Journal of Clinical Medicine

20 pages, 837 KB

Open AccessSystematic Review

Implementation of Evidence-Based Psychological Treatments to Address Depressive Disorders: A Systematic Review

by Rosa Lorente-Català, Amanda Díaz-García, Irene Jaén, Margalida Gili, Fermín Mayoral, Javier García-Campayo, Yolanda López-Del-Hoyo, Adoración Castro, María M. Hurtado, Caroline H. M. Planting and Azucena García-Palacios

J. Clin. Med. 2025, 14(17), 6347; https://doi.org/10.3390/jcm14176347 - 8 Sep 2025

Viewed by 1167

Abstract

Background: The depressed population needs to be treated and they do not have access to evidenced-based psychological practices (EBPPs). The consequences lead to significant daily impairments and huge economical costs. A large amount of research has focused on the demand for a more [...] Read more.

Background: The depressed population needs to be treated and they do not have access to evidenced-based psychological practices (EBPPs). The consequences lead to significant daily impairments and huge economical costs. A large amount of research has focused on the demand for a more extensive use of EBPPs. However, despite these practices being essential to the mental health system, EBPPs are poorly applied in clinical settings. This situation has led to the development of Implementation Research (IR), a scientific field that aims to address the challenge of translation and identify the factors involved in the implementation process. Several implementation studies have been carried out in the field of health. However, the evidence from implementation studies of psychological treatments addressing depression has not yet been summarized. The aim of this study is to conduct a systematic review to assess implementation studies that use EBPPs to address depression. Methods: A systematic review was conducted following the PRISMA guidelines, including implementation studies that applied EBPPs to address depressive disorders. The following databases were used: PubMed, Embase, APA PsycInfo, Cochrane Central, Scopus, and Web of Science. Two independent reviewers revised the studies to determine whether the eligibility criteria were met. Results: A total of 8797 studies were identified through database searches. After removing duplicates, a total of 3757 studies were screened based on titles and abstracts. Finally, 127 full-text articles were reviewed, yielding 31 studies that satisfied the inclusion criteria. Conclusions: This review offers valuable insights into the current state of IR in the implementation of EBPPs for treating depressive disorders. It underlines the necessity for a standardized nomenclature for study designs within the realm of IR and emphasizes the potential of hybrid efficacy–implementation studies to help close the gap between research and clinical practice. Despite the challenges encountered, this review points to a positive outlook for the use of IR in clinical psychology. A gradual adoption of IR is likely to strengthen its role in psychology and support the development of more effective strategies for implementing evidence-based interventions in clinical settings. Full article

(This article belongs to the Section Mental Health)

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11 pages, 1100 KB

Open AccessArticle

Use of Mechanical Enhanced Colonoscopy to Improve Polyp Detection During Colorectal Cancer Screening: A Real-World Healthcare Database Analysis

by Abraham Z. Cheloff and Seth A. Gross

J. Clin. Med. 2025, 14(17), 6346; https://doi.org/10.3390/jcm14176346 - 8 Sep 2025

Viewed by 1057

Abstract

Introduction: High performance colonoscopy requires the monitoring of an individual’s adenoma detection rate (ADR). The Endocuff (EndoCuff Vision, Olympus America Inc., Center Valley, PA, USA) is an endoscopic distal attachment device that increases surface area exposure during colonoscopy. While studies have shown that [...] Read more.

Introduction: High performance colonoscopy requires the monitoring of an individual’s adenoma detection rate (ADR). The Endocuff (EndoCuff Vision, Olympus America Inc., Center Valley, PA, USA) is an endoscopic distal attachment device that increases surface area exposure during colonoscopy. While studies have shown that Endocuff increased ADR, real-world data is limited on its effectiveness. Methods: The Premiere Health Database was reviewed from 2018 to 2021 to identify patients 50 years of age or older who had a screening colonoscopy. A keyword search for “Endocuff” was used to determine if Endocuff was utilized, and ICD10 codes were analyzed to determine if a polyp was found. Our primary outcome was a polyp detection rate (PDR) for Endocuff-assisted colonoscopy (EAC) and standard colonoscopy (SC). Secondary outcomes included an estimated adenoma detection rate (eADR). Logistic regression modeling was performed to examine the difference in PDR between the EAC and SC groups after controlling for baseline characteristics, insurance type, and provider experience. Results: Gastroenterologists performed 893,560 screening colonoscopies, of which 0.7% were Endocuff-assisted, while surgeons performed 234,962 screening colonoscopies and 0.5% were Endocuff-assisted. PDR was higher with EAC for both gastroenterologists (72.0% vs. 57.4%) and surgeons (55.6% vs. 43.7%), with eADR following similar trends. The odds ratio of polyp detection with vs. without Endocuff was 1.91 for gastroenterologists and 1.62 for surgeons. After adjusting for patient and provider factors, the adjusted odds ratios are 2.01 and 1.61, respectively. Conclusions: While Endocuff utilization remains low, this large study using real-world data demonstrates the ability to improve eADR by over 10% compared to standard colonoscopy. Full article

(This article belongs to the Special Issue Endoscopic Techniques in Digestive and Gynecological Diseases)

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13 pages, 1211 KB

Open AccessArticle

Missing Data in OHCA Registries: How Imputation Methods Affect Research Conclusions—Paper I

by Stella Jinran Zhan, Seyed Ehsan Saffari, Marcus Eng Hock Ong and Fahad Javaid Siddiqui

J. Clin. Med. 2025, 14(17), 6345; https://doi.org/10.3390/jcm14176345 - 8 Sep 2025

Viewed by 307

Abstract

Background/Objectives: Clinical observational studies often encounter missing data, which complicates association evaluation with reduced bias while accounting for confounders. This is particularly challenging in multi-national registries such as those for out-of-hospital cardiac arrest (OHCA), a time-sensitive medical emergency with low survival rates. While [...] Read more.

Background/Objectives: Clinical observational studies often encounter missing data, which complicates association evaluation with reduced bias while accounting for confounders. This is particularly challenging in multi-national registries such as those for out-of-hospital cardiac arrest (OHCA), a time-sensitive medical emergency with low survival rates. While various methods for handling missing data exist, observational studies frequently rely on complete-case analysis, limiting representativeness and potentially introducing bias. Our objective was to evaluate the impact of various single imputation methods on association analysis with OHCA registries. Methods: Using a complete dataset (N = 13,274) from the Pan-Asian Resuscitation Outcomes Study (PAROS) registry (1 January 2016–31 December 2020) as reference, we intentionally introduced missing values into selected variables via a Missing At Random (MAR) mechanism. We then compared statistical and machine learning (ML) single imputation methods to assess the association between bystander cardiopulmonary resuscitation (BCPR) and the issuance of a mobile app alert, adjusting for confounders. The impacts of complete-case analysis (CCA) and single imputation methods on conclusions in OHCA research were evaluated. Results: CCA was suboptimal for handling MAR data, resulting in more biased estimates and wider confidence intervals compared to single imputation methods. The missingness-indicator (MxI) method offered a trade-off between bias and ease of implementation. The K-Nearest Neighbours (KNN) method outperformed other imputation approaches, whereas missForest introduced bias under certain conditions. Conclusions: KNN and MxI are easy to use and better alternatives to CCA for reducing bias in observational studies. This study highlights the importance of selecting appropriate imputation methods to ensure reliable conclusions in OHCA research and has broader implications for other registries facing similar missing data challenges. Full article

(This article belongs to the Section Cardiology)

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12 pages, 708 KB

Open AccessArticle

Diabetes and Adverse Reproductive Outcomes in a Group of Mongolian Women: A Comparative Study with Non-Diabetic Subjects

by Bolor-Erdene Sarankhuu, Enkhjin Gantsolmon, Khangai Enkhtugs, Yanjmaa Sankhuu, Chantsaldulam Purevdorj, Seong-Lan Yu, Seok-Rae Park, Oyuntugs Byambasukh and Jaeku Kang

J. Clin. Med. 2025, 14(17), 6344; https://doi.org/10.3390/jcm14176344 - 8 Sep 2025

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Abstract

Background/Objectives: Diabetes mellitus (DM) poses an increasing burden in Mongolia, yet its impact on reproductive outcomes remains underexplored. This study aimed to compare pregnancy outcomes between diabetic and non-diabetic women and assess whether diabetes duration influences adverse reproductive events. Methods: We conducted a [...] Read more.

Background/Objectives: Diabetes mellitus (DM) poses an increasing burden in Mongolia, yet its impact on reproductive outcomes remains underexplored. This study aimed to compare pregnancy outcomes between diabetic and non-diabetic women and assess whether diabetes duration influences adverse reproductive events. Methods: We conducted a cross-sectional study among 223 diabetic and 495 non-diabetic women attending outpatient clinics in Ulaanbaatar between October and December 2024. Data on reproductive history were collected using structured questionnaires. Pregnancy outcomes included miscarriage, stillbirth, abortion, and live birth. Logistic regression models were applied to assess associations, adjusting for age, marital status, education, smoking, alcohol use, age at menarche, and reproductive history. Results: Mean age was 51.7 and 50.4 years for diabetic and non-diabetic women, respectively (p = 0.222). Diabetic women had more pregnancies (median: 4.00 vs. 3.00, p < 0.001) and a higher likelihood of abortion (35.4% vs. 25.5%, p = 0.004) and miscarriage (27.8% vs. 11.1%, p < 0.001). Stillbirths were more frequent in diabetic (4.0% vs. 2.2%) but not statistically significant. Pregnancy problems (miscarriage and/or stillbirth) were more prevalent in diabetic women (29.6% vs. 12.7%, p < 0.001). In adjusted models, diabetes was associated with higher odds of pregnancy problems (aOR = 1.64, 95% CI: 1.02–2.63, p = 0.042), miscarriage (aOR = 2.03, 95% CI: 1.21–3.40, p = 0.007), and abortion (aOR = 1.58, 95% CI: 1.14–2.19, p = 0.006). A dose response pattern was observed: miscarriage risk was higher in women with diabetes ≥10 years (OR = 2.67, 95% CI: 1.55–4.62, p < 0.001) than <10 years (OR = 1.79, 95% CI: 1.08–2.96, p = 0.023). Conclusions: Diabetes is independently associated with increased risks of miscarriage and abortion in Mongolian women, with longer disease duration further elevating this risk. Full article

(This article belongs to the Special Issue Updates in Diabetes and Obesity in Reproductive Health)

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13 pages, 257 KB

Open AccessReview

Salvage Surgery After Non-Curative Endoscopic Submucosal Dissection for Early Colorectal Cancer: A Comprehensive Review

by Felix Aigner, Christoph Skias, David Duller, Sebastian Wisiak, Karin Strohmeyer, Zoltan Horvath and Nicole Koter

J. Clin. Med. 2025, 14(17), 6343; https://doi.org/10.3390/jcm14176343 - 8 Sep 2025

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Abstract

Endoscopic submucosal dissection (ESD) has emerged as a minimally invasive technique for treating early colorectal cancer (CRC), offering the potential for en bloc resection and precise histopathological assessment. However, when ESD results in non-curative outcomes—characterized by factors such as positive margins, deep submucosal [...] Read more.

Endoscopic submucosal dissection (ESD) has emerged as a minimally invasive technique for treating early colorectal cancer (CRC), offering the potential for en bloc resection and precise histopathological assessment. However, when ESD results in non-curative outcomes—characterized by factors such as positive margins, deep submucosal invasion, or lymphovascular invasion—salvage surgery becomes a critical consideration. This review synthesizes current evidence on the indications, timing, surgical approaches, outcomes, and future directions of salvage surgery following non-curative ESD in early CRC. Full article

(This article belongs to the Special Issue Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors and Precursors)

14 pages, 588 KB

Open AccessArticle

Extracorporeal Life Support in a Porcine Model of Septic Endotoxemia with Acute Pulmonary Hypertension: An Experimental Study

by Stany Sandrio, Joerg Krebs, Tobias Spanier, Grietje Beck, Manfred Thiel and Peter Tobias Graf

J. Clin. Med. 2025, 14(17), 6342; https://doi.org/10.3390/jcm14176342 - 8 Sep 2025

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Abstract

Background: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering oxygenated blood [...] Read more.

Background: This study evaluated the effects of veno-arterial (V-A) and veno-venoarterial (V-VA) ECMO in a porcine model of septic endotoxemia-induced acute pulmonary arterial hypertension (PAH). Our hypotheses were as follows: (1) V-VA ECMO lowers pulmonary vascular resistance (PVR) by delivering oxygenated blood to the pulmonary circulation, and (2) both V-A and V-VA ECMO improve perfusion to vital organs while simultaneously unloading the right ventricle (RV). Methods: Acute PAH was induced with Salmonella abortus equi lipopolysaccharide (LPS) in 34 pigs. Animals were randomized to either a control group without ECMO or to two groups receiving V-A or V-VA ECMO. Results: All animals developed PAH after one hour of LPS infusion: mean pulmonary artery pressure (PAP) increased significantly from 26 (24–30) mmHg to 40 (34–46) mmHg (p < 0.0001), and PVR increased from 314 (221–390) to 787 (549–1073) (p < 0.0001). Neither V-A nor V-VA ECMO significantly reduced PVR compared to controls. RV end-diastolic area increased in the control group [6.1 (4.3–8.6) cm vs. 8.5 (7.8–9.7) cm, p = 0.2], but not in the V-A [4.7 (3.3–7.6) cm] and V-VA [4.3 (2.5–8.3) cm] ECMO groups. Blood flow in the cranial mesenteric artery and celiac trunk did not differ significantly with or without ECMO. Conclusions: Elevating pulmonary artery oxygen tension through V-A or V-VA ECMO did not reduce PVR or PAP. However, both ECMO configurations effectively unloaded the RV and maintained perfusion to abdominal organs. Full article

(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 3rd Edition)

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18 pages, 1351 KB

Open AccessReview

Factor XI and Cancer: Physiopathological Linkage and Clinical Perspectives

by Alfredo Mauriello, Anna Chiara Maratea, Celeste Fonderico, Vincenzo Quagliariello, Fabrizio Maurea and Nicola Maurea

J. Clin. Med. 2025, 14(17), 6341; https://doi.org/10.3390/jcm14176341 - 8 Sep 2025

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Abstract

Thrombotic complications are a common cause of morbidity and mortality in cancer patients. Factor XI (FXI) appears to play a direct role not only in thrombotic pathogenesis but also in cancer progression. This comprehensive review aims to define the pathophysiological relationships between FXI [...] Read more.

Thrombotic complications are a common cause of morbidity and mortality in cancer patients. Factor XI (FXI) appears to play a direct role not only in thrombotic pathogenesis but also in cancer progression. This comprehensive review aims to define the pathophysiological relationships between FXI and cancer and to assess existing therapeutic opportunities targeting this factor. This review highlights how FXI is implicated in tumor growth, tumor cell adhesion and migration, inflammation, and angiogenesis. FXI inhibition has been shown to reduce the risk of thrombosis, with a potentially improved safety profile in terms of bleeding risk. Several molecules, such as asundexian and abelacimab, are in clinical trials for the prevention and treatment of venous thromboembolic events, catheter-related thrombosis, and arterial thromboembolic events in cancer patients. In conclusion, factor XI is closely linked to the pathogenesis of cancer and its thromboembolic complications. The use of FXI inhibitors emerges as a promising therapeutic strategy, offering potentially positive effects in the prevention and treatment of thromboembolic complications without significantly increasing the risk of bleeding, a limitation of conventional anticoagulants. The preliminary evidence is that further clinical trials are required and that the available data is not enough to make firm clinical recommendations. Full article

(This article belongs to the Special Issue Cardio-Oncology: Clinical Advances in Cardiotoxicity Detection, Imaging and Therapeutic Strategies)

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11 pages, 1219 KB

Open AccessArticle

Mifepristone–Misoprostol Versus Misoprostol Alone for Early Missed Miscarriage After ART and Spontaneously Conceived Pregnancies

by Adi Dayan-Schwartz, Revital Vinitski, Haya Hassan, Ido Izhaki, Suzan Abd Elgani, Liron Kogan, Shira Baram, Firas Zbidat, Khadeje Seh, Noah Zafran, Ari Reiss and Ronit Beck-Fruchter

J. Clin. Med. 2025, 14(17), 6340; https://doi.org/10.3390/jcm14176340 - 8 Sep 2025

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Abstract

Background: Missed miscarriage (MM) is a common first-trimester complication. Misoprostol alone achieves moderate success, while combination therapy with mifepristone improves outcomes in spontaneous pregnancies. Evidence in assisted reproductive technology (ART) pregnancies is scarce. We evaluated whether combined mifepristone–misoprostol improves outcomes in ART [...] Read more.

Background: Missed miscarriage (MM) is a common first-trimester complication. Misoprostol alone achieves moderate success, while combination therapy with mifepristone improves outcomes in spontaneous pregnancies. Evidence in assisted reproductive technology (ART) pregnancies is scarce. We evaluated whether combined mifepristone–misoprostol improves outcomes in ART pregnancies compared with misoprostol alone and compared results with spontaneously conceived (SC) pregnancies. Methods: This retrospective matched cohort study was conducted at a single center (2017–2024). ART pregnancies were matched 1:2 with SC pregnancies by maternal age. Patients received misoprostol alone or 200 mg mifepristone followed 48 h later by misoprostol. The primary outcome was treatment success, defined as complete uterine evacuation without repeat misoprostol or surgery. Secondary outcomes included emergency visits, surgical procedures, and ART-related predictors. Subgroup analyses were performed by ART protocol. Results: Among 307 patients (94 ART, 213 SC), combined therapy yielded higher success than misoprostol alone in SC (84% vs. 71%, p = 0.023) and ART pregnancies (95% vs. 80%, p = 0.035). In hormonally supported frozen embryo transfer (HRT-FET) cycles, success was 100% with combined therapy versus 80% with misoprostol alone. Conclusions: Combined mifepristone–misoprostol is more effective than misoprostol alone, with particularly high success in HRT-FET cycles. Full article

(This article belongs to the Special Issue Assisted Reproductive Technology and Infertility Treatment: Current Updates and Perspectives—2nd Edition)

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17 pages, 1574 KB

Open AccessSystematic Review

Predictability of Lower Incisor Intrusion with Clear Aligners: A Systematic Review of Efficacy and Influencing Factors

by David Emilio Fracchia, Denis Bignotti, Stefano Lai, Eric Battista, Alessio Verdecchia and Enrico Spinas

J. Clin. Med. 2025, 14(17), 6339; https://doi.org/10.3390/jcm14176339 - 8 Sep 2025

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Abstract

Background/Objectives: This systematic review aimed to evaluate the effectiveness and predictability of lower incisor intrusion with clear aligners in permanent dentition, addressing one of the most challenging aspects of vertical tooth movement control in the mandibular anterior region. Methods: A comprehensive literature search [...] Read more.

Background/Objectives: This systematic review aimed to evaluate the effectiveness and predictability of lower incisor intrusion with clear aligners in permanent dentition, addressing one of the most challenging aspects of vertical tooth movement control in the mandibular anterior region. Methods: A comprehensive literature search was conducted across five databases (PubMed, Scopus, Embase, and Cochrane) according to PRISMA guidelines. Eight clinical studies fulfilled the eligibility criteria. Risk of bias was assessed using ROBINS-I, and certainty of evidence was graded with GRADE. Key outcomes included the amount of achieved versus planned intrusion, predictability, treatment protocols, use of auxiliaries, and patient-related factors such as age and compliance. Results: Reported mean intrusion values ranged from 0.4 to 1.5 mm, with predictability between 35% and 65%. The effectiveness of intrusion was influenced by the magnitude of planned movement, auxiliaries (e.g., attachments, elastics), refinement strategies, and patient-specific factors. Substantial heterogeneity was present in measurement methods (CBCT, cephalometry, digital models) and clinical protocols (aligner change intervals, refinement frequency), preventing meta-analysis. Seven of the eight studies were rated as having a serious risk of bias, and the overall certainty of evidence was moderate to low. Long-term outcomes and patient-centered measures were not adequately assessed. Conclusions: Within the limitations of the available evidence, lower incisor intrusion with clear aligners may be considered a feasible orthodontic option when supported by biomechanically informed clinical management. However, conclusions should be interpreted with caution due to heterogeneity, high risk of bias, and lack of long-term data. Further standardized studies with longer follow-up are required to strengthen reliability and clinical applicability. Full article

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

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19 pages, 767 KB

Open AccessSystematic Review

Redefining Pediatric SCIWORA: A Systematic Review of the Literature on Clinical Patterns, Imaging Profiles, and Management Insights

by Davide Palombi, Marco Galeazzi, Paolo Brigato, Sergio De Salvatore, Timothée De Saint Denis, Luca Massimi, Gianpiero Tamburrini and Leonardo Oggiano

J. Clin. Med. 2025, 14(17), 6338; https://doi.org/10.3390/jcm14176338 - 8 Sep 2025

Viewed by 309

Abstract

Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a [...] Read more.

Objectives: Among the spectrum of spinal injuries, Spinal Cord Injury Without Radiographic Abnormality (SCIWORA) occupies a unique and challenging position. SCIWORA presents diagnostic and therapeutic challenges due to its broad clinical and radiological heterogeneity. While most children recover favorably with conservative treatment, a subset may require surgery based on imaging findings. The findings underscore the need for standardized diagnostic criteria, MRI-based classification systems, and evidence-based treatment algorithms to improve consistency in care and long-term neurological outcomes. Methods: A systematic search of PubMed, Cochrane, Scopus, and Embase databases was performed through June 2025 following PRISMA guidelines. Inclusion criteria encompassed studies of pediatric SCIWORA (age < 18 years) reporting demographics, clinical and radiological features, management, and outcomes. Results: Sixty studies encompassing a total of 848 pediatric patients were included. The mean patient age was 9.33 years (±2.52), with a slight male predominance. The most common trauma mechanisms were road traffic accidents (40.3%), sports injuries (22%), and falls (18.8%). MRI findings were available in 399 cases: 46% had intraneural lesions (Type IIb), 39% showed no abnormality on MRI (Type I, or “real SCIWORA”), 9% had combined lesions (Type IIc), and 6% had extraneural abnormalities (Type IIa). Neurological severity at presentation was primarily ASIA Grade A (46.25%), but follow-up data showed substantial improvement, with ASIA E (normal function) increasing to 49.78%. Overall, 66.2% of patients experienced neurological improvement, while 33.8% remained stable. Conservative treatment was employed in 95.41% of cases. Only 4.59% underwent surgery, which was typically reserved for MRI-positive lesions demonstrating spinal instability or compression. Conclusions: Pediatric SCIWORA remains an uncommon but potentially devastating injury, with an outcome highly dependent on MRI findings and initial neurological status. This systematic review aims to clarify the contemporary understanding of pediatric SCIWORA, delineating “real” SCIWORA from other SCIWORA-like entities, and synthesizing the latest evidence regarding epidemiology, mechanisms, clinical presentation, MRI findings, and management in children. Full article

(This article belongs to the Special Issue From Acute Injury to Personalized Prevention—Developing Modern Strategies)

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15 pages, 1614 KB

Open AccessArticle

Clinical Predictive Factors for the Development of Short Bowel Syndrome in a Cohort of Patients with Crohn’s Disease: A Prospective Study

by Laura Parisio, Angelo Del Gaudio, Jacopo Iaccarino, Pierluigi Puca, Guia Becherucci, Gaetano Coppola, Carlo Covello, Federica Di Vincenzo, Elisa Foscarini, Lucrezia Laterza, Letizia Masi, Marco Pizzoferrato, Francesca Profeta, Daniela Pugliese, Valentina Petito, Marcello Chieppa, Giammarco Mocci, Giovanni Cammarota, Antonio Gasbarrini, Loris Riccardo Lopetuso, Marcello Covino, Franco Scaldaferri and Alfredo Papa Show full author list Hide full author list

J. Clin. Med. 2025, 14(17), 6337; https://doi.org/10.3390/jcm14176337 - 8 Sep 2025

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Abstract

Background/Objectives: Crohn’s disease (CD) is one of the most frequent causes of short bowel syndrome (SBS), a severe clinical condition with huge morbidity and social costs. SBS occurs when, following intestinal resections, the remaining small bowel in continuity is less than 200 [...] Read more.

Background/Objectives: Crohn’s disease (CD) is one of the most frequent causes of short bowel syndrome (SBS), a severe clinical condition with huge morbidity and social costs. SBS occurs when, following intestinal resections, the remaining small bowel in continuity is less than 200 cm in length. Intestinal failure (IF) can complicate SBS when intravenous nutritional or electrolyte supplementation is required to maintain dietary needs. The primary aim of this study was to identify clinical predictive factors of SBS in a cohort of outpatients with CD. Methods: We conducted a prospective, single-center, cohort study enrolling consecutive CD outpatients at a tertiary-level inflammatory bowel disease center. Detailed demographic and clinical features were collected. Significant factors associated with the onset of SBS in the univariate analysis were input into a multivariate logistic regression model to identify independent predictors of SBS. Results: In total, 232 CD patients (52.6% male, median age 49 years [IQR 37–60]) were included: 24.6% of them were smokers; extraintestinal manifestations (EIMs) were present in 21.6% of patients; and 67.7% of patients had at least one intestinal resection (27% of them with more than one surgical intervention). At enrollment, 96.1% of patients were on advanced therapies, and considering the course of the disease, 24.6% of patients were exposed to ≥3 different advanced therapies. A total of 18 patients had SBS and 9 had IF. In univariate analysis, the following variables were statistically associated with the risk of developing SBS: disease duration (p < 0.001), upper gastrointestinal disease localization (L4) (p < 0.001), penetrating behavior (p = 0.023), perianal disease (p = 0.036), length of first intestinal resection (p < 0.001), shorter time elapsing from CD diagnosis to start the first advanced therapy (p < 0.001), and treatment with advanced therapy after first intestinal resection (p < 0.001). In multivariate analysis, disease duration (OR 1.083, 95% C.I. 1.025–1.145, p = 0.005) and L4 (OR 20.079, 95% C.I. 2.473–163.06, p = 0.005) were independently associated with the development of SBS. Conversely, the number of different advanced therapies before the onset of SBS was independently associated with a reduced risk of developing SBS (OR 0.247, 95% C.I. 0.107–0.58, p = 0.001). Conclusions: Our data identifies several clinical features that could possibly predict the development of SBS in CD. Further studies with a larger sample size are needed to confirm our findings. Full article

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

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13 pages, 2106 KB

Open AccessArticle

Ethnic Variation in Lipoprotein(a) Levels in the Kazakhstan Population

by Makhabbat Bekbossynova, Tatyana Ivanova-Razumova, Gulzhan Myrzakhmetova, Saltanat Andossova, Aknur Kali, Aliya Sailybayeva and Timur Saliev

J. Clin. Med. 2025, 14(17), 6336; https://doi.org/10.3390/jcm14176336 - 8 Sep 2025

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Abstract

Background: Lipoprotein(a) (Lp(a)) is a genetically determined lipoprotein that plays an independent role in the development of atherosclerotic cardiovascular disease (ASCVD). Ethnic differences in Lp(a) levels are well-documented, yet regional data from Central Asia, particularly Kazakhstan, remain scarce. Methods: We conducted a retrospective, [...] Read more.

Background: Lipoprotein(a) (Lp(a)) is a genetically determined lipoprotein that plays an independent role in the development of atherosclerotic cardiovascular disease (ASCVD). Ethnic differences in Lp(a) levels are well-documented, yet regional data from Central Asia, particularly Kazakhstan, remain scarce. Methods: We conducted a retrospective, single-center study involving 3727 patients aged ≥ 18 years who underwent Lp(a) testing between January 2023 and June 2024. Participants were stratified by self-reported ethnicity and atherosclerosis status confirmed via coronary angiography. Lp(a) levels were analyzed using immunoturbidimetric assays. Results: Elevated Lp(a) levels (≥50 mg/dL) were identified in 19.6% of the total population. While Kazakhs exhibited a slightly higher prevalence of elevated Lp(a) compared to Russians, there were no statistically significant differences in Lp(a) levels across ethnic groups. ROC analysis revealed limited discriminatory power of Lp(a) for diagnosing atherosclerosis (AUC = 0.5464), although PRC analysis showed high sensitivity and precision in both Kazakh and Russian subgroups at lower thresholds. Conclusions: Despite modest ethnic variation in Lp(a) distribution, its predictive value for atherosclerosis remains limited as a standalone marker. These findings highlight the need for population-specific thresholds and support incorporating Lp(a) testing in broader cardiovascular risk assessment strategies in Central Asia. Full article

(This article belongs to the Section Cardiovascular Medicine)

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13 pages, 2740 KB

Open AccessArticle

Standard Percutaneous Transluminal Angioplasty Versus Intravascular Lithotripsy to Facilitate Trans-Femoral Transcatheter Aortic Valve Implantation in Patients with Aortic Stenosis and Severe Peripheral Arterial Disease

by David Belkin, Tamir Bental, Tullio Palmerini, Ran Kornowski and Pablo Codner

J. Clin. Med. 2025, 14(17), 6335; https://doi.org/10.3390/jcm14176335 - 8 Sep 2025

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Abstract

Background/Objectives: The optimal method to facilitate femoral access in patients with aortic stenosis and severe peripheral arterial disease (PAD) undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study compared the safety and efficacy of percutaneous transluminal angioplasty (PTA) versus Shockwave^® [...] Read more.

Background/Objectives: The optimal method to facilitate femoral access in patients with aortic stenosis and severe peripheral arterial disease (PAD) undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study compared the safety and efficacy of percutaneous transluminal angioplasty (PTA) versus Shockwave^® intravascular lithotripsy (IVL) in patients with severe PAD undergoing TAVI via the trans-femoral route enrolled in the Hostile TAVI registry trial. Methods: Patients with severe PAD from 28 international centers were enrolled in the registry. This sub-study analyzed patients who underwent transfemoral TAVI facilitated by PTA (n = 352) or IVL (n = 166). Primary endpoints included rates of survival, major vascular complications, and major bleeding. Outcomes were also stratified according to the severity of PAD using the novel Hostile risk score. Results: Patients in the PTA group were older and had lower rates of prior stroke/TIA. All-cause mortality at 3 years was similar between PTA and IVL groups (34.9% vs. 38.6%; p = 0.27, respectively). However, IVL was associated with fewer major vascular complications (21.7% vs. 13.3%; p = 0.033, respectively), less major bleeding (14.0% vs. 7.0%; p = 0.024, respectively), and shorter hospital stays (7.06 ± 6.69 vs. 4.29 ± 4.78 days; p < 0.001; 95% CI: 1.63–3.91, respectively). Cox regression analysis showed that at low (≤8.5) Hostile Scores, PTA was associated with higher rates of major vascular complications and major bleeding than IVL. Conclusions: In patients with aortic stenosis and severe PAD undergoing TAVI via the transfemoral route, IVL is safer than PTA, with fewer vascular and bleeding complications but similar intermediate-term survival. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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12 pages, 516 KB

Open AccessPerspective

Association Between Periodontitis and Cancer: A Perspective Review of Mechanisms and Clinical Evidence

by Marco Bonilla, Irene Peñalver, María José Mesa-López and Francisco Mesa

J. Clin. Med. 2025, 14(17), 6334; https://doi.org/10.3390/jcm14176334 - 8 Sep 2025

Viewed by 309

Abstract

Chronic periodontitis has emerged as a potential modifiable risk factor for several tumors, yet its role remains underexplored beyond epidemiological associations. This perspective review examines the immunological and molecular interplay between periodontitis and various cancers—including prostate, colorectal, oral squamous cell carcinoma, and oral [...] Read more.

Chronic periodontitis has emerged as a potential modifiable risk factor for several tumors, yet its role remains underexplored beyond epidemiological associations. This perspective review examines the immunological and molecular interplay between periodontitis and various cancers—including prostate, colorectal, oral squamous cell carcinoma, and oral potentially malignant disorders—highlighting shared inflammatory mediators and immune dysregulation. Special attention is given to immune cell profiles, cytokine expression, dysbiosis, and common miRNA signatures. Recent evidence suggests that periodontitis may act not only as a co-factor in tumor development but also, in some contexts, as a marker of therapeutic response, particularly in patients undergoing immune checkpoint inhibitor therapy. In our view, future research should prioritize mechanistic studies to define common immune–inflammatory pathways and clarify whether periodontitis functions as a field cancerization process or as a facilitator of malignant transformation in already compromised tissues. The relationship between cancer and periodontitis underscores the need to integrate oral health into oncologic care and immunotherapy management. Full article

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

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13 pages, 1356 KB

Open AccessArticle

AI Based Clinical Decision-Making Tool for Neurologists in the Emergency Department

by Alon Gorenshtein, Shiri Fistel, Moran Sorka, Gregory Telman, Raz Winer, Shlomi Peretz, Dvir Aran and Shahar Shelly

J. Clin. Med. 2025, 14(17), 6333; https://doi.org/10.3390/jcm14176333 - 8 Sep 2025

Viewed by 343

Abstract

Introduction: We aimed to prove integration of advanced machine learning methods within a robust ensemble framework can enhance clinical decision-support for neurologists managing patients in the emergency department (ED). Methods: We engineered an ensemble framework leveraging the capabilities of the Gemini [...] Read more.

Introduction: We aimed to prove integration of advanced machine learning methods within a robust ensemble framework can enhance clinical decision-support for neurologists managing patients in the emergency department (ED). Methods: We engineered an ensemble framework leveraging the capabilities of the Gemini 1.5-pro-002 large language model (LLM). The model was enhanced using prompt engineering and retrieval-augmented generation (RAG). Predictive modeling achieved by combining eXtreme Gradient Boosting (XGBoost) and logistic regression for optimal accuracy in clinical decision-making. Key clinical outcomes, such as admission and mortality, were assessed. A random subset of 100 cases was reviewed by three senior neurologists to evaluate the alignment of the AI’s predictions with expert clinical judgment. Results: We retrospectively analyzed 1368 consecutive ED patients who underwent neurological consultations, assessing their clinical features, diagnostic tests, and admission outcomes. Patients admitted were typically older and had higher mortality rates, shorter intervals to neurological evaluation, and a higher incidence of acute stroke compared to those discharged. For the primary analysis (n = 250), the Neuro artificial intelligence (AI) model demonstrated significant performance metrics, achieving an area under the curve (AUC) of 0.88 for general admission predictions in comparison to actual outcomes, an AUC of 0.86 for neurological department admissions, 0.93 for long-term mortality risk, and 1 for 48 h mortality risk. Our Neuro AI model predictions showed a strong correlation with expert consensus (Pearson correlation 0.79, p < 0.001), indicating its ability to provide consistent support amid divergent clinical opinions. Conclusions: Our Neuro AI model accurately predicted hospital admissions (AUC = 0.88) and neurological department admissions (AUC = 0.86), demonstrating strong alignment with expert clinical judgment. Full article

(This article belongs to the Special Issue Neural Application of Artificial Intelligence in Clinical Neuroscience)

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12 pages, 1779 KB

Open AccessArticle

Artificial Intelligence Algorithm Supporting the Diagnosis of Developmental Dysplasia of the Hip: Automated Ultrasound Image Segmentation

by Łukasz Pulik, Paweł Czech, Jadwiga Kaliszewska, Bartłomiej Mulewicz, Maciej Pykosz, Joanna Wiszniewska and Paweł Łęgosz

J. Clin. Med. 2025, 14(17), 6332; https://doi.org/10.3390/jcm14176332 - 8 Sep 2025

Viewed by 249

Abstract

Background: Developmental dysplasia of the hip (DDH), if not treated, can lead to osteoarthritis and disability. Ultrasound (US) is a primary screening method for the detection of DDH, but its interpretation remains highly operator-dependent. We propose a supervised machine learning (ML) image [...] Read more.

Background: Developmental dysplasia of the hip (DDH), if not treated, can lead to osteoarthritis and disability. Ultrasound (US) is a primary screening method for the detection of DDH, but its interpretation remains highly operator-dependent. We propose a supervised machine learning (ML) image segmentation model for the automated recognition of anatomical structures in hip US images. Methods: We conducted a retrospective observational analysis based on a dataset of 10,767 hip US images from 311 patients. All images were annotated for eight key structures according to the Graf method and split into training (75.0%), validation (9.5%), and test (15.5%) sets. Model performance was assessed using the Intersection over Union (IoU) and Dice Similarity Coefficient (DSC). Results: The best-performing model was based on the SegNeXt architecture with an MSCAN_L backbone. The model achieved high segmentation accuracy (IoU; DSC) for chondro-osseous border (0.632; 0.774), femoral head (0.916; 0.956), labrum (0.625; 0.769), cartilaginous (0.672; 0.804), and bony roof (0.725; 0.841). The average Euclidean distance for point-based landmarks (bony rim and lower limb) was 4.8 and 4.5 pixels, respectively, and the baseline deflection angle was 1.7 degrees. Conclusions: This ML-based approach demonstrates promising accuracy and may enhance the reliability and accessibility of US-based DDH screening. Future applications could integrate real-time angle measurement and automated classification to support clinical decision-making. Full article

(This article belongs to the Special Issue Artificial Intelligence and Machine Learning in Clinical Practice: Advancing Medical Imaging Analysis)

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11 pages, 486 KB

Open AccessReview

Antiplatelet Therapy in Atrial Fibrillation Patients on Direct Oral Anticoagulants Undergoing Percutaneous Coronary Intervention: Which and How

by Luca Martini, Matteo Lisi, Graziella Pompei, Manfredi Arioti, Francesco Bendandi, Michael Y. Henein, Matteo Cameli and Andrea Rubboli

J. Clin. Med. 2025, 14(17), 6331; https://doi.org/10.3390/jcm14176331 - 8 Sep 2025

Viewed by 284

Abstract

In patients on oral anticoagulation (OAC), typically for atrial fibrillation (AF), undergoing percutaneous coronary intervention (PCI), the antiplatelet drugs to be added to direct oral anticoagulant (DOAC) are aspirin and clopidogrel during the initial, short (up to one week) period of triple antithrombotic [...] Read more.

In patients on oral anticoagulation (OAC), typically for atrial fibrillation (AF), undergoing percutaneous coronary intervention (PCI), the antiplatelet drugs to be added to direct oral anticoagulant (DOAC) are aspirin and clopidogrel during the initial, short (up to one week) period of triple antithrombotic therapy (TAT), and clopidogrel alone during the subsequent 6- to 12-month period of double antithrombotic therapy (DAT). Both direct and indirect data support the recommendation to avoid the more potent P2Y12 inhibitors—ticagrelor and prasugrel—as part of TAT, owing to the increased risk of bleeding. There is less and inconclusive data available regarding the safety and efficacy of DAT when ticagrelor or prasugrel are used instead of clopidogrel. Also, there is very limited evidence for the use of aspirin instead of clopidogrel in a DAT regimen. While acknowledging the safety and effectiveness of the recommended strategies above, it would, nonetheless, be valuable to have alternative options in the choice of antiplatelet agents. In case of very high thrombotic risk, especially when stents are positioned in potentially risky sites (such as the left main or last remaining vessel) a more potent P2Y12 inhibitor than clopidogrel may be warranted. Moreover, non-responsiveness to, or pharmacological interactions of, clopidogrel may hamper its efficacy. In this review, we aim at presenting and discussing the evidence supporting the current recommendations for the use of the various antiplatelet agents in AF patients on OAC undergoing PCI, as well as at giving a glimpse at future perspectives. Full article

(This article belongs to the Special Issue Antithrombotic Therapies for Acute Coronary Syndrome and Atrial Fibrillation)

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14 pages, 1701 KB

Open AccessReview

The Importance of Dental Treatment in Patients Before Radiotherapy, Chemotherapy, and Cardiac Surgeries: A Narrative Review

by Seyedamirreza Mostafavi, Magdalena Wyszyńska and Małgorzata Skucha-Nowak

J. Clin. Med. 2025, 14(17), 6330; https://doi.org/10.3390/jcm14176330 - 8 Sep 2025

Viewed by 303

Abstract

Oncological patients or the individuals scheduled for cardiovascular surgeries are at risk of both oral and systemic complications when existing dental pathologies are not addressed before these therapies. This narrative review explores the current literature on the role of pre-treatment dental care in [...] Read more.

Oncological patients or the individuals scheduled for cardiovascular surgeries are at risk of both oral and systemic complications when existing dental pathologies are not addressed before these therapies. This narrative review explores the current literature on the role of pre-treatment dental care in reducing unfavorable outcomes and promoting treatment efficacy in medically compromised patients. The data show that early dental intervention, particularly prior to head and neck radiotherapy, considerably reduces the risk of osteoradionecrosis, rampant radiation caries, and xerostomia. Chemotherapy-associated mucositis, infections, and microbial imbalance are similarly worsened by untreated oral disease but may be managed through early sanitation and hygiene reinforcement. In cardiac patients, conditions such as apical periodontitis and periodontitis may lead to bacteremia, infective endocarditis, or prosthetic valve infections, highlighting the systemic relevance of oral health. Tooth extractions, restorative treatment of carious lesions, and control of active oral infections performed before systemic therapy can reduce complication rates, improve treatment continuity, and enhance patients’ quality of life. Integrating comprehensive dental assessment into routine pre-treatment planning allows early identification of oral health risks and supports a multidisciplinary approach that optimizes overall clinical outcomes. Full article

(This article belongs to the Special Issue Current Challenges in Clinical Dentistry: 2nd Edition)

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19 pages, 2790 KB

Open AccessArticle

Patterns of Morbidity in Ambatoboeny District, Northern Madagascar: A 12-Month Study

by Daniel Kasprowicz, Krzysztof Korzeniewski and Wanesa Wilczyńska

J. Clin. Med. 2025, 14(17), 6329; https://doi.org/10.3390/jcm14176329 - 8 Sep 2025

Viewed by 384

Abstract

Background: Ambatoboeny District in northern Madagascar faces significant health challenges due to widespread poverty, poor access to healthcare, and limited diagnostic capabilities. Despite high disease burden, data on morbidity patterns in the region are scarce. This study aims to identify the most prevalent [...] Read more.

Background: Ambatoboeny District in northern Madagascar faces significant health challenges due to widespread poverty, poor access to healthcare, and limited diagnostic capabilities. Despite high disease burden, data on morbidity patterns in the region are scarce. This study aims to identify the most prevalent diseases and most affected demographic groups, thus providing valuable insight into the region’s health profile. Methods: A retrospective analysis was conducted on medical records from 3678 patients who were admitted at Clinique Médicale BEYZYM, a secondary-level referral facility in Manerinerina, Boeny Region between January and December 2024. Diagnoses were retrieved from physician registration ledgers, hospitalization records, monthly laboratory reports, monthly general hospital activity reports and monthly reports from Centre de Traitement et de Diagnostic de la Tuberculose, which were cross-referenced and verified by trained clinical staff. Records were included if they contained identifiable demographic data and at least one clinical diagnosis. Diagnoses were coded using ICD-11 and were classified into 15 major categories. Results: The median patient age was 19.5 years (IQR: 7–42), with females accounting for 54% of the cohort. Most patients (87.2%) resided in Ambatoboeny. The most common reasons for admission were infectious and parasitic diseases (35.75%, 95% CI: 34.20–37.30), respiratory diseases (22.73%, 95% CI: 21.38–24.08), and diseases of the genitourinary system (13.95%, 95% CI: 12.83–15.07), collectively accounting for 72.43% of all recorded cases. Statistically significant differences in morbidity patterns were observed across age and sex groups. Conclusions: The findings underscore the multifaceted burden of disease in the Ambatoboeny District, where both infectious and chronic conditions coexist in a resource-limited setting. Delayed healthcare-seeking behavior, cultural beliefs, and diagnostic limitations further complicate care delivery. This study provides foundational data to inform targeted health policies, humanitarian medical missions, and diagnostic capacity-building tailored to local needs. Full article

(This article belongs to the Section Infectious Diseases)

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23 pages, 1411 KB

Open AccessReview

Cytokine Landscapes, Immune Dysregulation, and Treatment Perspectives in Philadelphia-Negative Myeloproliferative Neoplasms: A Narrative Review

by Samuel B. Todor and Romeo Gabriel Mihaila

J. Clin. Med. 2025, 14(17), 6328; https://doi.org/10.3390/jcm14176328 - 8 Sep 2025

Viewed by 404

Abstract

Philadelphia-negative myeloproliferative neoplasms (Ph-MPNs) are clonal hematologic malignancies characterized not only by driver mutations such as JAK2V617F, CALR, and MPL but also by a profoundly dysregulated immune microenvironment. Chronic inflammation and immune remodeling sustain malignant hematopoiesis and contribute to disease progression from essential [...] Read more.

Philadelphia-negative myeloproliferative neoplasms (Ph-MPNs) are clonal hematologic malignancies characterized not only by driver mutations such as JAK2V617F, CALR, and MPL but also by a profoundly dysregulated immune microenvironment. Chronic inflammation and immune remodeling sustain malignant hematopoiesis and contribute to disease progression from essential thrombocythemia (ET) and polycythemia vera (PV) to overt myelofibrosis (MF). Pro-inflammatory cytokines and chemokines—including IL-2, IFN-α, IL-23, and TNF-α—drive abnormal T cell polarization, favoring a pathogenic Th17 phenotype. Lymphocyte subset analysis reveals a predominance of exhausted PD-1⁺ T cells, reflecting impaired immune surveillance. Concurrently, alterations in neutrophil apoptosis lead to persistent inflammation and stromal activation. GRO-α (CXCL1) is elevated in ET but reduced in MF, suggesting a subtype-specific role in disease biology. Fibrosis-promoting factors such as TGF-β and IL-13 mediate bone marrow remodeling and megakaryocyte expansion, while VEGF and other angiogenic factors enhance vascular niche alterations, particularly in PV. These immunopathologic features underscore novel therapeutic vulnerabilities. In addition to JAK inhibition, targeted strategies such as CXCR1/2 antagonists, anti-TGF-β agents, and immune checkpoint inhibitors (PD-1/PD-L1 blockade) may offer disease-modifying potential. Understanding the interplay between cytokine signaling and immune cell dysfunction is crucial for developing precision immunotherapies in MPNs. Full article

(This article belongs to the Section Hematology)

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11 pages, 447 KB

Open AccessReview

The Use of JAK Inhibitors in Elderly Patients with Moderate-to-Severe Atopic Dermatitis: A Narrative Review of Clinical and Real-World Evidence

by Giuseppe Lauletta, Daniele Cecere, Luca Potestio, Francesca di Vico, Cataldo Patruno and Maddalena Napolitano

J. Clin. Med. 2025, 14(17), 6327; https://doi.org/10.3390/jcm14176327 - 8 Sep 2025

Viewed by 529

Abstract

Background: Atopic dermatitis (AD) in elderly patients presents unique clinical challenges due to comorbidities, polypharmacy, and an increased risk of adverse events. Janus kinase inhibitors (JAKis) have emerged as effective oral treatments, but limited data are available for their use in older adults. [...] Read more.

Background: Atopic dermatitis (AD) in elderly patients presents unique clinical challenges due to comorbidities, polypharmacy, and an increased risk of adverse events. Janus kinase inhibitors (JAKis) have emerged as effective oral treatments, but limited data are available for their use in older adults. Methods: A narrative review was conducted through a comprehensive search of PubMed/MEDLINE, Ovid, Scopus, Embase, Cochrane Library, Web of Science, and Google Scholar up to July 2025. Only English-language studies evaluating abrocitinib, baricitinib, or upadacitinib in elderly patients (≥65 years) with moderate-to-severe AD were included. Results: RCTs enrolled few elderly patients and lacked dedicated subgroup analyses. Abrocitinib showed similar efficacy in older and younger adults, but higher rates of adverse events, especially at the 200 mg dose. Real-world studies, mainly on upadacitinib, demonstrated rapid and sustained clinical improvements, including in difficult-to-treat areas. Safety outcomes were generally favorable; most adverse events were mild and manageable. Herpes zoster and hematological changes were more frequent in elderly patients, while serious cardiovascular events were rare. Conclusions: JAK inhibitors are effective therapeutic options for elderly patients with moderate-to-severe AD. Careful patient selection, dose tailoring, and close monitoring are essential. Further age-specific RCTs and long-term real-world data are needed to guide clinical practice. Full article

(This article belongs to the Special Issue Innovative Systemic Treatments for Atopic Dermatitis)

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24 pages, 4575 KB

Open AccessReview

Intercostal Artery Screening with Color Doppler Thoracic Ultrasound in Pleural Procedures: A Potential Yet Underexplored Imaging Modality for Minimizing Iatrogenic Bleeding Risk in Interventional Pulmonology

by Guido Marchi, Sara Cinquini, Francesco Tannura, Giacomo Guglielmi, Riccardo Gelli, Luca Pantano, Giovanni Cenerini, Valerie Wandael, Beatrice Vivaldi, Natascia Coltelli, Giulia Martinelli, Alessandra Celi, Salvatore Claudio Fanni, Massimiliano Serradori, Marco Gherardi, Luciano Gabbrielli, Francesco Pistelli and Laura Carrozzi

J. Clin. Med. 2025, 14(17), 6326; https://doi.org/10.3390/jcm14176326 - 7 Sep 2025

Viewed by 508

Abstract

Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. [...] Read more.

Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. Color Doppler thoracic ultrasound (CDUS) has emerged as a non-invasive, real-time modality capable of identifying ICAs and their anatomical variants prior to pleural access. This narrative review synthesizes current evidence on CDUS-guided ICA screening, focusing on its technical principles, diagnostic performance, and clinical applicability. While feasibility and utility are supported by multiple observational studies, robust evidence demonstrating a reduction in bleeding complications is still lacking. Barriers to widespread implementation include heterogeneous scanning protocols, operator dependency, and the absence of standardized training. We discuss the anatomical rationale for pre-procedural vascular mapping and highlight emerging protocols aimed at standardizing ICA visualization. Although not yet incorporated into major clinical guidelines, CDUS represents a promising tool to enhance procedural safety. Emerging AI applications may further improve vessel detection by reducing operator dependency and enhancing reproducibility. High-quality prospective studies are essential to validate potential clinical benefits, optimize implementation strategies, and support integration into routine pleural practice. Full article

(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions)

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12 pages, 505 KB

Open AccessArticle

Risk of Abortion and Ectopic Pregnancy in Women with a History of Polycystic Ovary Syndrome: A Nationwide Population-Based Cohort Study

by Jin-Sung Yuk, Sang-Hee Yoon and Seung-Woo Yang

J. Clin. Med. 2025, 14(17), 6325; https://doi.org/10.3390/jcm14176325 - 7 Sep 2025

Viewed by 431

Abstract

Objectives: The purpose of this retrospective cohort study was to ascertain the risk of abortion, ectopic pregnancy and hydatidiform mole development in women with polycystic ovary syndrome (PCOS) using data from Korea’s National Health Insurance Service. Method: The women aged 20–49 years who [...] Read more.

Objectives: The purpose of this retrospective cohort study was to ascertain the risk of abortion, ectopic pregnancy and hydatidiform mole development in women with polycystic ovary syndrome (PCOS) using data from Korea’s National Health Insurance Service. Method: The women aged 20–49 years who were diagnosed with PCOS between 1 January 2012 and 31 December 2020 were enrolled. The control group (non-PCOS group) was composed of women aged 20–49 years who visited medical institutions for health examinations during the same period. Women diagnosed with any cancer were excluded from both groups. Logistic regression analysis was used to evaluate the risks of abortion, ectopic pregnancy and hydatidiform mole in PCOS in the presence of certain pregnancy-related confounding factors. Results: A total of 724,307 women were extracted, 169,998 women without PCOS and 44,714 women with PCOS were enrolled in the study. The PCOS group had a higher incidence of GDM and endometriosis. Abortions, ectopic pregnancies and hydatidiform moles were higher in the PCOS group than in the control group (abortion: 14.7% vs. 7.3%, p < 0.001; ectopic pregnancy: 3.3% vs. 1.1%, p < 0.001; hydatidiform mole: 0.2% vs. 0.1%, p < 0.001). After adjusted logistic regression, PCOS was found to be a risk factor for abortion (RR = 1.473, 95% CI = 1.424–1.524; p < 0.001) and ectopic pregnancy (RR = 1.845, 95% CI = 1.716–1.984, p < 0.001) but not hydatidiform mole (RR = 1.225, 95% CI = 0.927–1.62, p = 0.154). Conclusions: A history of PCOS itself might increase the risk of abortion and ectopic pregnancy. These findings could be useful in prenatal counseling and the management of patients with PCOS-associated pregnancies. Full article

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

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16 pages, 2396 KB

Open AccessPerspective

Elective Umbilical Hernia Repair in Adults in the 21st Century: Challenging the Status Quo

by Sergio Huerta, Jared McAllister, Crystal Phung and Angela A. Guzzetta

J. Clin. Med. 2025, 14(17), 6324; https://doi.org/10.3390/jcm14176324 - 7 Sep 2025

Viewed by 299

Abstract

On the spectrum of complexity for general surgery operations, umbilical hernia repair (UHR) is on the light side. After inguinal hernias, they are the most commonly repaired hernias and, as such, umbilical hernias are an important component of a general surgery practice. Since [...] Read more.

On the spectrum of complexity for general surgery operations, umbilical hernia repair (UHR) is on the light side. After inguinal hernias, they are the most commonly repaired hernias and, as such, umbilical hernias are an important component of a general surgery practice. Since the time at which WJ Mayo published his seminal technique on the repair of umbilical hernias, multiple strategies for the management of umbilical hernias have emerged ranging from watchful waiting to open repair, as well as minimally invasive approaches. The present perspective maintains that each approach has its merits depending on the patient, surgeon, and institution. However, randomized controlled trials and clinical practice guidelines have favored some approaches over others. Similarly, recommendations have been developed regarding body mass index classification as well as hernia size for mesh placement. Other factors important to UHR are the choice of anesthesia and smoking cessation for elective repair. Though we do not contest well-designed randomized controlled trials (RTCs), or clinical guidelines, we offer our perspective on the care of these common hernias. Full article

(This article belongs to the Section General Surgery)

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11 pages, 2370 KB

Open AccessArticle

Evaluation of Maxillary Molar Distalization Supported by Mini-Implants with the Advanced Molar Distalization Appliance (amda^®): Preliminary Results of a Prospective Clinical Trial

by Nikolaos Karvelas, Aikaterini Samandara, Bogdan Radu Dragomir, Alice Chehab, Tinela Panaite, Cristian Romanec, Moschos A. Papadopoulos and Irina Nicoleta Zetu

J. Clin. Med. 2025, 14(17), 6323; https://doi.org/10.3390/jcm14176323 - 7 Sep 2025

Viewed by 373

Abstract

Background: Class II is considered one of the most common malocclusions, influencing 37% of schoolchildren in Europe and 33% of orthodontic patients in the United States. When this type of malocclusion is combined with increased overjet with proclined teeth and maxillary excess, then [...] Read more.

Background: Class II is considered one of the most common malocclusions, influencing 37% of schoolchildren in Europe and 33% of orthodontic patients in the United States. When this type of malocclusion is combined with increased overjet with proclined teeth and maxillary excess, then moving maxillary molars distally is suggested. According to the recent literature, modern appliances that lack patient cooperation can be combined with temporary anchorage devices to provide absolute and skeletal anchorage while supporting the non-compliance appliances to eliminate their side effects, such as anterior and posterior anchorage loss along with maxillary molar inclination and rotation. To counteract these limitations, the Advanced Molar Distalization Appliance (amda^®), a non-compliance appliance for maxillary molar distalization supported by two mini-implants (MIs) with anterior abutments, was recently developed. Methods: In this preliminary prospective clinical trial, eight consecutive patients treated with the amda^® are evaluated through lateral cephalometric radiographs, while its application, construction, and anchorage is presented and discussed. The evaluation of dentoalveolar and skeletal changes has been made with 14 variables measured on the pre- and post-cephalometric radiographs before and immediately after maxillary molar distalization (T₀ and T₁, respectively), along with cephalometric superimpositions by the structural method. Results: In total, the mean distal molar movement was 4.2 ± 1.37 mm, the mean distal tipping was 1.7 ± 1.9 degrees, and the vertical movement was 1.6 ± 2.6 mm. Conclusions: The amda^® seems to provide an ideal option for treating patients with Class II malocclusion, achieving bodily movement of the maxillary molars with only minimal distal tipping and no anchorage loss. Full article

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

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17 pages, 975 KB

Open AccessReview

The Popliteofibular Ligament: A Narrative Review of Anatomical Variants and Their Surgical Relevance in Posterolateral Knee Reconstruction

by Łukasz Olewnik, Ingrid C. Landfald, Bartosz Gonera, Kacper Ruzik and Robert F. LaPrade

J. Clin. Med. 2025, 14(17), 6322; https://doi.org/10.3390/jcm14176322 - 7 Sep 2025

Viewed by 363

Abstract

Purpose: This review aims to synthesize current knowledge of anatomical variations of the popliteofibular ligament (PFL) and evaluate the clinical relevance of the classification system proposed by Olewnik et al. in the context of the diagnosis, surgical treatment, and rehabilitation of posterolateral corner [...] Read more.

Purpose: This review aims to synthesize current knowledge of anatomical variations of the popliteofibular ligament (PFL) and evaluate the clinical relevance of the classification system proposed by Olewnik et al. in the context of the diagnosis, surgical treatment, and rehabilitation of posterolateral corner (PLC) injuries. Methods: A comprehensive analysis of anatomical, surgical, and radiological studies concerning the PFL was conducted. The implications of PFL morphological variants were examined across clinical applications, with an emphasis on reconstructive strategies, imaging interpretation, and rehabilitation planning. Emerging research directions, including AI-supported imaging and personalized algorithms, were also explored. Results: Olewnik’s classification identifies three distinct types of PFL, each with unique structural and biomechanical properties. Recognizing these variants enhances intraoperative orientation, facilitates tailored surgical techniques, and supports individualized rehabilitation protocols. Variant-specific biomechanics, identified via cadaveric studies and imaging, are essential for optimizing functional outcomes and minimizing postoperative instability. Furthermore, the classification offers a platform for developing future diagnostic and decision-support tools using artificial intelligence. Conclusions: The Olewnik et al. classification system should be adopted as a modern anatomical standard for the PFL. Its integration into clinical practice has the potential to improve surgical precision, reduce complication rates, and enhance patient-specific treatment planning. This framework also supports future advancements in orthopedic imaging, education, and AI-driven diagnostics. Beyond descriptive anatomy, we provide a pragmatic surgical algorithm for PLC repair/reconstruction that accounts for scar- and fibrosis-dominated fields and the limited bone stock of the fibular head. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 1344 KB

Open AccessArticle

Association of the Lactate/Albumin Ratio with Mortality and Hypovolemia in Critically Ill Patients: A Retrospective Cohort Study

by Jakub Droś, Rafał Świstek, Patryk Kasongo, Jakub Konieczyński, Piotr Bielański, Agnieszka Sajdyk, Anna Wrzosek, Tomasz Składzień, Rafał Depukat, Maria Marusińska, Klaudia Czech, Katarzyna Frączek, Katarzyna Paciorek, Weronika Skoczeń, Bartłomiej Stachera, Weronika Chaba, Agata Peszek, Gabriela Pabian, Małgorzata Pawlik, Klaudia Zięba, Katarzyna Wolak, Anna Włodarczyk, Weronika Tomasiczek, Tomasz Drygalski and Michał Terlecki Show full author list Hide full author list

J. Clin. Med. 2025, 14(17), 6321; https://doi.org/10.3390/jcm14176321 - 7 Sep 2025

Viewed by 366

Abstract

Background/Objectives: Previous research has demonstrated that the lactate/albumin ratio (L/A) may predict mortality among critically ill patients. Based on pathophysiological rationale, L/A may also correlate with volume status, however such an association has not been investigated extensively. This retrospective cohort study aimed to [...] Read more.

Background/Objectives: Previous research has demonstrated that the lactate/albumin ratio (L/A) may predict mortality among critically ill patients. Based on pathophysiological rationale, L/A may also correlate with volume status, however such an association has not been investigated extensively. This retrospective cohort study aimed to confirm the prognostic value of L/A and to assess the prognostic value of L/A and its relationship with hypovolemia severity in intensive care unit (ICU) patients. Methods: We analyzed data from consecutive adult patients admitted to the ICU. Admission L/A was evaluated in relation to 30-day mortality and indirect markers of volume status (mean arterial pressure on admission, median dose of norepinephrine and fluid intake within the first 24 h of ICU stay). Results: A total of 1421 patients were included. L/A ≥ 0.06 (estimated on the basis of ROC curve using the Youden index) was an independent predictor of 30-day mortality (HR = 1.423; 95%CI 1.183–1.712; p < 0.001). L/A moderately correlated with markers of absolute or relative hypovolemia, i.e., lower mean arterial pressure (r = −0.353, p < 0.001) on admission, higher norepinephrine dose (r = 0.506, p < 0.001) and greater fluid intake (r = 0.233, p < 0.001) within the first 24 h of ICU stay. Furthermore, L/A ≥ 0.06 on admission was an independent risk factor for the implementation of continuous renal replacement therapy (OR = 2.134; 95%CI 1.652–2.757; p = 0.001). Conclusions: L/A is not only a predictor of poor prognosis but also may be a valuable indirect marker of the extent of hypovolemia in critically ill patients. Further prospective studies are necessary to assess if this parameter should incline a decision for more aggressive fluid management in hypovolemic patients. Full article

(This article belongs to the Section Intensive Care)

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27 pages, 3093 KB

Open AccessArticle

Injury Pattern According to Player Position in Male Amateur Football Players in Greece: A Retrospective Study

by Konstantinos Vassis, Ioannis Misiris, Spyridon Plakias, Athanasios Siouras, Savvas Spanos, Eleftherios Giamouridis, Zacharias Dimitriadis, Dimitrios Tsaopoulos and Ioannis A. Poulis

J. Clin. Med. 2025, 14(17), 6320; https://doi.org/10.3390/jcm14176320 - 7 Sep 2025

Viewed by 536

Abstract

Background: Football has a high injury risk due to speed and contact, and injury patterns may vary by playing position. Positional roles affect physical and physiological demands and may influence injury characteristics. Although this has been examined in professionals, data from amateur players [...] Read more.

Background: Football has a high injury risk due to speed and contact, and injury patterns may vary by playing position. Positional roles affect physical and physiological demands and may influence injury characteristics. Although this has been examined in professionals, data from amateur players are scarce. This study examined the incidence, type, and severity of injuries among amateur footballers in Greece with respect to playing position. Methods: A retrospective epidemiological study analyzed musculoskeletal injuries in 222 amateur male football players during the 2022–2023 season. Data were collected via a CHERRIES-compliant online survey (SurveyMonkey^®) from May to July 2023. Eligible participants were active male athletes aged ≥18 years competing in amateur Greek leagues. Injuries were defined according to the FIFA–UEFA consensus and expressed as incidence rates per 1000 h of exposure. Statistical analyses used SPSS v25 with significance at p < 0.05. Results: Among players (mean age: 25.3 ± 5.7 years), injury prevalence ranged from 65.1% (DFs) to 79.3% (GKs) with no significant association between playing position and injury risk (p = 0.379). Injury incidence ranged from 4.5 to 5.7 per 1000 h, highest among MFs. Incidence rates ranged between 1.33 and 2.74 injuries/1000 h in matches versus 1.33 to 2.09/1000 h in training, with DFs, FWs, and MFs more prone to match injuries, whereas GKs had slightly higher training rates; however, the number of injuries did not significantly differ between games and training across positions (χ² = 5.21, p = 0.517). Muscle strains and lower-limb injuries predominated. Injury severity differed significantly by position (p = 0.001), but injury type and mechanism did not. Conclusions: GKs and MFs showed the highest prevalence and incidence, but position was not linked to overall risk. Severity differences highlight the need for position-specific prevention strategies. Full article

(This article belongs to the Special Issue New Insights into Physical Therapy)

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14 pages, 1907 KB

Open AccessArticle

Oral Contraceptive Use and Reproductive History in Relation to Metabolic Syndrome Among Women from KNHANES 2010–2023

by In Ae Cho, Jaeyoon Jo, Jeesun Lee, Hyunjin Lim, Yun-Hong Cheon and Rock Bum Kim

J. Clin. Med. 2025, 14(17), 6319; https://doi.org/10.3390/jcm14176319 - 7 Sep 2025

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Abstract

Background/Objectives: This study examined how reproductive factors—such as oral contraceptive (OC) use, age at menarche, number of pregnancies, and age at first delivery—are related to the risk of metabolic syndrome (MetS) in Korean women aged 30–69, based on their menopausal status. Methods [...] Read more.

Background/Objectives: This study examined how reproductive factors—such as oral contraceptive (OC) use, age at menarche, number of pregnancies, and age at first delivery—are related to the risk of metabolic syndrome (MetS) in Korean women aged 30–69, based on their menopausal status. Methods: Data from the Korea National Health and Nutrition Examination Survey 2010–2023 were analyzed, including 31,178 women with complete data. Survey-weighted logistic regression and restricted cubic spline analyses were conducted, adjusting for sociodemographic, lifestyle, and reproductive covariates. Results: OC use was associated with higher MetS risk in both pre-menopausal (adjusted OR 1.40, 95% CI 1.13–1.72) and post-menopausal women (adjusted OR 1.16, 95% CI 1.03–1.29). This association was observed primarily in relation to elevated blood pressure in both groups and high triglycerides in post-menopausal women. Other reproductive factors, including age at menarche, number of pregnancies, and age at first delivery, showed no significant associations with MetS risk. Conclusions: OC use was associated with higher MetS risk in this cross-sectional study of Korean women. These observational findings suggest a potential relationship that warrants further investigation through longitudinal studies to establish temporal relationships and explore underlying mechanisms. Full article

(This article belongs to the Topic Gynecological Endocrinology Updates)

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11 pages, 641 KB

Open AccessReview

Patient-Reported Outcomes and Quality of Life After Laparoscopic Pectopexy

by Anna Pitsillidi, Georgios Grigoriadis, Laura Vona, Guenter Noé and Angelos Daniilidis

J. Clin. Med. 2025, 14(17), 6318; https://doi.org/10.3390/jcm14176318 - 7 Sep 2025

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Abstract

Background: Pelvic organ prolapse (POP) significantly impairs patients’ quality of life, especially in urinary, bowel, and sexual domains. While laparoscopic sacrocolpopexy (LS) is the current gold standard for apical prolapse repair, it is associated with certain complications. Laparoscopic pectopexy (LP), a newer technique [...] Read more.

Background: Pelvic organ prolapse (POP) significantly impairs patients’ quality of life, especially in urinary, bowel, and sexual domains. While laparoscopic sacrocolpopexy (LS) is the current gold standard for apical prolapse repair, it is associated with certain complications. Laparoscopic pectopexy (LP), a newer technique utilizing the iliopectineal ligament for apical suspension, may offer improved outcomes with fewer adverse effects. This scoping review aimed to evaluate patient-reported outcomes (PROs) and quality of life (QoL) following LP and compare its effectiveness to other established surgical approaches. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Searches of PubMed, Scopus, and Web of Science databases were performed through June 2025. Eligible studies included randomized controlled trials, prospective and retrospective cohorts, and case series that reported PROs following LP. Data on validated QoL tools (e.g., P-QOL, PFDI-20, PFIQ-7, FSFI, PISQ-12), surgical technique, and follow-up duration were extracted. Due to heterogeneity in the study design and outcomes, findings were synthesized qualitatively. Results: Thirteen studies including a total of 742 patients met the inclusion criteria. Across all included studies, LP was associated with significant improvements in QoL metrics, including urinary and sexual function, and overall patient satisfaction. Tools such as PFDI-20, FSFI, PISQ-12, and PGI-I consistently showed postoperative improvement (p < 0.05). Comparative studies demonstrated that the outcomes for LP were similar or superior to those of sacrocolpopexy, sacrospinous fixation, or sacrohysteropexy, particularly regarding sexual function. Conclusions: LP is an effective surgical alternative for apical POP repair, offering significant improvements in patient-reported quality of life and functional outcomes. Its favorable safety profile and comparable efficacy to traditional methods make it a compelling option, particularly for patients with contraindications to sacral dissection. Findings are limited by small and heterogeneous studies, short follow-up, and potential publication and language biases. Further prospective studies with long-term follow-up periods are necessary to confirm these findings and refine patient selection criteria. Full article

(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Progress and Clinical Challenges)

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J. Clin. Med., Volume 14, Issue 17 (September-1 2025) – 428 articles

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