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Volume 14
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J. Clin. Med., Volume 14, Issue 20 (October-2 2025) – 323 articles

Cover Story (view full-size image): Artificial intelligence (AI) is increasingly applied to enhance diagnostic accuracy and efficiency. This study aimed to evaluate the precision of an AI-based method for assessing facial asymmetry. A total of 130 patients were analyzed using 3D facial images captured with the Vectra® M3 system, comparing manual and AI-based methods. Seven bilateral landmarks were identified manually to calculate an asymmetry index, while the AI algorithm automatically detected the same landmarks and computed the index. The accuracy of automated landmark identification was compared with manual measurements. The results demonstrated strong agreement between the two methods for five landmarks. The AI-based approach provides an efficient and reliable tool for facial asymmetry analysis using 3D imaging. View this paper
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10 pages, 214 KB  
Article
Quality of Life in Adults with Congenital Heart Disease: Insights from a Tertiary Centre
by Polona Kacar, Melita Flander and Katja Prokselj
J. Clin. Med. 2025, 14(20), 7451; https://doi.org/10.3390/jcm14207451 - 21 Oct 2025
Viewed by 429
Abstract
Objective: As the survival of individuals born with congenital heart disease (CHD) improves into adulthood, the focus has shifted from traditional clinical outcomes to patient-reported outcome measures that better reflect the impact of the disease on daily life. Our aim was to assess [...] Read more.
Objective: As the survival of individuals born with congenital heart disease (CHD) improves into adulthood, the focus has shifted from traditional clinical outcomes to patient-reported outcome measures that better reflect the impact of the disease on daily life. Our aim was to assess the quality of life (QoL) of adult patients with congenital heart disease (ACHD) followed in a tertiary centre and to evaluate the parameters that influence QoL in this population. Methods: This cross-sectional observational study included patients followed up at the national referral ACHD centre between April and September 2022. Sociodemographic and clinical data were collected from medical records and self-report questionnaires. Quality of life (QoL) was assessed using the validated Short Form–36 (SF-36) and Euro Quality of Life–5 Dimension (EQ-5D) questionnaires, including the EQ Visual Analogue Scale (VAS). Results: A total of 123 ACHD patients were included (median age 34 (29–41) years; 43.9% male). Most participants had moderate CHD (61%), and 14.6% were cyanotic. Overall, SF-36 Physical Component Summary scores were higher than Mental Component Summary scores. Almost half of the patients (48.8%) reported no problems in all five domains of the EQ-5D, with most problems reported in anxiety/depression domain. Patients with severe CHD, cyanosis, or HF reported lower QoL scores across multiple SF-36 domains, particularly general health, role–physical, and physical functioning domains. Conclusions: QoL among ACHD patients in our cohort was generally high in most domains as assessed by the SF-36 and EQ-5D. Patients with HF reported lower QoL scores, emphasizing the importance of close clinical follow-up and the need for tailored QoL assessment tools for this complex population. Full article
(This article belongs to the Special Issue Personalized Therapy and Clinical Outcomes for Congenital Heart Disease)
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14 pages, 544 KB  
Systematic Review
Breastfeeding During and After Breast Cancer Diagnosis—A Systematic Review of the Literature
by Anna Ampatzi, Nikoleta Aikaterini Xixi, Rozeta Sokou, Eleni Karapati, Zoi Iliodromiti, Paraskevi Volaki, Styliani Paliatsiou, Nicoletta Iacovidou and Theodora Boutsikou
J. Clin. Med. 2025, 14(20), 7450; https://doi.org/10.3390/jcm14207450 - 21 Oct 2025
Viewed by 337
Abstract
Background/Objectives: Breast cancer diagnosis in lactating women is relatively uncommon. The term Pregnancy-Associated Breast Cancer (PABC) refers to breast cancer diagnosed during pregnancy or within the first year postpartum. There are several factors that limit the ability to breastfeed. Despite emerging evidence suggesting [...] Read more.
Background/Objectives: Breast cancer diagnosis in lactating women is relatively uncommon. The term Pregnancy-Associated Breast Cancer (PABC) refers to breast cancer diagnosed during pregnancy or within the first year postpartum. There are several factors that limit the ability to breastfeed. Despite emerging evidence suggesting that breastfeeding may be feasible and should be supported in women with PABC, there is still limited evidence regarding the percentage of them who attempt breastfeeding, and the challenges they may encounter. This study aims to systematically reviewing the literature on the available evidence regarding breastfeeding in women diagnosed with PABC. Methods: PubMed and Scopus were systematically searched for studies on breastfeeding in PABC until 26 June 2025. Data on breastfeeding outcomes and diagnostic challenges in relation to PABC were extracted. The systematic review is registered in PROSPERO (CRD420251043141). Results: A total of 15 studies met the inclusion criteria and were included in this review. The results showed a scarcity of literature regarding the percentage of women with PABC who breastfeed. Existing data revealed that a small percentage successfully breastfeed. A common occurrence throughout the studies was the concern of breastfeeding during cancer treatment. In almost all cases, reduced milk production was reported, along with the co-administration of formula as a substitute for breast milk. Conclusions: Management of women with PABC should not be limited to oncologic treatment but should also encompass structured breastfeeding counseling and multidisciplinary support, ideally within specialized breast cancer centers. Such integrated care has the potential to optimize maternal health outcomes, improve quality of life, and promote a more favorable pregnancy and postpartum experience. Full article
(This article belongs to the Section Clinical Pediatrics)
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22 pages, 3004 KB  
Article
Comparative Biomechanical Evaluation of Bicortical Screw Versus Plate Fixation in Jones Fractures of the Fifth Metatarsal Using 3D-Printed Models
by Robert Daniel Dobrotă, Mark Pogărășteanu, Dumitru Ferechide, Ioana-Codruța Lebada and Marius Moga
J. Clin. Med. 2025, 14(20), 7449; https://doi.org/10.3390/jcm14207449 - 21 Oct 2025
Viewed by 310
Abstract
Background: Jones fractures of the 5th metatarsal are frequently associated with nonunion due to limited vascularization and repetitive mechanical stress. The aim of the study was to compare the biomechanical performance of T-plate and bicortical screw fixation using standardized 3D models. Methods: Three-dimensional [...] Read more.
Background: Jones fractures of the 5th metatarsal are frequently associated with nonunion due to limited vascularization and repetitive mechanical stress. The aim of the study was to compare the biomechanical performance of T-plate and bicortical screw fixation using standardized 3D models. Methods: Three-dimensional models of the 5th metatarsal were generated from CT images and printed using PolyJet technology (Stratasys J5 DentaJet) using a rigid-elastic composite with properties similar to cortical and cancellous bone. Jones fractures were fixed with either a locked T-plate or a bicortical screw. The samples were tested under axial and oblique static loads (α = 0°, 90°, 180°) and for three values of interfragmentary distance (d = 0.1–1 mm), in a 3 × 2 factorial design. Results: The T-plate fixation recorded a maximum yield force (Fmax) of 149.78 ± 8.53 N (138–161 N), significantly higher compared to the bicortical screw −98.56 ± 2.58 N (96–101 N), (p < 0.05). The ductility index was higher for the plate, indicating a progressive transition to yield. The α and d factors significantly influenced the mechanical behavior, with the polynomial model explaining over 95% of the total variation. Discussion: The plate fixation demonstrated greater strength and superior biomechanical tolerance in imperfect reduction scenarios. The main limitation is the lack of fatigue testing and the inability of 3D models to reproduce the structural heterogeneity of human bone. Conclusions: Implant selection should be individualized based on fracture stability. 3D models provide a reproducible platform for comparative evaluation of osteosynthesis methods, but future studies should include cyclic loading and biological validation. Full article
(This article belongs to the Section Orthopedics)
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12 pages, 1171 KB  
Article
Surgical Pulmonary Embolectomy Versus Systemic Thrombolysis in High-Risk Pulmonary Embolism: A Retrospective Single-Center Analysis
by Arash Motekallemi, Linus C. Markus Rohrwild, Jonas Ajouri, Ridvan Dryana, Tamari Tvildiani, Verena Vach, Ralf M. Muellenbach and Ali Asghar Peivandi
J. Clin. Med. 2025, 14(20), 7448; https://doi.org/10.3390/jcm14207448 - 21 Oct 2025
Viewed by 386
Abstract
Background: Pulmonary embolism (PE) is a life-threatening condition with high mortality, particularly in high-risk cases where rapid clinical deterioration is common. The optimal management strategy for high-risk PE remains debated. Systemic thrombolysis (ST) is widely used but is associated with substantial bleeding risks. [...] Read more.
Background: Pulmonary embolism (PE) is a life-threatening condition with high mortality, particularly in high-risk cases where rapid clinical deterioration is common. The optimal management strategy for high-risk PE remains debated. Systemic thrombolysis (ST) is widely used but is associated with substantial bleeding risks. Surgical pulmonary embolectomy (SPE) has re-emerged as a viable alternative, particularly in patients with contraindications to thrombolysis or failed response. However, the evidence comparing SPE and ST in critically ill patients remains limited, and current guidelines provide only limited guidance. This study aims to evaluate the outcomes between SPE and ST in critically ill patients, focusing on mortality and complication rates. Methods: This retrospective study included 96 high risk patients with severe acute pulmonary embolism treated between 2015 and 2023, with 48 undergoing SPE and 48 receiving ST who were matched 1:1 based on baseline variables and hemodynamic presentation. Outcomes assessed included in-hospital mortality, PE-related death, neurological complications, bleeding events, hospitalization duration, as well as further postinterventional complications. Results: In-hospital mortality was 16.6% in the SPE group in contrast to 25.0% in the ST group (p = 0.765). Neurological complications were significantly lower in SPE (2.1%) compared to ST (12.5%) (p = 0.05). Life-threatening hemorrhage occurred at similar rates in both groups (SPE: 18.8%, ST: 14.6%); however, non-life-threatening bleeding was more common in ST (16.7% vs. 2.1%, p = 0.014). Hospitalization duration was significantly longer for SPE patients (mean 17.4 vs. 11.4 days, p < 0.001), who also presented with more severe disease, including higher ECMO utilization. Conclusions: SPE is a safe and effective alternative to ST in PE, offering comparable mortality, fewer neurologic complication and a reduced risk of bleeding. These findings highlight the importance of individualized, risk-adapted treatment pathways and support the inclusion of SPE as a frontline consideration in the management of PE in critically ill patients in experienced centers with multidisciplinary support. Full article
(This article belongs to the Section General Surgery)
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15 pages, 932 KB  
Article
Interventions for Fontan Pathway Obstruction in Patients Following Total Cavopulmonary Connection
by Nicole Piber, Christina Ruda, Thibault Schaeffer, Muneaki Matsubara, Jonas Palm, Teresa Lemmen, Paul Philipp Heinisch, Stanimir Georgiev, Alfred Hager, Peter Ewert, Markus Krane, Jürgen Hörer and Masamichi Ono
J. Clin. Med. 2025, 14(20), 7447; https://doi.org/10.3390/jcm14207447 - 21 Oct 2025
Viewed by 302
Abstract
Background/Objectives: Obstruction of the Fontan pathway is a severe morbidity after total cavopulmonary connection (TCPC). This study aimed to evaluate the incidence and location of TCPC pathway obstruction and corresponding interventions. Methods: In all patients undergoing TCPC between 1994 and 2023, [...] Read more.
Background/Objectives: Obstruction of the Fontan pathway is a severe morbidity after total cavopulmonary connection (TCPC). This study aimed to evaluate the incidence and location of TCPC pathway obstruction and corresponding interventions. Methods: In all patients undergoing TCPC between 1994 and 2023, postoperative interventions for TCPC pathway obstruction were evaluated. Risk factors for TCPC pathway interventions were identified, and the impact of TCPC pathway interventions on late outcomes was analyzed. Results: Among 650 patients, 136 (21%) needed catheter/surgical interventions for TCPC pathway obstructions during the median duration of 0.2 (0.03–6.1) years postoperatively. Interventions comprised 128 catheters and 10 surgeries. Catheter intervention included 107 left pulmonary arteries (PA), 8 right PAs, and 27 extracardiac conduits. Surgery included eight conduit revisions, four PA enlargements, and two SVC enlargements. Freedom from interventions at 1, 3, 5, and 10 years was 87.7, 85.3, 83.6, and 78.5%, respectively. Previous Norwood procedure (HR: 2.228, p = 0.003), previous ductal stent (HR: 2.574, p < 0.001), previous PA interventions (HR: 2.514, p < 0.001), and high PA pressure before TCPC (HR: 1.161, p = 0.004) were risk factors. Patients requiring interventions had a higher incidence of protein-losing enteropathy (16.0 vs. 2.0%, p < 0.001), plastic bronchitis (8.3 vs. 0.8%, p < 0.001), and failing Fontan (28.6 vs. 7.6%, p < 0.001), compared to those who did not. Conclusions: Interventions for Fontan pathway obstruction were needed in 21% of patients. The left-PA stenosis was the main lesion, most cases of which were treated by stent implantation. Norwood procedure, ductal stent, pre-TCPC PA intervention, and high pre-TCPC PA pressure were identified as risks factors. Full article
(This article belongs to the Section General Surgery)
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11 pages, 1114 KB  
Article
Gait Recovery After Total Hip Arthroplasty with Subtrochanteric Osteotomy in Highly Dislocated Hips: A Retrospective Single-Center Cohort Study
by Chan-Jin Park, Gun-Woo Lee, Chan Young Lee and Kyung-Soon Park
J. Clin. Med. 2025, 14(20), 7446; https://doi.org/10.3390/jcm14207446 - 21 Oct 2025
Viewed by 327
Abstract
Background: We aimed to analyze various gait parameters before and after THA for patients with a highly dislocated hip to examine gait recovery and whether it is continued. Methods: This was a retrospective, single-center study. We enrolled 10 patients with a [...] Read more.
Background: We aimed to analyze various gait parameters before and after THA for patients with a highly dislocated hip to examine gait recovery and whether it is continued. Methods: This was a retrospective, single-center study. We enrolled 10 patients with a highly dislocated hip (10 hips) due to developmental dysplasia of the hip (DDH) or sequelae of septic arthritis of the hip (SSH). A spatio-temporal gait analysis was performed before THA with subtrochanteric osteotomy and one year after surgery for all patients, and 5 of them had a complete follow-up gait analysis at five years postoperatively. Demographics, clinical outcome, and radiological data were collected. Results: At one year postoperatively, the terminal double support (TDS) increased from 8.6% (4.3–12.6) to 11.3% (5.8–14.0) of the gait cycle (p = 0.02). The vertical ground reaction force (vGRF) increased from 0.96 N/BW (0.69–1.30) to 1.11 N/BW (0.95–1.31) for the first peak (p = 0.045) and from 0.87 N/BW (0.59–1.12) to 1.10 N/BW (1.00–1.30) for the second peak (p = 0.001). However, there was no improvement in any gait parameters at five years postoperatively compared to one year postoperatively. The mean HHS was 57.2 (43–67) before surgery and 79.6 (61–88) at the last follow-up (p = 0.001). The preoperative leg length discrepancy (LLD), which was 43.6 mm (18.2–71.6), and improved to 9.8 mm (2.1–22.1) after surgery. Conclusions: Improvements in stance-phase stability (TDS) and vertical ground reaction forces (vGRF) enhanced gait after THA in patients with highly dislocated hips; however, these gains were only observed until 1 year postoperatively, with no further improvement thereafter. Notably, the magnitude of improvement in TDS and vGRF may exceed that typically reported after THA for primary osteoarthritis. Full article
(This article belongs to the Section Orthopedics)
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22 pages, 1939 KB  
Article
Development and Validation of Prognostic Models for Treatment Response of Patients with B-Cell Lymphoma: Standard Statistical and Machine-Learning Approaches
by Adugnaw Zeleke Alem, Itismita Mohanty, Nalini Pati, Cameron Wellard, Eliza Chung, Eliza A. Hawkes, Zoe K. McQuilten, Erica M. Wood, Stephen Opat and Theophile Niyonsenga
J. Clin. Med. 2025, 14(20), 7445; https://doi.org/10.3390/jcm14207445 - 21 Oct 2025
Viewed by 400
Abstract
Background: Achieving a complete response after therapy is an important predictor of long-term survival in lymphoma patients. However, previous predictive models have primarily focused on overall survival (OS) and progression-free survival (PFS), often overlooking treatment response. Predicting the likelihood of complete response before [...] Read more.
Background: Achieving a complete response after therapy is an important predictor of long-term survival in lymphoma patients. However, previous predictive models have primarily focused on overall survival (OS) and progression-free survival (PFS), often overlooking treatment response. Predicting the likelihood of complete response before initiating therapy can provide more immediate and actionable insights. Thus, this study aims to develop and validate predictive models for treatment response to first-line therapy in patients with B-cell lymphomas. Methods: The study used 2763 patients from the Lymphoma and Related Diseases Registry (LaRDR). The data were randomly divided into training (n = 2221, 80%) and validation (n = 553, 20%) cohorts. Seven algorithms: logistic regression, K-nearest neighbor, support vector machine, random forest, Naïve Bayes, gradient boosting machine, and extreme gradient boosting were evaluated. Model performance was assessed using discrimination and classification metrics. Additionally, model calibration and clinical utility were evaluated using the Brier score and decision curve analysis, respectively. Results: All models demonstrated comparable performance in the validation cohort, with area under the curve (AUC) values ranging from 0.69 to 0.70. A nomogram incorporating the six variables, including stage, lactate dehydrogenase, performance status, BCL2 expression, anemia, and systemic immune-inflammation index, achieved an AUC of 0.70 (95% CI: 0.65–0.75), outperforming the international prognostic index (IPI: AUC = 0.65), revised IPI (AUC = 0.61), and NCCN-IPI (AUC = 0.63). Decision curve analysis confirmed the nomogram’s superior net benefit over IPI-based systems. Conclusions: While our nomogram demonstrated improved discriminative performance and clinical utility compared to IPI-based systems, further external validation is needed before clinical integration. Full article
(This article belongs to the Section Oncology)
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15 pages, 954 KB  
Article
Home Is Not Always Safe: Pediatric Unintentional Home Injuries in a Tertiary Emergency Department Setting
by Göksel Vatansever, Erkan Şimşekli, İdil Sivaslı, Ayşe Elçin Özge, Ahmet Hakan Aksu, Adnan Barutçu, İhsan Özdemir, Emre Yaşar Karbancıoğlu, Gülnur Göllü, Ufuk Ateş, Betül Ulukol, Tanıl Kendirli and Deniz Tekin
J. Clin. Med. 2025, 14(20), 7444; https://doi.org/10.3390/jcm14207444 - 21 Oct 2025
Viewed by 470
Abstract
Background/Objectives: Unintentional home injuries (UHIs) are a major yet preventable cause of morbidity and mortality among children. This study aimed to analyze the epidemiological characteristics, injury mechanisms, and clinical outcomes of pediatric UHIs over a nine-year period in Türkiye. Methods: This [...] Read more.
Background/Objectives: Unintentional home injuries (UHIs) are a major yet preventable cause of morbidity and mortality among children. This study aimed to analyze the epidemiological characteristics, injury mechanisms, and clinical outcomes of pediatric UHIs over a nine-year period in Türkiye. Methods: This retrospective study included all children under 18 years who were diagnosed with UHIs in the Pediatric Emergency Department (PED) of a tertiary university hospital between January 2016 and November 2024. Demographic data, injury mechanisms, imaging findings, surgical interventions, hospitalizations, and Pediatric Intensive Care Unit (PICU) admissions were statistically analyzed. Results: Among 852,090 PED visits, 12,327 (1.4%) were diagnosed with UHIs. Most patients were younger than five years (72.1%) and male (56.8%). The leading causes were falls/collisions (60.6%), burns (12.1%), and foreign body aspirations (10.4%). Hospitalization and PICU admission rates were 11.7% and 1.2%, respectively, mainly involving children aged 2–4 years. Younger age and corrosive ingestion were independent predictors of hospitalization, while burns, falls/collisions, corrosive ingestion, poisoning, and foreign body aspiration significantly increased PICU admission risk. A marked rise in both hospital and PICU admissions was observed during the COVID-19 pandemic. Two fatalities occurred following falls. Conclusions: Falls, burns, and foreign body aspirations were the most common causes of pediatric UHIs, predominantly affecting children aged 2–4 years. Strengthening caregiver supervision, promoting safer home environments, and implementing targeted prevention programs are essential to reduce their impact on children and healthcare systems. Full article
(This article belongs to the Section Clinical Pediatrics)
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19 pages, 1142 KB  
Review
Bridging the Gap: The Role of Non-Invasive Respiratory Supports in Weaning from Invasive Mechanical Ventilation
by Giulia Panzuti, Lara Pisani and Stefano Nava
J. Clin. Med. 2025, 14(20), 7443; https://doi.org/10.3390/jcm14207443 - 21 Oct 2025
Viewed by 720
Abstract
Weaning from invasive mechanical ventilation (IMV) is a key element in the management of critically ill patients, encompassing the entire process of discontinuing IMV. Despite its importance, considerable uncertainties remain regarding the optimal strategies to achieve successful weaning. Early weaning is crucial, as [...] Read more.
Weaning from invasive mechanical ventilation (IMV) is a key element in the management of critically ill patients, encompassing the entire process of discontinuing IMV. Despite its importance, considerable uncertainties remain regarding the optimal strategies to achieve successful weaning. Early weaning is crucial, as IMV is associated with complications related to high mortality rates, such as prolonged weaning and intubation-associated pneumonia (IAP). This review aims to highlight the role of non-invasive respiratory supports (NIRSs), including non-invasive ventilation (NIV) and high-flow nasal cannulas (HFNCs), as a therapeutic bridge between IMV dependency and spontaneous breathing. NIV and HFNCs are recommended to prevent post-extubation respiratory failure (PERF) in high-risk and low-risk patients, respectively, and their combination appears effective in high-risk populations. On the other hand, NIV is not advised in established non-hypercapnic PERF, as it may increase mortality by delaying intubation; however, it can facilitate extubation in patients with hypercapnic respiratory failure. NIRSs may also benefit patients at high risk of post-operative pulmonary complications such as acute respiratory failure (ARF), with either NIV or HFNCs being appropriate. In light of this evidence, appropriate NIRSs selection and application may be pivotal in achieving successful weaning and better outcomes in critically ill patients. Full article
(This article belongs to the Special Issue Non-Invasive Respiratory Support: Current Insights and Future Directions)
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13 pages, 388 KB  
Article
Efficacy and Safety of Valproic Acid Transition Regimens from Intravenous to Oral Administration in Epileptic Patients: A Single-Center Cross-Sectional Study
by Liying Chen, Yiting Zhou, Jing Zhang, Lisan Zhang and Guodong Lou
J. Clin. Med. 2025, 14(20), 7442; https://doi.org/10.3390/jcm14207442 - 21 Oct 2025
Viewed by 346
Abstract
Objectives: This study aims to evaluate the efficacy and safety of valproic acid (VPA) transition regimens (from intravenous to oral tablets) for anti-seizure treatment. Methods: A retrospective analysis was conducted on inpatients treated with intravenous VPA and oral tablets for epilepsy [...] Read more.
Objectives: This study aims to evaluate the efficacy and safety of valproic acid (VPA) transition regimens (from intravenous to oral tablets) for anti-seizure treatment. Methods: A retrospective analysis was conducted on inpatients treated with intravenous VPA and oral tablets for epilepsy at the Sir Run Run Shaw Hospital, affiliated with Zhejiang University, between January 2022 and December 2023. Various transition strategies from VPA injections to tablets were examined, and the efficacy and safety of different transition strategies were analyzed. Results: A total of 164 inpatients receiving VPA transition therapy were included in this study, which was divided into three groups based on the transition timing: the 0 h group, the 0–48 h group, and the >48 h group. Regarding VPA dosage, the median daily dose of intravenous VPA was separately 1076.50 mg/day, 1200 mg/day and 1438 mg/day in the 0 h group, 0–48 h group, and the >48 h group. During transition, the daily doses of VPA were significantly higher than that before and after the transition. After completely switching to oral administration, they were all decreased to 1000 mg/day. Moreover, a significant difference regarding the clinical efficacy was observed among the three groups. The >48 h group showed the highest rate of clinical efficacy, which was significantly greater than that of the 0 h group and 0–48 h group. Although there was no statistical significance detected regarding the average blood serum concentrations among the three groups; notably, a higher proportion of patients in the >48 h group (19.35%) had blood concentrations exceeding the desired therapeutic window compared with the 0–48 h group (8.06%) and 0 h group (0%). Adverse events included 30 cases in the 0 h group, 42 in the 0–48 h group, and 67 in the >48 h group, with statistically significant differences in hemoglobin reduction, headache/dizziness, and liver injury. No significant differences were found in digestive and skin-related reactions. Conclusions: The results suggest that the >48 h transition regimen may show some advantages in efficacy but also increases the risk of adverse reactions significantly. Therefore, it is recommended to complete the intravenous-to-oral switch carefully with blood drug concentrations strictly monitored. Full article
(This article belongs to the Section Pharmacology)
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10 pages, 548 KB  
Article
Early Use of Cryoprecipitate Versus Plasma and Clinical Outcomes in Major Spine Surgery
by Aparna Depuru, Jong Ok La, Miriam M. Treggiari and Nicole R. Guinn
J. Clin. Med. 2025, 14(20), 7441; https://doi.org/10.3390/jcm14207441 - 21 Oct 2025
Viewed by 251
Abstract
Background/Objectives: Major spine surgery often leads to significant blood loss and coagulopathy, necessitating blood product transfusion. Cryoprecipitate and plasma are two blood products commonly used to manage coagulopathy, but outcomes associated with their use in spine surgery remain unclear. Methods: This [...] Read more.
Background/Objectives: Major spine surgery often leads to significant blood loss and coagulopathy, necessitating blood product transfusion. Cryoprecipitate and plasma are two blood products commonly used to manage coagulopathy, but outcomes associated with their use in spine surgery remain unclear. Methods: This retrospective cohort study included adult patients undergoing major spine surgery from 2015 to 2022 within a single health system. Included patients received at least one unit of packed red blood cells (PRBCs) followed by either cryoprecipitate or plasma to investigate the treatment of coagulopathy after blood loss. Study endpoints included hospital length of stay (H-LOS), ICU length of stay (ICU-LOS), discharge disposition, one-year mortality, and total blood products transfused up to postoperative day (POD) 2. Multivariable linear and logistic regression was used to estimate associations between the use of cryoprecipitate or plasma and outcomes. Results: Of 189 patients meeting inclusion criteria, 120 received cryoprecipitate, and 69 received plasma as the first product after PRBCs. In the univariable analysis, the cryoprecipitate group had lower 1-year mortality (5.0% vs. 14.5%; [95% CI]: 0.31 [0.10, 0.88], p = 0.0031) and a shorter ICU-LOS (46 vs. 74 h; [95% CI]: 0.73 [0.53, 1.00], p = 0.048). However, despite a trend favoring the cryoprecipitate group, there were no differences between the cryoprecipitate and plasma groups in the multivariable model for H-LOS (adjusted geometric mean ratio [95% CI]: 0.84 [0.68, 1.04], p = 0.109), ICU-LOS (adjusted geometric mean ratio [95% CI]: 0.72 [0.50, 1.04], p = 0.078), one-year mortality (adjusted OR [95% CI]: 0.49 [0.13, 1.88], p = 0.288), or total blood products transfused up to POD2 (adjusted mean difference [95% CI]: −1 unit [−2, 1], p = 0.253). Compared with plasma, patients in the cryoprecipitate group were more likely to be discharged to home independently versus disposition to other facility or needing assistance (adjusted OR 0.41 [95% CI]: 0.16, 0.97, p = 0.049). Conclusions: Use of cryoprecipitate was associated with higher odds of home discharge, while other outcomes were similar between the two groups once adjusting for potential confounders. Further research is needed to better appreciate the clinical impact of the choice of blood products to treat coagulopathy in the setting of bleeding in major spine surgery. Full article
(This article belongs to the Section Orthopedics)
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13 pages, 1710 KB  
Article
Short-Term Outcomes After Transtibial Repair of Medial Meniscus Posterior Root Tears: A Case Series
by Dan Viorel Nistor, Samuel Piu, Diana Raluca Mihu and Romana von Mengershausen
J. Clin. Med. 2025, 14(20), 7440; https://doi.org/10.3390/jcm14207440 - 21 Oct 2025
Viewed by 458
Abstract
Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results [...] Read more.
Background/Objectives: While arthroscopic repair is established for the treatment of medial meniscus posterior root tears (MMPRT), the relationship between physiotherapy (PT) exposure, meniscal extrusion (ME), and structural healing remains unclear. The aim of this study was to evaluate short-term functional and structural results after transtibial pull-out (TPO) repair of isolated MMPRT and to explore the influence of patient age and postoperative physiotherapy volume. Methods: A retrospective single-center case series with 14 adults (64% women, age 59 years, body mass index (BMI) 31.0 kg/m2) who underwent TPO repair (April 2022–June 2024). Mean follow-up was 18.4 months. Outcomes included range of motion (ROM), pain levels using visual analog scale (VAS), International Knee Documentation Committee (IKDC), the Western Ontario Meniscal Evaluation Tool (WOMET), the 36-Item Short Form Survey (SF-36), and MRI-based ME, cartilage grade, and root-healing status. Postoperative PT volume was assessed with a self-developed, custom questionnaire. Correlations and subgroup analyses (<60 vs. ≥60 years) were performed. Results: Mean postoperative ROM was 121° and IKDC 63.4. Median PT exposure was 25.9 h, and the mean duration from symptom to repair was 215 days. MRI demonstrated complete healing in 70% of cases. A positive correlation was observed between postoperative ME and ROM (p = 0.008), while higher PT volume was associated with greater pain scores. Conclusions: TPO repair appears to be a viable treatment option for selected patients with MMPRT, showing acceptable early outcomes, even in older individuals with higher BMIs or delayed repair. Meniscal healing was frequent, although extrusion progression remained common and may influence the function. The observed links between ME, ROM, and PT-related pain highlight the need for standardized rehabilitation assessment. Larger, prospective studies are warranted to validate these exploratory findings and refine postoperative management. Full article
(This article belongs to the Special Issue Clinical Application of Knee Arthroscopy)
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21 pages, 5012 KB  
Article
Post-Traumatic Orbital Reconstruction Using Titanium Patient-Specific Implants: A Clinical and Radiological Cohort Study Focusing on Paranasal Sinuses Physiology
by Waldemar Reich, Louis Widmaier, Ulrich Kisser, Jens Heichel, Sven Otto and Frank Tavassol
J. Clin. Med. 2025, 14(20), 7439; https://doi.org/10.3390/jcm14207439 - 21 Oct 2025
Viewed by 395
Abstract
Background: This longitudinal cohort study evaluated implant-associated bone remodeling and paranasal sinus (PNS) status after the insertion of patient-specific titanium orbital implants (PSIs) in adult trauma patients. Sixteen patients with various orbital fractures underwent CT-based reconstruction at the University Hospital Halle (Germany) and [...] Read more.
Background: This longitudinal cohort study evaluated implant-associated bone remodeling and paranasal sinus (PNS) status after the insertion of patient-specific titanium orbital implants (PSIs) in adult trauma patients. Sixteen patients with various orbital fractures underwent CT-based reconstruction at the University Hospital Halle (Germany) and were followed up to 6.5 years (observation period February/2019–October/2025). Post-operative CT scans assessed orbital bone remodeling, patency of the ostiomeatal unit, and PSI/screw exposure. Findings: Bone apposition was observed in 16 cases; 13 showed a patent maxillary sinus outflow tract. The median Lund score for the injured sides was 1.0 vs. for the uninjured sides 0 (Wilcoxon test, p = 0.131). PSI or screw exposure occurred in isolated cases, and basal maxillary sinusitis was noted in four patients. Significant bone remodeling was detectable from 6 months post-operatively. No implant-associated complications required further intervention. Conclusions and Relevance: These findings highlight the safety and precision of PSIs, with low long-term complication rates and preserved sinus function in non-irradiated patients, supporting their use in complex orbital reconstructions. Full article
(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)
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29 pages, 508 KB  
Review
Clinical Applications of Virtual and Augmented Reality in Radiology: A Scoping Review
by Somin Mindy Lee, Henrique Coimbra Baffi, Tolulope Ola, Brian Tsang, Aaryan Gupta, Ricardo Faingold, Jennifer Stimec and Andrea S. Doria
J. Clin. Med. 2025, 14(20), 7438; https://doi.org/10.3390/jcm14207438 - 21 Oct 2025
Viewed by 425
Abstract
Background: Virtual reality (VR) and augmented reality (AR) have emerged as innovative tools in healthcare, particularly using diagnostic and interventional imaging methods, offering new avenues for enhancing patient care and procedural outcomes. Their applications range from improving preoperative planning and pain management [...] Read more.
Background: Virtual reality (VR) and augmented reality (AR) have emerged as innovative tools in healthcare, particularly using diagnostic and interventional imaging methods, offering new avenues for enhancing patient care and procedural outcomes. Their applications range from improving preoperative planning and pain management to providing advanced procedural support and training. Despite their growing integration into clinical practice, evidence of their cost-effectiveness and specific clinical benefits when using radiological tools remains limited. This review aims to map the current landscape of VR and AR applications using radiological modalities and highlight areas for future research. Objective: This scoping review explores the clinical applications of VR and AR in different radiological fields, aiming at assessing target areas, cost-effectiveness, and benefits of these technologies. Methods: We conducted a comprehensive literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. A total of 15 primary studies were included, covering diverse populations and applications of VR and AR. Results: In total, 15 studies (N = 781 patients) were included, with sample sizes ranging from 6 to 120. These studies highlighted various clinical applications of VR and AR, including imaging-guided preoperative planning, pain management, and procedural support. Although several studies demonstrated improvements in patient experiences and diagnostic accuracy, cost-effectiveness data were lacking. Notably, 47% of the studies focused exclusively on pediatric populations (N = 363), and 33% were randomized controlled trials. Quality assessment using the STARD criteria revealed that 60% of studies were rated as good (score > 12), 27% as fair (score 10–12), and 13% as suboptimal (score < 10), with inter-reader reliability showing substantial agreement (ICC = 0.76; 95% CI: 0.64–0.91). Out of 15 included studies, only 6 (40%) reported statistically significant improvements in patient experiences, with the remaining studies reporting positive trends (e.g., feasibility, usability, improved planning). Individual studies demonstrated significant benefits of VR interventions; for instance, one study reported a reduction in distress scores by a mean of 3.0 (95% CI: 1.0–5.0) and a decreased need for parental presence (risk ratio 0.3; 95% CI: 0.1–0.7; p < 0.001) compared to conventional methods. Conclusions: VR and AR technologies hold promise in enhancing patient care and procedural outcomes. Future research should focus on the cost-effectiveness of these technologies and identify specific target populations that would benefit the most. Additionally, adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) guidelines should be encouraged to ensure transparent and comprehensive reporting in VR and AR studies. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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15 pages, 302 KB  
Protocol
Sleep Disturbances Across Dementias and Cognitive Decline: Study Protocol for a Systematic Review and Network Meta-Analysis of Polysomnographic Findings
by Annibale Antonioni, Arianna Della Valle, Caterina Leitner, Emanuela Maria Raho, Edward Cesnik, Jay Guido Capone, Maria Elena Flacco, Francesca Casoni, Paola Proserpio, Luigi Ferini-Strambi and Andrea Galbiati
J. Clin. Med. 2025, 14(20), 7437; https://doi.org/10.3390/jcm14207437 - 21 Oct 2025
Viewed by 579
Abstract
Sleep disturbances are increasingly recognized as early and clinically meaningful features in the pathophysiology of neurodegenerative diseases. Polysomnography (PSG), i.e., the gold standard for objectively characterizing sleep architecture, may provide non-invasive and scalable biomarkers for both early detection and differential diagnosis of dementia. [...] Read more.
Sleep disturbances are increasingly recognized as early and clinically meaningful features in the pathophysiology of neurodegenerative diseases. Polysomnography (PSG), i.e., the gold standard for objectively characterizing sleep architecture, may provide non-invasive and scalable biomarkers for both early detection and differential diagnosis of dementia. This systematic review and network meta-analysis aims to synthesize existing evidence on PSG-derived sleep alterations across the neurodegenerative continuum, including subjective cognitive impairment, mild cognitive impairment, Alzheimer’s disease, frontotemporal dementia, Lewy body dementia, and Parkinson’s disease dementia, compared to healthy controls. It will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for reporting systematic reviews that include network meta-analyses, and it has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251114418. We will include peer-reviewed studies with nocturnal PSG data from adult participants, categorized using validated diagnostic criteria, and scored according to the most recent American Academy of Sleep Medicine guidelines. Both pairwise and network meta-analyses will be conducted using standardized mean differences to quantify group-level effects. Additional analyses will explore the correlations between PSG parameters, severity of cognitive impairment, behavioral symptoms, treatments, and relevant comorbidities. Longitudinal data, where available, will be analyzed separately to evaluate prognostic value. This study will provide a comprehensive synthesis of PSG alterations across neurodegenerative disorders, offering insights into their diagnostic utility and potential as early markers for stratification in clinical trials of disease-modifying therapies. Full article
(This article belongs to the Special Issue Sleep in Neurology—Sleep Disorders and Dysfunction of the Nervous System)
29 pages, 1306 KB  
Systematic Review
The Application of Combined PET/MRI in Staging and Response Assessment of Rectal Cancer
by Elima Hussain and Vipul R. Sheth
J. Clin. Med. 2025, 14(20), 7436; https://doi.org/10.3390/jcm14207436 - 21 Oct 2025
Viewed by 519
Abstract
Background/Objectives: Rectal cancer is a significant global health concern, requiring precise staging and response assessment to make treatment decisions. Magnetic resonance imaging (MRI) is the standard imaging modality for evaluating tumor stage and treatment response. Positron emission tomography/computed tomography (PET/CT) offers complementary insights [...] Read more.
Background/Objectives: Rectal cancer is a significant global health concern, requiring precise staging and response assessment to make treatment decisions. Magnetic resonance imaging (MRI) is the standard imaging modality for evaluating tumor stage and treatment response. Positron emission tomography/computed tomography (PET/CT) offers complementary insights into pelvic lymph node involvement, tumor response, and distant metastases. Integrating PET and MRI into a hybrid PET/MRI modality can provide superior assessment of tumor staging and response compared to conventional imaging techniques. This review shares an update on the role of PET/MRI in rectal cancer staging and treatment response assessment. Methods: A systematic review of the current literature was conducted by two independent reviewers. This study utilized databases including Embase, Biosis, PubMed, Scopus, and Web of Science, employing the following keywords as eligibility criteria: “PET/MRI” OR “PET/MR” AND “rectal cancer” OR “colorectal cancer” AND “staging” AND “treatment assessment” OR “planning”. The inclusion criteria were that studies must examine cancer staging and response assessment. The exclusion criteria for the search were letters to the editors, abstracts, and case reports; studies that included fewer than five patients; studies that included cancer other than rectal or colorectal cancer; studies that did not utilize PET/MRI for rectal cancer staging and assessment; and non-human studies. Results: PET/MRI demonstrates potential advantages over conventional imaging, providing superior soft tissue contrast, functional imaging capabilities, and improved lesion characterization. A total of ten studies suggest that PET/MRI may enhance tumor staging accuracy and better assess pelvic lymph node involvement than PET/CT and MRI alone; in four studies, PET/MRI also showed higher response accuracy. Challenges remain in standardizing imaging protocols, validating PET tracers, and encouraging widespread clinical adoption. Conclusions: PET/MRI has the potential to offer a superior imaging solution for rectal cancer staging and treatment response assessment. While preliminary studies highlight its advantages over PET/CT and MRI alone, further research is needed to establish standardized protocols, validate PET tracers for routine clinical use, and improve imaging quality through attenuation and motion correction. Full article
(This article belongs to the Special Issue Application of Magnetic Resonance Imaging (MRI) in the Diagnosis, Staging and Follow-Up of Oncological Diseases)
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15 pages, 2400 KB  
Article
The Effect of Bazedoxifene and Fulvestrant for Preventing Ovarian Hyperstimulation Syndrome: An Experimental Study
by Fatma Ozdemir, Gokhan Acmaz, Arzu Hanim Yay, Ozge Cengiz Mat, Gozde Erturk Zararsiz, Banu Acmaz, Ipek Muderris, Sabahattin Muhtaroglu, Erol Karakas and Mevlude Inanc
J. Clin. Med. 2025, 14(20), 7435; https://doi.org/10.3390/jcm14207435 - 21 Oct 2025
Viewed by 359
Abstract
Background: Ovarian hyperstimulation syndrome (OHSS) remains a major complication during controlled ovarian stimulation, particularly in women with high estradiol levels. This study aimed to investigate whether bazedoxifene or fulvestrant could be effective in preventing OHSS. Methods: Forty 22-day-old Wistar albino rats were randomly [...] Read more.
Background: Ovarian hyperstimulation syndrome (OHSS) remains a major complication during controlled ovarian stimulation, particularly in women with high estradiol levels. This study aimed to investigate whether bazedoxifene or fulvestrant could be effective in preventing OHSS. Methods: Forty 22-day-old Wistar albino rats were randomly assigned to four groups (n = 10 each). Group 1 received saline (negative control). Group 2 received pregnant mare serum gonadotropin (PMSG) plus hCG (positive control). Group 3 received PMSG + hCG plus fulvestrant, and Group 4 received PMSG + hCG plus bazedoxifene. Rat weight, peritoneal fluid, follicle counts, serum estradiol and VEGF levels, and ovarian ER/VEGF immunoreactivity were evaluated. Results: Peritoneal fluid was absent in controls but detected in 80% of positive controls and 40% of both treatment groups. Tertiary follicles and atresia were significantly higher in OHSS rats compared to controls. Fulvestrant reduced stromal ER expression, while bazedoxifene increased it. Both drugs decreased ascites formation and weight gain. Fulvestrant treatment showed unexpectedly elevated serum estradiol levels, likely due to assay interference. Conclusions: Fulvestrant and bazedoxifene may reduce OHSS severity by lowering ascites formation and weight gain. These agents could be potential therapeutic candidates for OHSS with appropriate timing and dosage. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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16 pages, 1059 KB  
Article
Implementation of Remote Patient Monitoring and Earlier CERT Activation: Effects on ICU Transfer and Mortality
by Victor Narcisse, Farhan Ishaq, Melissa Gomez, Sarah Homer, Laura Griffin, Sarah Pletcher and Ngoc-Anh Nguyen
J. Clin. Med. 2025, 14(20), 7434; https://doi.org/10.3390/jcm14207434 - 21 Oct 2025
Viewed by 473
Abstract
Introduction: Timely detection of clinical deterioration in hospitalized patients remains a challenge, often limited by intermittent vital signs (VS) monitoring and delayed escalation. Remote patient monitoring (RPM) offers a medium of high-frequency surveillance of patient VS and may facilitate earlier recognition of deterioration. [...] Read more.
Introduction: Timely detection of clinical deterioration in hospitalized patients remains a challenge, often limited by intermittent vital signs (VS) monitoring and delayed escalation. Remote patient monitoring (RPM) offers a medium of high-frequency surveillance of patient VS and may facilitate earlier recognition of deterioration. This study evaluated whether RPM integration into rapid response workflows improves clinical outcomes among patients requiring clinical emergency response team (CERT) activation and subsequent intensive care unit (ICU) transfer. Methods: A retrospective study was conducted to assess the impact of RPM implementation on severity of illness and mortality in adult patients who experienced CERT activation followed by ICU transfer. The primary outcomes were severity of illness at ICU admission and in-hospital mortality. We hypothesized that patients in the post-intervention group would demonstrate better outcomes compared to pre-intervention. Results: A total of 1120 patients were included (PRE: n = 656; POST: n = 464). The POST group, which received continuous monitoring via the BioButton® device and augmented workflows, demonstrated a lower mean APACHE-IV score at ICU transfer (83.96 vs. 90.01; p = 0.0016 and reduced in-hospital mortality (7.75% vs. 11.48%; p = 0.084). Median ICU stay in the PRE group was 5.85 (3.00–11.58) and 5.07 (2.59–9.22) in the POST group (p: 0.0565). Total LOS was 11.95 (6.57–20.40) and 10.50 (6.01–18.17), respectively [p = 0.0278]. Conclusions: Integration of RPM into hospital care pathways was associated with earlier recognition of clinical deterioration, reduced illness severity at ICU admission, and lower in-hospital mortality. These findings may support the utility of RPM as part of a comprehensive, multicomponent, rapid response model to recognize early physiological deterioration and may improve patient safety and outcomes in acute care settings. Full article
(This article belongs to the Section Intensive Care)
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13 pages, 830 KB  
Article
Colpocleisis—Still a Valuable Option: A Point of Technique
by Diana Hoehn, Hannes Egli, Martin Chase Marak, Gloria Ryu, Anna-Sophie Villiger, Giovanni Ruggeri, Michael David Mueller and Annette Kuhn
J. Clin. Med. 2025, 14(20), 7433; https://doi.org/10.3390/jcm14207433 - 21 Oct 2025
Viewed by 307
Abstract
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that increases with age and affects up to 40% of women. Colpocleisis is a possible native-tissue repair used in elderly persons not interested in vaginally penetrative sex to correct advanced POP. This study [...] Read more.
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that increases with age and affects up to 40% of women. Colpocleisis is a possible native-tissue repair used in elderly persons not interested in vaginally penetrative sex to correct advanced POP. This study aims to evaluate the recurrence and reoperation rate of a technique using purse-string sutures in a standardised way. Methods: This retrospective quality control study evaluated all women who underwent obliterative procedures for POP at the Department of Obstetrics and Gynaecology at the University Hospital of Bern from 2014 to 2023. Total Colpocleisis (TC) and Le-Fort Colpocleisis (LFC) were performed by a standardised technical procedure using purse-string sutures. The primary outcome was the recurrence rate measured by the POP-Q stage (stage 2 or higher). Reoperation rate, perioperative complications, bladder outlet disorders and incontinence symptoms were assessed as secondary outcomes. Results: We analysed eighty-eight patients who underwent obliterative surgery with TC or LFC in this study. The recurrence rate for all patients was 16%, and the reoperation rate was 9.2%. In patients without previous surgeries (52%), the recurrence rate was 7%. Thirteen patients (14.8%) had perioperative complications, mainly urinary tract infections (seven patients, 8%). Objective POP improved significantly (p < 0.001), as did the bladder voiding dysfunction in the rate of high postvoid residual volume (p < 0.05), stress urinary incontinence, overactive bladder and mixed urinary incontinence (p < 0.001). In three patients, de novo stress urinary incontinence developed postoperatively. Conclusions: Colpocleisis by the purse-string technique is an effective surgical treatment for advanced POP surgery. Recurrence and reoperation rates are similar to the previously mentioned techniques and are easy to learn due to the standardised procedure. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
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17 pages, 1834 KB  
Article
Extended ECG Monitoring in Patients with Hypertrophic Cardiomyopathy: The Tempo-HCM Study
by Juan Caro-Codón, Sergio Castrejón, Rosalía Cadenas, Carlos Casanova, Andrea Vélez, Mayte Basurte, Gemma Lacuey, Vicente Climent, Óscar Salvador, Andrea Severo-Sánchez, Luis Fernández, Esther Pérez-David, Rafael Peinado, Silvia Valbuena-López, Gabriela Guzmán, Álvaro Jiménez-Mas, Raúl Moreno and Jose L. Merino
J. Clin. Med. 2025, 14(20), 7432; https://doi.org/10.3390/jcm14207432 - 21 Oct 2025
Viewed by 324
Abstract
Background/Objectives: Current guidelines recommend 24–48 h Holter for risk stratification and atrial fibrillation (AF) screening in hypertrophic cardiomyopathy (HCM). However, the limited duration of this approach may not provide optimal sensitivity. In addition, extended ECG monitoring has been demonstrated to be more effective [...] Read more.
Background/Objectives: Current guidelines recommend 24–48 h Holter for risk stratification and atrial fibrillation (AF) screening in hypertrophic cardiomyopathy (HCM). However, the limited duration of this approach may not provide optimal sensitivity. In addition, extended ECG monitoring has been demonstrated to be more effective in detecting arrhythmias in other clinical entities. We aimed to assess the utility of extended ECG monitoring for 30 days in a non-high-risk cohort of HCM patients. Methods: We conducted a prospective multicentre study with 113 non-high-risk HCM patients who underwent 30-day ECG monitoring with a dedicated device. We compared the detection of relevant arrhythmias (AF, atrial flutter, and non-sustained ventricular tachycardia) during 30-day monitoring with the findings observed during the first 24 h. Results: Extended ECG monitoring detected relevant arrhythmias in 63.7% of patients, compared with 12.4% during the first 24 h (p < 0.001). This difference was mainly driven by non-sustained ventricular tachycardia (NSVT) (61.1% vs. 8.9%, p < 0.001). Atrial fibrillation episodes were detected in 10.6% of patients after completing prolonged monitoring vs. 6.2% during the first 24 h (p = 0.066). Extended monitoring resulted in a reclassification of 21.2% of patients to a higher sudden cardiac death (SCD) risk category using the HCM-SCD calculator. Conclusions: Extended ECG monitoring significantly enhances the detection of arrhythmias in HCM. Using this technique, NSVT were detected in most patients of a non-high-risk HCM cohort. Further investigation is warranted to determine the role of extended monitoring in SCD risk stratification and AF screening. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Hypertrophic Cardiomyopathy)
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13 pages, 1596 KB  
Article
Comparing the Effect of Osseodensification Versus Conventional Drilling Technique on Implant Stability and Bone Width in the Alveolar Ridge Split Procedure: A Retrospective Study
by Yunus Emre Guner and Varol Canakci
J. Clin. Med. 2025, 14(20), 7431; https://doi.org/10.3390/jcm14207431 - 21 Oct 2025
Viewed by 333
Abstract
Background/Objectives: Horizontal alveolar ridge deficiency is a common clinical challenge in dental implant placement. The osseodensification (OD) technique has been proposed as a minimally invasive alternative to conventional osteotomy. This study aimed to compare the outcomes of OD and conventionally performed ridge-split procedures [...] Read more.
Background/Objectives: Horizontal alveolar ridge deficiency is a common clinical challenge in dental implant placement. The osseodensification (OD) technique has been proposed as a minimally invasive alternative to conventional osteotomy. This study aimed to compare the outcomes of OD and conventionally performed ridge-split procedures in terms of implant stability and horizontal bone gain. Methods: In this retrospective study, 65 patients (a total of 268 implants) who underwent simultaneous implant placement with ridge-split procedures were evaluated. Cases were divided into two groups: OD burs (n = 133 implants) and the conventional Esset kit (n = 135 implants). Ridge width was measured at coronal and apical levels using cone-beam computed tomography (CBCT) preoperatively and four months postoperatively. Implant stability was assessed at the time of placement (primary stability) and at four months (secondary stability) using resonance frequency analysis (RFA). Results: Both techniques achieved comparable horizontal bone gain (1.1–1.6 mm; p > 0.05). In the maxilla, the OD group demonstrated a tendency toward higher primary and secondary stability values (p < 0.01). A similar trend was observed for secondary stability in the mandibular posterior region (p < 0.01). The mean Implant Stability Quotient (ISQ) values in the OD group generally exceeded the threshold of 65, considered sufficient for prosthetic loading. Conclusions: The findings suggest that the OD technique may have a favorable effect on implant stability, particularly in regions with low-to-moderate bone density, while providing comparable horizontal bone gain to the conventional method. These results indicate that OD could serve as a potentially useful alternative in the management of horizontal ridge deficiencies; however, its long-term efficacy should be further evaluated in larger, prospective clinical studies. Full article
(This article belongs to the Special Issue Clinical Updates and Perspectives of Implant Dentistry)
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17 pages, 1427 KB  
Systematic Review
Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) for Emergency Airway Management: A Systematic Review of Evidence and Implementation
by Saniyah Shaikh, Hamad Hejazi, Safwaan Shaikh, Adeeba Sajid, Rida Shahab, Ayesha Deed, Rida Afnan, Anam Hashmi, Raiyan Ehtesham Ahmed Sharieff, Asfiya Naureen and Marcelo A. F. Ribeiro, Jr.
J. Clin. Med. 2025, 14(20), 7430; https://doi.org/10.3390/jcm14207430 - 21 Oct 2025
Viewed by 346
Abstract
Background: Emergency airway management is a crucial and complex procedure frequently performed in the emergency department (ED). Airway contamination usually caused by blood, secretions, and emesis impairs ventilation, reduces successful intubation, and increases the complication rates, leading to difficult laryngoscopy, delayed intubation, [...] Read more.
Background: Emergency airway management is a crucial and complex procedure frequently performed in the emergency department (ED). Airway contamination usually caused by blood, secretions, and emesis impairs ventilation, reduces successful intubation, and increases the complication rates, leading to difficult laryngoscopy, delayed intubation, and increased mortality rates. One technique employed to decontaminate these airways when standard approaches fail is Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD). Methods: A comprehensive literature search was conducted across PubMed, Cochrane, and Science direct databases following a specific search strategy. All search results were screened in a two-stage process (title–abstract and full-text screening) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Data from finalized articles were extracted using a standardized excel file developed a priori. Lastly, quality and risk of bias were assessed using appropriate tools according to respective study designs, and data were narratively synthesized. Results: A total of 224 records were identified. Upon screening, seven studies were included consisting of five simulation-based studies and two clinical case reports. Simulation studies reported that SALAD training significantly improved first-pass intubation success (53.7–90.2%), reduced time to intubation (up to 30 s), and enhanced airway visualization. Clinical cases further reported successful first-pass intubation in patients with massive airway contamination without complications. Overall, across both study types, the SALAD technique improved airway management performance, provider confidence, and airway contamination control compared to standard suction techniques. Conclusions: This systematic review highlights the benefits of the SALAD technique by enhancing airway visualization, reinforcing it as a significant tool for contaminated airway management. Trainees who underwent SALAD training demonstrated improved first-pass intubation success, reduced intubation time, and increased operator confidence. While data from the included studies seems promising, most studies are small simulation-based studies with limited clinical outcome data. Given its clinical relevance and educational value, future studies must prioritize high-quality research in clinical environments to establish SALAD’s efficacy and to define its role in integration into prehospital protocols. Full article
(This article belongs to the Special Issue Airway Management: From Basic Techniques to Innovative Technologies)
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13 pages, 315 KB  
Systematic Review
Role of Point-of-Care Ultrasound in Inpatient Perioperative Medical Management: A Systematic Review
by Dhairya M. Jarsania, Mike J. Breunig, Gururaj J. Kolar, Meltiady Issa, Ryan Kingsley, Mohammed Nadir Bhuiyan, Cynthia J. Chelf and Robert W. Kirchoff
J. Clin. Med. 2025, 14(20), 7429; https://doi.org/10.3390/jcm14207429 - 21 Oct 2025
Viewed by 437
Abstract
Background: Point-of-care ultrasonography (POCUS) is becoming an increasingly relevant tool in hospital medicine, but its effective application in inpatient perioperative medicine remains to be determined. Much of the POCUS literature describes its use by anesthesiologists to evaluate cardiac function, volume status, pulmonary findings, [...] Read more.
Background: Point-of-care ultrasonography (POCUS) is becoming an increasingly relevant tool in hospital medicine, but its effective application in inpatient perioperative medicine remains to be determined. Much of the POCUS literature describes its use by anesthesiologists to evaluate cardiac function, volume status, pulmonary findings, and gastric volume. Objective: To identify, evaluate, and synthesize all available literature investigating the use of point-of-care ultrasound and associated clinical outcomes in inpatient perioperative medical management. Patients and Methods: A systematic review was designed using the PRISMA guidelines with sources of literature including Ovid, PubMed, Scopus, and the Web of Science. Literature search was conducted for published works between 1 January 2002 to 8 February 2024. Results: Three hundred sixty-seven abstracts were identified in our search, and, ultimately, 24 studies were included in this review. Most studies were done by anesthesiology evaluating cardiopulmonary and gastric POCUS. Studies supported using POCUS to expedite cardiac examination, promptly diagnose postoperative pulmonary complications, and optimize surgical timing. Conclusions: POCUS is a versatile tool in the perioperative setting; however, few studies were powered to assess clinical outcomes, and even fewer showed conclusive evidence of improved clinical outcomes. Furthermore, only two studies evaluated the use of POCUS specifically by acute care providers; more extensive studies are needed from their perspective as they take on increasing perioperative responsibilities. Full article
(This article belongs to the Special Issue Point of Care Sonography, an Essential Tool for Anesthesiology and Acute Care)
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15 pages, 658 KB  
Article
Comparative Effectiveness of SGLT2i and GLP-1RA on Blood Pressure in Hypertensive Patients with Type 2 Diabetes: A Saudi Multicenter Retrospective Study
by Ghadah Alshehri, Raghad Alrashidi, Renad Alhaqbani, Reema Almeshari, Nader Bin Sheraim, Alwaleed Alharbi, Majed S. Al Yami, Abdulmohsen Alanazi, Nourah Alsalamah and Amani Alrossies
J. Clin. Med. 2025, 14(20), 7428; https://doi.org/10.3390/jcm14207428 - 21 Oct 2025
Viewed by 484
Abstract
Background/Objectives: Sodium–glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown blood pressure (BP) reduction in type 2 diabetes (T2D). However, head-to-head comparisons in hypertensive patients remain limited. This study assessed the effects of SGLT2i and GLP-1RA on systolic BP (SBP), [...] Read more.
Background/Objectives: Sodium–glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown blood pressure (BP) reduction in type 2 diabetes (T2D). However, head-to-head comparisons in hypertensive patients remain limited. This study assessed the effects of SGLT2i and GLP-1RA on systolic BP (SBP), diastolic BP (DBP), antihypertensive regimen modifications, and adverse events in Saudi patients with both conditions. Methods: A retrospective cohort study was conducted between January 2022 and April 2024 using records from two hospitals. Adults with T2D and hypertension who initiated SGLT2i or GLP-1RA and had ≥2 BP readings were included. BP changes were analyzed with ANOVA; adverse events and treatment discontinuation were assessed with Chi-square and Kaplan–Meier analysis. Results: Of 505 patients, 291 (57.6%) received SGLT2i and 214 received GLP-1RA. Both classes significantly reduced SBP (p < 0.001), and DBP decreased significantly only in the SGLT2i group (p < 0.001). Antihypertensive regimen reduction occurred in 6.9% of patients, most commonly among SGLT2i users (74.3%), while 76.8% remained on the same regimen; the remaining patients had other modifications such as dosage adjustments or changes in individual agents. Adverse events occurred in 6.3% of patients with no group differences. Therapy discontinuation was higher with GLP-1RA (12.6%) versus SGLT2i (2.4%, p < 0.001). Conclusions: Both SGLT2i and GLP-1RA might be considered in patients with T2D and hypertension, with SGLT2i potentially offering additional benefits for DBP reduction and simplifying antihypertensive regimens, which could support clinical decision-making in real-world practice. Full article
(This article belongs to the Section Pharmacology)
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13 pages, 2126 KB  
Article
Comparison of Deep Neural Networks for the Classification of Adventitious Lung Sounds
by Said Polanco-Martagón, Yahir Hernández-Mier, Marco Aurelio Nuño-Maganda, José Hugo Barrón-Zambrano, Andrea Magadán-Salazar and César Alejandro Medellín-Vergara
J. Clin. Med. 2025, 14(20), 7427; https://doi.org/10.3390/jcm14207427 - 21 Oct 2025
Viewed by 230
Abstract
Background: Automatic adventitious lung sound classification using deep learning is a promising strategy for objective respiratory disease screening. Evaluating model performance is challenging, particularly with imbalanced clinical datasets. This study compares CNN architectures and proposes a dual-stream classification approach. Methods: Using the public [...] Read more.
Background: Automatic adventitious lung sound classification using deep learning is a promising strategy for objective respiratory disease screening. Evaluating model performance is challenging, particularly with imbalanced clinical datasets. This study compares CNN architectures and proposes a dual-stream classification approach. Methods: Using the public ICBHI 2017 dataset, we compared five pre-trained architectures: VGG16, VGG19, InceptionV3, MobileNetV2, and ResNet152V2. To mitigate class imbalance, we implemented pitch shifting, random shifting, and mixup data augmentation. We also developed and evaluated a novel VGGish-dual-stream network. The primary endpoint was the Average Score (AS), the arithmetic mean of Sensitivity and Specificity. Results: Among benchmarked models, ResNet152V2 achieved the highest AS (0.541), approaching the state-of-the-art range (0.56–0.58). This performance was characterised by a high Specificity (0.67) but low Sensitivity (0.41). Our proposed dual-stream network yielded a more balanced, albeit slightly lower, performance with an AS of 0.508. Conclusions: Standard CNN architectures like ResNet152V2 can achieve competitive classification performance but may exhibit a clinically significant bias towards high specificity at the expense of sensitivity. This trade-off poses a risk of missing pathological events (false negatives). To ensure clinical safety and utility, future work must prioritise strategies that explicitly improve model sensitivity. Full article
(This article belongs to the Section Respiratory Medicine)
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13 pages, 867 KB  
Article
Low-Dose Indapamide vs. Hydrochlorothiazide in Idiopathic Hypercalciuria: A Randomized Prospective Trial
by Maria Peraire, Jorge Guimerà, Antonia Costa-Bauzá, Pilar Sanchís, Felix Grases and Enrique Pieras
J. Clin. Med. 2025, 14(20), 7426; https://doi.org/10.3390/jcm14207426 - 21 Oct 2025
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Abstract
Background: Idiopathic hypercalciuria (IH) is the most common genetic metabolic disorder in patients with urinary stones and is usually treated with thiazide-type diuretics. However, direct evidence comparing low-dose indapamide and hydrochlorothiazide is scarce. This study aimed to compare their safety, efficacy and [...] Read more.
Background: Idiopathic hypercalciuria (IH) is the most common genetic metabolic disorder in patients with urinary stones and is usually treated with thiazide-type diuretics. However, direct evidence comparing low-dose indapamide and hydrochlorothiazide is scarce. This study aimed to compare their safety, efficacy and adherence in patients with IH. Methods: In this randomized prospective trial, a total of 101 patients with IH were recruited at Son Espases University Hospital (2020–2023), assigned to receive indapamide 1.5 mg/day (n = 53) or hydrochlorothiazide 25 mg/day (n = 48), and followed for 18 months. Adverse events, biochemical parameters and therapeutic adherence were evaluated. Results: A total of 90.24% patients on indapamide and 85.71% on hydrochlorothiazide showed normal calciuria (p = 0.53). Both treatments increased serum urate (p = 0.62). Indapamide significantly reduced β-crosslaps (p < 0.05), suggesting bone protection. No significant differences were found in citraturia, uricosuria, phosphaturia, magnesiuria, magnesemia, natremia, or kalemia. Indapamide caused more mild adverse events, lowering adherence, while hydrochlorothiazide caused the only severe adverse effect—moderate hypokalemia. No differences in kidney stone recurrence were observed (p = 0.82). Conclusions: This is the first paper elucidating low-dose indapamide and hydrochlorothiazide efficacy and safety for the treatment of IH. No significant differences were observed between the two drugs in terms of adverse events or treatment adherence. A longer follow-up is needed to assess kidney stone recurrence. Full article
(This article belongs to the Section Nephrology & Urology)
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15 pages, 987 KB  
Article
Predicting Mortality in Non-Variceal Upper Gastrointestinal Bleeding: Machine Learning Models Versus Conventional Clinical Risk Scores
by İzzet Ustaalioğlu and Rohat Ak
J. Clin. Med. 2025, 14(20), 7425; https://doi.org/10.3390/jcm14207425 - 21 Oct 2025
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Abstract
Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) is associated with considerable morbidity and mortality, particularly in emergency department (ED) settings. While traditional clinical scores such as the Glasgow-Blatchford Score (GBS), AIMS65, and Pre-Endoscopic Rockall are widely used for risk stratification, their accuracy in [...] Read more.
Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) is associated with considerable morbidity and mortality, particularly in emergency department (ED) settings. While traditional clinical scores such as the Glasgow-Blatchford Score (GBS), AIMS65, and Pre-Endoscopic Rockall are widely used for risk stratification, their accuracy in mortality prediction is limited. This study aimed to evaluate the performance of multiple supervised machine learning (ML) models in predicting 30-day all-cause mortality in NVUGIB and to compare these models with established risk scores. Methods: A retrospective cohort study was conducted on 1233 adult patients with NVUGIB who presented to the ED of a tertiary center between January 2022 and January 2025. Clinical and laboratory data were extracted from electronic records. Seven supervised ML algorithms—logistic regression, ridge regression, support vector machine, random forest, extreme gradient boosting (XGBoost), naïve Bayes, and artificial neural networks—were trained using six feature selection techniques generating 42 distinct models. Performance was assessed using AUROC, F1-score, sensitivity, specificity, and calibration metrics. Traditional scores (GBS, AIMS65, Rockall) were evaluated in parallel. Results: Among the cohort, 96 patients (7.8%) died within 30 days. The best-performing ML model (XGBoost with univariate feature selection) achieved an AUROC > 0.80 and F1-score of 0.909, significantly outperforming all traditional scores (highest AUROC: Rockall, 0.743; p < 0.001). ML models demonstrated higher sensitivity and specificity, with improved calibration. Key predictors consistently included age, comorbidities, hemodynamic parameters, and laboratory markers. The best-performing ML models demonstrated very high apparent AUROC values (up to 0.999 in internal analysis), substantially exceeding conventional scores. These results should be interpreted as apparent performance estimates, likely optimistic in the absence of external validation. Conclusions: While machine-learning models showed markedly higher apparent discrimination than conventional scores, these findings are based on a single-center retrospective dataset and require external multicenter validation before clinical implementation. Full article
(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)
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21 pages, 502 KB  
Perspective
Stress Echocardiography in Aortic Stenosis: From Diagnostic Challenges to Guideline-Endorsed Clinical Applications
by Roxana Hodas, Călin Pop and Antoniu Octavian Petris
J. Clin. Med. 2025, 14(20), 7424; https://doi.org/10.3390/jcm14207424 - 21 Oct 2025
Viewed by 395
Abstract
Aortic stenosis (AS) is the most common valvular heart disease in industrialized countries. Stress echocardiography (SE), using either exercise or dobutamine protocols, has emerged as a critical tool to overcome limitations of resting echocardiography, refine risk stratification, and guide the timing of aortic [...] Read more.
Aortic stenosis (AS) is the most common valvular heart disease in industrialized countries. Stress echocardiography (SE), using either exercise or dobutamine protocols, has emerged as a critical tool to overcome limitations of resting echocardiography, refine risk stratification, and guide the timing of aortic valve replacement. This review synthesizes contemporary evidence on the diagnostic, prognostic, and therapeutic role of SE in AS. Studies from all main databases (2000–2025) were systematically analyzed including prospective studies, consensus statements, and international guidelines. We highlight the physiological rationale, key prognostic markers, applications in asymptomatic severe and low-flow, low-gradient AS, and integration with multimodality imaging. SE is now guideline-endorsed for risk stratification in asymptomatic severe AS and the diagnosis of true severe versus pseudo-severe AS in low-flow, low-gradient disease. Future directions include advanced strain imaging, artificial intelligence, and broader adoption in the transcatheter era. Full article
(This article belongs to the Special Issue Application of Echocardiography in the Diagnosis and Management of Cardiac Diseases)
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23 pages, 348 KB  
Review
Non-Invasive Wearable Technology to Predict Heart Failure Decompensation
by Jack Devin, Eden Powell, Dylan McGagh, Tyler Jones, Brian Wang, Pierre Le Page, Andrew J. M. Lewis, Oliver J. Rider, Andrew R. J. Mitchell and John A. Henry
J. Clin. Med. 2025, 14(20), 7423; https://doi.org/10.3390/jcm14207423 - 21 Oct 2025
Viewed by 728
Abstract
Heart failure (HF) remains a leading cause of recurrent hospitalisations worldwide, largely driven by acute episodes of decompensation. Early identification of impending decompensation could enable timely intervention and potentially prevent costly admissions. Non-invasive wearable devices have emerged as promising tools for continuously monitoring [...] Read more.
Heart failure (HF) remains a leading cause of recurrent hospitalisations worldwide, largely driven by acute episodes of decompensation. Early identification of impending decompensation could enable timely intervention and potentially prevent costly admissions. Non-invasive wearable devices have emerged as promising tools for continuously monitoring physiological parameters and detecting early signs of deterioration. This review summarises recent advances in wearable technologies designed to predict HF decompensation and appraises their ability to generate clinically useful alerts. It will examine various modalities designed to monitor different aspects of cardiorespiratory physiology that have the potential to detect abnormalities preceding heart failure decompensation. Broadly, these devices either monitor physical activity capacity and cardiac function or monitor changes in pulmonary fluid congestion. We will also cover evidence exploring whether these devices can generate timely alerts for interventions to improve patient outcomes and reduce hospitalisations. However, despite advances in these technologies, challenges remain regarding their accuracy and usability for remote monitoring, as well as concerns with data storage, processing, patient adherence, and integration into existing healthcare workflows. While current limitations exist, previous results warrant further research into this area, with a focus on larger randomised trials, exploring both single- and multi-sensor systems, using artificial intelligence and cost-effectiveness analysis. Overall, non-invasive wearables represent an opportunity to create a more proactive approach to HF management, with the potential to shift the paradigm from reactive treatment to anticipatory care. Full article
(This article belongs to the Special Issue Advanced Therapy for Heart Failure and Other Combined Diseases)
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9 pages, 1065 KB  
Article
Retrospective Evaluation of Maxillary Sinus Volume Changes Following Bone-Anchored Midface Distraction Osteogenesis in Cleft Patients: A Case–Series Study
by Aleksandra Kołodziejska, Patryk Kołodziejski, Maria Gutowska, Martyna Dowgierd, Agnieszka Predko-Engel, Monika Jurczuk and Krzysztof Dowgierd
J. Clin. Med. 2025, 14(20), 7422; https://doi.org/10.3390/jcm14207422 - 21 Oct 2025
Viewed by 240
Abstract
Background/Objectives: This study retrospectively evaluated maxillary sinus volume changes and linear changes in the craniofacial region after Le Fort I distraction osteogenesis using a rigid external distraction system. Methods: Ten patients who underwent LeFort 1 distraction osteogenesis between 2012 and 2025 [...] Read more.
Background/Objectives: This study retrospectively evaluated maxillary sinus volume changes and linear changes in the craniofacial region after Le Fort I distraction osteogenesis using a rigid external distraction system. Methods: Ten patients who underwent LeFort 1 distraction osteogenesis between 2012 and 2025 were included in the study. Computed tomography scans and lateral cephalograms were obtained before and 12.3 ± 6.98 months after the surgery. The associated volumes of the maxillary left and right sinuses were subsequently measured using the semiautomatic segmentation method in the ITK-SNAP software. Linear measurements of the sinuses and cephalometric analysis were performed before and after the distraction. Results: The Wits appraisal (distance between perpendicular lines drawn from point A (on the maxilla) and point B (on the mandible) to the occlusal plane) presented an increase of 9.33 mm ± 7.93 mm, corresponding to an increase in the ANB angle by 9.88° ± 5.35°. There were statistically significant increases in the total sinus volume, by 3965 mm3 ± 5456 mm3 (n = 10, p = 0.047), and in the single maxillary sinus volume, by 1983 ± 2889 mm3 (n = 20, p = 0.003). A significant increase in height was also observed, with a mean value of 4.46 ± 2.94 mm (n = 20). Conclusions: Extraoral bone-anchored midface distraction osteogenesis led to increases in single sinus volume, total sinus volume and sinus height in the cleft cohort, resulting in improved maxillary retrusion and profile. However, the study group was small and non-uniform with different follow-up periods, indicating a need for further studies with larger, more homogenous cohorts. Full article
(This article belongs to the Special Issue Craniofacial Surgery: State of the Art and the Perspectives)
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