Journal of Clinical Medicine

10 pages, 750 KB

Open AccessArticle

Positive Airway Pressure-Related Aerophagia in Obstructive Sleep Apnea: Results from the InterfaceVent Real-Life Study

by Celia Vidal, Jean-Pierre Mallet, Sarah Skinner, Raphael Gilson, Olivier Gaubert, Arnaud Prigent, Frédéric Gagnadoux, Jean-Christian Borel, Arnaud Bourdin, Nicolas Molinari and Dany Jaffuel

J. Clin. Med. 2025, 14(18), 6424; https://doi.org/10.3390/jcm14186424 - 11 Sep 2025

Abstract

Background: Continuous positive airway pressure (CPAP) effectiveness can be compromised by adverse effects. Despite its potential impact on adherence and sleepiness, aerophagia remains under-recognized and poorly characterized. This ancillary analysis of the InterfaceVent study aimed to identify risk factors for aerophagia in a [...] Read more.

Background: Continuous positive airway pressure (CPAP) effectiveness can be compromised by adverse effects. Despite its potential impact on adherence and sleepiness, aerophagia remains under-recognized and poorly characterized. This ancillary analysis of the InterfaceVent study aimed to identify risk factors for aerophagia in a large real-life cohort of CPAP-treated patients and to assess its association with both CPAP adherence and sleepiness. Methods: InterfaceVent was a prospective, real-life, cross-sectional study. Adults treated for at least 3 months with CPAP were included. Patients self-reported mask-related side effects using visual analogue scales. Aerophagia was defined as a dichotomous outcome based on patient-reported symptoms and CPAP non-adherence as mean nightly usage <4 h. Sleepiness was assessed using Epworth Sleepiness Scale (ESS). Results: A total of 1461 patients (median age 67 years (Q1–Q3; 60–74); 27.6% women) were included. Aerophagia was reported by 8.3% of participants. Compared to patients without aerophagia, those affected were younger, more frequently female, and had lower BMI. Patients with aerophagia reported a median ESS score of 7 (4–10) versus 5 (3–8) for patients without aerophagia (p < 0.001). CPAP usage was significantly lower in the aerophagia group (median 6.37 vs. 6.75 h/day; p = 0.001), whereas non-adherence, did not significantly differ between groups (10.7% vs. 7.5%; p = 0.20). Conclusions: This ancillary analysis of the InterfaceVent study highlights the burden of aerophagia in CPAP-treated patients and identifies modifiable and non-modifiable risk factors. Better recognition and management of this under-reported side effect may improve CPAP adherence and patient comfort. Trial registration: InterfaceVent is registered with ClinicalTrials.gov (NCT03013283). The first registration date is 23 December 2016. Full article

(This article belongs to the Section Respiratory Medicine)

► Show Figures

Figure 1

14 pages, 994 KB

Open AccessArticle

Impact of Adjuvant Mannitol Administration on the Development of Delirium in Patients with Myocardial Infarction: Results of a Single-Center Pilot Study

by Oleg Olegovich Panteleev, Maria Anatolievna Kercheva, Vyacheslav Valerievich Ryabov, Sergey Vitalievich Demianov and Evgeny Viktorovich Vyshlov

J. Clin. Med. 2025, 14(18), 6423; https://doi.org/10.3390/jcm14186423 - 11 Sep 2025

Abstract

Delirium is a severe neuropsychiatric syndrome associated with a prolonged hospital stay and adverse outcomes. Background/Objectives: The aim of this study was to evaluate the efficacy and safety of mannitol in patients with myocardial infarction (MI) for the prevention of delirium. Methods: A [...] Read more.

Delirium is a severe neuropsychiatric syndrome associated with a prolonged hospital stay and adverse outcomes. Background/Objectives: The aim of this study was to evaluate the efficacy and safety of mannitol in patients with myocardial infarction (MI) for the prevention of delirium. Methods: A single-center, pilot, randomized, controlled clinical trial was conducted from 29 December 2024 to 9 May 2025. The study enrolled MI patients aged 65 years and older, with a pain-to-door time of less than 24 h, and a serum C-reactive protein (CRP) level exceeding 25 mg/L. In the mannitol group (n = 20), patients received a single 1 g/kg dose of intravenous mannitol. In the control group (n = 20), patients received standard therapy for MI. The primary outcome was the incidence of delirium. Secondary outcomes included the length of stay in the intensive care unit (ICU), the length of hospital stay, and in-hospital mortality. Results. The incidence of delirium in the mannitol group was 10% compared to 45% in the control group (OR = 7.3636 95% CI: 1.3372–40.5492; z = 2.294; p = 0.0218). The ICU LOS, in-hospital LOS, and in-hospital mortality did not differ between the two groups. Conclusions. Mannitol prescription for MI patients at high risk of delirium may be an effective and safe strategy for its prevention. Full article

(This article belongs to the Section Pharmacology)

► Show Figures

Figure 1

13 pages, 207 KB

Open AccessArticle

How Does the Interaction Between Preterm Delivery and Low Birthweight Contribute to Racial Disparity in Infant Mortality in the United States?

by James Thompson

J. Clin. Med. 2025, 14(18), 6422; https://doi.org/10.3390/jcm14186422 - 11 Sep 2025

Abstract

Background/Objectives: In the United States, Black infants are twice as likely as infants of all other races and ethnicities to die by one year of age. Mediation modeling predicted that preventing low birthweight could alleviate 75% of this disparity. However, the potential [...] Read more.

Background/Objectives: In the United States, Black infants are twice as likely as infants of all other races and ethnicities to die by one year of age. Mediation modeling predicted that preventing low birthweight could alleviate 75% of this disparity. However, the potential confounding and interacting role of preterm birth remains a question. The goal of this study was to determine how birthweight and length of gestation interact in causing racial disparity. Methods: Records from more than 25 million singleton births were retrieved from the United States National Natality Database for the years 2016 to 2022. Two interaction models were evaluated using Bayesian estimation of potential outcomes. The first modeled the interaction between birthweight and length of gestation with both mediators measured as binary (normal/abnormal). The second modeled the interaction using five classifications for both birthweight and length of gestation. Results: Eliminating either abnormal birthweights or abnormal lengths of gestation would reduce racial disparity in infant mortality by approximately 75%. There was no additional reduction of racial disparity by normalizing both. Modeling the combinations of specific categories of birthweight and length of gestation showed Black infants were 2.76 (2.72, 2.79) times more likely to be born with extremely low birthweight and extremely preterm delivery. This single combination explained over 60% of the racial disparity in infant mortality. Conclusions: The current study clarifies how birthweight and preterm birth contribute to racial disparity and illustrates how Bayesian estimation of potential outcomes enables complex mediational investigations. Full article

(This article belongs to the Section Epidemiology & Public Health)

14 pages, 1208 KB

Open AccessArticle

Early Risk Prediction for Biologic Therapy in Psoriasis Using Machine Learning Models Based on Routine Health Records

by Tair Lax, Noga Fallach, Edia Stemmer, Guy Shrem and Mali Salmon-Divon

J. Clin. Med. 2025, 14(18), 6421; https://doi.org/10.3390/jcm14186421 - 11 Sep 2025

Abstract

Background: Psoriasis is a chronic inflammatory skin disease with a variable course. Early identification of patients likely to require biologic therapy may help reduce complications and optimize care. In this study, we developed machine learning (ML) models to predict future biologic therapy [...] Read more.

Background: Psoriasis is a chronic inflammatory skin disease with a variable course. Early identification of patients likely to require biologic therapy may help reduce complications and optimize care. In this study, we developed machine learning (ML) models to predict future biologic therapy use in psoriasis patients. Methods: We conducted a retrospective study using electronic health records (EHR) from Clalit Health Services in Israel, including psoriasis patients who started biologic therapy and matched psoriasis controls. Predictors included demographics, comorbidities, treatment history, and laboratory test results. KNN, SVM, Random Forest, and Logistic Regression ML models were trained on data from either the first five years post-onset or the five years preceding biologic therapy. Performance was evaluated on a held-out test set using AUC-ROC, precision, recall, and F1-score, with an emphasis on recall to maximize identification of true positive cases. Results: The best-performing models incorporated clinical, demographic, and laboratory data. Using data from the first five years after onset, the SVM model achieved the highest performance (AUC = 0.83, recall = 0.7). For data from the five years preceding biologic therapy, the Random Forest model performed best (AUC = 0.93, recall = 0.95). Key predictors included comorbid immune-mediated conditions, topical treatment frequency, and markers of inflammation and metabolism. Conclusions: EHR-based ML models, particularly those incorporating routine laboratory, demographic, and clinical data, can effectively predict future biologic therapy use in psoriasis patients. Model performance may be improved with larger cohorts and more complete clinical and laboratory data. Full article

(This article belongs to the Special Issue Psoriasis in Focus: Current Research, Treatments, and Future Directions)

18 pages, 2800 KB

Open AccessArticle

Dual Impacts of Lung Transplantation on the Recovery and Comorbidity of Interstitial Lung Diseases: A Longitudinal Assessment of the Benefits and Burden

by Stefan Kuhnert, Luise Wilke, Janine Sommerlad, Silke Tello, Athiththan Yogeswaran, Faeq Husain-Syed, Anita Windhorst, Andreas Guenther, Matthias Hecker and Ekaterina Krauss

J. Clin. Med. 2025, 14(18), 6420; https://doi.org/10.3390/jcm14186420 - 11 Sep 2025

Abstract

Background: Lung transplantation (LTx) is a life-saving intervention for patients with advanced interstitial lung disease (ILD), markedly improving pulmonary function, exercise capacity, and right heart function, yet it is often accompanied by increased risks of metabolic, cardiovascular, and renal complications. Methods: We conducted [...] Read more.

Background: Lung transplantation (LTx) is a life-saving intervention for patients with advanced interstitial lung disease (ILD), markedly improving pulmonary function, exercise capacity, and right heart function, yet it is often accompanied by increased risks of metabolic, cardiovascular, and renal complications. Methods: We conducted a longitudinal analysis of 102 ILD patients post-LTx, integrating pulmonary, cardiovascular, metabolic, and functional parameters. Recovery was assessed using lung function parameters (FVC, DLCO, TLC, ITGV, and FEV1), 6MWD, Borg scores, sPAP, TAPSE, BMI, and weight, while the comorbidity burden was monitored via the Comorbidity–Polypharmacy Score (CPS). Results: Patients showed marked post-LTx improvements, with FVC and DLCO increasing by +37.99% and +42.90%, 6MWD by +166.5 m, and dyspnea decreasing by −3.25 points (Borg scale). Right heart function improved (sPAP −23.79 mmHg and TAPSE increased). Despite these gains, renal function (eGFR −14.14 mL/min/1.73 m²/year) and platelet counts (−17.79 × 10⁹/L/year) declined, while the CPS nearly doubled (16 to 30), reflecting rising comorbidities, including hypertension, diabetes, osteoporosis, reflux, and malignancies. Conclusions: While LTx significantly enhances pulmonary function, exercise capacity, and hemodynamics in ILD patients, it also triggers complex systemic adaptations and a rising comorbidity burden, underscoring the need for dynamic risk stratification and integrated care to balance the benefits and burden over time. Full article

(This article belongs to the Special Issue Lung Transplantation: Clinical Advances and Practice Updates)

► Show Figures

Figure 1

20 pages, 1344 KB

Open AccessSystematic Review

High-Energy Lasers in Oral Oncology: A Systematic Review and Meta-Analysis

by Diana Dembicka-Mączka, Jakub Fiegler-Rudol, Dariusz Skaba, Aleksandra Kawczyk-Krupka and Rafał Wiench

J. Clin. Med. 2025, 14(18), 6419; https://doi.org/10.3390/jcm14186419 - 11 Sep 2025

Abstract

Background: High-energy laser systems may offer oncologic control with fewer complications in OSCC. Methods: Following PRISMA 2020, 30 studies were synthesized. Effect sizes were pooled as HR, OR, or SMD, with 95% CIs using inverse variance methods. Fixed effects were used when [...] Read more.

Background: High-energy laser systems may offer oncologic control with fewer complications in OSCC. Methods: Following PRISMA 2020, 30 studies were synthesized. Effect sizes were pooled as HR, OR, or SMD, with 95% CIs using inverse variance methods. Fixed effects were used when I² ≤ 50, random effects otherwise. Risk of bias was assessed with RoB 2 and ROBINS-I. Results: Compared with conventional surgery, laser resection was associated with lower local recurrence (OR 0.58, 95% CI 0.43 to 0.77, I² 47, random effects), higher 3-year overall survival (HR 0.72, 95% CI 0.55 to 0.94, I² 22, fixed effects), and fewer intraoperative complications (OR 0.29, 95% CI 0.18 to 0.47, I² 39, random effects). Quality of life favored lasers at 3 months (SMD 0.61, 95% CI 0.38 to 0.84, I² 66, random effects). Upon subgroup analysis, CO₂ and Er,Cr:YSGG showed the most consistent benefits. Risk of bias was commonly low for sequence generation and reporting, but high for blinding due to the surgical context. Several cohorts were observational with potential confounding. Funnel plots and Egger tests did not indicate major small-study effects for the primary outcomes. Conclusions: High-energy lasers, particularly CO₂ and Er,Cr:YSGG, are associated with improved oncologic and functional outcomes versus conventional surgery. Given the study heterogeneity, limited RCTs, and risks of bias, these findings should be interpreted with caution and confirmed in standardized, multicenter randomized trials. The protocol is registered with PROSPERO (CRD420251119822). Full article

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

14 pages, 1398 KB

Open AccessArticle

Correlation Between Fungal and Bacterial Populations in Periodontitis Through Targeted Sequencing: A Pilot Study

by Jacob Ayers, Jennifer Chinnici, Amarpreet Sabharwal, Pinar Emecen-Huja, Hua-Hong Chien, Shilpi Joshi and Abhiram Maddi

J. Clin. Med. 2025, 14(18), 6418; https://doi.org/10.3390/jcm14186418 - 11 Sep 2025

Abstract

Background and Objective: The oral microbiome plays an important role in oral health and disease, including periodontitis, which affects about 40% of the adult population in the United States. Bacterial pathogens have been well studied and documented in their relationship with periodontitis; however, [...] Read more.

Background and Objective: The oral microbiome plays an important role in oral health and disease, including periodontitis, which affects about 40% of the adult population in the United States. Bacterial pathogens have been well studied and documented in their relationship with periodontitis; however, the role of fungi in periodontitis is still unclear. The purpose of this study is to determine the relationship of specific fungal species with periodontal pathogenic bacteria in healthy, mild periodontitis, and severe periodontitis patients. Methods: In this study, human participants were recruited, and saliva samples were collected. Twelve participants representing periodontal health (n = 2), mild periodontitis (n = 3), and severe periodontitis (n = 7) were included. Salivary samples were sequenced for analysis of their mycobiome (ITS sequencing) and microbiome (16s RNA sequencing). Results: A total of 375 species of bacteria and 39 species of fungi were identified among all samples. Clustering was observed for bacteria in healthy and mild periodontitis, but more variability was observed in the severe periodontal disease group. Variability was observed for fungi among all samples and groups. Red complex bacteria were negatively correlated with Candida species for the disease groups, although the correlation was not statistically significant. A significant correlation was observed between red-complex bacteria in the severe periodontal disease group. Additionally, a significant correlation was observed among Candida species in all groups. Conclusions: This pilot study simultaneously processed saliva samples for microbiome and mycobiome sequencing and found a trend towards negative correlation between Candida species and red complex bacteria. Full article

(This article belongs to the Special Issue Advances in Periodontitis and Other Periodontal Diseases)

► Show Figures

Figure 1

16 pages, 340 KB

Open AccessArticle

Prognostic Value of FasL, BDNF, and IL-1β as Predictors of Therapeutic Response in Schizophrenia

by Zofia Szymona-Kuciewicz, Maja Owe-Larsson, Marta Flis, Hanna Karakula-Juchnowicz, Barbara Zdzisinska, Ewa Dudzinska, Ewa M. Urbanska and Kinga Szymona

J. Clin. Med. 2025, 14(18), 6417; https://doi.org/10.3390/jcm14186417 - 11 Sep 2025

Abstract

Background/Objectives: Pro-inflammatory, neurotrophic, and proapoptotic factors affect the course of schizophrenia; however, their impact on the clinical response during relapse is not well recognized. A member of TNF family, Fas ligand (FasL), participates in apoptosis, but its connection with treatment-resistant schizophrenia is [...] Read more.

Background/Objectives: Pro-inflammatory, neurotrophic, and proapoptotic factors affect the course of schizophrenia; however, their impact on the clinical response during relapse is not well recognized. A member of TNF family, Fas ligand (FasL), participates in apoptosis, but its connection with treatment-resistant schizophrenia is unknown. Methods: For this preliminary exploratory study, 53 patients with schizophrenia relapse and 45 healthy subjects were enrolled. Pro-inflammatory interleukin IL-1β, brain-derived neurotrophic factor (BDNF), FasL levels, and clinical evaluations (PANSS, SANS, SAPS) were studied at admission, after a 4-week therapy, and at remission. Results: In the clozapine-treated therapy-resistant group, IL-1β correlated negatively with clinical improvement (admission, 4-week treatment). In patients not treated with clozapine, IL-1β correlated negatively with disease duration (admission). A negative correlation occurred between FasL and clinical improvement in general symptoms (admission, 4-week treatment), FasL and leukocyte count (admission), and IL-1β and BDNF levels (4-week treatment). In the clozapine-treated group, the negative correlation between FasL levels and the leukocyte count was absent. Conclusions: The severity of psychopathology in patients with schizophrenia seems to correlate with higher IL-1β and lower BDNF. The novelty of our findings is the observation that higher FasL is negatively associated with the degree of clinical improvement. Thus, a decline of FasL during treatment may be proposed as a predictor of clinical recovery. With caution, we suggest that clozapine use may be linked to a protective effect against FasL signaling and the alleviation of apoptotic processes. Full article

(This article belongs to the Special Issue Innovations in Psychosis and Schizophrenia: New Findings and Implications)

15 pages, 782 KB

Open AccessReview

Artificial Intelligence in Nuclear Cardiology

by Roberto Sciagrà, Samuele Valente and Marco Dominietto

J. Clin. Med. 2025, 14(18), 6416; https://doi.org/10.3390/jcm14186416 - 11 Sep 2025

Abstract

Background/Objectives: Artificial Intelligence (AI) is becoming increasingly important in Medicine. The aim of this review is to summarize its use in the field of Nuclear Cardiology. Methods: First, we provide a short description of how AI works. Then we performed a [...] Read more.

Background/Objectives: Artificial Intelligence (AI) is becoming increasingly important in Medicine. The aim of this review is to summarize its use in the field of Nuclear Cardiology. Methods: First, we provide a short description of how AI works. Then we performed a review of the literature focusing on the articles in which AI is used for image interpretation for diagnostic or prognostic purposes. Results: AI has been applied according to various approaches for both diagnosis and prognosis. The achieved gains have been so far relatively limited as compared to traditional methodologies. However, promising results have been reported, including interesting perspectives for the explainability of AI results and their potential integration in clinical routine. Conclusions: AI is soon going to play an important role in Nuclear Cardiology, but further improvements are needed to reach significant gains in terms of diagnostic accuracy, and prospective studies on its prognostic capabilities are still lacking. Furthermore, several important issues must be solved, such as availability and feasibility within the processing workflow, explainability, liability, and ethics of its application in clinical decision-making. Full article

(This article belongs to the Special Issue Clinical Perspectives in Cardiac Imaging: How to See the Unseen)

► Show Figures

Figure 1

12 pages, 231 KB

Open AccessArticle

Symptoms of Emotional Disorders and Their Co-Occurrence with Adherence Levels in Individuals Aged 55 and Older with Chronic Diseases

by Anna Polak-Szabela, Irena Wrońska and Mariola Głowacka

J. Clin. Med. 2025, 14(18), 6415; https://doi.org/10.3390/jcm14186415 - 11 Sep 2025

Abstract

Background/Objectives: Adherence to therapeutic recommendations is a key factor influencing treatment effectiveness, particularly in older adults with chronic diseases. Emotional disorders, such as depression and anxiety, may significantly affect adherence and overall health outcomes. The aim of this study was to analyze [...] Read more.

Background/Objectives: Adherence to therapeutic recommendations is a key factor influencing treatment effectiveness, particularly in older adults with chronic diseases. Emotional disorders, such as depression and anxiety, may significantly affect adherence and overall health outcomes. The aim of this study was to analyze depressive symptoms and trait anxiety in individuals aged 55 years and older and to determine their association with adherence to therapeutic recommendations. Methods: The study included 2040 participants (1406 women and 634 men) aged 55 to 100 years (mean age: 65 years), all of whom had chronic diseases, most commonly cardiovascular and metabolic conditions. The sociodemographic variables analyzed were age, gender, and education level. Emotional functioning was assessed using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI). Therapeutic adherence, defined as the extent to which patients followed their treatment plan, was measured with the Adherence in Chronic Diseases Scale (ACDS). Results: ACDS scores ranged from 0 to 28 points, with a mean of 23.84. The majority of participants demonstrated moderate adherence (1149 individuals; 56.3%), followed by high adherence (593 individuals; 29.1%), while low adherence was observed in 298 participants (14.6%). Age and education level were not significantly correlated with adherence (p > 0.05). However, BDI scores showed a weak but statistically significant negative correlation with adherence (r = −0.185; p < 0.05). Similarly, STAI scores demonstrated a weak but significant negative correlation with adherence (r = −0.203; p < 0.05). In addition, BDI and STAI results were moderately correlated with each other (r = 0.453; p < 0.05). No significant differences in adherence were observed between men and women. Conclusions: In this large cohort of over 2000 Polish adults aged 55 years and older with chronic diseases, higher levels of depressive and anxiety symptoms were consistently associated with poorer adherence, with the co-occurrence of both disorders further amplifying this effect. These findings provide confirmatory evidence from an underrepresented Central European population with multimorbidity and underscore the need for systematic mental health screening and adherence-focused interventions in older patients. Full article

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

12 pages, 844 KB

Open AccessArticle

Multimodal Evaluation of Arrhythmogenic Substrate Predicts Atrial Fibrosis and Atrial Fibrillation Recurrence After Catheter Ablation

by Ioan-Alexandru Minciună, Raluca Tomoaia, Patricia Vajda, Nicoleta Cosmina Hart, Renata Paula Agoston, Tudor Cornea, Georgiana Alexandra Birsan, Andreea-Maria Linul, Gabriel Cismaru, Mihai Puiu, Radu Ovidiu Roșu, Gelu Simu and Dana Pop

J. Clin. Med. 2025, 14(18), 6414; https://doi.org/10.3390/jcm14186414 - 11 Sep 2025

Abstract

Background/Objectives: For many years, catheter ablation (CA) has been a cornerstone in atrial fibrillation (AF) rhythm control therapy; however, recurrence remains common. Multiple parameters have been proposed to quantify AF arrhythmogenic substrate, yet reliable predictors of long-term outcomes are lacking. To assess [...] Read more.

Background/Objectives: For many years, catheter ablation (CA) has been a cornerstone in atrial fibrillation (AF) rhythm control therapy; however, recurrence remains common. Multiple parameters have been proposed to quantify AF arrhythmogenic substrate, yet reliable predictors of long-term outcomes are lacking. To assess the value of non-invasive amplified P-wave duration (PWD), echocardiographic parameters, biomarkers, and electroanatomical mapping (EAM) were used in predicting left atrial (LA) fibrosis and arrhythmia recurrence after CA. Methods: We included 196 patients undergoing first CA for paroxysmal or persistent AF. Amplified 12-lead ECG PWD parameters [Pmax, Pmin and left atrial P-wave (LAP)], echocardiographic parameters, and biomarkers were assessed pre-procedure. We measured low-voltage areas (LVA, 0.2–0.5 mV) on high-density voltage EAM during sinus rhythm as a surrogate of fibrosis. Freedom from arrhythmia was evaluated at 6 and 12 months. Results: Patients with LVA on EAM had prolonged Pmax (148 vs. 135 ms, p < 0.0001), Pmin (111 vs. 101.5 ms, p = 0.0001), LAP (73.5 vs. 55.5 ms, p < 0.0001), larger LA diameter (p = 0.0002), area (p = 0.0365) and volume (p = 0.004), higher E/E’ (p = 0.0007) and E/A ratios (p = 0.037), more mitral regurgitation (p = 0.0315), and higher pro-BNP levels (p = 0.0094). Univariate analysis showed 12-month recurrence rates higher with greater Pmax, Pmin, LAP, LVA presence and extent; however, in multivariate analysis, only P-wave parameters remained independently associated with recurrence. Conclusions: Prolonged PWD parameters strongly reflect LA substrate (Pmax, Pmin) and independently predict post-ablation AF recurrence (Pmax, Pmin, and LAP). LA size, diastolic dysfunction, and mitral regurgitation were associated with LA fibrosis, while pro-BNP was associated with both fibrosis and arrhythmia recurrence. Integrating these simple, non-invasive markers into a multimodal assessment alongside EAM could improve pre-procedural risk stratification and guide individualized ablation strategies. Full article

(This article belongs to the Special Issue Advances in Catheter Ablation: Current Challenges and Future Perspectives)

► Show Figures

Figure 1

16 pages, 2355 KB

Open AccessArticle

Investigating the Metabolic Benefits of Magnetic Mitohormesis in Patients with Type 2 Diabetes Mellitus

by Fan Shuen Tseng, Gek Hsiang Lim, Yong Mong Bee, Phong Ching Lee, Yee Kit Tai, Alfredo Franco-Obregón and Hong Chang Tan

J. Clin. Med. 2025, 14(18), 6413; https://doi.org/10.3390/jcm14186413 - 11 Sep 2025

Abstract

Background/Objectives: Exercise is a key pillar in the management of type 2 diabetes mellitus (T2DM), but adherence rates to physical activity are poor. Pulsed electromagnetic field (PEMF) therapy, termed magnetic mitohormesis (MM), has been shown in preclinical and early human studies to [...] Read more.

Background/Objectives: Exercise is a key pillar in the management of type 2 diabetes mellitus (T2DM), but adherence rates to physical activity are poor. Pulsed electromagnetic field (PEMF) therapy, termed magnetic mitohormesis (MM), has been shown in preclinical and early human studies to mimic the metabolic benefits of exercise without physical strain. However, its effects on glycemic control remain unknown. We evaluate the metabolic benefits of MM in patients with suboptimally-controlled T2DM. Methods: An exploratory study was conducted in 40 adults with T2DM (glycated hemoglobin, HbA1c 7.0–10.0%). MM treatment comprised 12 sessions organized weekly, where low-dose PEMF was delivered to alternate legs for 10 min per visit. Metabolic assessments—anthropometry, HbA1c, fasting glucose and insulin resistance (measured by Homeostatic Model Assessment for Insulin Resistance, HOMA-IR)—were measured at baseline and post-treatment. Subgroup analysis was performed to compare the effects of MM on patients with and without central obesity (defined as waist-to-hip ratio ≥ 1.0). Results: Participants had a mean age of 59.4 years and HbA1c of 8.1%. MM treatment was well tolerated with no adverse events, and 77.5% of patients completed all 12 sessions. There were no significant changes in HbA1c, fasting glucose or HOMA-IR for the overall cohort. However, in patients with central obesity, 88.9% showed a reduction in HbA1c post-treatment compared to 32.3% without central obesity (p < 0.01), and mean HbA1c decreased from 7.5% to 7.1% (p < 0.01). Conclusions: Our findings suggest that MM is safe and well-tolerated in T2DM patients and may confer a preferential benefit for individuals with greater central obesity. Full article

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

15 pages, 325 KB

Open AccessArticle

Exploring the Link Between Suicidal Concern and Pharmacotherapy in Adolescents: Evidence from a Clinical Cohort

by Francesca Marazzi, Marika Orlandi, Arianna Vecchio, Valentina De Giorgis and Martina Maria Mensi

J. Clin. Med. 2025, 14(18), 6412; https://doi.org/10.3390/jcm14186412 - 11 Sep 2025

Abstract

Background/Objectives: Suicidal risk is a major public health concern among adolescents. Pharmacological treatment in this population remains complex and often targets underlying psychiatric disorders rather than suicidal risk itself. This study aimed to examine associations between suicidal concern (SC) and psychotropic prescriptions in [...] Read more.

Background/Objectives: Suicidal risk is a major public health concern among adolescents. Pharmacological treatment in this population remains complex and often targets underlying psychiatric disorders rather than suicidal risk itself. This study aimed to examine associations between suicidal concern (SC) and psychotropic prescriptions in hospitalized adolescents with psychiatric disorders. A secondary aim was to assess whether suicidal risk level predicted pharmacological treatment at discharge (T1). Methods: A cross-sectional study was conducted on 224 adolescents (men age = 15.4, SD = 1.55). SC was assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Participants were categorized into SC and without SC (No Suicidal Concern—NSC) groups and further stratified by low and high suicidal risk. Psychotropic prescriptions at admission (T0) and T1 were compared, adjusting for age, gender, and psychiatric diagnoses. Results: The SC group showed more severe clinical presentations, including higher symptom burden and functional impairment. At discharge, they were more frequently prescribed antipsychotics and supplements, and more often received multiple medications compared to the NSC group. Logistic regression confirmed SC as a significant predictor of antipsychotic and supplement prescriptions at T1, independent of age, gender, and diagnosis. In contrast, suicidal risk level did not significantly predict specific prescriptions or polypharmacy prescriptions. Conclusions: SC appears to influence pharmacological decisions beyond diagnostic classifications, with a tendency toward risk-containment strategies. These findings emphasize the need for individualized, developmentally appropriate, and evidence-based treatment planning. Importantly, SC should be considered not only as a symptom but as a potential independent treatment target in adolescent psychiatry. Full article

(This article belongs to the Special Issue (Recent Advances) Treating Psychiatry Disorders in Children and Adolescents: From Theory to Practice: 2nd Edition)

► Show Figures

Figure 1

17 pages, 1886 KB

Open AccessArticle

Prevalence of Obesity After Living Kidney Donation and Associated Risk Factors: Cardiovascular and Renal Implications

by Ana Cunha, Manuela Almeida, Beatriz Gil Braga, Sofia Sousa, José Silvano, Catarina Ribeiro, Sofia Pedroso, La Salete Martins and Jorge Malheiro

J. Clin. Med. 2025, 14(18), 6411; https://doi.org/10.3390/jcm14186411 - 11 Sep 2025

Abstract

Background: Living kidney donor (LKD) transplantation contributes to mitigating the organ shortage and some programs now accept donors with borderline criteria, such as obesity. However, the long-term impact of these criteria extension remains unclear. Methods: This study retrospectively analyzed 306 LKD from 1998 [...] Read more.

Background: Living kidney donor (LKD) transplantation contributes to mitigating the organ shortage and some programs now accept donors with borderline criteria, such as obesity. However, the long-term impact of these criteria extension remains unclear. Methods: This study retrospectively analyzed 306 LKD from 1998 to 2020 to examine obesity trends, predictors, and impact on cardiovascular risk and kidney function. Results: Before donation, 49% of donors were normal weight, 41% were overweight, and 10% were obese. Obese donors were older (50.8 ± 8.8 years, p = 0.009) and had higher rates of dyslipidemia and hypertension (41%, p < 0.001 for both). Over 9 years, obesity rates were stable (8.8–14.8%). A mixed logistic regression model showed that dyslipidemia (OR 6.1, p = 0.042), age (OR 0.9, p = 0.005) and body mass index (OR 5.3, p < 0.001) were strong predictors of post-donation obesity. Overweight donors showed an increase in obesity rates over time in the McNemar’s paired analysis [14% obesity by year 3 (p = 0.001); 12.5% at year 10 (p = 0.014)]. Post-donation hypertension was more prevalent in obese donors’ (61.1% vs. 30.4%, p = 0.011), though proteinuria and estimated glomerular filtration rate (eGFR) did not differ significantly. Conclusions: These findings show that pre-donation overweight, younger age, and dyslipidemia predict post-donation obesity, with hypertension posing added risk for obese donors. There was no impact concerning proteinuria and eGFR. The study underscores the importance of careful donor selection and risk informed counseling. Full article

(This article belongs to the Section Nephrology & Urology)

► Show Figures

Figure 1

16 pages, 1737 KB

Open AccessArticle

miR-197, miR-101, and miR-143 and Pro-Inflammatory Cytokines in Migraine

by Roberto Carlos Rosales-Gómez, Beatriz Teresita Martín-Márquez, Alvaro Jovanny Tovar-Cuevas, Omar Cárdenas-Saenz, Patricia Orozco-Puga, Milton Omar Guzmán-Ornelas, Nathan Alejandro Peña-Dueñas, Flavio Sandoval-García, Daniela Ortiz-Ríos, Mariana Chávez-Tostado, Diana Mercedes Hernández-Corona, Miriam Méndez-del Villar and Fernanda-Isadora Corona-Meraz

J. Clin. Med. 2025, 14(18), 6410; https://doi.org/10.3390/jcm14186410 - 11 Sep 2025

Abstract

Background: Migraine is a disabling neurological disorder where the release of neuropeptides and a local and systemic proinflammatory state prevail. MicroRNAs (miRs) are epigenetic regulators that control the expression of genes involved in inflammation, neovascularization, and pain-related processes. Cytokines mediate the inflammatory [...] Read more.

Background: Migraine is a disabling neurological disorder where the release of neuropeptides and a local and systemic proinflammatory state prevail. MicroRNAs (miRs) are epigenetic regulators that control the expression of genes involved in inflammation, neovascularization, and pain-related processes. Cytokines mediate the inflammatory state, while miRs can modulate their expression. Methods: This is an analytical and observational study in which subjects with a diagnosis of chronic and episodic migraine and healthy controls were recruited, and the migraine patients were classified by episodic or chronic migraine, as well as with or without aura. Cytokines were measured using the ELISA technique, and the microRNAs hsa-miR-197-3p, hsa-miR-101-3p, and hsa-miR-143-3p were evaluated using qPCR methodology. We also utilized bioinformatic tools, such as miRBase, TargetScan, miRNet, and miRPath, to analyze the interactions and pathways involved. Results: Our findings revealed that hsa-miR-197-3p is elevated in patients without aura (29.91 ± 11.14 with aura vs. 81.10 ± 53.85 without aura, RU; p = 0.021), whereas hsa-miR-143-3p is elevated in episodic migraine (0.0639 ± 0.0227 in EM vs. 0.0308 ± 0.0174, RU p = 0.011). Furthermore, we found higher levels of IL-17 (9.46 ± 1.06 in CM vs. 7.61 ± 2.12 in EM, p = 0.030), IL-6 (4.95 ± 2.84 in CM vs. 1.52 ± 0.98 non-migraine subjects, p = 0.016), and TNFα in chronic migraine patients (0.46 ± 0.24 in CM vs. 0.20 ± 0.05 in non-migraine, p = 0.011 and vs. 0.20 ± 0.13 in EM, p = 0.016). Conclusions: Inflammation is present in migraine regardless of the clinical characteristics of the patients, although it may be accentuated in chronic migraine. Our preliminary findings suggest a potential role for peripheral inflammatory markers, including specific microRNAs (miR-197, miR-101, and miR-143) and cytokines (TNF-α, IL-6, and IL-17A), in the pathophysiology of migraine. These results, although limited by sample size and cross-sectional design, highlight molecular pathways that warrant further investigation. Full article

(This article belongs to the Special Issue Advances and Updates in Migraine)

► Show Figures

Figure 1

17 pages, 2293 KB

Open AccessReview

Pathogenic Role of Cytokines in Rheumatoid Arthritis

by Sho Fujimoto and Hiroaki Niiro

J. Clin. Med. 2025, 14(18), 6409; https://doi.org/10.3390/jcm14186409 - 11 Sep 2025

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by a multistep pathogenesis, from the preclinical phase of autoantibody emergence to the clinical onset of synovitis and joint destruction. Cytokines play central roles throughout this progression by orchestrating immune cell activation, tissue inflammation, [...] Read more.

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by a multistep pathogenesis, from the preclinical phase of autoantibody emergence to the clinical onset of synovitis and joint destruction. Cytokines play central roles throughout this progression by orchestrating immune cell activation, tissue inflammation, and bone erosion. In the preclinical phase, several cytokines, including IL-12, IL-6, IL-21 and TGF-β, promote Tfh and Tph cell differentiation, helping autoreactive B cells to produce ACPA. During the clinical phase, TNF-α, IL-6, and IL-1β drive synovitis by activating macrophages and fibroblast-like synoviocytes, while also promoting RANKL (Receptor Activator of Nuclear factor κB Ligand) expression and osteoclast differentiation. This review highlights the pathogenic role of cytokines in RA and discusses their relevance as biomarkers and therapeutic targets. A better understanding of cytokine networks may offer new opportunities for early intervention and disease prevention in RA. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Clinical Updates on Diagnosis and Treatment)

► Show Figures

Figure 1

14 pages, 412 KB

Open AccessArticle

MRI-Based Evaluation of PRP Therapy in Knee Osteoarthritis: WORMS and Synovial Changes at 6 Months

by Takanori Wakayama, Yoshitomo Saita, Sayuri Uchino, Yohei Kobayashi, Hirofumi Nishio, Shin Fukusato, Yasumasa Momoi, Hiroshi Ikeda, Kazuo Kaneko and Muneaki Ishijima

J. Clin. Med. 2025, 14(18), 6408; https://doi.org/10.3390/jcm14186408 - 11 Sep 2025

Abstract

Objective: Platelet-rich plasma (PRP) therapy has become a popular treatment for knee osteoarthritis. We aimed to determine the outcomes of knee osteoarthritis patients following PRP therapy using magnetic resonance imaging (MRI) findings and patient-reported outcome measures (PROMs). Design: In this retrospective observational cohort [...] Read more.

Objective: Platelet-rich plasma (PRP) therapy has become a popular treatment for knee osteoarthritis. We aimed to determine the outcomes of knee osteoarthritis patients following PRP therapy using magnetic resonance imaging (MRI) findings and patient-reported outcome measures (PROMs). Design: In this retrospective observational cohort study, we enrolled 161 patients (221 knees) with varus knee osteoarthritis who received multiple PRP injections at our hospital from June 2017 to June 2019. Patients underwent whole-body MRI before and 6 months after treatment. Whole-organ MRI score (WORMS) cartilage integrity and synovial fluid volume were assessed for the medial femorotibial (MFTJ), lateral femorotibial (LFTJ), and patellofemoral joints (PFJ). Pain visual analog scale and Knee Injury and Osteoarthritis Outcome scores were used as PROMs. In addition, a historical control group of 30 patients with medial knee osteoarthritis who did not receive intra-articular injections was evaluated by MRI over the same period for comparison. Results: After 6 months of PRP therapy, the mean WORMS cartilage score of the LFTJ and PFJ and the total WORMS cartilage score for all three joints improved significantly, and synovial fluid volume reduced significantly. Moreover, a reduction in synovial fluid volume correlated with improvements in several KOOS subscales but not with VAS, which may explain the lack of association with responder status. These results suggest that synovial fluid reduction reflects functional improvement but is not a direct surrogate for pain relief. In addition, the change score of WORMS PFJ cartilage correlated positively with clinical outcomes in responders. By contrast, in the control group, no compartment demonstrated improvement in WORMS cartilage scores, and several compartments showed a trend toward deterioration. Conclusions: In this retrospective observational study, PRP therapy was associated with improvements in WORMS cartilage integrity scores and reductions in synovial fluid volume, with partial correlations to patient-reported outcomes. The inclusion of a historical control group strengthens the interpretation of these findings, although definitive conclusions cannot be drawn. Further randomized controlled trials are needed to confirm these preliminary observations. Full article

(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)

► Show Figures

Figure 1

11 pages, 617 KB

Open AccessReview

Wide-Awake Local Anesthesia with No Tourniquet (WALANT) Carpal Tunnel Release in the Clinic: A Clinical Practice Update

by T. Hunter Stocker-Downing, Rebecca McAllister, Sean Chan, Ian Mullikin and Kevin Krul

J. Clin. Med. 2025, 14(18), 6407; https://doi.org/10.3390/jcm14186407 - 11 Sep 2025

Abstract

Background: Wide-awake local anesthesia with no tourniquet (WALANT) carpal tunnel release (CTR), performed in the clinic setting, has emerged as a safe, efficient, and cost-effective alternative to traditional operating room (OR)-based decompression. With increasing adoption in clinic settings, WALANT CTR offers the potential [...] Read more.

Background: Wide-awake local anesthesia with no tourniquet (WALANT) carpal tunnel release (CTR), performed in the clinic setting, has emerged as a safe, efficient, and cost-effective alternative to traditional operating room (OR)-based decompression. With increasing adoption in clinic settings, WALANT CTR offers the potential to improve access, reduce costs, and maintain excellent patient outcomes. Purpose: This clinical practice update provides an evidence-based summary of clinic-based WALANT CTR, including patient selection, procedural setup, safety profile, cost implications, and system-level considerations for implementation. Recent Findings: Multiple prospective and retrospective studies confirm the safety of WALANT CTR in the clinic setting, with complication rates comparable to OR-based procedures and no increase in surgical-site infections when field sterility is used. Cost analyses report a 70–85% reduction in facility costs per operative case, and patient satisfaction remains consistently high, even among those with anxiety disorders or psychiatric conditions. Adjunctive interventions such as virtual reality technology devices and noise-canceling headphones further enhance the awake surgical experience. Institutional adoption remains variable, with barriers including sterility concerns, billing uncertainty, and credentialing logistics. This clinical update offers detailed, practical guidance on implementing WALANT CTR for surgeons and staff, covering scheduling, staff training, clinical integration, billing, and compliance considerations. Summary: Clinic-based WALANT CTR is a high-value, patient-centered approach supported by a growing body of literature. With appropriate patient selection, streamlined workflows, and institutional support, this model can optimize surgical care delivery in both resource-rich and limited environments. Full article

(This article belongs to the Special Issue Hand Surgery: Clinical Advances and Practice Updates)

13 pages, 1251 KB

Open AccessArticle

Serum Osmolality and Stroke Mortality in the ICU: A U-Shaped Risk Pattern and Its Clinical Implications

by Ge Li and Wenshi Wei

J. Clin. Med. 2025, 14(18), 6406; https://doi.org/10.3390/jcm14186406 - 11 Sep 2025

Abstract

Background: Serum osmolality (SOSM) is a simple and objective tool for assessing hydration status and has been demonstrated in several studies to hold significant prognostic value in patients with cardiovascular and cerebrovascular diseases. This study aims to evaluate the association between SOSM and [...] Read more.

Background: Serum osmolality (SOSM) is a simple and objective tool for assessing hydration status and has been demonstrated in several studies to hold significant prognostic value in patients with cardiovascular and cerebrovascular diseases. This study aims to evaluate the association between SOSM and clinical outcomes in patients with stroke. Methods: This study evaluated the prognostic relevance of SOSM in stroke patients using data from the MIMIC-IV database. Eligible participants were divided into four quartile groups based on their SOSM: Q1, 277.62–296.30 mOsm/kg H₂O; Q2, 296.31–301.60 mOsm/kg H₂O; Q3, 301.61–307.74 mOsm/kg H₂O; and Q4, 307.75–327.50 mOsm/kg H₂O. This study used Cox proportional hazards regression, subgroup analysis, and restricted cubic spline analysis to examine the association between SOSM and mortality. Results: This study included 6005 stroke patients. The 30-day and 365-day mortality rates were 13.49% and 15.84%, respectively. After adjusting for relevant confounders, multivariate Cox regression analysis showed that higher SOSM was independently associated with an increased risk of 30-day death (HR: 1.83; 95% CI: 1.48–2.27; p < 0.001) and 365-day death (HR: 1.71; 95% CI: 1.41–2.08; p < 0.001). Analyses using restricted cubic splines (RCSs) and threshold effect modeling demonstrated a clear U-shaped relationship between SOSM and both short-term and long-term risk of death in stroke patients. Furthermore, subgroup analyses confirmed the stability of this association across diverse patient profiles. Conclusions: SOSM is independently associated with both 30-day and 365-day mortality in stroke patients. Our findings indicate that SOSM may be an effective indicator for stratifying high-risk patients who might benefit from targeted interventions, ultimately improving prognostic outcomes. Full article

(This article belongs to the Section Intensive Care)

► Show Figures

Figure 1

9 pages, 4472 KB

Open AccessArticle

The Use of a DCIA Free Flap with Internal and External Oblique Abdominal Muscle in Compound Oral Cavity Defects: A Pilot Study

by Katarzyna Iwulska, Marcin Czajka, Drążek Jacek, Dubis Przemysław and Mariusz Szuta

J. Clin. Med. 2025, 14(18), 6405; https://doi.org/10.3390/jcm14186405 - 11 Sep 2025

Abstract

Background/Objectives: The deep circumflex iliac artery (DCIA) free flap with internal abdominal oblique muscle (IAOM) is a well-known method of reconstruction used in cases of oral cavity neoplasms. Because the IAOM can be insufficient for extensive defects after removal of advanced carcinomas [...] Read more.

Background/Objectives: The deep circumflex iliac artery (DCIA) free flap with internal abdominal oblique muscle (IAOM) is a well-known method of reconstruction used in cases of oral cavity neoplasms. Because the IAOM can be insufficient for extensive defects after removal of advanced carcinomas of the tongue, floor of the mouth, or gingiva, the additional preparation of a perforator-supported external abdominal oblique (EAOM) muscle flap can be useful. The aim of this study was to introduce the use of a DCIA flap with an IAOM and EAOM island in the reconstruction of oral cavity compound defects. Methods: A retrospective analysis was performed involving eight patients who underwent reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Patients underwent the operation between June 2021 and February 2025 in the Department of Maxillofacial Surgery of the Rydygier Hospital in Kraków, Poland. Results: A group of eight patients underwent an operation due to squamous cell carcinoma of the oral cavity. The most common primary subsite of disease was the floor of the mouth (n = 4, 50%), followed by the lower gingiva (n = 2, 25%) and retromolar area (n = 2, 25%). All patients required resection involving part of the mandible, the floor of the mouth, and part of the tongue simultaneously with reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Osteotomies were performed in two flaps (one single osteotomy, one double osteotomy). Reconstruction was successfully performed in seven out of eight patients (overall success rate 88%). Conclusions: The DCIA free flap with IAOM and perforator-supported EAOM flap is a reliable method for compound soft tissue and bone defects in maxillofacial reconstruction. The use of IAOM and EAOM can be helpful in cases of three-dimensional soft tissue defects of the lower gingiva, the floor of the mouth, and the tongue. The lower gingiva and floor of the mouth can be reconstructed with IAOM, while the more mobile part of the tongue can be reconstructed with a perforator-supported EAOM island. Full article

(This article belongs to the Section General Surgery)

► Show Figures

Figure 1

15 pages, 947 KB

Open AccessArticle

Long-Term Impact of Tonsillectomy on Quality of Life (QoL) in Patients with Palatine Tonsillitis and Palatine Tonsillar Hypertrophy

by Aleksander Jurkiewicz, Przemysław Bant, Kornel Szczygielski, Michał Kaczmarczyk and Dariusz Jurkiewicz

J. Clin. Med. 2025, 14(18), 6404; https://doi.org/10.3390/jcm14186404 - 10 Sep 2025

Abstract

Tonsillectomy is one of the most common surgical procedures and, given the limited efficacy of conservative treatment, remains the primary approach for managing palatine tonsillitis (PT) and palatine tonsillar hypertrophy (PTH). Both conditions negatively affect quality of life (QoL), increase healthcare costs, and [...] Read more.

Tonsillectomy is one of the most common surgical procedures and, given the limited efficacy of conservative treatment, remains the primary approach for managing palatine tonsillitis (PT) and palatine tonsillar hypertrophy (PTH). Both conditions negatively affect quality of life (QoL), increase healthcare costs, and contribute to work absenteeism. Objectives: The primary aim of this study is to assess QoL following tonsillectomy and uvulopalatopharyngoplasty (UPPP) in patients qualified for surgical treatment due to PT and PTH. Methods: A prospective cohort study was conducted among 89 adults (85% follow-up) who had undergone tonsillectomy and UPPP. QoL was assessed 6 years post-op using the Glasgow Benefit Inventory (GBI), the Schwentner questionnaire, and VAS. The study group included 89 patients (85% of those who underwent surgery), including 26 women (29%) and 63 men (71%). Results: Patients with PT and PTH showed significant QoL improvement after palatine tonsillectomy. The mean GBI score indicated QoL improvement after both tonsillectomy (+25.7) and UPPP (+15.8), with the most pronounced improvements in physical and general health. Overall, GBI scores were higher in PT compared to PTH (26.6 compared to 15.5), mainly due to better results in the physical health domain (55.9 compared to 12.9). Conclusions: Palatine tonsillectomy has a positive impact on QoL in both PT and PTH patients, with higher questionnaire scores observed in the PT group. Tonsillectomy contributed more significantly to the improvement in QoL than UPPP, as measured by the GBI, the Schwentner questionnaire, and the Visual Analogue Scale (VAS). Furthermore, our study demonstrated that, when evaluating and qualifying patients for tonsillectomy, a more comprehensive otolaryngological assessment should be conducted, including evaluation of the nasal cavity and nasopharynx, as comorbid conditions in these regions are correlated with postoperative QoL outcomes. Full article

(This article belongs to the Section Otolaryngology)

► Show Figures

Figure 1

14 pages, 750 KB

Open AccessArticle

Ten-Year Experience with Native Joint Septic Arthritis: A Retrospective Cohort Study from a Tertiary Center

by Pietro Cimatti, Jacopo Ciaffi, Benedetta Dallari, Francesco Amicucci, Giovanni Trisolino, Elisa Storni, Alessandra Maso, Francesco Ursini and Dante Dallari

J. Clin. Med. 2025, 14(18), 6403; https://doi.org/10.3390/jcm14186403 - 10 Sep 2025

Abstract

Background: Native joint septic arthritis is a severe infection associated with considerable morbidity. The data about the microbiological spectrum, treatment methods, and long-term outcomes are heterogeneous. Methods: We performed a decade-long retrospective study encompassing all patients with native joint septic arthritis [...] Read more.

Background: Native joint septic arthritis is a severe infection associated with considerable morbidity. The data about the microbiological spectrum, treatment methods, and long-term outcomes are heterogeneous. Methods: We performed a decade-long retrospective study encompassing all patients with native joint septic arthritis treated at our institution, a tertiary orthopedic center. Data on demographics, clinical parameters, microbiology, surgical interventions, and antibiotic use were gathered. Outcomes included reoperation, persistent infection and mortality during follow-up. We used logistic regression to identify predictors of adverse outcomes, and Kaplan–Meier analyses to evaluate reoperation-free survival among microbiologic groups. Results: A total of 114 patients (103 adults and 11 children) were included. Cultures yielded positive results in 72 out of 103 (70%) adults and 8 out of 11 (73%) children. Staphylococcus aureus was the primary pathogen in adults (49% of positives) and children (88%), followed by coagulase-negative staphylococci. Antibiotics were administered to all patients, with combinations of at least two molecules in 68% of adults and 91% of children, while surgical intervention predominantly consisted of debridement alone. In adults, an elevated preoperative white blood cell count was associated with unfavorable outcomes in univariate analysis (odds ratio 1.14, 95% confidence interval 1.01–1.30, p = 0.040). The Kaplan–Meier analysis revealed no significant differences in reoperation-free survival across microbiologic groups (log-rank p = 0.361). Conclusions: Over a ten-year period, Staphylococcus aureus remained the predominant cause of native joint septic arthritis; however, culture-negative cases and coagulase-negative staphylococci were also common. Only preoperative leukocytosis was a predictor of poor outcomes, while microbiologic etiology did not significantly influence the risk of reoperation, potentially indicating early and effective therapy. These findings highlight the intricacy of native joint septic arthritis and the necessity for enhanced diagnostics and prognostic stratification. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

9 pages, 192 KB

Open AccessArticle

Healthcare Service Utilization and Medication Use in 128,239 Children with Atopic Dermatitis in Israel—A Cross-Sectional Case-Control Study

by Naama Tova Cohen, Amit Iton-Schwartz, Doron Comaneshter and Yulia Valdman-Grinshpoun

J. Clin. Med. 2025, 14(18), 6402; https://doi.org/10.3390/jcm14186402 - 10 Sep 2025

Abstract

Background: Atopic dermatitis (AD) is a chronic inflammatory disease requiring topical and systemic treatments. This study examines healthcare service utilization and medication use in children with AD in a large healthcare organization during the year 2024. Methods: A cross-sectional case-control study was conducted [...] Read more.

Background: Atopic dermatitis (AD) is a chronic inflammatory disease requiring topical and systemic treatments. This study examines healthcare service utilization and medication use in children with AD in a large healthcare organization during the year 2024. Methods: A cross-sectional case-control study was conducted comparing 128,239 children with AD to 128,239 matched controls regarding healthcare utilization and medication use. Multivariate analysis assessed differences between the groups. Results: Children with AD had increased healthcare utilization compared to the control group, with higher rates of visits to pediatricians, general practitioners, and dermatologists. A total of 144 children (0.11%) with AD were treated by immunosuppressive drugs, as compared to 78 children (0.06%) in the control group (OR 1.8, 95% CI 1.4–2.4, p-value < 0.001). A total of 410 children (0.32%) were treated with biologic drugs as compared to 12 children (0.01%) in the control group (OR 34.3, 95% CI 19.3–60.9, p-value < 0.001). A total of 34 children (0.03%) were treated with Janus kinase (JAK) inhibitors as compared to 2 children (0.002%) in the control group (OR 17, 95% CI 4.1–70.8, p-value < 0.001). Conclusions: Increased utilization of healthcare services was observed in pediatric patients with AD compared to the control group. As only a small proportion of the children with AD received immunosuppressants, biologic treatments, and JAK inhibitors, we suggest that the use of systemic medications should be strongly considered in pediatric patients with moderate to severe AD. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

9 pages, 411 KB

Open AccessReview

Wearable Sensors for the Assessment of Functional Outcome Following Reverse Shoulder Arthroplasty: A Systematic Scoping Review

by Peter K. Edwards, Jay R. Ebert, William G. Blakeney, Stefan Bauer and Allan W. Wang

J. Clin. Med. 2025, 14(18), 6401; https://doi.org/10.3390/jcm14186401 - 10 Sep 2025

Abstract

This scoping review assessed the current use of wearable sensors in monitoring recovery following reverse shoulder arthroplasty (RSA). A systematic search of electronic databases was undertaken (MEDLINE, EMBASE, CINAHL, and Web of Science) between 2005 and 2024 following the PRISMA-ScR protocol. Studies were [...] Read more.

This scoping review assessed the current use of wearable sensors in monitoring recovery following reverse shoulder arthroplasty (RSA). A systematic search of electronic databases was undertaken (MEDLINE, EMBASE, CINAHL, and Web of Science) between 2005 and 2024 following the PRISMA-ScR protocol. Studies were eligible if they were peer reviewed, available in full text, and reported the use of wearable sensors to evaluate shoulder motion or activity in postoperative RSA patients. Fifty-seven studies were identified, of which six met the inclusion criteria. Studies were either focused on assessing shoulder motion (n = 3) or on measuring upper limb activity counts or activity intensities (n = 3); however the calculation of output variables were different across most studies. Sensors were positioned on the operated upper arm in all studies, though sensor placement on the sternum and the wrist varied. Session durations ranged from 24 h to continuous monitoring beyond seven days. Daily wear times were most commonly during full waking hours. The large variation in wearable sensor configuration, testing protocols, and the calculation of output variables limited the comparability across studies. Standardization in sensor protocols and outcomes is required to enable the reliable wearable assessment of postoperative recovery after RSA. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

► Show Figures

Figure 1

15 pages, 1006 KB

Open AccessArticle

Academic Burnout in University Students with Specific Learning Disorders: The Mediating Role of Anxiety in the Relationship Between Burnout and Depression

by Michela Camia, Matteo Reho, Elisabetta Ferrari, Claudia Daria Boni, Valentina Ferretti, Giacomo Guaraldi, Elisabetta Genovese, Giorgia Varallo, Erika Benassi, Alessia Scarano, Valentina Baldini, Angela Ciaramidaro and Maristella Scorza

J. Clin. Med. 2025, 14(18), 6400; https://doi.org/10.3390/jcm14186400 - 10 Sep 2025

Abstract

Background: The number of students with Specific Learning Disorders (SLDs) in universities has recently increased. Thus, it is important to analyze their difficulties throughout their academic studies and propose adequate interventions to prevent emotional problems and dropout. Previous research has reported higher [...] Read more.

Background: The number of students with Specific Learning Disorders (SLDs) in universities has recently increased. Thus, it is important to analyze their difficulties throughout their academic studies and propose adequate interventions to prevent emotional problems and dropout. Previous research has reported higher levels of internalizing problems (anxiety and depression) in students with SLDs compared to those with typical development. Surprisingly, academic burnout among students with SLDs remains a largely overlooked and under-researched issue. The present work is one of the first studies that seeks to address this critical gap by examining the levels of academic burnout, and exploring its relationship with depression and anxiety in university students both with and without SLDs. Methods: The sample included 120 university students (M = 42, F = 78; mean age = 21.16, SD = 2.26). Of these, 60 students had SLDs and 60 had typical development (TD). Students were asked to complete three questionnaires assessing burnout (BAT-C), depression (BDI-II), and anxiety (STAI-Y). Results: The comparison between groups revealed that students with SLDs reported significantly higher levels of total burnout (mean difference = −3.98, t[118] = −2.59, p = 0.011, d = 0.47) and trait anxiety (mean difference = −2.87, t[118] = −2.73, p = 0.007, d = 0.50), with a moderate effect size for both differences. They also exhibited greater cognitive impairment related to burnout (U = 2333.50, p = 0.006, r = 0.25). No group differences were found in depression. Path analyses showed that while trait anxiety mediated the burnout–depression link in both groups, state anxiety was a significant mediator only for students with SLDs (β = 0.22, p = 0.025). Conclusions: The findings provide new evidence of the importance of monitoring academic burnout and anxiety in students with SLDs. The results show that anxiety plays a crucial mediating role between burnout and depression in students with SLDs, reinforcing the need for specific psychological support programs in universities. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

26 pages, 2810 KB

Open AccessArticle

Assessment of Postural Stability in Semi-Open Prisoners: A Pilot Study

by Michalina Błażkiewicz, Jacek Wąsik, Justyna Kędziorek, Wiktoria Bandura, Jakub Kacprzak, Kamil Radecki, Karolina Kowalewska and Dariusz Mosler

J. Clin. Med. 2025, 14(18), 6399; https://doi.org/10.3390/jcm14186399 - 10 Sep 2025

Abstract

Background/Objectives: This study investigated postural stability in male inmates of a semi-open correctional facility, with a specific focus on comparing individuals with and without a history of substance dependence. The aim was to identify how addiction-related neurophysiological changes impact postural control under [...] Read more.

Background/Objectives: This study investigated postural stability in male inmates of a semi-open correctional facility, with a specific focus on comparing individuals with and without a history of substance dependence. The aim was to identify how addiction-related neurophysiological changes impact postural control under varying sensory and biomechanical demands. Methods: A total of 47 adult male prisoners (mean age: 24.3 years) participated in this study. Nineteen inmates had a documented history of alcohol or drug dependence (addicted group), while twenty-eight had no such history (non-addicted group). All participants were physically able and free of neurological disorders. Postural control was assessed using a stabilometric platform and wireless IMU across six 30 s standing tasks of varying difficulty (bipedal/unipedal stance and eyes open/closed). Linear (center of pressure path and ellipse area) and nonlinear (sample entropy, fractal dimension, and the Lyapunov exponent) sway metrics were analyzed, along with trunk kinematics from IMU data. This study received institutional ethical approval; trial registration was not required. Results: The addicted group showed greater instability, especially in the eyes-closed and single-leg tasks, with increased sway and irregularity in the anterior–posterior direction. IMU data indicated altered trunk motion, suggesting impaired neuromuscular control. In contrast, non-addicted individuals demonstrated more efficient, targeted postural strategies, while addicted participants relied on broader, less selective movements, possibly reflecting compensatory or neuroadaptive changes from substance use. Conclusions: Substance dependence is associated with compromised postural stability in incarcerated men. Balance assessments may be valuable for detecting functional impairments and guiding rehabilitation within prison healthcare systems. Full article

(This article belongs to the Special Issue Substance and Behavioral Addictions: Prevention and Diagnosis)

► Show Figures

Figure 1

16 pages, 866 KB

Open AccessArticle

Optimizing Pediatric Intermediate Care: Clinical Predictors of Deterioration and Length of Stay in a Tertiary Setting

by Giacomo Brisca, Carlotta Pepino, Marcello Mariani, Giacomo Tardini, Marta Romanengo, Emanuele Giacheri, Marisa Mallamaci, Isabella Buffoni, Valentina Carrato, Marina Francesca Strati, Stefania Santaniello, Rossana Taravella, Laura Puzone, Lisa Rossoni, Michela Di Filippo, Daniela Pirlo and Andrea Moscatelli

J. Clin. Med. 2025, 14(18), 6398; https://doi.org/10.3390/jcm14186398 - 10 Sep 2025

Abstract

Background/Objective: Pediatric Intermediate Care Units (PIMCUs) provide enhanced monitoring and support for children who require more care than standard wards but do not meet full Pediatric Intensive Care Unit (PICU) criteria. Despite their growing role, evidence on how to stratify risk and predict [...] Read more.

Background/Objective: Pediatric Intermediate Care Units (PIMCUs) provide enhanced monitoring and support for children who require more care than standard wards but do not meet full Pediatric Intensive Care Unit (PICU) criteria. Despite their growing role, evidence on how to stratify risk and predict clinical trajectories within this specific population remains scarce. This study aimed to identify admission factors associated with (1) early unplanned transfer to the PICU within 48 h and (2) prolonged length of stay (LOS) in the PIMCU of a tertiary Italian pediatric hospital. Methods: We conducted a retrospective observational study including 893 children admitted to the PIMCU at IRCCS Gaslini Children’s Hospital (Genoa, Italy) between January 2022 and June 2023. Demographic, clinical, laboratory, and outcome data were collected. Multivariable logistic regression and negative binomial models were used to assess predictors of early PICU transfer and prolonged LOS, respectively. Results: Early PICU transfer occurred in 2.8% of cases. Tachypnea (OR = 2.80; p = 0.018) and nasogastric tube (OR = 3.72; p = 0.014) at admission were independently associated with PICU transfer within 48 h. Prolonged LOS was significantly associated with the need for respiratory support and the presence of medical devices, including nasogastric tubes, central venous lines, and thoracic/abdominal drains. Conclusions: Specific clinical markers and device use at admission can help identify patients at higher risk of deterioration or extended PIMCU stay, supporting more accurate triage, early intervention, and resource optimization in pediatric intermediate care settings. Full article

(This article belongs to the Section Clinical Pediatrics)

► Show Figures

Graphical abstract

9 pages, 211 KB

Open AccessReview

Peripheral Venipuncture in Pediatric Patients: A Mini-Review of Clinical Practice and Technological Advances

by Luiza Elena Corneanu, Ovidiu Rusalim Petriș, Cătălina Lionte, Mara Sînziana Sîngeap, Eric Oliviu Coșovanu, Sabrina Grigolo and Ivona Andreea Șova

J. Clin. Med. 2025, 14(18), 6397; https://doi.org/10.3390/jcm14186397 - 10 Sep 2025

Abstract

Background: Venous blood collection in pediatric patients is a critical procedure for diagnostic and monitoring purposes, yet it remains considerably more challenging than in adults. Factors such as small vein size, limited cooperation, and heightened sensitivity to pain contribute to technical difficulties and [...] Read more.

Background: Venous blood collection in pediatric patients is a critical procedure for diagnostic and monitoring purposes, yet it remains considerably more challenging than in adults. Factors such as small vein size, limited cooperation, and heightened sensitivity to pain contribute to technical difficulties and increased error rates. Objectives: This mini-review aims to provide a concise synthesis of current clinical practices and emerging technologies that support safer, more efficient venipuncture in children. Results: Key findings include the anatomical and procedural considerations relevant to pediatric venipuncture, age-specific recommendations for technique and positioning, as well as evidence-based strategies to reduce pain and anxiety. Common preanalytical errors, particularly hemolysis and insufficient sample volumes, are also addressed, along with their implications for clinical outcomes. Recent advances in medical digitalization, including the use of venous ultrasound, near-infrared projection, and transillumination, offer valuable support in overcoming procedural challenges. These technologies are not meant to replace human expertise but to complement it, improving vein visualization and increasing first-attempt success rates when integrated into a child-centered approach. Conclusions: Venous blood collection in pediatric patients requires a delicate balance between technical proficiency and human-centered care. Emphasis is placed on the importance of a child-centered approach, combining technical skill with empathy and clear communication. Enhancing the quality and safety of venous sampling in children requires not only training and standardization, but also a deeper understanding of the psychological dimensions involved in pediatric care. Full article

(This article belongs to the Section Clinical Pediatrics)

20 pages, 1071 KB

Open AccessReview

Colchicine and Atherosclerotic Coronary Artery Disease: An Updated Review

by Simona Giubilato, Giuseppe Ciliberti, Pietro Scicchitano, Antonio Di Monaco, Federico Fortuni, Filippo Zilio, Claudio Mario Ciampi, Stefano Cangemi, Antonella Spinelli, Laura Gatto, Luca Franchin, Stefano Cornara, Michele Magnesa, Carlotta Sorini Dini, Enrica Vitale, Nicola Gasparetto, Giovanna Geraci, Roberta Rossini, Roberta Della Bona, Federico Nardi, Domenico Gabrielli, Michele Massimo Gulizia, Massimo Grimaldi, Fabrizio Oliva and Massimo Imazio Show full author list Hide full author list

J. Clin. Med. 2025, 14(18), 6396; https://doi.org/10.3390/jcm14186396 - 10 Sep 2025

Abstract

Atherosclerotic coronary artery disease remains a leading cause of morbidity and mortality worldwide, despite advances in lipid-lowering and antithrombotic therapies. Increasing evidence highlights the pivotal role of inflammation in all stages of atherosclerosis, from plaque formation to rupture. Colchicine, a well-known anti-inflammatory drug [...] Read more.

Atherosclerotic coronary artery disease remains a leading cause of morbidity and mortality worldwide, despite advances in lipid-lowering and antithrombotic therapies. Increasing evidence highlights the pivotal role of inflammation in all stages of atherosclerosis, from plaque formation to rupture. Colchicine, a well-known anti-inflammatory drug traditionally used in gout and pericarditis, has emerged as a promising agent in the secondary prevention of cardiovascular events. Recent clinical trials have demonstrated significant reductions in cardiovascular outcomes with low-dose colchicine, especially in patients with stable CAD and following myocardial infarction. This review provides an updated overview of the pathophysiological rationale for colchicine use in atherosclerosis, summarizes key clinical trial data, and discusses potential mechanisms, safety considerations, and future directions. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Prognosis of Coronary Heart Disease)

► Show Figures

Figure 1

12 pages, 765 KB

Open AccessArticle

Development and Validation of a Scoring System for Prediction of Tolerance to Inhaled Treprostinil in Patients with PAH or PH-ILD

by Alan Lanurias Diaz, Ashwin Kumar, Obada Kholoki, David M. O’Sullivan, Kristen Swanson, Brett Carollo, Joseph Bahgat, Harrison W. Farber and Raj Parikh

J. Clin. Med. 2025, 14(18), 6395; https://doi.org/10.3390/jcm14186395 - 10 Sep 2025

Abstract

Background: Treprostinil has demonstrated effectiveness in treating Pulmonary Arterial Hypertension (PAH) and Pulmonary Hypertension associated with Interstitial Lung Disease (PH-ILD). However, tolerability remains a clinical challenge. Identifying factors influencing tolerability is important, given the adverse outcomes of PAH and PH-ILD and the [...] Read more.

Background: Treprostinil has demonstrated effectiveness in treating Pulmonary Arterial Hypertension (PAH) and Pulmonary Hypertension associated with Interstitial Lung Disease (PH-ILD). However, tolerability remains a clinical challenge. Identifying factors influencing tolerability is important, given the adverse outcomes of PAH and PH-ILD and the potential of treprostinil to slow disease progression. Objective: This study was undertaken to identify tolerance factors and develop a predictive scoring system. Methods: A retrospective analysis of 65 patients (37 PAH, 28 PH-ILD) was conducted using patient history, pulmonary function tests (PFTs), transthoracic echocardiograms (TTEs), and right heart catheterizations (RHCs). Of these, 67.7% (n = 44) tolerated treprostinil, while 32.3% (n = 21) were intolerant. Results: Patients who tolerated treprostinil had better pulmonary function, with a higher forced expiratory volume in one second/forced vital capacity (FEV₁/FVC) ratio (82.27 ± 16.06 vs. 72.86 ± 17.76, p = 0.037) and superior right ventricular function, as indicated by higher tricuspid annular plane systolic excursion (TAPSE: 2.05 ± 0.37 vs. 1.64 ± 0.42, p < 0.001), higher cardiac index (CI: 2.51 ± 0.67 vs. 2.03 ± 0.53, p = 0.003), and improved functional status (p < 0.001). The Inhaled Treprostinil Intolerance Score (ITIS), incorporating TAPSE < 1.6, CI < 2, FEV₁/FVC < 70%, and WHO functional class (FC) 3 or 4, demonstrated strong predictive accuracy (cutoff ≥ 2, AUC = 0.884 ± 0.048, p < 0.001). Predictive performance was stronger in PAH patients (AUC = 0.921 ± 0.053) than PH-ILD (AUC = 0.833 ± 0.093, p < 0.001). Conclusions: These findings demonstrate the importance of clinical parameters in predicting treprostinil tolerance. Further investigation is warranted to refine the scoring system, particularly for PH-ILD patients. Full article

(This article belongs to the Special Issue Advances in Pulmonary Hypertension and Idiopathic Pulmonary Fibrosis)

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Clin. Med., Volume 14, Issue 18 (September-2 2025) – 77 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI