribing 5-alpha reductase inhibitors (5-ARIs) (51.3%) and combined alpha-blockers and 5-ARIs therapy (50.0%), whereas EjD risks were more frequently addressed before alpha-blocker monotherapy (59.2%) and transurethral resection of the prostate (TURP) (56.6%). A substantial proportion of urologists discussed alternative treatments based on sexual dysfunction risks, particularly before TURP (53.9%), alpha-blockers (47.4%), and 5-ARIs (43.4%). Univariate analysis revealed a trend towards more open discussions among non-Saudi urologists (OR 4.58, 95% CI 0.88–23.74, p = 0.06) and a significant association with working in private hospitals (OR 3.68, 95% CI 0.39–35.14, p = 0.03). However, these associations did not hold in multivariate analysis. Conclusions: Urologists in Saudi Arabia demonstrate variability in discussing sexual complications with patients before BPH treatments. Consistent and comprehensive discussions about ED and EjD risks are crucial for informed patient decision-making. Standardized guidelines and educational programs are needed to enhance urologists’ communication skills and ensure consistent patient counseling. Full article
(This article belongs to the Section Nephrology & Urology)
13 pages, 1107 KiB  
Article
Fear of Falling in Older Adults Undergoing Comprehensive Geriatric Care: Results of a Prospective Observational Study
by Marco Meyer, Andreas Arnold, Thomas Stein, Ulrich Niemöller and Christian Tanislav
J. Clin. Med. 2025, 14(12), 4366; https://doi.org/10.3390/jcm14124366 - 19 Jun 2025
Viewed by 375
Abstract
Objectives: This prospective observational study aimed to investigate the prevalence, progression, and clinical factors associated with fear of falling (FOF) in older adults hospitalized for comprehensive geriatric care (CGC). Methods: FOF was assessed using two measures: a single-item question (SIQ) asking, [...] Read more.
Objectives: This prospective observational study aimed to investigate the prevalence, progression, and clinical factors associated with fear of falling (FOF) in older adults hospitalized for comprehensive geriatric care (CGC). Methods: FOF was assessed using two measures: a single-item question (SIQ) asking, “Are you currently afraid of falling?” with responses scored as (0) not at all; (1) a little; (2) quite a bit; (3) very much, and the Falls Efficacy Scale International (FES-I). FES-I scores were categorized into low (FES-I 16–19), moderate (FES-I 20–27), and high (FES-I 28–64) concerns about falling. FOF scores were analyzed in relation to patients’ characteristics and functional performance. Results: A total of 103 patients were included in the final analysis (mean age: 81.9 years, 64.1% female). Upon hospital admission, 74.8% of patients reported FOF (SIQ ≥ 1), with no significant change at discharge (73.8%, p > 0.999). Patients’ FES-I scores indicated high concerns about falling, with only slight improvements following CGC. The median FES-I score upon admission decreased from 31 (IQR: 23.5–40) to 30 (IQR: 23.5–38) at discharge (p < 0.001). Logistic regression analysis revealed that persistently high concerns about falling (FES-I 28–64) after undergoing CGC were associated with depressive symptoms (Geriatric Depression Scale score ≥ 6; OR: 3.61, 95% CI: 1.30–10.04) and a diagnosis of heart failure (OR: 3.63, 95% CI: 1.30–10.11). Patients’ scores in the Barthel Index, Timed Up and Go Test, and Tinetti Test improved after treatment, but these changes (Δ) did not show a significant correlation with those in the FES-I or SIQ. Conclusions: Our findings demonstrate that FOF is highly prevalent among older adults hospitalized for CGC and persists with only minimal improvement following treatment. Persistently high concerns about falling even after completing CGC were associated with depressive symptoms and a diagnosis of heart failure. These results highlight the potential for more targeted interventions within CGC to more effectively address FOF in this vulnerable population. Full article
(This article belongs to the Special Issue Geriatric Diseases: Management and Epidemiology)
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9 pages, 345 KiB  
Review
The Impact of Sex Hormones on Keratoconus
by Konstantinos Droutsas, Iasonas Makrypoulias, Irini Chatziralli, Konstantinos Panagiotopoulos, Maria-Evanthia Sotirianakou and Dimitris Papaconstantinou
J. Clin. Med. 2025, 14(12), 4365; https://doi.org/10.3390/jcm14124365 - 19 Jun 2025
Viewed by 280
Abstract
Keratoconus (KC) is a progressive non-inflammatory disorder characterized by significant changes in the corneal structure, leading to severe vision loss. Risk factors include eye rubbing, a positive family history, and allergic reactions. There is growing evidence suggesting that sex hormones may influence the [...] Read more.
Keratoconus (KC) is a progressive non-inflammatory disorder characterized by significant changes in the corneal structure, leading to severe vision loss. Risk factors include eye rubbing, a positive family history, and allergic reactions. There is growing evidence suggesting that sex hormones may influence the development and progression of KC, but the exact mechanisms and extent of their impact remain unclear and controversial. This review aims to examine the current literature on the association between KC and sex hormones and to evaluate the potential of these hormones as clinical markers for diagnosing, prognosticating, and managing KC. Full article
(This article belongs to the Section Ophthalmology)
36 pages, 701 KiB  
Review
The Mental Health of Children with Cerebral Palsy: A Review of the Last Five Years of Research
by Rebecca Rausch, Summer Chahin, Caroline Miller, Lindsey Dopheide, Nicholas Bovio, Ann Harris and Dilip Patel
J. Clin. Med. 2025, 14(12), 4364; https://doi.org/10.3390/jcm14124364 - 19 Jun 2025
Viewed by 433
Abstract
Background/Objectives: Children and adolescents with cerebral palsy (CP) often experience associated functional limitations, diseases, or impairments. Included in these associated concerns are mental health symptoms/disorders and academic concerns. There has been an increasing research focus on the mental health of youth with CP [...] Read more.
Background/Objectives: Children and adolescents with cerebral palsy (CP) often experience associated functional limitations, diseases, or impairments. Included in these associated concerns are mental health symptoms/disorders and academic concerns. There has been an increasing research focus on the mental health of youth with CP over the past 5 years, and there is a need to synthesize this research. This review aims to synthesize the most recent research on the mental and behavioral health of youth with CP. Methods: A literature search on research focused on mental health, academic functioning, and mental and behavioral treatment for youth with CP was conducted in August of 2024 and limited to the last 5 years to highlight the most recent developments in this area of research. Four hundred and forty-eight articles were screened, and thirty-eight articles were included in this review. Results: Based on this literature review, children with CP have high rates of mental health diagnoses across multiple diagnostic areas, including autism spectrum disorder, attention-deficit hyperactivity disorder, intellectual developmental disorder, anxiety, and depression. Academic concerns are common for children with CP. Intervention studies have focused on both child and parent interventions. Conclusions: Research over the past 5 years has added to prevalence estimates of mental health disorders in the pediatric CP population. Considering the high rates of mental health symptoms found in children with CP, future research should focus further on mental health interventions for this population. Full article
(This article belongs to the Special Issue Cerebral Palsy: Clinical Rehabilitation and Treatment)
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17 pages, 529 KiB  
Review
Techniques for Success in Nipple-Sparing Mastectomy and Immediate Reconstruction
by Jenn J. Park, Carter J. Boyd, Kshipra Hemal, Thomas J. Sorenson, Chris Amro, Nicholas A. Vernice, Alexis C. Lakatta, Oriana Cohen, Mihye Choi and Nolan S. Karp
J. Clin. Med. 2025, 14(12), 4363; https://doi.org/10.3390/jcm14124363 - 19 Jun 2025
Viewed by 455
Abstract
Background: Nipple-sparing mastectomy (NSM), given demonstrated oncologic safety, is widely used for both therapeutic and prophylactic mastectomy. The popularity of NSM has spurred advancements by breast and plastic surgeons, liberalizing the indications for NSM and improving patient and aesthetic reconstructive outcomes. This review [...] Read more.
Background: Nipple-sparing mastectomy (NSM), given demonstrated oncologic safety, is widely used for both therapeutic and prophylactic mastectomy. The popularity of NSM has spurred advancements by breast and plastic surgeons, liberalizing the indications for NSM and improving patient and aesthetic reconstructive outcomes. This review explores these developments and establishes up-to-date surgical tenets for successful NSM and reconstruction. Methods: A comprehensive literature review was conducted using the PubMed, Google Scholar, and Cochrane Library databases, focusing on peer-reviewed studies published up to 2024. Articles were selected based on relevance, quantity, and documentation of clinical outcomes and patient satisfaction. Results: NSM is utilized frequently for both invasive breast cancers and prophylactic mastectomy, with expanded criteria for candidacy by breast surgeons. Staged procedures such as adjunct reduction, mastopexy, or nipple delay allow patients with larger or ptotic breasts to undergo NSM with comparable outcomes. Long-term outcome studies have identified important risk factors for complications, including smoking history, higher mastectomy weight, certain medical comorbidities, and suboptimal mastectomy flaps. Evolutions in reconstructive decision making in direct-to-implant and staged tissue expander placement have improved aesthetic results while accounting for poor mastectomy flap quality or adjuvant therapy. Long-term outcomes show NSM remains safe and has comparable rates of local recurrence. Patient-reported outcomes demonstrate satisfaction with NSM, especially in sexual and psychological wellbeing metrics. Conclusions: NSM has been demonstrated to be safe in long-term oncologic outcomes. Its widespread popularity over the past ten years has helped identify methods to improve upon surgical and aesthetic outcomes, including decision-making in reconstruction; considerations for challenging patient-related characteristics such as macromastia, ptosis, and NAC asymmetry; and novel advances in areas such as neurotization. Full article
(This article belongs to the Special Issue Current State of the Art in Breast Reconstruction)
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9 pages, 1045 KiB  
Article
Femtosecond Laser-Assisted Donor and Recipient Preparation for Bowman Layer Transplantation
by Rosemarie Schlosser, Annekatrin Rickmann, Peter Szurman, Silke Wahl, Berthold Seitz, Philip Wakili, Lisa Julia Müller, Philipp Ken Roberts and Karl Thomas Boden
J. Clin. Med. 2025, 14(12), 4362; https://doi.org/10.3390/jcm14124362 - 19 Jun 2025
Viewed by 236
Abstract
Objectives: A Ziemer LDV Z8 femtosecond laser (FSL) was used to obtain optimal cutting parameters with precise settings for donor and recipient preparations for Bowman layer transplantation. Methods: Of 48 human research corneas examined, 32 were used for Bowman layer preparation [...] Read more.
Objectives: A Ziemer LDV Z8 femtosecond laser (FSL) was used to obtain optimal cutting parameters with precise settings for donor and recipient preparations for Bowman layer transplantation. Methods: Of 48 human research corneas examined, 32 were used for Bowman layer preparation (donor) and 16 for pocket preparation (recipient) using the LDV Z8 FSL. The cutting thickness of the Bowman layer, pocket depth, and corresponding laser settings were varied. The quality of sections was evaluated based on the occurrence of adhesions, bridges, or perforations. Histological specimens were prepared and analyzed. Results: Preparation of the Bowman layer and recipient pocket was possible using all selected settings. The thinner the Bowman layer and the more superficial the pocket preparation, the higher the risk of perforation was. Considering the fact that the Bowman layer was cut as thinly as possible, a Bowman layer thickness of 30 µm showed a 100% success rate. Bowman layers cut at 25 µm had a lower success rate (50%). The pocket depth of 150 µm showed a 100% success rate in the preparation. Histological processing revealed smooth, precisely cut edges of Bowman layers and pockets. Implantation into the pocket was successful in all cases. Conclusions: Both Bowman layer and pocket preparation were technically and surgically feasible using the LDV Z8 FSL, and the prepared Bowman layers were thinner than those reported in previous studies. The optimal Bowman layer thickness was 30 µm, and a resection depth of 150 µm was used to prepare the pockets safely. Full article
(This article belongs to the Special Issue Advancements in Femtosecond Laser Applications)
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13 pages, 1085 KiB  
Article
Cost-Effectiveness of Difelikefalin for the Treatment of Moderate-to-Severe Chronic Kidney Disease-Associated Pruritus (CKD-aP) in UK Adult Patients Receiving In-Centre Haemodialysis
by Kieran McCafferty, Cameron Collins, Imogen Taylor, Thilo Schaufler and Garth Baxter
J. Clin. Med. 2025, 14(12), 4361; https://doi.org/10.3390/jcm14124361 - 19 Jun 2025
Viewed by 337
Abstract
Background/Objectives: CKD-associated pruritus (CKD-aP) is a serious systemic comorbidity occurring in patients with CKD. Despite the burden of CKD-aP, there are limited efficacious treatments available for its management; difelikefalin is the only approved treatment based on its efficacy and safety demonstrated in [...] Read more.
Background/Objectives: CKD-associated pruritus (CKD-aP) is a serious systemic comorbidity occurring in patients with CKD. Despite the burden of CKD-aP, there are limited efficacious treatments available for its management; difelikefalin is the only approved treatment based on its efficacy and safety demonstrated in two clinical studies, namely KALM-1 and KALM-2. This study aimed to evaluate the cost-effectiveness of difelikefalin plus best supportive care (BSC) versus BSC alone when treating moderate-to-severe CKD-aP in patients receiving in-centre haemodialysis, from the perspective of the UK healthcare system. Methods: A de novo lifetime Markov health economic model was built to assess the cost-effectiveness of difelikefalin. The modelled efficacy of difelikefalin was based on data from KALM-1 and KALM-2 pooled at the patient level. The main efficacy driver was the total 5-D Itch scale score. Per-cycle probabilities of changing health states defined by CKD-aP severity were used to derive transition matrices; the model also estimated time-dependent annual probabilities of death and transplant for people on haemodialysis. An increased risk of mortality for modelled patients with very severe, severe, or moderate CKD-aP was applied. Health state utilities and management costs were based on published evidence. Results: Modelled patients treated with difelikefalin were estimated to have a reduced severity of CKD-aP. Consequently, difelikefalin plus BSC was associated with an increased life expectancy of 0.11 years per person and improved HRQoL compared with BSC alone. This translated to higher quality-adjusted life years, at 0.26 per person gained compared to BSC alone. Improved patient outcomes were achieved at an incremental cost of £7814 per person. Conclusions: Overall, at a price of £31.90/vial, difelikefalin was estimated to be a cost-effective treatment for moderate-to-severe CKD-aP at a willingness-to-pay threshold of £30,000/QALY, with conclusions robust to sensitivity analysis. Full article
(This article belongs to the Section Clinical Neurology)
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19 pages, 336 KiB  
Review
Pain Neuroscience Education on Reducing Opioid Dependency in African American and Caucasian Populations: A Narrative Review
by Austin Granger and Ersilia Mirabelli
J. Clin. Med. 2025, 14(12), 4360; https://doi.org/10.3390/jcm14124360 - 19 Jun 2025
Viewed by 389
Abstract
This review explores pain neuroscience education (PNE) in the context of opioid dependence among Caucasian and African American populations, addressing disparities and sociocultural influences in the opioid epidemic. Von Bertalanffy’s general systems theory and Bronfenbrenner’s ecological systems theory comprise the underlying theoretical frameworks [...] Read more.
This review explores pain neuroscience education (PNE) in the context of opioid dependence among Caucasian and African American populations, addressing disparities and sociocultural influences in the opioid epidemic. Von Bertalanffy’s general systems theory and Bronfenbrenner’s ecological systems theory comprise the underlying theoretical frameworks behind the review, emphasizing the importance of biopsychosocial perspectives of chronic pain and ecological systems on individual development. Within these frameworks, the study objective is to summarize relevant and contemporary literature among African American and Caucasian populations regarding opioid dependency, neuroplasticity in chronic pain, and PNE. Peer-reviewed articles published within the last 10 years were reviewed for relevance. Limitations include a lack of research on the intersection of ethnicity and PNE, a lack of studies investigating interdisciplinary input regarding PNE, and a focus on only two ethnic groups. This narrative review finds that African Americans face systemic barriers to effective treatment for pain and opioid use disorder (OUD), while Caucasians are more likely to be overprescribed with higher rates of OUD. From a systems and ecological perspective, maladaptive neuroplasticity in chronic pain (biologic subsystem) intersects with ethnic disparities in prescribing access and pain beliefs (psychosocial subsystem) to influence opioid use and the chronic pain experience. PNE shows promise as an adjunct to traditional physical therapy in reducing nociplastic pain, potentially affecting opioid dependency. Future research should incorporate readiness-to-change models, generational and ethnocultural perspectives, and neuroimaging with PNE to optimize the delivery of PNE to individuals of different backgrounds. Full article
(This article belongs to the Section Clinical Rehabilitation)
9 pages, 275 KiB  
Review
Augmented Reality Integration in Surgery for Craniosynostoses: Advancing Precision in the Management of Craniofacial Deformities
by Divya Sharma, Adam Matthew Holden and Soudeh Nezamivand-Chegini
J. Clin. Med. 2025, 14(12), 4359; https://doi.org/10.3390/jcm14124359 - 19 Jun 2025
Viewed by 371
Abstract
Craniofacial deformities, particularly craniosynostosis, present significant surgical challenges due to complex anatomy and the need for individualised, high-precision interventions. Augmented reality (AR) has emerged as a promising tool in craniofacial surgery, offering enhanced spatial visualisation, real-time anatomical referencing, and improved surgical accuracy. This [...] Read more.
Craniofacial deformities, particularly craniosynostosis, present significant surgical challenges due to complex anatomy and the need for individualised, high-precision interventions. Augmented reality (AR) has emerged as a promising tool in craniofacial surgery, offering enhanced spatial visualisation, real-time anatomical referencing, and improved surgical accuracy. This review explores the current and emerging applications of AR in preoperative planning, intraoperative navigation, and surgical education within paediatric craniofacial surgery. Through a literature review of peer-reviewed studies, we examine how AR platforms, such as the VOSTARS system and Microsoft HoloLens, facilitate virtual simulations, precise osteotomies, and collaborative remote guidance. Despite demonstrated benefits in feasibility and accuracy, widespread clinical adoption is limited by technical, ergonomic, financial, and training-related challenges. Future directions include the integration of artificial intelligence, haptic feedback, and robotic assistance to further augment surgical precision and training efficacy. AR holds transformative potential for improving outcomes and efficiency in craniofacial deformity correction, warranting continued research and clinical validation. Full article
(This article belongs to the Special Issue Craniofacial Surgery: State of the Art and the Perspectives)
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14 pages, 1128 KiB  
Article
Predictors of Atrial Fibrillation in Heart Failure Patients with Indications for ICD Implantation
by Tariel Atabekov, Roman Batalov, Evgenii Archakov, Irina Silivanova, Mikhail Khlynin, Irina Kisteneva, Sergey Krivolapov and Sergey Popov
J. Clin. Med. 2025, 14(12), 4358; https://doi.org/10.3390/jcm14124358 - 18 Jun 2025
Viewed by 396
Abstract
Background/Objectives: Atrial fibrillation (AF) is a prevalent arrhythmia that significantly complicates the management of heart failure (HF) patients, particularly those who have implantable cardioverter–defibrillators (ICDs). The interplay between AF and inappropriate ICD therapy poses a critical challenge in optimizing patient outcomes, as [...] Read more.
Background/Objectives: Atrial fibrillation (AF) is a prevalent arrhythmia that significantly complicates the management of heart failure (HF) patients, particularly those who have implantable cardioverter–defibrillators (ICDs). The interplay between AF and inappropriate ICD therapy poses a critical challenge in optimizing patient outcomes, as inappropriate shocks can lead to increased morbidity, psychological distress, and a reduced quality of life. We aimed to explore the various clinical and demographic predictors of AF in HF patients with indications for ICD implantation. Methods: This study included 122 patients who were indicated for ICD implantation and had undergone transthoracic echocardiography (TE). We evaluated the relationships between clinical and demographic factors and the occurrence of AF, which was recorded either before ICD implantation or during the follow-up period afterward. From our findings, we established predictors and a risk model for AF. Results: Out of 122 HF patients with ICDs, 52 (42.6%) experienced an episode of AF either prior to ICD implantation or during a follow-up period of 20.5 [6.0; 53.0] months, as recorded by the ICDs’ endogram. Patients with AF were older compared to those without AF (p < 0.001). Additionally, they exhibited a higher left ventricular early diastolic filling rate (LVE) (p = 0.006) and a greater left atrial index (LAI) (p = 0.002). These three factors—age, LVE and LAI—were found to be independently associated with AF in both univariable and multivariable logistic regression analyses. The final model, including age, LVE, and LAI, showed a good discrimination capability with an AUC of 0.775. At a cutoff value of >0.47, the model achieved a sensitivity of 67.3% and a specificity of 77.2% in identifying HF patients with ICDs at risk for AF. Conclusions: This study found that 42.6% of HF patients with ICDs experienced AF, with older age, higher LVE, and greater LAI identified as significant predictors. Full article
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