Journal of Clinical Medicine

16 pages, 2474 KiB

Open AccessArticle

Structural and Functional Assessment of the Macular Inner Retinal Layers in Multiple Sclerosis Eyes Without History of Optic Neuropathy

by Lucilla Barbano, Lucia Ziccardi, Carmen Dell'Aquila, Mattia D’Andrea, Carolina Gabri Nicoletti, Doriana Landi, Giorgia Mataluni, Antonio Di Renzo, Fabio Buttari, Roberto dell'Omo, Girolama Alessandra Marfia, Diego Centonze and Vincenzo Parisi

J. Clin. Med. 2025, 14(16), 5919; https://doi.org/10.3390/jcm14165919 (registering DOI) - 21 Aug 2025

Abstract

Background: Considering the lack of studies regarding the localized evaluation of the macular inner retina in multiple sclerosis patients without optic neuritis (MSnoON eyes), we investigated the structure and function of retinal ganglion cells (RGCs) located in different macular areas. Methods: [...] Read more.

Background: Considering the lack of studies regarding the localized evaluation of the macular inner retina in multiple sclerosis patients without optic neuritis (MSnoON eyes), we investigated the structure and function of retinal ganglion cells (RGCs) located in different macular areas. Methods: In 24 MSnoON patients (mean age: 45.22 ± 5.57 years; 14 females and 10 males; mean MS disease duration: 11.07 ± 5.88 years) and in 30 age-similar (mean age: 45.09 ± 5.08 years) control subjects, complete ophthalmological examination, optical coherence tomography (OCT) and multifocal photopic negative response (mfPhNR) were performed. The ganglion cell layer thickness (GCL+-T) via OCT and the response amplitude density (RAD) through mfPhNR were measured from localized macular regions, including rings and Early Treatment of Diabetic Retinopathy Study (ETDRS) sectors. Results: When comparing MSnoON data from all tested areas with respect to the controls, macular GCL+-T and mfPhNR RAD mean values were found to be significantly (ANOVA, p < 0.01) reduced. In the MSonON group, considering both rings and sectors, the GCL+-T values were significantly and linearly correlated (Pearson’s test, p < 0.01) to the mfPhNR RAD values. Conclusions: In MS, even in the absence of optic neuritis, potential primary morpho-functional involvement of the inner macular elements can occur. This impairment widely involves all macular areas and sectors. Full article

(This article belongs to the Section Ophthalmology)

11 pages, 464 KiB

Open AccessArticle

Cervical Regeneration Following Monopolar Electrosurgical Conization: A Prospective Evaluation of Volume, Length, and Transformation Zone Reformation

by Şule Gül Aydın, Sevda Baş, Fatma Özmen, Şeyma Yaşar, Zeynel Abidin Taş, Ahmet Zeki Nessar, Sevtap Seyfettinoğlu and Mehmet Ali Narin

J. Clin. Med. 2025, 14(16), 5918; https://doi.org/10.3390/jcm14165918 - 21 Aug 2025

Abstract

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for [...] Read more.

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for cervical tissue regeneration. Methods: This prospective observational study included 28 patients who underwent MESC due to abnormal cervical cytology or biopsy-confirmed cervical intraepithelial neoplasia. Preoperative, postoperative one month and six month cervical measurements were obtained using two-dimensional transvaginal ultrasonography. Monthly colposcopic evaluations were conducted, cervical biopsies were taken at the third month, and a cytological assessment was performed at the sixth month. Cervical volume and length regeneration were calculated and analyzed in relation to the dimensions of the excised cone. Regeneration percentages and their correlations with excised tissue dimensions were evaluated using paired t-tests and Pearson correlation analysis. Results: Mean cervical volume and length regeneration rates at six months were 84.61% ± 5.64 and 86.36% ± 3.33, respectively. The transformation zone was histologically visible in 32.1% of patients at three months and cytologically in 75.9% at six months. An inverse correlation was observed between both cone volume and length and cervical regeneration (p < 0.005). Patients with larger preoperative cervical dimensions exhibited a higher regenerative capacity. Positive surgical margins were found in only one patient (3.4%), and no high-grade cytologic abnormalities were noted at follow-up. Conclusions: MESC may enable substantial cervical regeneration within six months. Larger excisions impair healing and delay transformation zone reformation, which may inform the optimal timing for initiating gynecological and colposcopic examinations, as well as for performing cervical interventions when indicated. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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17 pages, 792 KiB

Open AccessArticle

Does Preoperative CT Improve Outcomes in Femoral Neck Fracture Fixation? A Retrospective Study

by Ludovico Lucenti, Andrea Sodano, Flora Maria Chiara Panvini, Andrea Vescio, Giacomo Papotto, Gianluca Testa and Vito Pavone

J. Clin. Med. 2025, 14(16), 5917; https://doi.org/10.3390/jcm14165917 - 21 Aug 2025

Abstract

Background/Objectives: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using [...] Read more.

Background/Objectives: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using cannulated screws. Methods: The present study retrospectively analyzed 55 patients treated with cannulated screw fixation over seven years. Preoperative CT scans, fracture classification (Garden and Pauwels), and surgical timing were evaluated. Results: All 55 patients were treated with three cannulated screws by nine fellowship-trained surgeons. The average age of the CT-yes group was 54.44 years (SD 15.45), while the average age of the CT-no group was 56.93 (SD 14.95). Differences in age among the two groups were not statistically significant. In 4 patients, the treatment with cannulated screws failed, leading to a subsequent total hip arthroplasty for avascular necrosis (AVN). Three of them belonged to the CT-yes group, while only one belonged to the CT-no group. A statistical analysis showed no significant differences between patients who underwent a CT scan and those who did not have a CT scan and their results (p = 0.282).Results indicate no statistically significant difference in outcomes between patients who underwent a CT scan before the surgical treatment and those who did not, while a well-conducted X-ray assessment is essential and can be sufficient to fully understand and treat most of the fractures. Conclusions: The risks of avascular necrosis and non-union must be considered in the decision-making process regarding the suitable treatment. Early surgery did not significantly improve treatment results, but it is recommended. Fixation with cannulated screws remains a good treatment, especially for some patterns of fractures and younger patients. Given the study’s limitations, including the small sample size and retrospective nature, prospective multicenter studies are warranted to better understand the role of CT scans in optimizing surgical planning and improving patient outcomes. Full article

(This article belongs to the Section Orthopedics)

13 pages, 4621 KiB

Open AccessArticle

Enigmatic Cases of Finger Proximal Interphalangeal Joint Swelling: Case Series and Focused Review of the Literature

by Gershon Zinger, Yaakov Applbaum and Amos Peyser

J. Clin. Med. 2025, 14(16), 5916; https://doi.org/10.3390/jcm14165916 - 21 Aug 2025

Abstract

Objectives: This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger’s proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our [...] Read more.

Objectives: This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger’s proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our case series and providing a structured framework for clinical reasoning, including imaging, biopsy, and laboratory assessment. Non-traumatic causes of finger swelling may include rheumatological disease, atypical infection, tumor, or metabolic conditions. Routine evaluation includes history, examination, and radiographs. Additional evaluation may include ultrasound, inflammatory screening labs, magnetic resonance imaging (MRI) and computed tomography (CT). Despite these efforts, a diagnosis may still be elusive. The objective of this study is to provide a useful clinical differential diagnosis and provide lessons learned from this unique group of patients. Methods: Starting in February 2017, patients with isolated unilateral PIP swelling were followed. Clinical information was collected, including history, examination, and laboratory and imaging studies. Patients were followed until a specific diagnosis was obtained. In addition to the series of patients, a focused literature review is given to present additional unusual causes of atraumatic isolated PIP swelling that were not found in this series. Results: There were five cases that met the criteria. This includes two cases ultimately diagnosed with psoriatic arthritis, and one case each of osteoid osteoma, gout and palindromic rheumatoid arthritis. Conclusions: The single most effective test that helped to reach the final diagnosis in this series was the CT scan. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 616 KiB

Open AccessArticle

The Significance of Enzymatic Cholestasis in Inflammatory Bowel Disease Patients for the Diagnosis of Primary Sclerosing Cholangitis—A Retrospective Study

by Matei Mandea, Dragos M. Oancea, Mihaela C. Ghioca, Speranta M. Iacob, Razvan A. Iacob, Ioana. G. Lupescu and Liliana S. Gheorghe

J. Clin. Med. 2025, 14(16), 5915; https://doi.org/10.3390/jcm14165915 - 21 Aug 2025

Abstract

This retrospective longitudinal study evaluated the significance of cholestasis syndrome and the diagnosis of primary sclerosing cholangitis (PSC) in inflammatory bowel disease (IBD) patients from a tertiary center in Romania. Methods: From 2011 to 2022, 3767 patients suspected for IBD were evaluated, with [...] Read more.

This retrospective longitudinal study evaluated the significance of cholestasis syndrome and the diagnosis of primary sclerosing cholangitis (PSC) in inflammatory bowel disease (IBD) patients from a tertiary center in Romania. Methods: From 2011 to 2022, 3767 patients suspected for IBD were evaluated, with 2499 confirmed cases. Of these, 34 patients (1.36%) had an IBD-PSC phenotype. Of the IBD-PSC cases, 56% were associated with UC and 44% with CD. Results: Enzymatic cholestasis was observed in 13.3% of IBD patients, with gamma-glutamyl transpeptidase (GGT) elevated in 70.2% and alkaline phosphatase (ALP) in 51.3%. However, only 10.2% of the patients with enzymatic cholestasis were diagnosed with PSC. Other liver diseases identified included metabolic-associated steatotic liver disease (MASLD), chronic viral hepatitis, Primary Biliary Cholangitis, autoimmune hepatitis, and liver neoplasms. A higher incidence of cholangiocarcinoma (11.76% vs. 0.24%, p < 0.001) and liver-related death (8.82% vs. 0.65%, p < 0.001) was found between IBD-PSC patients and those without PSC. PSC-CD patients were diagnosed at a younger age (30.2 vs. 43 years, p < 0.001), had higher rates of severe disease (73.3% vs. 10.5%, p < 0.001), required more biological treatment (60% vs. 15.7%, p < 0.001), and experienced higher mortality (20% vs. 0%, p < 0.001). Discussions: This study represents the most extensive cohort analysis of PSC-IBD patients in Romania and Eastern Europe, highlighting clinical differences between PSC-UC and PSC-CD phenotypes. Conclusions: The regular monitoring of ALP and GGT in IBD patients helps detect liver diseases, including PSC. However, only one in ten patients with IBD and enzymatic cholestasis was diagnosed with PSC. Full article

(This article belongs to the Collection Clinical Research in Hepatology)

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10 pages, 1502 KiB

Open AccessCase Report

Pulmonary Infiltrates in a Non-Cystic Fibrosis Bronchiectasis Patient: A Case Report

by Francesco Rocco Bertuccio, Nicola Baio, Simone Montini, Valentina Ferroni, Vittorio Chino, Lucrezia Pisanu, Marianna Russo, Ilaria Giana, Elisabetta Gallo, Lorenzo Arlando, Klodjana Mucaj, Mitela Tafa, Maria Arminio, Emanuela De Stefano, Alessandro Cascina, Angelo Guido Corsico, Giulia Maria Stella and Valentina Conio

J. Clin. Med. 2025, 14(16), 5914; https://doi.org/10.3390/jcm14165914 - 21 Aug 2025

Abstract

Background: Scedosporium apiospermum is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic [...] Read more.

Background: Scedosporium apiospermum is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic resistance to multiple antifungal agents. Case Presentation: We report the case of a 66-year-old immunocompetent woman with idiopathic bilateral non-cystic fibrosis bronchiectasis, who presented with subacute cough and increased sputum production. Chest high-resolution CT revealed new subsolid and ground-glass infiltrates superimposed on stable bronchiectatic changes. Bronchoalveolar lavage (BAL) cultures isolated S. apiospermum as the sole pathogen. The patient was treated with oral voriconazole (200 mg BID) for 4 weeks, followed by a 4-week course of aerosolized amphotericin B. Clinical and radiological improvement was observed, and no relapse occurred during follow-up. Discussion: This case highlights the potential for S. apiospermum to cause clinically relevant pulmonary infection in structurally abnormal but immunocompetent lungs. Non-CF bronchiectasis may facilitate fungal colonization due to impaired mucociliary clearance and chronic mucus retention. Combined antifungal therapy involving systemic voriconazole and inhaled amphotericin B (though not yet standardized) was employed based on clinical rationale and the available literature, resulting in favorable outcomes. Conclusions:S. apiospermum pulmonary infection, although rare in immunocompetent hosts with bronchiectasis, should be considered in cases of new or persistent infiltrates. Early recognition and individualized antifungal strategies, including the potential role of inhaled agents, may improve clinical outcomes. This case reinforces the importance of multidisciplinary collaboration in the management of complex fungal infections in chronic airway disease. Full article

(This article belongs to the Section Respiratory Medicine)

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28 pages, 978 KiB

Open AccessReview

Artificial Intelligence in Alzheimer’s Disease Diagnosis and Prognosis Using PET-MRI: A Narrative Review of High-Impact Literature Post-Tauvid Approval

by Rafail C. Christodoulou, Amanda Woodward, Rafael Pitsillos, Reina Ibrahim and Michalis F. Georgiou

J. Clin. Med. 2025, 14(16), 5913; https://doi.org/10.3390/jcm14165913 - 21 Aug 2025

Abstract

Background: Artificial intelligence (AI) is reshaping neuroimaging workflows for Alzheimer’s disease (AD) diagnosis, particularly through PET and MRI analysis advances. Since the FDA approval of Tauvid, a PET tracer targeting tau pathology, there has been a notable increase in studies applying AI to [...] Read more.

Background: Artificial intelligence (AI) is reshaping neuroimaging workflows for Alzheimer’s disease (AD) diagnosis, particularly through PET and MRI analysis advances. Since the FDA approval of Tauvid, a PET tracer targeting tau pathology, there has been a notable increase in studies applying AI to neuroimaging data. This narrative review synthesizes recent, high-impact literature to highlight clinically relevant AI applications in AD imaging. Methods: This review examined peer-reviewed studies published between January 2020 and January 2025, focusing on the use of AI, including machine learning, deep learning, and hybrid models for diagnostic and prognostic tasks in AD using PET and/or MRI. Studies were identified through targeted PubMed, Scopus, and Embase searches, emphasizing methodological diversity and clinical relevance. Results: A total of 111 studies were categorized into five thematic areas: Image preprocessing and segmentation, diagnostic classification, prognosis and disease staging, multimodal data fusion, and emerging innovations. Deep learning models such as convolutional neural networks (CNNs), generative adversarial networks (GANs), and transformer-based architectures were widely employed by the research community in the field of AD. At the same time, several models reported strong diagnostic performance, but methodological challenges such as reproducibility, small sample sizes, and lack of external validation limit clinical translation. Trends in explainable AI, synthetic imaging, and integration of clinical biomarkers are also discussed. Conclusions: AI is rapidly advancing the field of AD imaging, offering tools for enhanced segmentation, staging, and early diagnosis. Multimodal approaches and biomarker-guided models show particular promise. However, future research must focus on reproducibility, interpretability, and standardized validation to bridge the gap between research and clinical practice. Full article

(This article belongs to the Special Issue Artificial Intelligence (AI) and Deep Learning (DL) in Medical Imaging)

19 pages, 2582 KiB

Open AccessArticle

Updated Swiss Growth References 2025: No Height Differences, but BMI Variations Associated with Migration

by Urs Eiholzer, Anika Stephan, Ilja Dubinski, Christiane Fritz and Cees Noordam

J. Clin. Med. 2025, 14(16), 5912; https://doi.org/10.3390/jcm14165912 - 21 Aug 2025

Abstract

Background/Objectives: The 2019 Swiss growth references for height, weight, and BMI were based on a large dataset from the German-speaking part of Switzerland (Cohort 2019). The current study aimed to ensure national representativeness by proportionate amounts of additional data from the French-speaking (Suisse [...] Read more.

Background/Objectives: The 2019 Swiss growth references for height, weight, and BMI were based on a large dataset from the German-speaking part of Switzerland (Cohort 2019). The current study aimed to ensure national representativeness by proportionate amounts of additional data from the French-speaking (Suisse Romande) and Italian-speaking (Ticino) regions to validate the 2019 growth curves and to update the national growth references. It also investigated the influence of parental migration background on child growth. Methods: Anthropometric data from 43,290 children and adolescents—including 11,816 new cases—were analyzed (Cohort 2019 + 2025). Percentile curves were modeled using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) framework. Results: The extended dataset largely confirms the 2019 growth references. Variations in height percentiles were small and clinically negligible. Clinically relevant differences in BMI percentiles were observed in girls, with the most pronounced deviations—up to 0.8 kg/m²—at the 97th percentile. Analyses by parental migration background revealed relevant differences in BMI. Conclusions: The extended Swiss Growth References (Cohort 2019 + 2025) are robust and provide valid reference data for all Swiss children and adolescents, offering contemporary tools for decision-making in clinical practice. To maintain their validity over time, targeted updates are required, with special attention to demographic changes resulting from migration. Full article

(This article belongs to the Section Clinical Pediatrics)

18 pages, 308 KiB

Open AccessArticle

Predictors of Metabolic Syndrome in Polish Women—The Role of Body Composition and Sociodemographic Factors

by Katarzyna Dereń, Magdalena Zielińska, Anna Bartosiewicz and Edyta Łuszczki

J. Clin. Med. 2025, 14(16), 5911; https://doi.org/10.3390/jcm14165911 - 21 Aug 2025

Abstract

Background: The increasing prevalence of overweight and obesity worldwide is one of the most serious public health challenges, reaching epidemic proportions. Excessive body weight is often accompanied by metabolic disorders such as insulin resistance, atherogenic dyslipidaemia and hypertension—collectively known as metabolic syndrome. This [...] Read more.

Background: The increasing prevalence of overweight and obesity worldwide is one of the most serious public health challenges, reaching epidemic proportions. Excessive body weight is often accompanied by metabolic disorders such as insulin resistance, atherogenic dyslipidaemia and hypertension—collectively known as metabolic syndrome. This cross-sectional study aimed to identify predictors of metabolic syndrome in women using logistic regression analysis based on selected sociodemographic, anthropometric, and lifestyle variables. Methods: The study included 250 women aged 23–85 recruited in the Podkarpackie region of Poland. Data on sociodemographic characteristics and smoking status were collected via a questionnaire. Physical activity and sedentary behaviours were assessed using the Global Physical Activity Questionnaire. Body composition was measured using bioelectrical impedance analysis. Fasting capillary blood samples and blood pressure measurements were obtained by qualified medical staff in accordance with standard procedures. Results: Obesity was strongly associated with metabolic syndrome components, particularly abnormal blood pressure (66.3%) and fasting glucose (64%), both of which were statistically significant (p < 0.01). Age was a significant predictor of metabolic syndrome (OR = 1.06; p < 0.01) and its components, including hypertension, dysglycaemia and dyslipidaemia. Waist-to-hip ratio was strongly linked to metabolic syndrome (OR = 356.97; p < 0.01) and obesity (OR = 5.89 × 10³⁰; p < 0.001); however, these exceptionally high values should be interpreted with caution, as they may reflect statistical artifacts due to model instability or sample characteristics, rather than a meaningful or generalizable association. Higher body fat mass was associated with an increased risk of obesity, hypertension and dysglycaemia (OR = 1.42, 1.06 and 1.06 respectively; p < 0.01). Conclusions: These results emphasise the significant role of obesity as a risk factor for metabolic syndrome in women, highlighting the need for personalised preventive strategies that consider lifestyle and sociodemographic factors, such as targeted health education, promotion of physical activity, and dietary counselling adapted to the needs of women at risk. Full article

(This article belongs to the Special Issue The Complex Interplay Between Physical Activity, Sleep, Diet, and Obesity: Clinical Insights for Treatment and Prevention)

15 pages, 1106 KiB

Open AccessReview

Temporary Peripheral Nerve Stimulation (PNS) of the Cervical Medial Branch Nerve (CMBN) for Chronic Axial Neck Pain—A Literature Review and Case Series

by Vinicius Tieppo Francio, Kelsey Gustafson, Logan Leavitt, Ryan Zwick, Christopher M. Lam, Andrew Sack, Dawood Sayed and Usman Latif

J. Clin. Med. 2025, 14(16), 5910; https://doi.org/10.3390/jcm14165910 - 21 Aug 2025

Abstract

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing [...] Read more.

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing literature and present a retrospective single-center case series of patients who underwent temporary PNS targeting the cervical medial branch nerves (CMBNs) for chronic axial neck pain. Methods: This investigation comprises a narrative literature review alongside a single-center, retrospective case series evaluating percutaneous, temporary PNS for the management of cervical spondylosis facet arthropathy in the absence of myelopathy or radiculopathy. The primary outcomes were pain reduction, as measured by the numeric rating scale, and improvements in functional disability, with assessments conducted at baseline and at 60 days post-intervention. Results: PNS represents a neuromodulatory, nondestructive intervention that targets the CMBN to alleviate chronic axial neck pain, in contrast to the destructive mechanisms inherent in cervical radiofrequency ablation (CRFA). Although PNS has been applied to other neural targets, its use in the cervical region is sparsely documented, with limited case studies available. Notably, this case series is the first to report pain and disability outcomes specifically associated with CMBN PNS. At the 60-day follow-up, 66% of subjects achieved the minimal clinically important difference (MCID) for pain reduction, while 77% met the MCID for disability reduction. Moreover, our analysis uniquely examined the impact of previous CRFA and a history of cervical spine surgery on treatment outcomes, revealing that patients with such interventions experienced more modest improvements compared to their surgery- and CRFA-naive counterparts. Conclusions: The current literature reveals a significant gap regarding the use of CMBN PNS, underscoring an unmet need in the treatment algorithm for chronic axial neck pain beyond conservative modalities. Our findings suggest that CMBN PNS may offer a promising adjunctive therapy for carefully selected patients with refractory chronic axial neck pain who have not improved after medications, physical therapy, or injections. Additionally, the comparative analysis of outcomes in patients with a history of CRFA or cervical surgery underscores potential advantages of PNS prior to destructive therapies. Future research, ideally in the form of prospective studies with larger cohorts and extended follow-up durations, is warranted to further evaluate long-term outcomes and refine the place of PNS in the treatment algorithm. Full article

(This article belongs to the Special Issue Neck Pain: Advancements in Assessment and Contemporary Management)

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15 pages, 260 KiB

Open AccessArticle

Dental Health Status of Incarcerated Individuals in Silesia: A Five-Year Retrospective Case-Control Study

by Jakub Fiegler-Rudol, Piotr Ziobro, Anna Zawilska, Karolina Lau and Janusz Kasperczyk

J. Clin. Med. 2025, 14(16), 5909; https://doi.org/10.3390/jcm14165909 - 21 Aug 2025

Abstract

Background: Incarcerated individuals often experience poor oral health due to limited access to care and socioeconomic disadvantages. Objective: This study assessed the dental health status of incarcerated individuals in Silesia over a five-year period using the Decayed, Missing, and Filled Teeth [...] Read more.

Background: Incarcerated individuals often experience poor oral health due to limited access to care and socioeconomic disadvantages. Objective: This study assessed the dental health status of incarcerated individuals in Silesia over a five-year period using the Decayed, Missing, and Filled Teeth (DMFT) index and compared their outcomes to a matched control group from the general population. Methods: We conducted a retrospective observational case-control study at the University Centre for Dentistry in Bytom, reviewing records of 136 incarcerated patients (mean age 36.8 ± 7.9 years; 9.4% women) and a matched control group between 2019 and 2024. Results: Incarcerated individuals had a higher mean DMFT score (14.4 ± 5.7) compared to controls (11.5 ± 6.5; mean difference = 2.95, 95% CI: 1.53 to 4.37; Cohen’s d = 0.49), with more decayed (4.9 ± 3.2 vs. 3.4 ± 2.4) and missing teeth (4.3 ± 3.2 vs. 3.5 ± 2.6). Most incarcerated patients (65.5%) required oral surgical treatment, most commonly for retained roots (25.9%) and impacted teeth (24.5%). No significant DMFT differences were observed based on age or sex, although disparities were most pronounced in older female prisoners (mean DMFT 17.8 vs. 9.8 in controls aged 40+). Conclusions: Incarcerated individuals in Silesia demonstrated a significantly higher burden of untreated dental disease and greater tooth loss compared to non-incarcerated controls over the five-year period. The predominance of advanced dental conditions requiring surgical intervention highlights missed opportunities for early and preventive care in this vulnerable population. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

11 pages, 535 KiB

Open AccessArticle

Comparison of Pulsed Radiofrequency and Endoscopic Piriformis Release for Refractory Piriformis Syndrome: A Propensity Score-Matched Retrospective Cohort Study

by Eunsung Park, Duyoung Choi and Cheol Lee

J. Clin. Med. 2025, 14(16), 5908; https://doi.org/10.3390/jcm14165908 - 21 Aug 2025

Abstract

Background/Objective: Piriformis syndrome (PS) causes sciatic nerve entrapment and chronic pain. In refractory cases, pulsed radiofrequency (PRF) and endoscopic piriformis release (EPR) are used, but comparative evidence is limited. Methods: This retrospective cohort study compared PRF and EPR in patients treated from 2018 [...] Read more.

Background/Objective: Piriformis syndrome (PS) causes sciatic nerve entrapment and chronic pain. In refractory cases, pulsed radiofrequency (PRF) and endoscopic piriformis release (EPR) are used, but comparative evidence is limited. Methods: This retrospective cohort study compared PRF and EPR in patients treated from 2018 to 2024 at a tertiary hospital using propensity score matching (PSM). Patients with PS, unresponsive to conservative treatment (≥3 months), were included. PRF targeted the sciatic nerve under imaging guidance; EPR involved endoscopic decompression. Primary outcomes were Numeric Rating Scale (NRS) scores at 3 and 6 months. Secondary outcomes included patient satisfaction, reintervention rates, complications, and the Oswestry Disability Index (ODI), where available. After PSM, 115 patients were analyzed per cohort. Multivariate regression identified the predictors of pain improvement. Results: From 465 eligible patients (PRF 350; EPR 115), after PSM, 230 patients were analyzed (115 per cohort). The baseline NRS score was 7.4 ± 1.4 (PRF) vs. 7.5 ± 1.3 (EPR). At 3 months, EPR showed a lower NRS score (2.6 ± 1.3) compared to PRF (3.2 ± 1.6; p = 0.032). At 6 months, the EPR NRS score was 2.2 ± 1.1 vs. 2.9 ± 1.5 for PRF (p = 0.018). EPR had a higher rate of ≥50% NRS score reduction (78% vs. 65%; p = 0.041). EPR patients reported higher satisfaction and fewer reinterventions but more complications. Regression analysis identified EPR (OR = 2.15), higher baseline NRS scores, and shorter symptom duration as predictors of improvement. Conclusions: EPR provided superior pain relief compared to PRF at 3 and 6 months, although with a higher risk of complications. PRF remains a safer initial option. Full article

(This article belongs to the Special Issue Clinical Insights and Emerging Strategies in Chronic Pain Management)

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15 pages, 557 KiB

Open AccessArticle

Long-Term Impact of Chronic Obstructive Pulmonary Disease and Atrial Fibrillation on Post-Acute Myocardial Infarction Long-Term All-Cause Mortality: Insights from the SAMI III Project

by Arthur Shiyovich, Harel Gilutz, Keren Skalsky and Ygal Plakht

J. Clin. Med. 2025, 14(16), 5907; https://doi.org/10.3390/jcm14165907 - 21 Aug 2025

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common comorbidities in patients with acute myocardial infarction (AMI) and are associated with adverse cardiovascular outcomes. However, the impact of their coexistence on long-term post-AMI outcomes remains unclear. This study aimed to [...] Read more.

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common comorbidities in patients with acute myocardial infarction (AMI) and are associated with adverse cardiovascular outcomes. However, the impact of their coexistence on long-term post-AMI outcomes remains unclear. This study aimed to investigate the long-term effects of COPD and AF on AMI survivors. Methods: This retrospective cohort study analyzed data from consecutive AMI hospitalizations between 1 January 2002 and 31 October 2017. Patients were categorized into four groups based on the presence or absence of COPD and AF. The primary outcome was all-cause mortality up to 10 years post-discharge. Multivariate survival models were used to assess independent associations. Results: A total of 15,449 AMI survivors (mean age 66 ± 14 years, 30% female) were included, of whom 1386 (8.9%) had COPD, 2547 (16.5%) had AF, and 376 (2.4%) had both conditions. Over a median follow-up of 7.7 (IQR 3.3–10) years, 44.7% of the patients died. COPD (AdjHR = 1.89, 95% CI: 1.74–2.05), AF (AdjHR = 1.39, 95% CI: 1.31–1.48), and coexistence of both conditions (AdjHR = 1.82, 95% CI: 1.61–2.04) were associated with an increased risk for mortality (p < 0.001 for each). However, in patients with both conditions, the mortality risk was comparable to that of COPD alone. Conclusions: While both COPD and AF are associated with increased long-term mortality after AMI, COPD appears to be the primary independent driver of this risk. These findings underscore the need for proactive screening and individualized management in this high-risk population. Full article

(This article belongs to the Section Respiratory Medicine)

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14 pages, 500 KiB

Open AccessArticle

Surgical Treatment of Severe Aortic Stenosis: Sutureless Versus Stented Bioprosthetic Aortic Valve Replacement

by Alessandro Ricasoli, Carmelo Mignosa, Salvatore Lentini, Laura Asta, Adriana Sbrigata, Claudia Altieri and Calogera Pisano

J. Clin. Med. 2025, 14(16), 5906; https://doi.org/10.3390/jcm14165906 - 21 Aug 2025

Abstract

Objective: The aim of this study is to analyze the effects of sutureless aortic valve bioprosthesis implantation compared with stented conventional bioprosthesis in patients with severe aortic stenosis. This is a propensity matching institutional study. Materials and Methods: We compared 37 patients [...] Read more.

Objective: The aim of this study is to analyze the effects of sutureless aortic valve bioprosthesis implantation compared with stented conventional bioprosthesis in patients with severe aortic stenosis. This is a propensity matching institutional study. Materials and Methods: We compared 37 patients who underwent aortic valve replacement with Carpentier Edwards Perimount implantation (group 1) with 37 patients with sutureless Perceval S implanted (group 2). Preoperative, intraoperative, and postoperative parameters were studied. Results: The cross-clamp time, the mechanical ventilation times, the intensive care unit, and the hospital stay were significantly shorter in group 2 than in group 1 (p-value < 0.001). The cardio-pulmonary bypass time was 74 [45, 201] minutes in group 2 and 82 [48, 654] minutes in group 1 (p-value = 0.113). The postoperative mean gradients were 13 [6, 44] mmHg in group 2 and 14 [6, 19] mmHg in group 1 (p-value 0.285), and the effective orifice areas in these two groups were 1.5 ± 0.18 cm² vs. 1.1 ± 0.4 cm² (p = 0.002). The percentage of minimally invasive approach was higher in group 2 than in group 1. The echocardiographic follow-up analysis showed that the mean and maximum gradients with a sutureless prosthesis implant were lower than that of a traditional prosthesis, although this difference was not statistically significant. Conclusions: The Perceval S valve seems to be an effective alternative solution for biological valve implantation with good hemodynamic characteristics as compared with Carpentier Edwards Perimount prosthesis, providing shorter ischemic and extracorporeal circulation time and better postoperative recovery. Perceval S valve implantation facilitates the minimally invasive approach. Full article

(This article belongs to the Special Issue Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis)

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16 pages, 640 KiB

Open AccessReview

New Trends in Airway Management During Endoscopic Retrograde Cholangiopancreatography: A Narrative Review

by Federica Maiellare, Fabio Sbaraglia, Miryam Del Vicario, Riccardo Fattore, Giuliano Ferrone, Monica Lucente, Alessandra Piersanti, Domenico Posa, Giorgia Spinazzola, Daniele De Padova, Caterina Malatesta, Carmela Memoli and Marco Rossi

J. Clin. Med. 2025, 14(16), 5905; https://doi.org/10.3390/jcm14165905 - 21 Aug 2025

Abstract

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to [...] Read more.

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to the complexity of procedures and patient comorbidities. This narrative review aims to underscore the current absence of definitive evidence supporting a single airway management strategy during ERCP. In each section, we examine the strengths and limitations of various airway management strategies, including spontaneous breathing, endotracheal intubation, and newer techniques such as high-flow nasal oxygen (HFNO) and supraglottic airway devices (SGAs), tailored for endoscopic procedures. We explore and discuss the multifactorial determinants that influence clinical decision-making, including patient-specific risk factors, procedural complexity, resource availability, and potential complications. Any anesthesiological choice must guarantee the immobility of the patient and the versatility of the position and must be integrated with the preferences and skills of the endoscopist, the available means in the endoscopic suite, and the internal protocols. Spontaneous breathing with sedation may be appropriate for low-risk, short-duration procedures but carries risks of hypoventilation and aspiration, while GA with a device to manage airways improves procedural conditions and perioperative risks. Still, it is resource-intensive and may delay recovery. Transitions between different strategies are inherently fluid, reflecting the need for a flexible, patient-centered approach tailored to the specific clinical context. Rigorous future research is essential to establish evidence-based guidelines that enhance both safety and efficiency of airway management in this setting. Full article

(This article belongs to the Section Anesthesiology)

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12 pages, 1291 KiB

Open AccessArticle

The Impact of Early Mobilization on the Incidence of Intensive Care Unit: Acquired Weakness in Patients with Sepsis in the Critical Care—The Shinshu Multicenter Prospective Cohort Study (EROSCCS Study)

by Yasunari Sakai, Kohei Taniuchi, Takuma Karasawa, Ken Matsui, Takeshi Matsumoto, Shota Ikegami, Hiroshi Imamura and Hiroshi Horiuchi

J. Clin. Med. 2025, 14(16), 5904; https://doi.org/10.3390/jcm14165904 - 21 Aug 2025

Abstract

Background: Post-Intensive Care Syndrome (PICS), which includes Intensive Care Unit-Acquired Weakness (ICU-AW), can lead to lasting functional impairments even after patients are discharged from the hospital. Early mobilization is a key strategy for preventing ICU-AW, a major contributor to PICS. The primary [...] Read more.

Background: Post-Intensive Care Syndrome (PICS), which includes Intensive Care Unit-Acquired Weakness (ICU-AW), can lead to lasting functional impairments even after patients are discharged from the hospital. Early mobilization is a key strategy for preventing ICU-AW, a major contributor to PICS. The primary objective of this study is to assess the impact of early mobilization on ICU-AW in critically ill sepsis patients, while also evaluating the feasibility of a larger, multicenter study through comparison with previous data. Methods: This multicenter observational study, conducted in four hospitals in Nagano Prefecture, Japan, from April 2020 to March 2023, included sepsis patients admitted to the ICU or emergency departments. Patients were classified into ICU-AW and non-ICU-AW groups based on admission data. Background factors and discharge outcomes (complications, ADL, physical function) were assessed. Logistic regression analysis was performed to evaluate the relationship between early mobilization and ICU-AW incidence, with a subgroup analysis on the impact of a dedicated team or physiotherapist. Results: A total of 154 sepsis patients were enrolled, with 76 (49.4%) diagnosed with ICU-AW at discharge. The most common infection source in ICU-AW patients was the urinary tract (31%). Early mobilization (≥3 days) significantly reduced ICU-AW incidence, with adjusted odds ratios of 3.73 (95% CI = 1.79–7.77) for treatment details and 2.93 (95% CI = 1.22–7.08) for patient factors. However, the presence of a dedicated team or physiotherapist did not significantly affect ICU-AW incidence, with adjusted odds ratios of 0.50 (95% CI = 0.24–10.6) and 0.99 (95% CI = 0.40–2.47), respectively. Conclusions: Early mobilization effectively reduced ICU-AW incidence in sepsis patients, though a dedicated team or physiotherapist had no significant impact. Urinary tract infections were the most common infection source in ICU-AW patients. Early mobilization during dialysis for acute kidney injury shows promising potential and warrants further promotion. Full article

(This article belongs to the Section Intensive Care)

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11 pages, 1155 KiB

Open AccessArticle

The Endometrial Receptivity Test: The Impact of Combined Treatment with Pentoxifylline and Alpha-Tocopherol in Patients with Recurrent Implantation Failure or Recurrent Pregnancy Loss

by Laurine Prudhomme, Cécile Habran, Soraya Labied, Frédéric Wenders, Laetitia Rousseau, Carine Munaut and Laurie Henry

J. Clin. Med. 2025, 14(16), 5903; https://doi.org/10.3390/jcm14165903 - 21 Aug 2025

Abstract

Background/Objectives: The management of patients with recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL) is a real challenge. Studying endometrial proliferation and vascularization by ultrasound during the embryo implantation window is an option for investigating these failures. This approach involves measuring [...] Read more.

Background/Objectives: The management of patients with recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL) is a real challenge. Studying endometrial proliferation and vascularization by ultrasound during the embryo implantation window is an option for investigating these failures. This approach involves measuring the endometrial volume, the uterine arteries pulsatility index (PI), and the sub-endometrial flow index (VFI). Methods: The aim of our single-center retrospective study was to evaluate the benefit of treatment with pentoxifylline (400 mg twice daily) and alpha-tocopherol (500 IU twice daily), which was administered for at least 3 months. This study included 52 patients presenting abnormal ultrasound criteria, i.e., endometrial volume less than 2 cm³ and/or PI greater than 2.8 and/or VFI less than 0.25. Results: After treatment, we observed a significant increase in endometrial volume of 0.32 cm³ (p = 0.0054), as well as a significant increase in VFI of 0.49 (p = 0.041) in comparison to the control group. After treatment, the PI of the right uterine artery decreased significantly by 0.25 (p = 0.029) and the PI of the left uterine artery decreased by 0.27, but not significantly. In addition, our study showed that the clinical pregnancy rate (CPR) was more improved in the treated group compared to controls. Conclusions: Our study showed a promising benefit of pentoxifylline and alpha-tocopherol on endometrial properties; this needs to be corroborated by a larger prospective study. Full article

(This article belongs to the Special Issue Female Infertility: Clinical Diagnosis and Treatment)

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34 pages, 964 KiB

Open AccessSystematic Review

Resting-State Electroencephalogram (EEG) as a Biomarker of Learning Disabilities in Children—A Systematic Review

by James Chmiel, Jarosław Nadobnik, Szymon Smerdel and Mirela Niedzielska

J. Clin. Med. 2025, 14(16), 5902; https://doi.org/10.3390/jcm14165902 - 21 Aug 2025

Abstract

Introduction: Learning disabilities (LD) compromise academic achievement in approximately 5–10% of school-aged children, yet the neurophysiological signatures that could facilitate earlier detection or stratification remain poorly defined. Resting-state electroencephalography (rs-EEG) offers millisecond resolution and is cost-effective, but its findings have never been synthesized [...] Read more.

Introduction: Learning disabilities (LD) compromise academic achievement in approximately 5–10% of school-aged children, yet the neurophysiological signatures that could facilitate earlier detection or stratification remain poorly defined. Resting-state electroencephalography (rs-EEG) offers millisecond resolution and is cost-effective, but its findings have never been synthesized systematically across pediatric LD cohorts. Methods: Following a PROSPERO-registered protocol (CRD420251087821) and adhering to PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, Scopus, and PsycINFO through 31 March 2025 for peer-reviewed studies that recorded eyes-open or eyes-closed rs-EEG using ≥ 4 scalp electrodes in children (≤18 years) formally diagnosed with LD, and compared the results with typically developing peers or normative databases. Four reviewers independently screened titles and abstracts, extracted data, and assessed the risk of bias using ROBINS-I. Results: Seventeen studies (704 children with LD; 620 controls) met the inclusion criteria. The overall risk of bias was moderate, primarily due to small clinic-based samples and inconsistent control for confounding variables. Three consistent electrophysiological patterns emerged: (i) a 20–60% increase in delta/theta power over mesial-frontal, fronto-central and left peri-Sylvian cortices, resulting in markedly elevated θ/α and θ/β ratios; (ii) blunting or anterior displacement of the posterior alpha rhythm, particularly in language-critical temporo-parietal regions; and (iii) developmentally immature connectivity, characterized by widespread slow-band hypercoherence alongside hypo-connected upper-alpha networks linking left-hemisphere language hubs to posterior sensory areas. These abnormalities were correlated with reading, writing, and IQ scores and, in two longitudinal cohorts, they partially normalized in parallel with academic improvement. Furthermore, a link between reduced posterior/overall alpha and neuroinflammation has been found. Conclusions: Rs-EEG reveals a robust yet heterogeneous electrophysiological profile of pediatric LD, supporting a hybrid model that combines maturational delay with persistent circuit-level atypicalities in some children. While current evidence suggests that rs-EEG features show promise as potential biomarkers for LD detection and subtyping, these findings remain preliminary. Definitive clinical translation will require multi-site, dense-array longitudinal studies employing harmonized pipelines, integration with MRI and genetics, and the inclusion of EEG metrics in intervention trials. Full article

(This article belongs to the Special Issue Innovations in Neurorehabilitation)

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14 pages, 1341 KiB

Open AccessArticle

Optimizing Ovarian Stimulation for IVF in PCOS Patients: A Novel Day 1 GnRH Antagonist Protocol

by Sudarsan Ghosh Dastidar, Biswanath Ghosh Dastidar, Ratna Chattopadhyay and Chandan Chakraborty

J. Clin. Med. 2025, 14(16), 5901; https://doi.org/10.3390/jcm14165901 - 21 Aug 2025

Abstract

Objectives: Gonadotropin-releasing hormone (GnRH) antagonist protocols are preferred in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF) as they provide the best combination of flexibility, acceptable outcomes, and safety. Numerous studies have compared outcomes between GnRH agonist long protocol and [...] Read more.

Objectives: Gonadotropin-releasing hormone (GnRH) antagonist protocols are preferred in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF) as they provide the best combination of flexibility, acceptable outcomes, and safety. Numerous studies have compared outcomes between GnRH agonist long protocol and standard flexible antagonist protocol. However, there are scant studies investigating the effectiveness of antagonist administration from day 1 of ovarian stimulation in PCOS patients. Methods: We performed a retrospective cohort study to compare laboratory and clinical outcomes in IVF between standard flexible day 5/day 6 versus day 1 GnRH antagonist protocol in PCOS patients. Results: Our data indicates significantly superior oocyte yield and top-quality embryo proportion in patients with antagonists from day 1. Cumulative clinical pregnancy rates also tended to be superior in this group. Conclusions: Our findings indicate that administration of GnRH antagonists from day 1 of stimulation in PCOS patients undergoing IVF may lead to superior results. Full article

(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS): State of the Art: 2nd Edition)

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21 pages, 1124 KiB

Open AccessArticle

Effects of Dance-Based Aerobic Training on Functional Capacity and Risk of Falls in Older Adults with Mild Cognitive Impairment

by Marcelina Sánchez-Alcalá, María del Carmen Carcelén-Fraile, Paulino Vico-Rodríguez, Marta Cano-Orihuela and María del Mar Carcelén-Fraile

J. Clin. Med. 2025, 14(16), 5900; https://doi.org/10.3390/jcm14165900 - 21 Aug 2025

Abstract

Background: Older adults with mild cognitive impairment are at increased risk for physical decline and falls due to decreased strength, flexibility, balance, and gait. Dance-based aerobic training has emerged as a promising and enjoyable intervention to promote physical function and cognitive stimulation. This [...] Read more.

Background: Older adults with mild cognitive impairment are at increased risk for physical decline and falls due to decreased strength, flexibility, balance, and gait. Dance-based aerobic training has emerged as a promising and enjoyable intervention to promote physical function and cognitive stimulation. This study aimed to evaluate the efficacy of a 12-week structured dance-based aerobic program, based on line dancing and Latin rhythms (e.g., salsa, merengue, and bachata), in improving functional capacity and reducing the risk of falls in older adults with mild cognitive impairment. Methods: A randomized controlled trial was conducted with 92 participants aged ≥65 years diagnosed with mild cognitive impairment. The participants were randomly assigned to an experimental group (dance-based training, twice weekly for 12 weeks) or a control group (usual activity). Outcomes included muscle strength (grip dynamometry), flexibility (back scratch and chair sit-and-reach tests), gait speed (Timed Up and Go test), balance (Tinetti scale), and total falls risk score (Tinetti). Mixed ANOVA and Cohen’s d were used for statistical analysis. Results: Significant improvements were observed in the experimental group on all variables compared to the control group. Muscle strength (p < 0.001, d = 0.86), gait speed (p = 0.026, d = 0.48), and upper and lower extremity flexibility (d = 0.43–0.79) improved significantly. The balance and gait components of the Tinetti scale also increased (p = 0.007 and p = 0.048, respectively), as did the total Tinetti score (p = 0.002, d = 0.67), indicating a reduction in the risk of falls. Conclusions: These findings suggest that, under structured conditions, dance-based aerobic training may serve as a promising non-pharmacological strategy to support healthy aging in older adults with mild cognitive impairment, although further validation in larger cohorts is needed. Full article

(This article belongs to the Special Issue Mental Disorders, Cognitive Impairment and Dementia Among Older Adults)

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9 pages, 448 KiB

Open AccessArticle

Re-Evaluating the Contraction Stress Test for Term Fetal Growth Restriction Fetuses: A Retrospective Study ^†

by Roie Alter, Hagar Herz, Adiel Cohen, Naama Lessans, Yossef Ezra and Doron Kabiri

J. Clin. Med. 2025, 14(16), 5899; https://doi.org/10.3390/jcm14165899 - 21 Aug 2025

Abstract

Background: Fetal growth restriction (FGR) is associated with increased perinatal morbidity and mortality, yet optimal intrapartum management remains debated. The contraction stress test (CST) has been proposed as a tool to assess fetal tolerance to labor, but its prognostic value in FGR pregnancies [...] Read more.

Background: Fetal growth restriction (FGR) is associated with increased perinatal morbidity and mortality, yet optimal intrapartum management remains debated. The contraction stress test (CST) has been proposed as a tool to assess fetal tolerance to labor, but its prognostic value in FGR pregnancies is unclear. This study aimed to evaluate the utility of CST in predicting perinatal outcomes among term fetuses with FGR and to compare these outcomes with those of small-for-gestational-age (SGA) fetuses. Methods: We conducted a retrospective cohort study of term singleton deliveries at a tertiary care center over a two-year period. FGR was defined as birthweight below the 3rd percentile or, prenatally, below the 10th percentile with abnormal Doppler findings. SGA fetuses were defined as birthweights between the 3rd and 10th percentiles. Participants were stratified into the following three groups: (1) FGR with a negative CST result, (2) FGR without CST, and (3) SGA without FGR. The primary outcome was the rate of emergency cesarean delivery. Secondary outcomes included a composite of neonatal adverse events (Apgar score < 7 at 5 min, umbilical cord pH < 7.1, NICU admission, prolonged neonatal hospitalization, intubation, or intraventricular hemorrhage) and a combined metric of neonatal and maternal adverse events. Results: A total of 1688 term singleton pregnancies were included in this analysis, comprising 33 cases of FGR with negative CST results, 275 cases of FGR without CST, and 1123 cases classified as SGA. Emergency cesarean delivery rates were comparable between FGR with negative CST (15.2%) and FGR without CST (14.9%), both were significantly higher than in the SGA group (9.7%, p = 0.025). Composite neonatal adverse events did not differ significantly between the FGR groups (21.2% vs. 24.7%) but were more frequent than in the SGA group (8.1%, p < 0.001). Similarly, the incidence of combined neonatal and maternal adverse events was not different between the FGR groups (30.3% vs. 33.5%) yet exceeded that of the SGA group (15.1%, p < 0.001). Conclusions: In this cohort, a negative CST performed prior to labor induction did not reduce the risk of adverse maternal or neonatal outcomes in pregnancies complicated by FGR. These findings indicate that routine use of CST may offer limited prognostic benefit in the evaluation of term FGR, highlighting the necessity for further studies to establish evidence-based surveillance and management strategies for this high-risk group. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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12 pages, 592 KiB

Open AccessArticle

High-Quality Targeted Temperature Management After Cardiac Arrest; Results from the Korean Hypothermia Network Prospective Registry

by Hyo Jin Bang, Chun Song Youn, Byung Kook Lee, Sang Hoon Oh, Hyo Joon Kim, Ae Kyung Gong, Ji-Sook Lee, Soo Hyun Kim, Kyu Nam Park, In Soo Cho and on behalf of the Korean Hypothermia Network Investigators

J. Clin. Med. 2025, 14(16), 5898; https://doi.org/10.3390/jcm14165898 - 21 Aug 2025

Abstract

Backgrounds: Most out-of-hospital cardiac arrest (OHCA) survivors are comatose due to hypoxic ischemic brain injury. Targeted temperature management (TTM) is the only evidence-based neuroprotective intervention for this condition; however, the optimal implementation of TTM has yet to be determined. The concept of high-quality [...] Read more.

Backgrounds: Most out-of-hospital cardiac arrest (OHCA) survivors are comatose due to hypoxic ischemic brain injury. Targeted temperature management (TTM) is the only evidence-based neuroprotective intervention for this condition; however, the optimal implementation of TTM has yet to be determined. The concept of high-quality TTM has been proposed to improve patient outcomes, but its clinical impact has not been thoroughly evaluated. This study investigates whether adherence to high-quality TTM is associated with improved neurological outcomes and survival among OHCA patients. Methods: This retrospective analysis used data from the Korean Hypothermia Network Prospective Registry 1.0, including 1060 adult OHCA patients treated with TTM at 33 °C between 2015 and 2018. High-quality TTM was defined as follows: temperature variability during maintenance within ±1.0 °C, maintenance duration ≥ 24 h, rewarming rate ≤ 0.5 °C/h, and post-TTM fever control (temperature < 38.5 °C). Patients were classified into high- and low-quality TTM groups. The primary outcomes were survival and neurological status (CPC ranging from 1 to 2 indicated a good outcome) 6 months after cardiac arrest (CA). Results: Of the 1060 patients, 491 (46.3%) received high-quality TTM. Compared with the low-quality TTM group, the high-quality TTM group had higher rates of survival (44.6% vs. 36.4%, p = 0.006). Multivariate analysis revealed that high-quality TTM was independently associated with survival (OR 1.802, 95% CI: 1.171–2.773) and good neurological outcomes (OR 1.748, 95% CI: 1.102–2.770). Conclusions: High-quality TTM is associated with improved survival and better neurological outcomes in OHCA patients. Standardizing TTM delivery on the basis of quality metrics may increase its effectiveness in clinical practice. Full article

(This article belongs to the Section Emergency Medicine)

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12 pages, 1069 KiB

Open AccessArticle

The Relationship Between Cardiac Syndrome X and Obstructive Sleep Apnea and the Effects of Sleep Apnea Treatment on Myocardial Ischemia

by Umit Ozturk, Beste Ozben, Mustafa Kursat Tigen, Baran Balcan, Tunc Ones, Gulin Sunter, Nuh Filizoglu, Murat Sunbul, Emre Gurel and Altug Cincin

J. Clin. Med. 2025, 14(16), 5897; https://doi.org/10.3390/jcm14165897 - 21 Aug 2025

Abstract

Background/Objectives: Cardiac Syndrome X (CSX) is associated with significant physical and psychiatric morbidity despite no obvious effect on long-term mortality. Obstructive sleep apnea (OSA) is a prevalent condition in close association with numerous cardiovascular diseases. The precise relation between CSX and OSA remains [...] Read more.

Background/Objectives: Cardiac Syndrome X (CSX) is associated with significant physical and psychiatric morbidity despite no obvious effect on long-term mortality. Obstructive sleep apnea (OSA) is a prevalent condition in close association with numerous cardiovascular diseases. The precise relation between CSX and OSA remains unclear. The aim of this study is to explore the relation between OSA and CSX, as well as the impact of continuous positive airway pressure (CPAP) therapy on myocardial ischemia. Methods: This single-center prospective cohort study examined patients who were selected consecutively from the Cardiology Outpatient Clinic with angina or angina-equivalent complaints and with ischemia on myocardial perfusion scintigraphy (MPS), and who were subsequently diagnosed with CSX via coronary angiography. Patients with previous myocardial infarction and previous percutaneous coronary intervention or coronary artery by-pass grafting surgery were excluded, since these conditions could not be regarded as CSX. The presence of OSA was explored by polysomnography (PSG). CPAP therapy was applied for three months to those diagnosed with OSA. Following a three-month course of treatment, a myocardial perfusion scintigraphy (MPS) was conducted, to assess myocardial ischemia. The IBM^® SPSS Statistics Version 26 software was employed for the purpose of statistical analysis. Results: Among the 27 consecutive patients (mean age 58.1 ± 9.6 years and 22 female) with CSX 24 patients were found to have OSA according to PSG examination. CPAP therapy was applied to 17 patients (mean age 56.4 ± 8.6 years, 14 female) who accepted to participate in the treatment phase of the study. Following a three-month course of treatment, myocardial ischemia was reduced in 13 of the 17 patients. There were statistically significant correlations between the reduction in myocardial ischemia and patient’s diagnosis of hypertension (p = 0.006), higher serum HDL cholesterol levels (p = 0.009), and adherence to CPAP therapy (p = 0.047). Conclusions: The prevalence of OSA is significantly higher among the patients with CSX compared to the general adult population. In patients with CSX and OSA, improvement in myocardial ischemia was observed in MPS following CPAP therapy. Full article

(This article belongs to the Section Cardiology)

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14 pages, 8088 KiB

Open AccessArticle

A Comparison of Intraoperative 3D and Conventional 2D Fluoroscopy to Detect Screw Misplacement in Volar Plate Osteosynthesis of the Distal Radius

by Fenna Brunken, Benno Bullert, Livia Morlock, Jula Gierse, Paul A. Grützner, Sven Y. Vetter and Nils Beisemann

J. Clin. Med. 2025, 14(16), 5896; https://doi.org/10.3390/jcm14165896 - 21 Aug 2025

Abstract

Background/Objectives: Dorsal screw protrusion or intra-articular screw penetration at the distal radius can cause extensor tendon injuries or articular surface damage. Despite the use of various views, the detection of screw misplacement remains limited in 2D fluoroscopy. This study compares the sensitivity [...] Read more.

Background/Objectives: Dorsal screw protrusion or intra-articular screw penetration at the distal radius can cause extensor tendon injuries or articular surface damage. Despite the use of various views, the detection of screw misplacement remains limited in 2D fluoroscopy. This study compares the sensitivity of 2D and 3D fluoroscopy for detecting screw misplacement at the distal radius. Methods: Volar locking plates were placed in six cadaveric forearms, and dorsal or intra-articular screw misplacement was induced. For each screw position, images were acquired by 2D and 3D fluoroscopy and assessed by three blinded observers. Sensitivity and specificity, inter-rater agreement, and observer confidence were evaluated. The dose area product (DAP) was measured separately for 2D and 3D fluoroscopy. Results: Three-dimensional fluoroscopy showed higher sensitivities for detecting dorsal (97.22%) and intra-articular (95.83%) screw misplacements than two-dimensional fluoroscopy. In 2D fluoroscopy, sensitivity for detecting dorsal screw protrusions improved from 63.89 to 75.00–77.78% with the inclusion of tangential views. For intra-articular penetrations, sensitivity in 2D fluoroscopy increased from 79.17 to 83.33% with the addition of oblique views. Observer confidence was higher in 3D fluoroscopy. DAP was significantly higher in 3D (42.4 ± 0.4 cGycm²) compared to 2D fluoroscopy (14.2 ± 3.7 cGycm²) (p < 0.0001). Conclusions: Compared to 2D fluoroscopy, 3D fluoroscopy improves the detection of screw misplacement at the distal radius. However, its routine use is constrained by increased radiation exposure and limited availability. If 3D fluoroscopy is not accessible, the addition of dorsal tangential and oblique views may improve the sensitivity of 2D fluoroscopy. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 2170 KiB

Open AccessReview

Uncommon and Accessory Electrocardiographic Findings in Brugada Syndrome: A Review

by Antonino Micari, Paolo Bellocchi, Asya Cautela, Alice Moncada, Matteo Pluchino, Maurizio Cusmà-Piccione, Lilia Oreto, Giampiero Vizzari, Giuseppe Dattilo and Pasquale Crea

J. Clin. Med. 2025, 14(16), 5895; https://doi.org/10.3390/jcm14165895 - 21 Aug 2025

Abstract

Brugada syndrome (BrS) is a cardiac arrhythmic disorder associated with distinctive electrocardiographic (ECG) abnormalities and an increased risk of sudden cardiac death due to ventricular arrhythmias. While the classic BrS ECG pattern is a coved ST-segment elevation in the right precordial leads, a [...] Read more.

Brugada syndrome (BrS) is a cardiac arrhythmic disorder associated with distinctive electrocardiographic (ECG) abnormalities and an increased risk of sudden cardiac death due to ventricular arrhythmias. While the classic BrS ECG pattern is a coved ST-segment elevation in the right precordial leads, a wide spectrum of atypical ECG presentations can mislead the diagnosis. This review discusses rare and under-recognized ECG findings associated with BrS, including its coexistence with right and left bundle branch block, alterations in peripheral leads and in the morphology of the QRS complex, as well as atrioventricular conduction abnormalities. Emphasis is placed on the clinical relevance of these findings, their underlying electrophysiological mechanisms, and their prognostic implications. Recognizing these atypical manifestations is critical to avoid misdiagnosing or failing to recognize the condition in patients with BrS. Full article

(This article belongs to the Special Issue Cardiac Electrophysiology: Focus on Clinical Practice)

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29 pages, 688 KiB

Open AccessReview

Heart Failure Readmission Prevention Strategies—A Comparative Review of Medications, Devices, and Other Interventions

by Remzi Oguz Baris and Corey E. Tabit

J. Clin. Med. 2025, 14(16), 5894; https://doi.org/10.3390/jcm14165894 - 21 Aug 2025

Abstract

Heart failure readmissions remain a major challenge for healthcare systems, contributing significantly to morbidity, mortality, and increased healthcare costs. Despite advancements in medical and device-based therapies, rehospitalization rates remain high, particularly within the first 30 days of discharge. This review aims to evaluate [...] Read more.

Heart failure readmissions remain a major challenge for healthcare systems, contributing significantly to morbidity, mortality, and increased healthcare costs. Despite advancements in medical and device-based therapies, rehospitalization rates remain high, particularly within the first 30 days of discharge. This review aims to evaluate the primary factors associated with HF readmissions and discuss evidence-based strategies to reduce these rates. The review examines the efficacy of pharmacological therapies and their impact on readmission rates, highlighting key interventions such as diuretics, beta-blockers, ACE inhibitors, ARBs, ARNIs, SGLT2 inhibitors, and intravenous iron supplementation. Additionally, device-based interventions, including CardioMEMS, LVADs, CRT-P/D, ICDs, Furoscix, and the ReDS vest, are critically evaluated for their role in the early detection and management of decompensation. Non-pharmacological strategies are also underscored, such as dietary modifications, exercise, cardiac rehabilitation, and structured follow-up programs. By synthesizing current evidence, this review provides a comprehensive analysis of heart failure readmission factors and proposes multidisciplinary, patient-centered strategies to improve outcomes and reduce hospitalizations. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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14 pages, 530 KiB

Open AccessArticle

The Impact of Metabolic Syndrome on the Outcomes of Rehabilitation in Post-COVID-19 Patients

by Alicja Mińko, Agnieszka Turoń-Skrzypińska, Aleksandra Rył and Iwona Rotter

J. Clin. Med. 2025, 14(16), 5893; https://doi.org/10.3390/jcm14165893 - 21 Aug 2025

Abstract

Background/Objectives: The coexistence of metabolic syndrome and COVID-19 presents a major challenge for healthcare systems, as individuals with metabolic syndrome are at significantly higher risk of severe disease and poor outcomes. The aim of this study was to assess how metabolic syndrome [...] Read more.

Background/Objectives: The coexistence of metabolic syndrome and COVID-19 presents a major challenge for healthcare systems, as individuals with metabolic syndrome are at significantly higher risk of severe disease and poor outcomes. The aim of this study was to assess how metabolic syndrome influences the outcomes of rehabilitation in patients recovering from COVID-19. Methods: This is a prospective observational study conducted at a rehabilitation hospital in Szczecin (Poland). One hundred and forty-six patients with COVID-19 were enrolled. Data on age, gender, BMI, comorbidities, and hospitalization were analyzed. The intervention included a comprehensive post-COVID-19 rehabilitation program. Data were collected using functional tests (6MWT and spirometry), and clinical records were analyzed. Results: Patients with metabolic syndrome had significantly higher BMI (p < 0.001), lower HDL cholesterol (p < 0.001), and higher triglyceride levels (p < 0.001) compared with the group without metabolic syndrome. After rehabilitation, both groups showed significant improvements in 6MWT distance (with MetS p < 0.001; without MetS p < 0.001) and FEV₁% predicted (MetS p = 0.025; without MetS p = 0.021). However, regression analysis shows that age was a significant negative predictor of 6MWT performance in both groups (p < 0.01), whereas hypertension and diabetes predicted worse post-rehabilitation outcomes in the group without MetS. Conclusions: Comprehensive rehabilitation after COVID-19 benefits all patients, regardless of the presence of metabolic syndrome. However, individual clinical factors such as age, hypertension, diabetes, and male gender are crucial to its effectiveness. This highlights the need for individualized rehabilitation programs, especially for patients with metabolic conditions, which can significantly increase the effectiveness of therapeutic interventions. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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14 pages, 1415 KiB

Open AccessArticle

Prognostic Role of the Naples Score in Extensive-Stage Small Cell Lung Cancer: A Missed Opportunity in Inflammation-Based Stratification

by Fahri Akgül, İvo Gökmen, İsmail Bayrakçı, Didem Divriklioğlu, Aysun Fatma Akkuş, Gizem Bakır Kahveci, Tayyip İlker Aydın and Bülent Erdoğan

J. Clin. Med. 2025, 14(16), 5892; https://doi.org/10.3390/jcm14165892 - 21 Aug 2025

Abstract

Background: The Naples Prognostic Score (NPS) is a composite inflammation–nutrition index whose prognostic value has been scarcely examined in extensive-stage small cell lung cancer (ES-SCLC). This study aimed to evaluate the prognostic significance of the NPS in this setting. Methods: A retrospective analysis [...] Read more.

Background: The Naples Prognostic Score (NPS) is a composite inflammation–nutrition index whose prognostic value has been scarcely examined in extensive-stage small cell lung cancer (ES-SCLC). This study aimed to evaluate the prognostic significance of the NPS in this setting. Methods: A retrospective analysis was performed on 142 patients diagnosed with ES-SCLC between March 2014 and June 2024. The NPS was calculated using the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), serum albumin, and total cholesterol levels. Patients were classified into three NPS categories (0, 1–2, and 3–4), and subsequently dichotomized into low-risk (0–2) and high-risk (3–4) groups. Survival outcomes were assessed using Kaplan–Meier estimates and multivariate Cox regression models. Results: Median overall survival (OS) was significantly longer in the low-risk group compared to the high-risk group (10.3 vs. 6.3 months; p = 0.012). High NPS remained an independent predictor of reduced OS (HR: 1.45; 95% CI: 1.02–2.06; p = 0.041). The prognostic strength of the NPS was primarily driven by low LMR and hypoalbuminemia, which were individually associated with worse outcomes. Conclusions: The NPS may serve as a simple, accessible, and independent prognostic tool in ES-SCLC, potentially aiding in clinical risk stratification and treatment planning. Full article

(This article belongs to the Section Oncology)

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12 pages, 1332 KiB

Open AccessArticle

Global Trends and Cross-Country Differences in Authorship by Women in Academic Anaesthesiology Since 1996: A Repeated Cross-Sectional Analysis

by Helena Schluchter, Dorothea Andel, Albert De Bettignies, Harald Andel and Eva Schaden

J. Clin. Med. 2025, 14(16), 5891; https://doi.org/10.3390/jcm14165891 - 21 Aug 2025

Abstract

Background/Objectives: Despite an increase in the number of women medical graduates, gender disparities persist in academic anaesthesiology. Women in medical science face challenges in publications, research funding, editorial board membership, and peer review, and they remain under-represented, particularly in senior authorship and [...] Read more.

Background/Objectives: Despite an increase in the number of women medical graduates, gender disparities persist in academic anaesthesiology. Women in medical science face challenges in publications, research funding, editorial board membership, and peer review, and they remain under-represented, particularly in senior authorship and leadership positions. Methods: This repeated cross-sectional bibliometric analysis examined global trends and cross-country differences in the representation of women as first, co-, and senior authors of peer-reviewed articles published in five high-impact anaesthesiology journals over three decades, with a focus on developments in recent years. Gender was assigned to authors’ first names algorithmically in two steps (Gender API and NamSor). Results: A total of 7571 publications were analysed, comprising 37,738 authors. Women constituted 11,732 (31.09%) authorships in total, and men consistently accounted for a substantial majority among authors (p < 0.001). Despite a significant overall increase in authorship by women—peaking in 2022 at 590 (36.88%) first authors, 2245 (37.85%) co-authors, and 402 (28.05%) senior authors (all p < 0.001)—stagnation was observed in recent years, with no significant changes for first and co-authors after 2016 (p > 0.05). Country-level analysis revealed few significant differences, with Japan consistently reporting the lowest percentages of women authors. Conclusions: This study underscores persistent gender disparities in academic anaesthesiology, despite a moderate increase in authorship by women over three decades. Gender disparity remains a global issue, and the recent stagnation highlights the necessity for more comprehensive efforts and innovative strategies to foster a more inclusive research community in academic anaesthesiology. Full article

(This article belongs to the Section Anesthesiology)

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12 pages, 1249 KiB

Open AccessArticle

A Comparison of Short-Term Clinical Outcomes Between the Navitor and Evolut Transcatheter Aortic Valve Prostheses

by Caterina Campanella, Katherine Kaiser, Stephanie Voss, Melchior Burri, Magdalena Erlebach, Nazan Puluca, Felix Wirth, Markus Krane and Hendrik Ruge

J. Clin. Med. 2025, 14(16), 5890; https://doi.org/10.3390/jcm14165890 - 21 Aug 2025

Abstract

Background: The novel Navitor intra-annular self-expandable transcatheter aortic valve prosthesis is designed to improve coronary access, reduce paravalvular leaks, and enhance hemodynamic performance. Comparative data with the established Evolut platform (R, Pro, FX) are still lacking. This study aimed to evaluate the short-term [...] Read more.

Background: The novel Navitor intra-annular self-expandable transcatheter aortic valve prosthesis is designed to improve coronary access, reduce paravalvular leaks, and enhance hemodynamic performance. Comparative data with the established Evolut platform (R, Pro, FX) are still lacking. This study aimed to evaluate the short-term clinical outcomes of Navitor (NAV) versus Evolut transcatheter heart valves. Methods: We conducted a single-center analysis of patients undergoing transfemoral TAVR between January 2015 and May 2024. A propensity score matching protocol including 18 baseline variables was used to balance baseline characteristics. Clinical outcomes were assessed using VARC-3 criteria. Results: Of 1067 TAVR patients, 210 were analyzed after matching—70 with the Nav valve and 140 with the Evolut valve. Baseline characteristics were comparable between groups, with a mean age of 80.9 ± 6.5 years in the NAV group and 80.7 ± 6.7 years in the Evolut group (p = 0.9). Both groups had an intermediate STS predicted risk of mortality, 3.9 ± 3.4% for NAV and 3.9 ± 3.2% for Evolut (p = 1.0). The effective aortic annulus diameter was comparable between the NAV (23.9 ± 1.5 mm) and Evolut group (23.9 ± 2.4 mm, p = 0.8). Hemodynamic performance at discharge was similar, with mean gradients of 7.5 ± 2.8 mmHg (NAV) vs. 7.4 ± 3.7 mmHg (Evolut, p = 0.9). Valve orifice areas and paravalvular leak rates showed no difference between the groups. Device success rates at discharge were good for both THVs: 89.3% for Evolut and 91.4% for NAV (p = 0.8). Disabling stroke occurred less frequently in the NAV group (0.0% vs. 7.1%, p = 0.033), while other early safety outcomes and 30-day mortalities were similar. Conclusions: The Navitor valve offers comparable hemodynamic performance, paravalvular leak rates, and procedural success to the Evolut platform. While early safety outcomes were largely similar, the Navitor valve was associated with a lower 30-day disabling stroke rate. Full article

(This article belongs to the Section Cardiovascular Medicine)

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J. Clin. Med., Volume 14, Issue 16 (August-2 2025) – 313 articles

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