Journal of Clinical Medicine

16 pages, 5650 KiB

Open AccessArticle

Loading Pressure Induced by 4 mm Implants on the Inferior Alveolar Nerve: A 3D Finite Element Analysis Model

by Roberta Gasparro, Fabrizio Renno, Simone De Vita, Antonio Lanzotti, Massimo Martorelli, Francesco Penta, Gilberto Sammartino and Pietro Ausiello

J. Clin. Med. 2025, 14(7), 2535; https://doi.org/10.3390/jcm14072535 - 7 Apr 2025

Viewed by 338

Abstract

Background/Objectives: One of the most serious complications following implant placement in the atrophic posterior mandible is injury to the inferior alveolar nerve (IAN), which can also happen during occlusal loading of the implants. This study investigates the effects of 4 mm implant [...] Read more.

Background/Objectives: One of the most serious complications following implant placement in the atrophic posterior mandible is injury to the inferior alveolar nerve (IAN), which can also happen during occlusal loading of the implants. This study investigates the effects of 4 mm implant stress transmission to the inferior alveolar nerve during occlusal loading in cases of severe posterior mandibular atrophy. Methods: The computer-aided design (CAD) model was created and modified through Direct Modeling techniques. The structure of cortical and trabecular bones was simplified, and it was modeled as a cylinder block. Finite element analysis (FEA) was carried out in 3D to investigate the pressure distribution over the IAN at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm), and stress and strain deformations were simulated in the mandibular model. Results: The results of the pressure analysis on the inferior alveolar nerve indicate that the pressure distribution at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm) is consistently below 0.026 MPa, which corresponds to the maximum pressure range that may block nerve impulses. This occurs even at the theoretical and simulated distance of 0.1 mm, suggesting that cortical bone stiffness plays a crucial role in mitigating stress at reduced implant-to-nerve proximities. Conclusions: Within the limits of this study, ultra-short implants can be placed even less than 0.5 mm (up to 0.1 mm under the 3D-FEA hypothesis) above the inferior alveolar nerve under the 3D-FEA hypothesis, while maintaining pressure below the threshold value. This is due to the rigidity of the cortical bone, which helps to reduce pressure transmission to the nerve. These findings may expand the indications for ultra-short implants, even in mandibles with a residual bone height of just 4 mm. Full article

(This article belongs to the Special Issue Dental Implantology: Clinical Updates and Perspectives)

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8 pages, 165 KiB

Open AccessEditorial

Unraveling the Complexity of Internet Addiction: A Multi-Faceted Perspective from Five Key Studies

by Silvia Cimino and Luca Cerniglia

J. Clin. Med. 2025, 14(7), 2534; https://doi.org/10.3390/jcm14072534 - 7 Apr 2025

Viewed by 325

Abstract

Internet addiction (IA) is one of the global concerns of our time, and research continues on understanding its psychological, neurobiological, and behavioral bases [...] Full article

(This article belongs to the Section Mental Health)

9 pages, 605 KiB

Open AccessArticle

Comparison of 27-Gauge to 25-Gauge Vitrectomy in Patients with Tractional Retinal Detachment Associated with Proliferative Diabetic Retinopathy

by Hiromi Ohara, Tomohiko Torikai, Jun Takeuchi, Tadashi Yokoi, Takashi Koto and Makoto Inoue

J. Clin. Med. 2025, 14(7), 2533; https://doi.org/10.3390/jcm14072533 - 7 Apr 2025

Viewed by 305

Abstract

Background/Objectives: To compare the surgical outcomes of 25-gauge (G) vitrectomy to those of 27G vitrectomy for proliferative diabetic retinopathy (PDR) with a tractional retinal detachment (TRD). Methods: Eighty-three consecutive eyes of 71 patients with PDR and TRD that underwent initial vitrectomy at the [...] Read more.

Background/Objectives: To compare the surgical outcomes of 25-gauge (G) vitrectomy to those of 27G vitrectomy for proliferative diabetic retinopathy (PDR) with a tractional retinal detachment (TRD). Methods: Eighty-three consecutive eyes of 71 patients with PDR and TRD that underwent initial vitrectomy at the Kyorin Eye Center from June 2021 to August 2023 and were followed for ≥3 months were studied retrospectively. The surgical outcomes of the 10,000 cut/min (cpm) 25G vitrectomy (25G group, 25 eyes) to that of the 20,000 cpm 27G vitrectomy (27G group, 58 eyes) were compared. Results: The preoperative PDR status, surgical procedures, and postoperative outcomes were assessed relative to the surgical success. The 25G group had significantly more eyes with severe PDR (p = 0.010), no prior laser photocoagulation (p = 0.027), macular detachment (p = 0.006), and the use of bimanual technique (p = 0.005). However, the operative times and incidence of iatrogenic breaks were not significantly different. The visual acuity improved significantly in both groups at 3 months postoperatively. The primary anatomical success was 88% in the 25G and 97% in the 27G groups (p > 0.05). The risk factors for a postoperative retinal detachment were significantly associated with the grade (p = 0.042) and type of PDR (p = 0.041), the use of perfluorocarbon liquid (p = 0.028), and bimanual techniques (p = 0.017). Conclusions: The high anatomical success for both groups for TRD secondary to PDR indicates that both can be used to treat eyes with PDR. The 27G vitrectomy may reduce the need for bimanual techniques. Full article

(This article belongs to the Special Issue Vitreoretinal Disease: Clinical Insights and Treatment Strategies)

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21 pages, 3647 KiB

Open AccessArticle

Systemic Responses Towards Oxy-Inflammation, Hormones, and Mood in Breast Cancer Survivors: Preliminary Evidences from Dragon Boat Endurance Race

by Michela Montorsi, Alessandra Vezzoli, Federica Mrakic Sposta, Maristella Gussoni, Andrea Brizzolari, Gerardo Bosco, Cinzia Dellanoce, Alessandra Barassi, Barbara Picconi, Cristina Ranuncoli and Simona Mrakic Sposta

J. Clin. Med. 2025, 14(7), 2532; https://doi.org/10.3390/jcm14072532 - 7 Apr 2025

Viewed by 588

Abstract

Background/Objectives: Endurance exercise increases oxygen demand and, when not balanced by antioxidant defenses, consequently, oxidative stress and inflammatory cytokines increase too. In breast cancer survivors (BCS), post-treatment, physical capacity decreases, lowering life quality. Dragon boat (DB) paddling has shown benefits in reducing lymphedema [...] Read more.

Background/Objectives: Endurance exercise increases oxygen demand and, when not balanced by antioxidant defenses, consequently, oxidative stress and inflammatory cytokines increase too. In breast cancer survivors (BCS), post-treatment, physical capacity decreases, lowering life quality. Dragon boat (DB) paddling has shown benefits in reducing lymphedema and improving psychological well-being. This study aimed at non-invasively investigating in BCS, by means of saliva and urine samples, the systemic responses to oxy-inflammation, and appetite hormones after a DB endurance race. Methods: 15 BCS and 15 healthy women (5 (CTR) who performed the DB race too) were studied. BCS and CTR were monitored pre- and post-race. Reactive oxygen species (ROS) production, total antioxidant capacity (TAC), lipid peroxidation (8-iso), DNA oxidation (8-OH-dG), nitric oxide metabolites (NOx), inflammation markers (IL-6-10 and TNFα), appetite hormones, electrolytes concentration, psychometric, and physical scales were assessed. Results: At rest, compared to healthy women, BCS showed a significant increase in oxy-inflammation biomarkers. BCS showed a general increase in oxy-inflammation parameters compared to CTR after the DB race. In BCS, there were the following results: ROS: +80%; lipid peroxidation: +103%; DNA oxidation: +44%; interleukins-6: +179%; IL-10: +55%; TNFα: +9%, NOx: +60% increases and unbalanced appetite hormones: leptin (−32%); and ghrelin (+53%). Moreover, the dragon boat offered a holistic approach to recovery, addressing emotional and social needs supporting belonging, love, and esteem needs, reported to be about 56% of the motivations in this activity, while post-race the following increased: a sense of fatigue (+55%); tiredness (48%); a cold sensation (+15%); and +32% pain. Conclusions: This study provided evidence that, in BCS, a DB endurance race produces an important imbalance in the oxy-inflammation state, at the same time being accompanied by a positive impact on subjective mood and general wellness. Future studies should focus on long-term effects. Full article

(This article belongs to the Topic Physical Exercise Impacts on Human Physical and Psychological Health)

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31 pages, 412 KiB

Open AccessReview

Visual Function After Schlemm’s Canal-Based MIGS

by Masayuki Kasahara and Nobuyuki Shoji

J. Clin. Med. 2025, 14(7), 2531; https://doi.org/10.3390/jcm14072531 - 7 Apr 2025

Viewed by 435

Abstract

Filtration surgery is highly effective in lowering intraocular pressure; however, it is associated with a higher risk of severe complications. Visual dysfunction may persist in relatively uneventful cases because of induced astigmatism or worsening optical aberrations. Therefore, for early- to moderate-stage glaucoma, an [...] Read more.

Filtration surgery is highly effective in lowering intraocular pressure; however, it is associated with a higher risk of severe complications. Visual dysfunction may persist in relatively uneventful cases because of induced astigmatism or worsening optical aberrations. Therefore, for early- to moderate-stage glaucoma, an increasing number of surgeons are prioritizing surgical safety and preserving postoperative visual function by opting for minimally invasive glaucoma surgery (MIGS). Among the various MIGS techniques, canal-opening surgery—targeting aqueous outflow through the Schlemm’s canal (Schlemm’s canal-based MIGS, CB-MIGS)—has gained increasing popularity. Unlike filtration surgery, CB-MIGS does not require creating an aqueous outflow pathway between the intraocular and extraocular spaces. Consequently, it is considered a minimally invasive procedure with a reduced risk of severe complications and is increasingly being chosen for suitable cases. Although this surgical technique has limitations in lowering intraocular pressure, it avoids the manipulation of the conjunctiva or sclera and is primarily performed through a small corneal incision. Therefore, a minimal impact on induced astigmatism or postoperative refractive changes is expected. However, few reviews comprehensively summarize postoperative changes in visual function. Therefore, this study reviews the literature on visual function after CB-MIGS, focusing on changes in best-corrected visual acuity (BCVA), refraction, astigmatism, and the effectiveness of visual field preservation to assess the extent of these postoperative changes. Hyphema is the primary cause of early postoperative vision loss and is often transient in cases in which other complications would have led to visual impairment. Severe complications that threaten vision are rare. Additionally, compared with filtration surgery, postoperative visual recovery tends to be faster, and the degree of induced astigmatism is comparable to that of standalone cataract surgery. When combined with cataract surgery, the refractive error is at the same level as that of cataract surgery alone. However, in some cases, mild hyperopic shifts may occur because of axial length shortening, depending on the extent of intraocular pressure reduction. This possibility has been highlighted in several studies. Regarding the effectiveness of slowing the progression of visual field defects, most studies have focused on short- to medium-term postoperative outcomes. Many of these studies have reported the sufficient suppression of progression rates. However, studies with large sample sizes and long-term prospective designs are limited. To establish more robust evidence, future research should focus on conducting larger-scale, long-term investigations. Full article

(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))

42 pages, 845 KiB

Open AccessSystematic Review

Diagnostic and Prognostic Value of Hematological Parameters in Necrotizing Enterocolitis: A Systematic Review

by Rozeta Sokou, Petros Mantzios, Alexia Eleftheria Palioura, Andreas G. Tsantes, Alexandra Lianou, Daniele Piovani, Konstantina A. Tsante, Katerina Lampropoulou, Nicoletta Iacovidou and Stefanos Bonovas

J. Clin. Med. 2025, 14(7), 2530; https://doi.org/10.3390/jcm14072530 - 7 Apr 2025

Viewed by 455

Abstract

Background/Objectives: Necrotizing enterocolitis (NEC) is a severe, potentially fatal gastrointestinal disease that primarily affects preterm neonates, especially those with very low birth weight (<1500 g). Despite extensive research, its pathophysiology remains unclear, with NEC considered a spectrum of disorders driven by systemic [...] Read more.

Background/Objectives: Necrotizing enterocolitis (NEC) is a severe, potentially fatal gastrointestinal disease that primarily affects preterm neonates, especially those with very low birth weight (<1500 g). Despite extensive research, its pathophysiology remains unclear, with NEC considered a spectrum of disorders driven by systemic inflammation, microbiota dysregulation, and intestinal hypoxic injury. Diagnosis is challenging due to its subtle presentation and reliance on clinical and radiographic findings, underscoring the urgent need for reliable early biomarkers. Complete blood count (CBC) is one of the most frequently performed laboratory tests in neonatal care, providing valuable insights associated with hematologic alterations associated with NEC. Given its cost-effectiveness, accessibility, and rapid turnaround time, CBC parameters have been increasingly investigated for their diagnostic and prognostic potential in NEC. This systematic review consolidates existing evidence on the diagnostic and prognostic utility of CBC parameters in NEC, examining their association with disease onset, progression, and outcomes. Methods: A systematic review of the literature in PubMed and Scopus databases was conducted, between February 25 and December 2024. Results: Following a PRISMA-compliant search strategy, 77 eligible studies were included, analyzing data from 295,195 neonates, of whom 14,570 had NEC. Among the 77 studies, 17 examined NEC-associated mortality as a primary outcome, while 13 studies focused on the development of predictive models incorporating CBC parameters alongside other clinical and laboratory data to assess NEC severity and prognosis in neonates. The findings highlight the potential of CBC-derived markers to facilitate early NEC detection and risk stratification. However, variations in study design and diagnostic criteria highlight the need for prospective studies to validate their clinical use. Conclusions: Despite advancements in understanding NEC, its diagnosis remains challenging due to the absence of fully reliable biomarkers. CBC parameters show promise in offering early diagnostic and prognostic insights. However, further validation is needed for their routine integration into NICU practice. Given the persistent challenges in NEC diagnosis and management, our findings highlight the necessity for integrated scoring systems that combine hematologic, clinical, and radiologic data to enhance early detection and optimize neonatal care. Further research is essential to refine these predictive models, enabling timely interventions and improving survival rates in NEC-affected neonates. Full article

(This article belongs to the Section Clinical Pediatrics)

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25 pages, 1777 KiB

Open AccessSystematic Review

Clinical Significance of Blood Cell-Derived Inflammation Markers in Assessing Potential Early and Late Postoperative Complications in Patients with Colorectal Cancer: A Systematic Review

by Irina Shevchenko, Dragos Serban, Laurentiu Simion, Ion Motofei, Bogdan Mihai Cristea, Dan Dumitrescu, Corneliu Tudor, Ana Maria Dascalu, Crenguta Serboiu, Laura Carina Tribus, Andrei Marin, Adrian Marius Silaghi and Daniel Ovidiu Costea

J. Clin. Med. 2025, 14(7), 2529; https://doi.org/10.3390/jcm14072529 - 7 Apr 2025

Viewed by 352

Abstract

Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor [...] Read more.

Background/Objectives: Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Despite advancements in surgical techniques and oncological treatments, postoperative complications remain a significant challenge, affecting both immediate recovery and long-term survival. Systemic inflammation has been identified as a critical factor influencing cancer progression and postoperative outcomes. This systematic review evaluates the clinical significance of blood cell-derived inflammatory markers in predicting early and late postoperative complications in CRC patients. Methods: We included studies involving adult patients (≥18 years) with histologically confirmed colorectal cancer, for whom elective radical surgery was performed, as well as at least one of the considered blood-based inflammatory biomarkers (NLR, PLR, SII, or LMR) documented in relation to outcomes. Results: After removing duplicates, 19 studies published between 2016 and 2025 were included in the qualitative analysis. A total of 7023 patients who underwent elective curative surgery for colorectal cancer were analyzed, with mean age varying widely between 47.3 and 74.6 years. Preoperative NLR values were significantly correlated with severe complications, IAI, AL, and overall complications in 13 out of 19 studies (68.4%), with a cutoff value between 2.21 and 4, while early postoperative NLR values were predictive for AL. Late postoperative complications, such as recurrence and overall survival, were also associated with elevated preoperative NLR and PLR values. However, variability in study designs, patient populations, and cutoff values for these indices contributed to inconsistent findings. Conclusions: Blood cell-derived inflammatory markers offer a valuable, non-invasive tool for assessing postoperative risks in patients with CRC. New design nomograms or risk scores that include, beside blood cell-derived inflammation markers, other relevant data, could ensure an optimal predictive value that could be easily used in clinical practice for personalized risk management in patients with colorectal cancer. Full article

(This article belongs to the Special Issue Colon and Rectal Surgery: Current Clinical Practice and Future Trends)

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52 pages, 823 KiB

Open AccessSystematic Review

Acanthamoeba Keratitis Management and Prognostic Factors: A Systematic Review

by Pedro Marques-Couto, Mariana Monteiro, Ana Margarida Ferreira, João Pinheiro-Costa and Rodrigo Vilares-Morgado

J. Clin. Med. 2025, 14(7), 2528; https://doi.org/10.3390/jcm14072528 - 7 Apr 2025

Viewed by 447

Abstract

Background/Objectives: The aim of this study was to review the therapeutic and prognostic factors influencing Acanthamoeba Keratitis (AK) management. Methods: A systematic search was performed across MEDLINE^® (via PubMed), Web of Science^®, and Scopus^®, following the [...] Read more.

Background/Objectives: The aim of this study was to review the therapeutic and prognostic factors influencing Acanthamoeba Keratitis (AK) management. Methods: A systematic search was performed across MEDLINE^® (via PubMed), Web of Science^®, and Scopus^®, following the PRISMA 2020 guidelines, and registered in PROSPERO (CRD420251010774). Studies reporting AK treatment regiments and prognostic factors were included. After extracting the data from the included articles, the relevant aspects of the treatment and the prognostic factors were compared and summarized. Results: Sixty-one articles were included: nine were prospective, including 3 randomized controlled trials (RCTs), and fifty-two were retrospective. The findings suggest that therapeutic epithelial debridement (TED), followed by an association with biguanides, diamidines, and an antibacterial agent, is a strong initial treatment option. An adjunctive medical treatment with topical voriconazole 1% or oral miltefosine may also be considered. Surgical approaches were also assessed when the pharmaceutical therapy failed, with Deep Anterior Lamellar Keratoplasty (DALK) playing an important role in the cases without a deep stroma involvement. Early Therapeutic Penetrating Keratoplasty (TPK) should be used as a salvage therapy and Optical Penetrating Keratoplasty (OPK) should be used for rehabilitation purposes. Key prognostic factors include older age, delayed diagnosis, corticosteroid use before prompt diagnosis, poor initial best corrected visual acuity (BCVA), and AK stage at presentation. Conclusions: The initial treatment with TED, biguanides, and diamidines remains the foundation of treatment. Surgical options can be considered in advanced cases. An early diagnosis, age, and initial BCVA are prognosis factors that should be considered. Future research may focus on improvement of protocols and searching for novel agents. Full article

(This article belongs to the Special Issue Clinical Advances and Management in Corneal Diseases)

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20 pages, 957 KiB

Open AccessReview

Atypical Hemolytic Uremic Syndrome: A Review of Complement Dysregulation, Genetic Susceptibility and Multiorgan Involvement

by Razvan-George Bogdan, Paula Anderco, Cristian Ichim, Anca-Maria Cimpean, Samuel Bogdan Todor, Mihai Glaja-Iliescu, Zorin Petrisor Crainiceanu and Mirela Livia Popa

J. Clin. Med. 2025, 14(7), 2527; https://doi.org/10.3390/jcm14072527 - 7 Apr 2025

Viewed by 469

Abstract

Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening thrombotic microangiopathy (TMA) characterized by complement dysregulation, leading to microvascular thrombosis and multi-organ injury. TMAs are defined by thrombocytopenia, microangiopathic hemolytic anemia and organ dysfunction caused by small-vessel thrombosis. Unlike thrombotic thrombocytopenic purpura, which [...] Read more.

Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening thrombotic microangiopathy (TMA) characterized by complement dysregulation, leading to microvascular thrombosis and multi-organ injury. TMAs are defined by thrombocytopenia, microangiopathic hemolytic anemia and organ dysfunction caused by small-vessel thrombosis. Unlike thrombotic thrombocytopenic purpura, which results from severe ADAMTS13 deficiency, aHUS is driven by uncontrolled activation of the alternative complement pathway. While the kidneys are most frequently affected, other vital organs can also be involved. Genetic susceptibility contributes significantly to disease risk, but a trigger such as infection, pregnancy or autoimmune disease is usually required. Diagnosis is challenging due to overlapping features with other TMAs and relies on exclusion and complement testing. C5 inhibitors, such as eculizumab and ravulizumab, have revolutionized treatment but necessitate prophylactic vaccination and ongoing clinical surveillance. While these therapies provide effective disease control, discontinuing treatment remains complex, especially in patients with complement gene mutations. New therapies targeting various points in the complement cascade are under investigation and may offer safer, more cost-effective options. Progress in genetic profiling and biomarker discovery is essential for earlier diagnosis, individualized therapy and relapse prevention. This review highlights recent advances in the understanding of aHUS pathophysiology, clinical features and evolving therapeutic strategies aimed at improving patient outcomes. Full article

(This article belongs to the Section Emergency Medicine)

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8 pages, 3022 KiB

Open AccessCase Report

The Effect of a Smart Diaper Sensor on Incontinence-Associated Dermatitis Afflicting a Sedentary Patient with Cognitive Impairment

by Sol Lee and Jae-Hyung Kim

J. Clin. Med. 2025, 14(7), 2526; https://doi.org/10.3390/jcm14072526 - 7 Apr 2025

Viewed by 243

Abstract

Background: Urinary incontinence (UI) is common among hospitalized patients and often leads to complications like incontinence-associated dermatitis (IAD). This risk is heightened among patients with cognitive impairment, as delayed diaper changes can worsen skin conditions. Smart diaper sensors provide a promising solution to [...] Read more.

Background: Urinary incontinence (UI) is common among hospitalized patients and often leads to complications like incontinence-associated dermatitis (IAD). This risk is heightened among patients with cognitive impairment, as delayed diaper changes can worsen skin conditions. Smart diaper sensors provide a promising solution to these challenges. Methods: A 76-year-old woman with cognitive impairment and gait disturbance presented with itchy erythema and rashes consistent with IAD. Conventional treatments offered partial relief but did not resolve the symptoms. The MONIT smart diaper sensor was used in combination with antifungal ointment. The sensor, attached externally to the diaper, monitored moisture levels in real time and sent alerts to a smartphone via Bluetooth when a diaper change was needed. Results: The MONIT system significantly improved skin condition, as evidenced by reduced scores on the incontinence-associated dermatitis and its severity (IADS) instrument and the perineal assessment tool (PAT). Conclusions: The combined use of the MONIT smart diaper sensor and antifungal treatment effectively managed IAD, reducing its severity and preventing complications. Smart diaper sensors represent valuable tools for improving care for sedentary patients with cognitive impairment, offering innovative support for timely interventions. Full article

(This article belongs to the Section Mental Health)

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19 pages, 1153 KiB

Open AccessArticle

Prefrontal Cortical Near-Infrared Spectroscopy for Acute Pain Assessment in Infants: A Feasibility Study

by Matthias Nissen and Ralf-Bodo Tröbs

J. Clin. Med. 2025, 14(7), 2525; https://doi.org/10.3390/jcm14072525 - 7 Apr 2025

Viewed by 384

Abstract

Background: Assessing pain in infants is challenging due to their inability to communicate discomfort. Accurate pain evaluation is essential, as unaddressed pain might lead to long-term neurological consequences. This study investigates the use of conventional two-site near-infrared spectroscopy (NIRS) to evaluate hemodynamic responses [...] Read more.

Background: Assessing pain in infants is challenging due to their inability to communicate discomfort. Accurate pain evaluation is essential, as unaddressed pain might lead to long-term neurological consequences. This study investigates the use of conventional two-site near-infrared spectroscopy (NIRS) to evaluate hemodynamic responses in the prefrontal cortex during nociceptive stimuli. Methods: Data were prospectively collected from ten infants undergoing elective heel lance/squeeze (HLS) after surgery. Continuous bilateral NIRS oxygenation monitoring was performed alongside cardiorespiratory and behavioral (Children’s and Infant’s Postoperative Pain Score (CHIPPS)) pain assessments before, during, and after HLS. The primary outcome was the correlation between NIRS response and CHIPPS. Results: The average gestational and postnatal ages were 39 weeks and 49 days. No significant changes in prefrontal oxygenation levels (left, right, combined, ipsilateral, contralateral) were observed during the first ten seconds of HLS compared with baseline. Although CHIPPS and heart rates increased, oxygenation levels remained unchanged throughout the entire HLS event. Significant fluctuations in oxygenation levels from baseline were recorded across all optode configurations, with changes in the lowest oxygenation levels at the contralateral and left hemispheres inversely correlated with CHIPPS and HR changes. Conclusions: While there were subtle alterations in NIRS signals suggesting potential nociceptive-evoked changes, these were inconclusive. By design, the utilized two-site conventional NIRS system may not effectively detect acute pain. Future studies on prefrontal cortical pain processing could benefit from confirmatory NIRS signals from the primary somatosensory and motor regions. Integrating data from fNIRS, fMRI, EEG, along with sympathetic indicators like skin conductance and heart rate variability, would improve the quantification of cortical pain processing in non-verbal infants. Full article

(This article belongs to the Special Issue Targeted Medicine in Postoperative Pain Management)

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17 pages, 2660 KiB

Open AccessArticle

Pain and Tooth Movement During Orthodontic Leveling and Alignment—A Questionnaire-Based Study

by Eryk Prajwos, Maciej Jedliński, Małgorzata Król, Michał Kaczmarek, Alicja Grabarczyk, Patrycja Kaźmierczak and Joanna Janiszewska-Olszowska

J. Clin. Med. 2025, 14(7), 2524; https://doi.org/10.3390/jcm14072524 - 7 Apr 2025

Viewed by 260

Abstract

Background: Orthodontic treatment with fixed appliances often induces pain. Despite existing research on pain management, the dynamic nature of orthodontic pain and its relationship with tooth movement remain underexplored. This study surveys adults under fixed appliance therapy to investigate pain dynamics, modifying factors, [...] Read more.

Background: Orthodontic treatment with fixed appliances often induces pain. Despite existing research on pain management, the dynamic nature of orthodontic pain and its relationship with tooth movement remain underexplored. This study surveys adults under fixed appliance therapy to investigate pain dynamics, modifying factors, and perceived tooth movement, aiming to provide insights for improved patient care and treatment outcomes. Methods: This study focused on healthy individuals aged 18 to 50 undergoing fixed appliance treatment for up to six months after having braces bonded. A 24-question survey was administered over a one-month period. The survey explored pain intensity, pain dynamics, modifying factors, and perceived tooth movement. Results: Pain typically began within the first few hours after bonding and peaked the following day for most respondents. The upper incisors and molars were the most frequently reported areas of pain, corresponding to the teeth perceived as moving earliest. Chewing was identified as the primary external pain trigger. Gender significantly influenced pain perception, with women reporting higher pain levels and greater use of medication. The majority of participants managed without medication. Conclusions: Pain during the early phase of fixed appliance therapy follows a predictable pattern, with peak intensity occurring on the day after bonding. Pain perception strongly correlates with early tooth movement, particularly in the upper incisors. Gender differences were evident, but other demographic factors had minimal influence. Chewing was the primary pain aggravator, emphasizing the need for dietary modifications. Understanding these findings can help orthodontists develop personalized pain management strategies. Full article

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

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13 pages, 433 KiB

Open AccessArticle

Carotid Resistance and Pulsatility: Non-Invasive Markers for Diabetes Mellitus-Related Vascular Diseases

by Chun-Chieh Liu, Chao-Liang Chou, Chuen-Fei Chen, Chun-Fang Cheng, Shu-Xin Lu, Yih-Jer Wu, Tzu-Wei Wu and Li-Yu Wang

J. Clin. Med. 2025, 14(7), 2523; https://doi.org/10.3390/jcm14072523 - 7 Apr 2025

Viewed by 228

Abstract

Background: Diabetes mellitus (DM) is a major determinant of aging-related vascular diseases. The arterial pulsatility index (PI) and resistance index (RI) are biomarkers of vascular aging. The available data regarding DM with arterial PI and RI are limited. The specific aim of this [...] Read more.

Background: Diabetes mellitus (DM) is a major determinant of aging-related vascular diseases. The arterial pulsatility index (PI) and resistance index (RI) are biomarkers of vascular aging. The available data regarding DM with arterial PI and RI are limited. The specific aim of this study was to explore the relationships between DM and the segment-specific PI and RI of the extracranial carotid arteries. Methods: We enrolled 402 DM cases and 3416 non-DM controls from a community-based cohort. Each subject’s blood flow velocities in the extracranial common (CCA), internal (ICA), and external (ECA) carotid arteries were measured by color Doppler ultrasonography and used to calculate PIs and RIs. Results: The DM cases had significantly higher age–sex-adjusted means of carotid RIs and PIs than the non-DM controls (all p-values < 0.005). After controlling for the effects of conventional cardio-metabolic risk factors, all carotid RIs and PIs remained significantly correlated with higher odds ratios (ORs) of having DM. The relationships with DM were stronger and more significant for the ECA RI and PI. The multivariable-adjusted ORs were 1.36 (95% confidence interval [CI], 1.21~1.54, p = 3.9 × 10⁻⁷) and 1.30 (95% CI, 1.17~1.45, p = 8.7 × 10⁻⁷) for 1.0 SD increases in the ECA RI and PI, respectively. Compared to the best fit model of conventional cardio-metabolic risk factors, the additions of the ECA RI and PI significantly increased the area under the receiver operating characteristic curve by 0.85% (95% CI, 0.11~1.59%; p = 0.023) and 0.69% (95% CI, 0.01~1.37%; p = 0.046), respectively. Conclusions: This study shows significantly positive associations between DM and carotid RIs and PIs. Carotid RIs and PIs are potential biomarkers for DM-related vascular diseases. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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20 pages, 1282 KiB

Open AccessReview

The Role of Prophylactic Gastrectomy in Gastric Adenocarcinoma and Proximal Polyposis of the Stomach: A Systematic Review

by Cosmina Fugărețu, Valeriu Marin Șurlin, Catalin Misarca, Daniela Marinescu, Stefan Patrascu, Sandu Ramboiu, Radu Petre, Victor Dan Eugen Strâmbu and Michael Schenker

J. Clin. Med. 2025, 14(7), 2522; https://doi.org/10.3390/jcm14072522 - 7 Apr 2025

Viewed by 282

Abstract

Background/Objectives: Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) is a recently discovered autosomal dominant transmission disease. Patients with this condition have a higher risk of developing gastric cancer. There are numerous questions regarding the natural history of this condition, as [...] Read more.

Background/Objectives: Gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS) is a recently discovered autosomal dominant transmission disease. Patients with this condition have a higher risk of developing gastric cancer. There are numerous questions regarding the natural history of this condition, as well as concerning the diagnostic and therapeutic management of these patients. In this systematic review, we aimed to examine the current literature to determine the role of prophylactic gastrectomy in patients diagnosed with gastric adenocarcinoma and proximal polyposis of the stomach. Additional outcomes are Helicobacter pylori (HP) infection, treatment with proton pump inhibitors (PPI), and colonoscopic examination and abdominal imaging examination, as they are important factors in the therapeutic decision. Methods: We performed a systematic review of the articles published in PubMed and Google Scholar, according to the PRISMA 2020 criteria. Results: We obtained 24 studies that included 83 patients diagnosed with GAPPS, of which 42 underwent prophylactic gastrectomy, 24 benefited from endoscopic follow-up, and 17 were diagnosed with gastric cancer at the first gastroscopic examination. In the prophylactic gastrectomy specimens, malignant gastric disease was confirmed in 10% of cases. GAPPS has been diagnosed more frequently in women. Conclusions: So far, the specialized literature includes a limited number of patients diagnosed with GAPPS. There are also no guidelines yet for the diagnosis and treatment of these patients. Prophylactic gastrectomy or endoscopic surveillance are the only options for patients diagnosed with GAPPS without gastric cancer at the initial examination. For prophylactic gastrectomy, the robotic and laparoscopic approach was preferred. For establishing appropriate lymphadenectomy in prophylactic gastrectomy, future research on gastrectomy specimens is necessary. Most of the included studies were deficient in terms of postoperative follow-up of patients. Thus, we consider it useful to include these patients in a single database. For a comprehensive examination of these and making an appropriate therapeutic decision, we consider it necessary to perform a colonoscopic evaluation, take abdominal imaging, and determine the Helicobacter pylori infection status. Full article

(This article belongs to the Special Issue Gastrointestinal Cancer: Outcomes and Therapeutic Management)

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13 pages, 408 KiB

Open AccessArticle

Effectiveness of P6 Stimulation and Transdermal Scopolamine Patch for the Reduction of Nausea and Vomiting During Caesarean Section Under Combined Spinal–Epidural Anesthesia: A Randomized Clinical Trial

by Danielle Levin, Sarah Levin and Shaul Cohen

J. Clin. Med. 2025, 14(7), 2521; https://doi.org/10.3390/jcm14072521 - 7 Apr 2025

Viewed by 724

Abstract

Background/Objectives: Obstetric patients undergoing elective cesarean section (CS) with combined spinal–epidural (CSE) anesthesia often experience intraoperative nausea and vomiting (N&V). While prophylactic treatment with antiemetic drugs can be effective, it may also carry potential adverse effects for both the mother and the baby. [...] Read more.

Background/Objectives: Obstetric patients undergoing elective cesarean section (CS) with combined spinal–epidural (CSE) anesthesia often experience intraoperative nausea and vomiting (N&V). While prophylactic treatment with antiemetic drugs can be effective, it may also carry potential adverse effects for both the mother and the baby. To address this, we designed a randomized clinical trial to assess the effectiveness of transdermal scopolamine patches and electrical P6 stimulation as preventive measures for N&V in patients scheduled for elective CS under CSE anesthesia. Methods: Following the Institutional Review Board approval and informed consent, a total of 240 patients were randomly allocated into three groups: (1) transdermal scopolamine, (2) P6 stimulation (via a peripheral nerve stimulator), and (3) combined transdermal scopolamine and P6 stimulation, with 80 parturients in each group. The primary outcome was defined as the presence or absence of intraoperative nausea and vomiting during the procedure. Results: The incidences of intraoperative nausea and vomiting were similar across all three treatment groups, with no significant differences observed at any point during the surgery. Additionally, there were no notable differences in overall satisfaction with anesthetic care among the three study groups. Conclusions: These findings indicate that while both transcutaneous P6 acupoint stimulation and transdermal scopolamine are straightforward, safe, and effective methods, combining these two antiemetic strategies does not offer additional benefits in reducing nausea and vomiting. Nevertheless, both approaches may be particularly appealing to patients and obstetric anesthesiologists who prioritize treatments with fewer potential side effects. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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9 pages, 193 KiB

Open AccessArticle

Is Retinol Binding Protein 4 a Good Biomarker of Renal Function in Children with Neurogenic Bladder After Myelomeningocele?

by Alicja Szymańska, Joanna Bagińska-Chyży and Agata Korzeniecka-Kozerska

J. Clin. Med. 2025, 14(7), 2520; https://doi.org/10.3390/jcm14072520 - 7 Apr 2025

Viewed by 305

Abstract

Background: This prospective study aimed to evaluate renal function using retinol binding protein 4 (RBP4), cystatin C, and glomerular filtration rate (GFR) in relation to physical activity and lesion level in children with neurogenic bladder (NB) post-myelomeningocele. Methods: Two groups were studied: [...] Read more.

Background: This prospective study aimed to evaluate renal function using retinol binding protein 4 (RBP4), cystatin C, and glomerular filtration rate (GFR) in relation to physical activity and lesion level in children with neurogenic bladder (NB) post-myelomeningocele. Methods: Two groups were studied: 33 children with NB and 20 healthy controls. Data collected included demographic details, physical activity levels, uroflowmetry, urodynamic diagnosis, and renal function parameters. Urinary RBP4 and serum cystatin C were measured using ELISA, and GFR was calculated using the Schwartz formula. Results: The NB group had higher median serum cystatin C and urinary RBP4/creatinine ratios compared to the control group (0.28 vs. 0.22; 18.6 vs. 3.2, respectively). The participants were categorized based on activity levels, lesion levels, catheterization status, and urodynamic diagnosis. No differences in RBP4, cystatin C, or urodynamic diagnosis were observed according to activity and lesion levels. Significant differences in GFR were found based on activity and lesion levels, with higher median GFR in NB children (182.7 vs. 147.3). No differences were found between catheterized and non-catheterized children in the studied parameters. Conclusions: Elevated urinary RBP4 in NB patients suggests possible proximal renal tubule dysfunction. Higher serum cystatin C despite lower creatinine levels indicates altered renal function in NB children. Urinary RBP4 correlates positively with bladder pressure at maximum cystometric capacity, suggesting potential utility in therapy monitoring and modification. Full article

(This article belongs to the Section Clinical Pediatrics)

11 pages, 4920 KiB

Open AccessArticle

The Current Landscape of Clinical Trials

by Geeta Joshi, Tara K. Bhandari, Pushkar Joshi, Smriti Bhandari, Shalini Reddy Araveeti, Aditi Jain, Subash Khadka, Shaun Trecarten, Ahmad Abdelaziz, Harshit Garg and Mukund Bhandari

J. Clin. Med. 2025, 14(7), 2519; https://doi.org/10.3390/jcm14072519 - 7 Apr 2025

Viewed by 372

Abstract

Background/Objectives: Clinical trials are essential in the development of new medical treatments, offering crucial data on their safety and effectiveness. Methods: This study provides a comprehensive analysis of clinical trials registered on ClinicalTrials.gov, examining the current landscape, challenges, and innovations that have shaped [...] Read more.

Background/Objectives: Clinical trials are essential in the development of new medical treatments, offering crucial data on their safety and effectiveness. Methods: This study provides a comprehensive analysis of clinical trials registered on ClinicalTrials.gov, examining the current landscape, challenges, and innovations that have shaped the field over the past century. Data were extracted on 7 March 2025 and analyzed to identify patterns in trial design, sponsorship, participant demographics, and geographical distribution. Results: The analysis reveals a continuous increase in clinical trial registrations, peaking in 2021, driven by the COVID-19 pandemic. Most trials focus on cancer, reflecting its global burden, with randomized controlled trials (RCTs) being the most common study design. However, challenges persist, including underrepresentation of certain demographics, limited global distribution, and insufficient reporting of trial results. Additionally, the underrepresentation of pediatric, elderly, and minority populations in trials limits the generalizability of findings. Conclusions: The analysis underscores the need for more inclusive and globally distributed research to address disparities in health outcomes. Full article

(This article belongs to the Section Clinical Research Methods)

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16 pages, 1622 KiB

Open AccessArticle

Potential Biomarkers for IDH-Mutant and IDH-Wild-Type Glioblastomas: A Single-Center Retrospective Study

by Mustafa Emre Sarac, Zeki Boga, Ümit Kara, Tolga Akbıyık, Ahmet Hamit Çınkı and Semih Kivanc Olguner

J. Clin. Med. 2025, 14(7), 2518; https://doi.org/10.3390/jcm14072518 - 7 Apr 2025

Viewed by 306

Abstract

Background/Objectives: Glioblastoma ranks among the most aggressive brain tumors, with poor prognosis. Currently, there are insufficient data regarding the prognostic value of isocitrate dehydrogenase (IDH) mutation status and inflammatory markers. This study demonstrates the prognostic value of IDH mutation status and preoperative inflammatory [...] Read more.

Background/Objectives: Glioblastoma ranks among the most aggressive brain tumors, with poor prognosis. Currently, there are insufficient data regarding the prognostic value of isocitrate dehydrogenase (IDH) mutation status and inflammatory markers. This study demonstrates the prognostic value of IDH mutation status and preoperative inflammatory markers in glioblastoma. Methods: This single-center retrospective study encompassed 66 glioblastoma patients who had surgical treatment in our institution from January 2020 to March 2022. The patients were categorized into two groups: IDH-mutant (n = 30) and IDH-wild-type (n = 36). We made a comparative assessment of demographic characteristics, clinical parameters, preoperative blood parameters, and survival outcome across the two groups. Statistical analyses included Kaplan–Meier survival curves, ROC analysis, and multivariate Cox regression. Results: The IDH-mutant group demonstrated a significantly lower mean age (53.93 ± 12.00) compared to the wild-type group (62.39 ± 10.12) (p = 0.003). Median overall survival was notably longer in the IDH-mutant group, at 16.0 months, versus 6.5 months in the wild-type group (p = 0.030). An elevated neutrophil/lymphocyte ratio above 3.39 (sensitivity 95.12%, specificity 52.0%) and a platelet/lymphocyte ratio exceeding 136.25 (sensitivity 80.49%, specificity 64.0%) were associated with poor prognosis. Cox regression analysis identified IDH-wild-type status (HR = 2.84, 95% CI: 1.56–5.18) and elevated NLR (HR = 1.84, 95% CI: 1.16–2.92) as independent poor prognostic factors. Conclusions: We show that IDH-wild-type glioblastomal patients have a significantly poorer overall prognosis. In this case, the metrics of preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio seem to be supplied with some value as biomarkers for the expansion of the disease and predicting likely outcomes. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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15 pages, 262 KiB

Open AccessSystematic Review

Predictors of Antenatal Care Service Utilization Among Women of Reproductive Age in Ethiopia: A Systematic Review and Meta-Analysis

by Amanuel Yoseph, G. Mutwiri and Francisco Guillen-Grima

J. Clin. Med. 2025, 14(7), 2517; https://doi.org/10.3390/jcm14072517 - 7 Apr 2025

Viewed by 297

Abstract

Objective: This study aimed to provide pooled predictors of ANC (antenatal care) service use among women of reproductive age in Ethiopia. Methods: Studies were systematically searched using PubMed, Medline, CINAHL, EMBASE, and Google Scholar. The Newcastle–Ottawa scale (NOS) tool was utilized for quality [...] Read more.

Objective: This study aimed to provide pooled predictors of ANC (antenatal care) service use among women of reproductive age in Ethiopia. Methods: Studies were systematically searched using PubMed, Medline, CINAHL, EMBASE, and Google Scholar. The Newcastle–Ottawa scale (NOS) tool was utilized for quality assessment (risk of bias). All data analyses were conducted by utilizing Stata version 17. A random-effects model was used to obtain the pooled predictors of ANC use. The publication bias was checked using a funnel plot and Egger’s regression test. Results: Twenty-two studies with a sample size of 25,671 were included in this review. The identified predictors of ANC service use were highest wealth rank (AOR 1.92 [95% CI: 1.53–2.31]), formal women education (AOR 2.40 [95% CI: 1.75–3.06]), formal husband education (AOR 1.49 [95% CI: 1.36–1.66]), women age ≥ 20 (AOR 1.75 [95% CI: 1.47–2.17]), mass media exposure (AOR 1.44 [95% CI: 1.21–1.66]), good maternal knowledge about the pregnancy complication (AOR 1.49 [95% CI: 1.11–1.88]), planned pregnancy (AOR 1.59 [95% CI: 1.28–1.91]), women autonomy (AOR 1.42 [95% CI: 1.23–1.62]), and positive husband attitude about the ANC service use (AOR 2.63 [95% CI: 1.47–3.79]). Conclusions: Several predictors have increased the ANC service utilization, like wealth status, women’s and their husbands’ education, older/increasing women’s age, media exposure, maternal knowledge about pregnancy complications, planned pregnancy, women’s autonomy to decide on household health care, and positive husband attitude about the ANC service utilization. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Epidemiology & Public Health)

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Open AccessArticle

Innovative Use of Bleomycin Electrosclerotherapy (BEST) for High-Flow Arteriovenous Malformations in the Head District: Preliminary Results of Two Cases

by Linda Latini, Sandra Bracco, Samuele Cioni, Sara Leonini, Flavia Cascino and Paolo Gennaro

J. Clin. Med. 2025, 14(7), 2516; https://doi.org/10.3390/jcm14072516 - 7 Apr 2025

Viewed by 286

Abstract

Background: According to the ISSVA 2018 classification, arteriovenous malformations (AVMs) are high-flow vascular malformations, distinct from low-flow lesions. About 60% of extracranial AVMs occur in the head and neck, making their management a focus of maxillofacial surgery. Due to their complexity, precise [...] Read more.

Background: According to the ISSVA 2018 classification, arteriovenous malformations (AVMs) are high-flow vascular malformations, distinct from low-flow lesions. About 60% of extracranial AVMs occur in the head and neck, making their management a focus of maxillofacial surgery. Due to their complexity, precise diagnosis and careful treatment planning are crucial for optimal aesthetics and structural preservation. The standard approach combines embolization with surgical resection, though Bleomycin electrosclerotherapy (BEST) has recently gained recognition. Methods: From July 2023 to December 2024, a total of 16 patients with vascular malformations were treated with bleomycin electrosclerotherapy at the Azienda Ospedaliera Universitaria Senese (AOUS). Among them, two patients were affected by arteriovenous malformations. These two patients underwent this treatment to avoid more invasive and demolitive procedures, considering the anatomical region involved. Both patients had previously been treated at other hospitals, experiencing subsequent lesion recurrence. Preoperative evaluation included angiographic and ultrasound studies. The patients underwent electrosclerotherapy sessions and were closely monitored during follow-up. The uniqueness of this innovative approach lies in the use of fractionated doses of bleomycin for each treatment session, compared to the standard protocols described in the literature. Results: BEST has demonstrated efficacy in the treatment of high-flow AVMs by delivering bleomycin into the interstitial tissue and subsequently applying electroporation so the drug’s effects can be precisely localized and amplified. The macroscopically evident results, patient satisfaction, and, most importantly, the objective ultrasound flow data demonstrate the effectiveness of this treatment. Conclusions: Arteriovenous malformations (AVMs) pose treatment challenges due to their variability and lack of standardized guidelines. This study explores electrosclerotherapy with bleomycin in two head and neck AVM cases, using fractionated doses to enhance safety and efficacy. The findings support its potential as a minimally invasive alternative, warranting further research on broader applications. Full article

(This article belongs to the Special Issue Vascular Surgery: Current Advances and Future Directions)

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18 pages, 731 KiB

Open AccessCommunication

The Role of Artificial Intelligence in Managing Bipolar Disorder: A New Frontier in Patient Care

by Jelena Milic, Iva Zrnic, Edita Grego, Dragana Jovic, Veroslava Stankovic, Sanja Djurdjevic and Rosa Sapic

J. Clin. Med. 2025, 14(7), 2515; https://doi.org/10.3390/jcm14072515 - 7 Apr 2025

Viewed by 491

Abstract

Background/Objectives: Bipolar disorder (BD) is a complex and chronic mental health condition that poses significant challenges for both patients and healthcare providers. Traditional treatment methods, including medication and therapy, remain vital, but there is increasing interest in the application of artificial intelligence (AI) [...] Read more.

Background/Objectives: Bipolar disorder (BD) is a complex and chronic mental health condition that poses significant challenges for both patients and healthcare providers. Traditional treatment methods, including medication and therapy, remain vital, but there is increasing interest in the application of artificial intelligence (AI) to enhance BD management. AI has the potential to improve mood episode prediction, personalize treatment plans, and provide real-time support, offering new opportunities for managing BD more effectively. Our primary objective was to explore the potential role of AI in transforming the management of BD, specifically in mood tracking, prediction, and personalized treatment regimens. Methods: To explore the potential role of AI in transforming BD management, we conducted a review of recent literature using key search terms. We included studies that discussed AI applications in mood tracking, prediction, and treatment personalization. The studies were selected based on their relevance to AI’s role in BD management, with attention to the PICO criteria: Population—individuals diagnosed with BD; Intervention—AI tools for mood prediction, treatment personalization, and real-time support; Comparison—traditional treatment methods (when available); Outcome—measures of mood episode prediction, treatment effectiveness, and improvements in patient care. Results: The findings from recent research reveal promising developments in the use of AI for BD management. Studies suggest that AI-powered tools can enable more proactive and personalized care, improving treatment outcomes and reducing the burden on healthcare professionals. AI’s ability to analyze data from wearable devices, smartphones, and even social media platforms provides valuable insights for early detection and more dynamic treatment adjustments. Conclusions: While AI’s application in BD management is still in its early stages, it presents transformative potential for improving patient care. However, further research and development are crucial to fully realize AI’s potential in supporting BD patients and optimizing treatment efficacy. Full article

(This article belongs to the Special Issue Patient-Oriented Treatments for Bipolar Disorder)

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12 pages, 1626 KiB

Open AccessArticle

Comparing Electromyographic Muscle Activities and Kinematics During Sit-to-Stand Transitions in Patients with Adult Spinal Deformity Versus Healthy Controls

by Yukako Hayamizu, Tetsuyuki Nagafusa, Kumi Sasaki, Masaaki Nagashima, Katsuya Yamauchi, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Tomohiro Yamada, Yukihiro Matsuyama and Yu Yamato

J. Clin. Med. 2025, 14(7), 2514; https://doi.org/10.3390/jcm14072514 - 7 Apr 2025

Viewed by 278

Abstract

Background/Objectives: Adult spinal deformity (ASD) affects sit-to-stand (STS) transitions due to abnormal spinal alignment, influencing muscle function. This study investigated lower-extremity electromyographic activity and kinematic parameters during STS transitions in ASD patients. Methods: A cross-sectional study was conducted with ASD patients scheduled for [...] Read more.

Background/Objectives: Adult spinal deformity (ASD) affects sit-to-stand (STS) transitions due to abnormal spinal alignment, influencing muscle function. This study investigated lower-extremity electromyographic activity and kinematic parameters during STS transitions in ASD patients. Methods: A cross-sectional study was conducted with ASD patients scheduled for corrective surgery. The STS task was divided into three phases, and electromyographic activity, temporal parameters, and joint kinematics were compared between ASD patients and controls. Surface electromyography measured muscle activity, and a high-speed camera recorded phase durations and joint movements. Results: Compared to 17 controls, 17 ASD patients exhibited significantly increased %MVIC (ASD, controls, p-value) in the biceps femoris during the flexion momentum phase (23.7 ± 26.5, 12.3 ± 8.6, p = 0.048) and extension phase (48.6 ± 25.8, 32.8 ± 40.5, p = 0.011), and in the soleus during the flexion momentum phase (16.2 ± 7.5, 8.5 ± 2.9, p = 0.001). The ASD group also showed greater joint motion and longer phase durations during STS transitions. Conclusions: ASD patients display increased lower limb muscle activation, prolonged phase durations, and more joint motion during STS transitions. These findings highlight neuromuscular and biomechanical differences, though whether these are pathological, adaptive, or compensatory remains unclear. Full article

(This article belongs to the Section Clinical Rehabilitation)

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10 pages, 401 KiB

Open AccessArticle

Outcome Following Open Repair of Hereditary and Non-Hereditary Thoracoabdominal Aortic Aneurysm in Patients Under 60 Years Old—A Multicenter Study

by Jelle Frankort, Siebe Frankort, Panagiotis Doukas, Christian Uhl, Michael J. Jacobs, Barend M. E. Mees and Alexander Gombert

J. Clin. Med. 2025, 14(7), 2513; https://doi.org/10.3390/jcm14072513 - 7 Apr 2025

Viewed by 223

Abstract

Objective: This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. Methods: We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000–2024) at [...] Read more.

Objective: This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. Methods: We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000–2024) at two European centers. The primary endpoint was early outcome. We used a Kaplan–Meier curve to assess survival, and logistic regression to identify predictors. Results: Operative death rates were similar (hereditary: 13/106 [12.3%] vs. non-hereditary: 22/167 [13.2%], p = 0.83). Hereditary aortopathy patients were younger (median 42 vs. 54 years, p < 0.001) with lower BMI (24.1 vs. 28.4 kg/m², p < 0.001). Non-genetic patients had higher rates of chronic kidney insufficiency (58/167 (34.7%) vs. 14/106 (13.2%), p < 0.001), coronary artery disease (43/167 (25.7%) vs. 9/106 (8.5%), p < 0.001), and prior myocardial infarction (31/167 (18.6%) vs. 4/106 (3.8%), p < 0.001). Hereditary aortopathy patients suffered more often from post-dissection TAAA (68/106 [64.2%] vs. 44/167 [26.3%], p < 0.001) and prior aortic surgery (81/106 (76.4%) vs. 79/167 (47.3%), p < 0.001). Pulmonary complications (67.0% vs. 61.1%, p = 0.32), acute kidney injury (25.5% vs. 22.8%, p = 0.61), and spinal cord ischemia (6.6% vs. 10.2%, p = 0.31) were comparable between groups. Overall 5-year survival was 65.7%; the rate of any reintervention during follow up was 21.2%. Logistic regression identified no predictors for perioperative mortality. Conclusions: Open TAAA repair in patients < 60 years carries relevant perioperative mortality, which is comparable between hereditary and non-hereditary groups; non-hereditary patients had impaired preoperative cardiopulmonary status. Full article

(This article belongs to the Special Issue Aortic Pathologies: Aneurysm, Atherosclerosis and More)

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14 pages, 934 KiB

Open AccessArticle

Biomarkers of Inflammation and Association with Cardiovascular Magnetic Resonance Imaging for Risk Stratification and Outcome in Patients with Severe Aortic Stenosis

by Matthias Koschutnik, Christina Brunner, Christian Nitsche, Carolina Donà, Varius Dannenberg, Kseniya Halavina, Sophia Koschatko, Charlotte Jantsch, Katharina Mascherbauer, Christina Kronberger, Michael Poledniczek, Caglayan Demirel, Dietrich Beitzke, Christian Loewe, Christian Hengstenberg, Andreas A. Kammerlander and Philipp E. Bartko

J. Clin. Med. 2025, 14(7), 2512; https://doi.org/10.3390/jcm14072512 - 7 Apr 2025

Viewed by 255

Abstract

Background: Inflammatory indices have been proposed as simple and routinely obtainable markers of systemic inflammation in cardiac disease. This study investigated whether the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the pan-immune inflammation value (PIV) serve as biomarkers for risk stratification [...] Read more.

Background: Inflammatory indices have been proposed as simple and routinely obtainable markers of systemic inflammation in cardiac disease. This study investigated whether the neutrophil-to-lymphocyte ratio (NLR), the monocyte-to-lymphocyte ratio (MLR), and the pan-immune inflammation value (PIV) serve as biomarkers for risk stratification and outcomes measures in patients with severe aortic stenosis (AS) following valve replacement (AVR). Methods: In this retrospective analysis (January 2017–June 2022), patients with AS underwent pre-procedural cardiovascular magnetic resonance (CMR) imaging and were assigned a treatment strategy by a multidisciplinary Heart Team: (1) transcatheter AVR, (2) surgical AVR, or (3) no valvular intervention. Kaplan–Meier estimates and regression analyses were used to demonstrate associations between the NLR, MLR, and PIV with myocardial fibrosis—assessed by late gadolinium enhancement (LGE) and extracellular volume (ECV) on CMR—and a combined endpoint of heart failure hospitalizations and all-cause mortality. Results: A total of 356 patients (median age: 80 years, 50% male) were followed for a median of 40 months, during which 162 (46%) reached the combined endpoint. Linear regression identified C-reactive protein, but not the presence of LGE or elevated ECV, as the only independent predictor of all three inflammatory indices (p for all <0.001). After multivariable adjustment for clinical (EuroSCORE II), laboratory (baseline N-terminal prohormone of brain natriuretic peptide [NT-proBNP] and C-reactive protein), and imaging parameters (AV mean pressure gradient, right ventricular ejection fraction, and ECV), the above-the-upper-quartile NLR (adjusted hazard ratio [aHR]: 1.45, 95%-confidence interval [CI]: 1.01–1.92, p = 0.042), MLR (aHR: 1.48, 95%-CI: 1.05–2.09, p = 0.025), and PIV (aHR: 1.56, 95%-CI: 1.11–2.21, p = 0.011) remained significantly associated with adverse outcomes. Following AVR, the median NLR (3.5 to 3.4) and PIV (460 to 376) showed a significant post-procedural decline compared to baseline (p ≤ 0.019 for both). Conclusions: Inflammatory indices are readily available biomarkers independently associated with adverse outcomes in severe AS following AVR. However, no significant relationship was observed between the NLR, MLR, PIV, and myocardial fibrosis on CMR. Full article

(This article belongs to the Special Issue Current Concepts in Diagnosis and Therapy of Aortic Valve Disease)

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12 pages, 2190 KiB

Open AccessArticle

Prevalence and Potential Impact of Gastrointestinal Insufflation During Cardiopulmonary Resuscitation

by Maximilian Andreas Fichtl, Sophia Anna Henne, Viktoria Bogner-Flatz, Michael Dommasch, Philipp Zehnder, Karl Georg Kanz and Wilhelm Flatz

J. Clin. Med. 2025, 14(7), 2511; https://doi.org/10.3390/jcm14072511 - 7 Apr 2025

Viewed by 210

Abstract

Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. [...] Read more.

Background/Objectives: Insufflation of the gastrointestinal tract, as a side effect of improper ventilation, is a known complication in resuscitation patients. As animal studies have shown, this can be associated with an increase in intra-abdominal pressure with adverse effects on hemodynamics and respiratory mechanics. In this study, we investigated the prevalence and severity of insufflation and discussed the potential impact on the outcome of resuscitation. Methods: This study was based on computed tomography (CT) images from two university hospitals in Munich, Germany, which were taken as part of the trauma room care of out-of-hospital cardiac arrest (OHCA) patients. According to local resuscitation protocol, CT performed during ongoing cardiopulmonary resuscitation or after the return of spontaneous circulation (ROSC) was archived to determine the potentially reversible cause of cardiac arrest. CT images from 2014 to 2018 were analyzed in this study. Using an advanced visualization and analysis platform for medical image data, the gas volume within the gastrointestinal tract was determined and compared between resuscitations with lethal and secondary survival outcomes. Results: A total of 92.44% of included OHCA patients (n = 172) showed signs of increased gastrointestinal gas volume in comparison to the physiologically prevalent gas volume. In OHCA patients with a lethal outcome, significantly more gas was detected in the gastrointestinal tract with a median of 757.40 mL compared to 380.65 mL in resuscitations with secondary survival (p ≤ 0.05; W = 4278). Furthermore, Cohen’s r was used to calculate the effect size, indicating a weak association with the outcome of resuscitation (r = 0.24). In addition, a logistic regression analysis was performed to examine the influence of age, gender (female), and the gas volume of the intestines and stomach on the dependent variable “death”. The analysis shows that the model, as a whole, is significant (Chi² = 17.67; p 0.02; n = 172) and supports the hypothesis that intestinal insufflation correlates with a lethal outcome from resuscitation (b = 0.001; OR 1.001 (95% CI [1.000–1.002]; p = 0.021). Conclusions: Insufflation in resuscitation patients is a common phenomenon with potential consequences for the outcome. Even if the effect we have shown appears small, the outcome of resuscitation patients can possibly be improved by preventing or correcting insufflation. To understand its potential impact on resuscitation outcomes fully, further work must be performed to investigate causality. Full article

(This article belongs to the Special Issue Clinical Advances in Trauma and Emergency Medicine)

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8 pages, 187 KiB

Open AccessArticle

Ultrasound as a First-Line Modality for Acute Colonic Diverticulitis: A Prospective Comparison with CT

by Gil N. Bachar, Eli Atar, Moran Dahan, Haim Neiman, Tamar Gurvitz, Issa Nidal and Selma Gabrieli

J. Clin. Med. 2025, 14(7), 2510; https://doi.org/10.3390/jcm14072510 - 7 Apr 2025

Viewed by 272

Abstract

Objectives: We aimed to compare the accuracy of ultrasound and computed tomography (CT) for the diagnosis of patients with suspected acute diverticulitis and to determine if ultrasound might serve as the primary tool for this purpose in the emergency department. Methods: A double-blind [...] Read more.

Objectives: We aimed to compare the accuracy of ultrasound and computed tomography (CT) for the diagnosis of patients with suspected acute diverticulitis and to determine if ultrasound might serve as the primary tool for this purpose in the emergency department. Methods: A double-blind prospective study design was used. The study group included 142 consecutive patients with clinically suspected diverticulitis admitted to the emergency department of a tertiary medical center in 2016–2019. All underwent first ultrasound examination followed by abdominal CT. The final diagnosis was interpreted independently by an expert radiologist in a blinded fashion. Imaging data were compared with final diagnosis and we analyzed the findings against the medical, clinical, and laboratory data. Results: The final diagnosis was colonic diverticulitis in 98 patients. Sensitivity was 93.8% for ultrasound and 100% for CT; corresponding specificity rates were 86.7% and 100%. Agreement between the modalities was excellent (kappa = 0.81). CT demonstrated complicated diverticulosis in 18 patients: 8 pericolic abscesses, 9 micro-perforations, and 1 fistula. Ultrasound missed one abscess and five micro-perforations; however, all were small and were treated conservatively. Twenty-three patients were found to have an acute abdominal condition other than diverticulitis; sensitivity in these cases was 60.8% for ultrasound and 91.3% for CT. In 21 patients, the diagnosis was unknown. Conclusions: Ultrasound has similar sensitivity and specificity to CT for the diagnosis of acute colonic diverticulitis. We believe ultrasound may serve as the initial imaging modality in the emergency department, with CT reserved for large abscesses or inconclusive ultrasound findings. Full article

(This article belongs to the Special Issue Diagnosis and Surgical Treatment for Colorectal Cancer)

14 pages, 2130 KiB

Open AccessArticle

Neutrophil-to-Lymphocyte Ratio as a Prognostic Biomarker for Long-Term Survival in Older Adults at a Mental Health Care Center: A Historical Cohort Analysis

by Piotr Paweł Chmielewski, Bartłomiej Strzelec, Paul Mozdziak and Bartosz Kempisty

J. Clin. Med. 2025, 14(7), 2509; https://doi.org/10.3390/jcm14072509 - 7 Apr 2025

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Abstract

Background/Objectives: Identifying reliable biomarkers for healthy aging and longevity is a fundamental challenge in aging research and medical sciences. The neutrophil-to-lymphocyte ratio (NLR) is a readily measurable indicator of immune balance that reflects the interplay between innate immune activation and adaptive immune [...] Read more.

Background/Objectives: Identifying reliable biomarkers for healthy aging and longevity is a fundamental challenge in aging research and medical sciences. The neutrophil-to-lymphocyte ratio (NLR) is a readily measurable indicator of immune balance that reflects the interplay between innate immune activation and adaptive immune suppression. Methods: This study examined NLR values in 204 physically healthy residents (98 men and 106 women) stratified into four lifespan categories based on death certificates. Page’s test and ordinal regression (Cumulative Link Model) were used to assess trends with longevity. Results: In men, a downward trend in NLR values was observed. In women, a significant age-related decline in NLR was identified, with longer-lived individuals showing notably lower NLR values compared to their shorter-lived counterparts. The findings suggest that lower NLR is associated with longer survival, particularly in older women, reflecting superior immune regulation and reduced systemic inflammation. Conversely, elevated NLR may indicate immune dysfunction and heightened inflammatory burden. Conclusions: The results of this study complement existing findings, reinforcing the critical importance of immune balance in supporting healthy aging and longevity. These findings also underscore the potential of NLR as a robust biomarker for evaluating immune function and anticipating resilience to age-related decline, offering a practical tool for assessing immune health in the aging population. Full article

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

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9 pages, 745 KiB

Open AccessArticle

The Impact of Vascular Anatomic Variations in the Infra-Pyloric Area on the Surgical Outcomes of Laparoscopic Pylorus-Preserving Gastrectomy in Early Gastric Cancer: A Post Hoc Analysis of a Multicenter Prospective Trial (KLASS-04)

by Sang Soo Eom, Sin Hye Park, Young Shick Rhee, Sa-Hong Kim, Hyuk-Joon Lee, Young-Woo Kim, Han-Kwang Yang, Do Joong Park, Sang Uk Han, Hyung-Ho Kim, Woo Jin Hyung, Ji-Ho Park, Yun-Suhk Suh, Oh-Kyung Kwon, Wook Kim, Young-Kyu Park, Hong Man Yoon, Sang-Hoon Ahn, Seong-Ho Kong and Keun Won Ryu

J. Clin. Med. 2025, 14(7), 2508; https://doi.org/10.3390/jcm14072508 - 7 Apr 2025

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Abstract

Background/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical [...] Read more.

Background/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical variations in the IPA and surgical outcomes based on data from a multicenter prospective trial. Methods: A post hoc analysis was conducted based on the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial, in which patients randomly underwent LPPG or laparoscopic distal gastrectomy (LDG). The IPA variations were categorized into three groups: distal, caudal, and proximal. Clinicopathological characteristics and surgical outcomes were analyzed according to the IPA type. Results: Among the 192 patients, the distribution of IPA types was as follows: 45 (23.44%) distal, 74 (38.54%) caudal, and 73 (38.02%) proximal. There were no significant differences in the clinicopathological characteristics between the IPA types. Of the 119 patients who underwent LPPG, a significant difference in operative time was observed based on the IPA type, with a longer duration observed with the distal type compared to that of the proximal type (distal type vs. proximal type: 202.5 (150–275) vs. 170 (105–265) min, p = 0.0300). No significant differences were observed in other surgical outcomes. Conclusions: The distribution of IPA types was more diverse than that reported in previous studies. There was a statistically significant difference in the operating time based on the IPA type. Identifying IPA variations during LPPG may be beneficial for gastric cancer surgeons. Full article

(This article belongs to the Section General Surgery)

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14 pages, 3488 KiB

Open AccessArticle

The Distribution of Ocular Normative Parameters in a Spanish School Population

by Rut González-Jiménez, F. Javier Povedano-Montero, Ricardo Bernárdez-Vilaboa, Rosario Gomez-de-Liano, Noemí Guemes-Villahoz and Juan E. Cedrún-Sánchez

J. Clin. Med. 2025, 14(7), 2507; https://doi.org/10.3390/jcm14072507 - 7 Apr 2025

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Abstract

Background/Objectives: The prevalence of myopia is increasing globally, including in Spain. The early detection of ocular biometric parameters associated with myopia development is crucial for implementing control strategies. This study aims to describe the normative biometric values in a Spanish school-aged population [...] Read more.

Background/Objectives: The prevalence of myopia is increasing globally, including in Spain. The early detection of ocular biometric parameters associated with myopia development is crucial for implementing control strategies. This study aims to describe the normative biometric values in a Spanish school-aged population and compare them with previously established reference data. Methods: A cross-sectional, observational, and analytical study was conducted on 558 students aged 6 to 12 years from the Educare Valdefuentes School in Madrid. Ocular biometric parameters, including axial length (AL), corneal curvature (CR), anterior chamber depth (ACD), crystalline lens thickness (LT), corneal thickness (CCT), and posterior vitreous depth (PVD), were measured using IOLMaster 700. The axial length/corneal radius (AL/CR) ratio was calculated. Percentile growth curves were generated, and the results were statistically analyzed using IBM SPSS 29. Results: AL significantly increased with age (p < 0.001), and boys had longer AL than girls. The AL/CR ratio showed a moderate correlation with myopia risk (ρ = 0.647, p < 0.001). Compared to previous European studies, no significant differences were found, except for minor variations in AL and CR. Conclusions: These percentile-based biometric values provide a useful reference for monitoring ocular growth and assessing myopia risk in Spanish children. The AL/CR ratio remains a strong predictor of myopia development, supporting its role in early detection strategies. Full article

(This article belongs to the Section Ophthalmology)

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16 pages, 1208 KiB

Open AccessPerspective

Reconsidering Gender in Asthma: Is It All About Sex? A Perspective Review

by Alessio Marinelli, Silvano Dragonieri, Andrea Portacci, Vitaliano Nicola Quaranta and Giovanna Elisiana Carpagnano

J. Clin. Med. 2025, 14(7), 2506; https://doi.org/10.3390/jcm14072506 - 7 Apr 2025

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Abstract

Asthma is a prevalent chronic condition, affecting an estimated 260 million people worldwide, according to the 2021 Global Burden of Disease Study. This condition significantly impacts individuals of all ages. One notable finding is that asthma prevalence among adults was higher in females [...] Read more.

Asthma is a prevalent chronic condition, affecting an estimated 260 million people worldwide, according to the 2021 Global Burden of Disease Study. This condition significantly impacts individuals of all ages. One notable finding is that asthma prevalence among adults was higher in females than males. Recent evidence suggests that these disparities in asthma prevalence and outcomes are likely due to complex interactions among hormonal, anatomical, and environmental factors, coupled with societal and behavioral influences. The interchangeable use of the terms “sex” and “gender” in the scientific literature is frequently inconsistent. Biological sex is defined by anatomical and physiological characteristics determined by genetics; “gender”, on the other hand, is a more complex construct and a universally accepted definition is still lacking. This lack of clarity, coupled with potential knowledge gaps, misunderstandings, or the inherent difficulty in differentiating sex- and gender-related effects, often leads to the terms being poorly defined or used interchangeably. Such imprecise usage hinders accurate data interpretation and research progress. This paper provides a perspective review synthesizing current knowledge regarding the influence of sex and gender on asthma, specifically focusing on their impact on disease pathogenesis, clinical presentation, severity, and management strategies. Full article

(This article belongs to the Section Respiratory Medicine)

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