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J. Clin. Med., Volume 14, Issue 8 (April-2 2025) – 323 articles

Cover Story (view full-size image): Metastatic hormone-sensitive prostate cancer (mHSPCa) may present de novo or as significant disease progression and typically requires systemic treatment. Recently, triplet therapy—integrating ADT, docetaxel, and an ARSI—has emerged as an effective approach, particularly in high-volume metastatic disease, as supported by ARASENS and PEACE-1. Advances in imaging, such as PSMA PET-CT, have improved disease detection, allowing for earlier detection of metastasis and timely initiation of appropriate therapy. Genomic profiling has enabled the development of biomarker-driven, personalized treatment strategies. As novel therapies, targeted agents, and immunotherapies undergo investigation, optimizing treatment selection based on disease burden, molecular characteristics, and patient factors will be essential. View this paper
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17 pages, 9364 KiB  
Article
Management Concepts of Bisphosphonate-Related Atypical Femoral Fractures
by Liviu-Coriolan Misca, Rehan Gul and Jenel Marian Patrascu
J. Clin. Med. 2025, 14(8), 2858; https://doi.org/10.3390/jcm14082858 - 21 Apr 2025
Abstract
Background/Objectives: Osteoporosis is an important health issue worldwide, and bisphosphonates are commonly prescribed for its treatment. However, certain complications can occur with long-term bisphosphonate therapy. The complication highlighted in this study was atypical femoral fractures, which are rare but significant. The orthopedic [...] Read more.
Background/Objectives: Osteoporosis is an important health issue worldwide, and bisphosphonates are commonly prescribed for its treatment. However, certain complications can occur with long-term bisphosphonate therapy. The complication highlighted in this study was atypical femoral fractures, which are rare but significant. The orthopedic consensus identifies surgical intervention as the gold-standard treatment for atypical femoral fractures, typically involving intramedullary or cephalomedullary nailing (CMN). The aim was to monitor patients for a follow-up period exceeding six months after surgical fixation with a CMN, with the majority of patients being followed up for more than 18 months after their initial surgery. Methods: This single-center analysis was conducted on a mixed cohort comprising a total of 10 patients. The study was conducted between September and November 2024. The inclusion criterion was surgical treatment for bisphosphonate-related atypical femoral fractures (AFFs) between June 2022 and November 2024 at a Level 1 Trauma Center, Cork University Hospital in the Republic of Ireland. The patients were monitored through a structured follow-up protocol that extended beyond six months, with the majority of patients being followed up for over 18 months. Follow-up assessments were conducted at defined intervals, including key evaluations at 3 and 6 months and at their final review. Clinical parameters such as pain, functional recovery, and radiological healing were considered. Results: No significant functional difference was observed at follow-up between the patients who sustained displaced fractures and those who presented with undisplaced fractures. Sixty percent of the patients remained pain-free from the 3-month postoperative follow-up, and the same percentage continued to be pain-free at the final follow-up. Conclusions: Cephalomedullary nailing is a safe option for the treatment of atypical femoral fractures. Patients with a bisphosphonate atypical femoral fracture should undergo bilateral screening and should be followed up for a longer period than the standard post-traumatic care intervals that are in place for typical femoral fractures. Full article
(This article belongs to the Section Orthopedics)
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13 pages, 1012 KiB  
Article
Endothelial Activation and Stress Index—A Novel and Simple Prognostic Tool in Coronary Artery Bypass Grafting
by Philipp Krombholz-Reindl, Andreas Vötsch, Klaus Linni, Rainald Seitelberger, Roman Gottardi, Michael Lichtenauer, Matthias Hammerer, Elke Boxhammer and Andreas Winkler
J. Clin. Med. 2025, 14(8), 2857; https://doi.org/10.3390/jcm14082857 - 21 Apr 2025
Abstract
Objectives: Risk stratification in coronary artery bypass grafting (CABG) remains challenging despite existing models. The Endothelial Activation and Stress Index (EASIX), originally developed for hematological conditions, has shown promise in various medical fields as a predictor of adverse outcomes. EASIX, calculated from lactate [...] Read more.
Objectives: Risk stratification in coronary artery bypass grafting (CABG) remains challenging despite existing models. The Endothelial Activation and Stress Index (EASIX), originally developed for hematological conditions, has shown promise in various medical fields as a predictor of adverse outcomes. EASIX, calculated from lactate dehydrogenase, creatinine, and platelet count, reflects endothelial dysfunction and systemic inflammation. This study investigates EASIX’s potential in predicting mortality and morbidity in patients undergoing CABG. Methods: A total of 475 patients undergoing isolated CABG between January 2017 and June 2020 were retrospectively analyzed. EASIX scores were calculated from pre-operative blood samples. Patients were stratified based on an EASIX cut-off value of 1.16. Results: Patients with EASIX ≥ 1.16 were older and had more comorbidities. They experienced higher 30-day mortality (5.0% vs. 0.8%, p = 0.004), increased wound infections (6.7% vs. 2.5%, p = 0.035), and more frequent prolonged ventilation (9.2% vs. 4.2%, p = 0.040). The long-term survival analysis showed significant differences at 3 years (p = 0.030) and 5 years (p < 0.001). EASIX demonstrated moderate discriminatory power for long-term survival (AUROC 0.669, 95% CI: 0.598–0.740, p < 0.001). Importantly, the multivariable analysis revealed EASIX as an independent risk factor for long-term mortality, even after adjusting for traditional risk factors and comorbidities (HR: 2.65, 95% CI: 1.59–4.42, p < 0.001). Conclusions: EASIX ≥ 1.16 was associated with postoperative morbidity and poorer long-term survival in patients undergoing CABG. This easily calculable score could enhance risk stratification and guide personalized postoperative management. Full article
(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)
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13 pages, 781 KiB  
Article
Coflex Interspinous Stabilization with Decompression for Lumbar Spinal Stenosis: An Average 14-Year Follow-Up
by Juneyoung Heo, Ji-Hoon Baek, Ji Hyun Kim, Jae Chil Chang, Hyung-ki Park and Su Chan Lee
J. Clin. Med. 2025, 14(8), 2856; https://doi.org/10.3390/jcm14082856 - 21 Apr 2025
Abstract
Background: This study aimed to evaluate the long-term clinical usefulness and radiologic changes around the Coflex device following decompression with Coflex insertion for degenerative lumbar spinal stenosis (DLSS), with an average follow-up of 14 years. Methods: This retrospective study included 147 patients who [...] Read more.
Background: This study aimed to evaluate the long-term clinical usefulness and radiologic changes around the Coflex device following decompression with Coflex insertion for degenerative lumbar spinal stenosis (DLSS), with an average follow-up of 14 years. Methods: This retrospective study included 147 patients who underwent decompression and Coflex insertion for single-level DLSS at a single institution between January 2007 and December 2010. Patients with spinal stenosis unresponsive to 3 months of conservative treatment were treated surgically. The mean follow-up duration was 173.9 ± 23.7 (range, 119–214) months. Results: The mean visual analog scale score decreased from 8.22 ± 1.06 preoperatively to 2.08 ± 1.58 postoperatively. Intervertebral disc height and foramen height at the Coflex insertion site decreased by 5.3% and 2.0%, respectively, after surgery. The reoperation rate at the operated site was 25% (n = 37). A significantly higher reoperation rate was observed in patients with translational instability (odds ratio [OR], 7.77; 95% confidence interval [CI], 2.453–24.658; p < 0.01) and angular instability (OR, 1.59; 95% CI, 0.492–5.133; p < 0.001). Eight patients underwent reoperation due to rapid progression of instability within 2 years of Coflex insertion; thereafter, a similar cumulative incidence rate was consistently observed. The adjacent-segment reoperation rate was 10.8% (n = 16). Conclusions: The Coflex interspinous device helps preserve disc and foramen height but is associated with a high reoperation rate, particularly in patients with spinal instability. Therefore, careful patient selection is crucial when considering its use. Full article
(This article belongs to the Section Orthopedics)
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11 pages, 553 KiB  
Article
Hospitalization Predictors in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Post Hoc Study of a Multicentric Retrospective Analysis
by Grgur Salai, Tatjana Tokić Vukan-Ćusa, Mirna Vergles, Sanda Škrinjarić Cincar, Jelena Ostojić, Matea Škoro, Žarko Vrbica, Emilija Lozo Vukovac, Neven Tudorić and Andrea Vukić Dugac
J. Clin. Med. 2025, 14(8), 2855; https://doi.org/10.3390/jcm14082855 - 21 Apr 2025
Abstract
Background/Objectives: Hospitalizations for acute exacerbations in patients with chronic obstructive pulmonary disease (AECOPD) are connected with considerable mortality and morbidity and have a great impact on healthcare costs. We aimed to identify potentially important characteristics that distinguish patients with AECOPD that required [...] Read more.
Background/Objectives: Hospitalizations for acute exacerbations in patients with chronic obstructive pulmonary disease (AECOPD) are connected with considerable mortality and morbidity and have a great impact on healthcare costs. We aimed to identify potentially important characteristics that distinguish patients with AECOPD that required hospitalization between those that did not. Methods: We performed a post hoc study of a previously conducted observational study assessing the discharge records of AECOPD patients who were either hospitalized or discharged directly from the emergency department (ED). Results: A total of N = 593 AECOPD patients (37.4% female) were included: N = 225 (37.9%) were hospitalized, while 368 (62.1%) were discharged from the ED. Patients had a mean age of 71 (±9.14) years. Further, 64.7% had arterial hypertension, and 60.4% of hospitalized and 42.1% of discharged patients had cardiovascular disease (excluding hypertension) (p < 0.001). In addition, 24% of hospitalized patients suffered from diabetes mellitus (vs. 16.8% of those discharged, p = 0.042). Patients that were discharged had a higher median eosinophil count than hospitalized patients (p < 0.001). Among the 368 patients discharged from the ED, 23.6% visited the ED due to AECOPD, and 50.6% were hospitalized in the subsequent three months. Patients that had at least one AECOPD in the subsequent three months had significantly lower initial eosinophil counts than those that did not (p = 0.015). Conclusions: Hospitalized AECOPD patients had a higher prevalence of pre-existing cardiovascular disease, diabetes mellitus and lower blood eosinophil counts. Patients that had subsequently visited ED in the following three months initially had lower blood eosinophil counts than those that did not make subsequent visits. Full article
(This article belongs to the Section Respiratory Medicine)
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12 pages, 249 KiB  
Review
Drug-Coated Balloon Treatment for Urethral Strictures: Is This the Future? A Review of the Current Literature
by Konstantinos Kapriniotis, Ioannis Loufopoulos, Aikaterini Apostolopoulou, Paul C. B. Anderson and Efstathios Papaefstathiou
J. Clin. Med. 2025, 14(8), 2854; https://doi.org/10.3390/jcm14082854 - 21 Apr 2025
Abstract
Urethral strictures significantly impact patients’ quality of life, with endoscopic treatments such as direct vision internal urethrotomy (DVIU) and dilatation showing high recurrence rates. Drug-coated balloon (DCB) treatment, which delivers paclitaxel locally after dilation, is an innovative, minimally invasive approach aimed at reducing [...] Read more.
Urethral strictures significantly impact patients’ quality of life, with endoscopic treatments such as direct vision internal urethrotomy (DVIU) and dilatation showing high recurrence rates. Drug-coated balloon (DCB) treatment, which delivers paclitaxel locally after dilation, is an innovative, minimally invasive approach aimed at reducing fibrosis and stricture recurrence. Paclitaxel’s antiproliferative and antifibrotic properties inhibit excessive collagen deposition, improving long-term outcomes. DCB treatment is now included in guidelines for managing recurrent bulbar strictures less than 3 cm in length. Recent studies, including the ROBUST trials, have demonstrated the efficacy of Optilume in improving the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax). DCB has also shown a significant reduction in reintervention rates compared with endoscopic treatments in long-term studies, confirming its safety profile. However, the durability of DCB in complex or longer strictures remains uncertain, and its role as a salvage therapy post-urethroplasty requires further investigation. DCB represents a promising, cost-effective advancement in managing recurrent bulbar urethral strictures, particularly for patients unsuitable for urethroplasty. Future research should focus on refining patient selection criteria and exploring indications for other anatomical sites. Full article
(This article belongs to the Special Issue Recent Advances in Reconstructive Urology and Prosthetic Surgery)
19 pages, 1431 KiB  
Article
Epidemiological Assessment of Depression, Activities of Daily Living and Associated Factors in Elderly Individuals Aged 65 Years and Older: Evidence from a Population-Based Study
by Mehmet Emin Arayici, Ali Kose, Suleyman Dolu, Sema Gultekin Arayici, Gizem Gedik, Beyza Nur Kilic and Ozum Erkin
J. Clin. Med. 2025, 14(8), 2853; https://doi.org/10.3390/jcm14082853 - 21 Apr 2025
Abstract
Background: It is a well-established fact that late-life depression represents a significant public health issue, particularly in low- and middle-income countries experiencing rapid demographic aging. Although its clinical and societal impacts are well-recognized, data on the interplay between depressive symptoms and functional status [...] Read more.
Background: It is a well-established fact that late-life depression represents a significant public health issue, particularly in low- and middle-income countries experiencing rapid demographic aging. Although its clinical and societal impacts are well-recognized, data on the interplay between depressive symptoms and functional status in older populations remain limited for Türkiye. This study aimed to estimate the prevalence of depression among individuals aged 65 years or older, examine its associations with instrumental and basic activities of daily living, and identify key sociodemographic and behavioral correlates. Methods: In this study, data obtained from a population-based survey in 2264 clusters by the Turkish Statistical Institute (TUIK) were used, and weighted data were yielded from 6,036,396 adults aged 65 and over. Depression was measured using the Geriatric Depression Scale (GDS), categorizing participants as “not depressed”, “mildly depressed”, or “severely depressed”. Functional status was evaluated using the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale and the Katz Activities of Daily Living (ADL) Scale. Logistic regression models, adjusted for age and body mass index (BMI), were used to determine the associations of depression with functional impairment and various covariates, including gender, education, marital status, chronic disease, physical activity, smoking, and alcohol use. Results: Overall, the prevalence of depression in this cohort was 49.9% [95% CI = 48.7–51%], with 36.0% [95% CI = 34.8–37.0%] classified as mild and 13.9% [95% CI = 13.1–14.7%] as severe depression. IADL and ADL scores were negatively correlated with GDS scores (r = −0.416 and r = −0.321, respectively; p < 0.001). In logistic models, lower IADL scores were linked to higher odds of mild (OR = 0.797, 95% CI = [0.796–0.798], p < 0.001) and severe depression (OR = 0.689, 95% CI = [0.688–0.690], p < 0.001). Being semi-dependent or dependent in ADL further escalated depression risk. Female gender, lower education, single/divorced status, chronic disease, and inactivity also emerged as strong predictors. Conclusions: The findings of this study suggest that depression is highly prevalent among older adults in Türkiye, with functional impairment, unfavorable health behaviors, and sociodemographic vulnerabilities heightening risk. Integrating depression screening into geriatric care—alongside interventions to maintain functional independence—may help mitigate the burden of late-life depression in similar contexts. Full article
(This article belongs to the Special Issue Geriatric Diseases: Management and Epidemiology)
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22 pages, 2719 KiB  
Article
Prognostic Value of the Red Cell Distribution Width-to-eGFR Ratio (RGR) Across Chronic Heart Failure Phenotypes: A Retrospective Observational Pilot Study
by Andreea Varga, Liviu Cristescu, Marius-Stefan Marusteri, Razvan Gheorghita Mares, Dragos-Gabriel Iancu, Radu Adrian Suteu, Raluca-Maria Tilinca and Ioan Tilea
J. Clin. Med. 2025, 14(8), 2852; https://doi.org/10.3390/jcm14082852 - 21 Apr 2025
Abstract
Background/Objectives: This study aimed to investigate the prognostic value of the red cell distribution width-to-estimated glomerular filtration rate (RGR) ratio in patients hospitalized with chronic heart failure (CHF) and its potential interaction with NT-proBNP levels. By integrating anemia and renal dysfunction markers, the [...] Read more.
Background/Objectives: This study aimed to investigate the prognostic value of the red cell distribution width-to-estimated glomerular filtration rate (RGR) ratio in patients hospitalized with chronic heart failure (CHF) and its potential interaction with NT-proBNP levels. By integrating anemia and renal dysfunction markers, the RGR may provide enhanced predictive insights regarding extended length of hospital stay (ELOS) > 7 days, in-hospital mortality, and 6-month all-cause mortality across specific CHF phenotypes. Methods: In this retrospective, single-center pilot observational study, 627 CHF admissions (January 2022–August 2024) were analyzed. Patients were classified according to the ESC guidelines into heart failure with reduced (HFrEF), mildly reduced (HFmrEF), or preserved ejection fraction (HFpEF). The RGR was calculated as red cell distribution width standard deviation (RDW-SD) divided by estimated glomerular filtration rate (eGFR). Predictive accuracy was evaluated using logistic regression, receiver operating characteristic (ROC) analyses, and stepwise Cox proportional hazard regression. Results: RGR was significantly higher in HFrEF than in HFpEF (p = 0.042) and predicted ELOS only in HFpEF (AUC = 0.619). In contrast, for in-hospital mortality, RGR achieved excellent discrimination in HFrEF (AUC = 0.945), outperforming RDW and NT-proBNP. In HFmrEF, RDW exhibited the highest predictive power (AUC = 0.826), whereas in HFpEF, NT-proBNP was the strongest predictor (AUC = 0.958), although RGR preserved good discrimination (AUC = 0.746). Across the entire cohort and HF phenotypes, RGR consistently emerged as a significant predictor in univariable analysis. In multivariable models, it improved the significance prognosis especially alongside NT-proBNP in the entire cohort and HFrEF. For 6-month all-cause mortality, RGR surpassed RDW in prediction in all HF phenotypes. Conclusions: The RGR independently predicts prolonged hospitalization, in-hospital, and 6-month mortality in CHF—often outperforming RDW and eGFR and being comparable to NT-proBNP, especially in HFrEF. These findings suggest that RGR may serve as a valuable risk stratification tool in CHF management. Full article
(This article belongs to the Section Cardiology)
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24 pages, 1054 KiB  
Review
The Role of Endocannabinoids in Physiological Processes and Disease Pathology: A Comprehensive Review
by Paulina Simankowicz and Joanna Stępniewska
J. Clin. Med. 2025, 14(8), 2851; https://doi.org/10.3390/jcm14082851 - 21 Apr 2025
Abstract
The endocannabinoid system is a complex communication system involved in maintaining homeostasis in various physiological processes, including metabolism, immune response, pain modulation, and neuroprotection. Endocannabinoids, mainly anandamide and 2-arachidonoylglycerol, are natural ligands of the cannabinoid receptors CB1 and CB2, which are widely distributed [...] Read more.
The endocannabinoid system is a complex communication system involved in maintaining homeostasis in various physiological processes, including metabolism, immune response, pain modulation, and neuroprotection. Endocannabinoids, mainly anandamide and 2-arachidonoylglycerol, are natural ligands of the cannabinoid receptors CB1 and CB2, which are widely distributed throughout the central nervous system and peripheral tissues. Their biosynthesis, degradation, and interaction with other signaling pathways play crucial roles in both health and disease. This article provides a comprehensive overview of the physiological and pathological roles of endocannabinoids, discusses their potential as therapeutic targets, and highlights recent advances in endocannabinoid-based treatments. Full article
(This article belongs to the Section Pharmacology)
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19 pages, 4643 KiB  
Review
Multimodal Imaging of Immune Checkpoint Inhibitor Myocarditis
by Shreyans Patel, Kartikeya Dave, Mario J. Garcia, Carlos A. Gongora, Mark I. Travin and Lili Zhang
J. Clin. Med. 2025, 14(8), 2850; https://doi.org/10.3390/jcm14082850 - 21 Apr 2025
Abstract
Immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of cancer treatment and are increasingly used either as monotherapy or in combination with other ICIs, chemotherapy, and molecularly targeted agents. ICI myocarditis is a rare but potentially fatal irAE associated with the use [...] Read more.
Immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of cancer treatment and are increasingly used either as monotherapy or in combination with other ICIs, chemotherapy, and molecularly targeted agents. ICI myocarditis is a rare but potentially fatal irAE associated with the use of ICI characterized by T-cell mediated cardiomyocyte death. Diagnosing ICI myocarditis can be intricate as its atypical presentations. Multimodal imaging plays a crucial role in the diagnosis and risk stratification of ICI myocarditis. Current management strategies for ICI myocarditis include corticosteroids and immunosuppressants. Multidisciplinary collaboration is vital in these cases—combining oncology expertise with cardiology insights. Full article
(This article belongs to the Special Issue Cardiovascular Imaging: Opportunities and Challenges in Clinical Application: 3rd Edition)
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17 pages, 10141 KiB  
Article
Stabilizing Macular Edema Fluctuations: Outcomes of Intravitreal Fluocinolone Acetonide for Diabetic Macular Edema and Non-Infectious Uveitis
by Bettina Hohberger, Melanie Royer, Cindy Sheree Flamann and Antonio Bergua
J. Clin. Med. 2025, 14(8), 2849; https://doi.org/10.3390/jcm14082849 - 21 Apr 2025
Abstract
Background/Objectives: Chronic macular edema (CME) is a common complication of diabetic retinopathy or non-infectious uveitis affecting the posterior segment (NIU-PS). Alongside anti-VEGF therapy, glucocorticoids are frequently used to manage CME. Given the heterogeneous nature of patients’ medical history, their social conditions, and [...] Read more.
Background/Objectives: Chronic macular edema (CME) is a common complication of diabetic retinopathy or non-infectious uveitis affecting the posterior segment (NIU-PS). Alongside anti-VEGF therapy, glucocorticoids are frequently used to manage CME. Given the heterogeneous nature of patients’ medical history, their social conditions, and disease manifestations, individualized treatment is essential for optimal outcomes. This study assesses the effectiveness of intravitreal fluocinolone acetonide (FA) (Iluvien®) in treating persistent and recurrent macular edema in clinical practice at the University Hospital of Erlangen–Nuremberg, Germany. Methods: A total of 46 eyes with diabetic macular edema (DME) (21 eyes) and NIU-PS (25 eyes) were retrospectively analyzed over a follow-up period of up to 36 months. Since persistent retinal thickness fluctuations are linked to long-term retinal damage and functional decline, this study analyzed central retinal thickness (CRT)—including its fluctuations measured as CRT amplitude—alongside BCVA as the primary outcomes. Results: After an initial decrease in CRT in the first year after FA treatment, the maximum CRT amplitude significantly decreased in the following years. For patients with DME, CRT amplitude reduced from 271.4 µm to 91.57 µm in the first year (p = 0.0056) and 106.0 µm in the second year (p = 0.0109). For patients with NIU-PS, CRT amplitude decreased from 185.2 µm to 87.7 µm in the first year (p = 0.0131) and 97.3 µm in the second year (p = 0.0375). Mean BCVA remained stable in both cohorts. Conclusions: Intravitreal FA proved to be effective in reducing and stabilizing CRT in patients with chronic DME and NIU-PS without losing visual acuity, reducing treatment burden. Full article
(This article belongs to the Section Ophthalmology)
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12 pages, 243 KiB  
Article
The Risk Factors for Post-Bronchoscopy Respiratory Infection in Lung Cancer Patients—A Retrospective Case–Control Study from a Center in Greece
by Vasileios Papavasileiou, Thomas Raptakis, Georgios Lavasidis, Georgios Niotis, Katerina Papavasileiou, Stefanos Lampadakis, Vasiliki Athanasopoulou, Pavlos Siozos, Kalliopi Theoni Vandorou, Garyfallia Nizami, Stelios Loukides and Ilektra Voulgareli
J. Clin. Med. 2025, 14(8), 2848; https://doi.org/10.3390/jcm14082848 - 21 Apr 2025
Abstract
Introduction: Flexible bronchoscopy and its new methods have revolutionized the era of the diagnosis, staging, and restaging of lung cancer. A rare late complication is post-bronchoscopy respiratory infection, but it is critical due to treatment delays, treatment cancellation, and death. The aim of [...] Read more.
Introduction: Flexible bronchoscopy and its new methods have revolutionized the era of the diagnosis, staging, and restaging of lung cancer. A rare late complication is post-bronchoscopy respiratory infection, but it is critical due to treatment delays, treatment cancellation, and death. The aim of this study is to identify risk factors for respiratory tract infection after bronchoscopy in patients with lung cancer. Methods: A retrospective single-center observational study of 182 hospitalized patients was conducted at U.G.H. “ATTIKON” who underwent bronchoscopy for diagnosis/staging/restaging of lung cancer from January 2022 to April 2023. Patients were divided into two groups based on whether or not they developed post-bronchoscopy respiratory infection. Results: Analyzing the data between the groups, several potential risk factors for infection were identified, including recent hospitalization for COVID-19 within the last month (OR: 6.16; p = 0.01), history of COPD (OR: 8; p = 0.03), presence of emphysema on CT scan (OR: 8; p = 0.03), endobronchial lesions causing ≥ 50% bronchial obstruction with inability to advance the bronchoscope (OR: 9.6; p < 0.01), increased white blood cell count (≥8.5 K/μL) before bronchoscopy (OR: 8; p = 0.03), and advanced stage IV non-small-cell lung cancer (OR: 9.67; p = 0.02). Conclusions: Comparing our results with previous studies on risk factors for respiratory infections after bronchoscopy, we found that recent hospitalization for SARS-CoV-2 infection was a unique finding in our study. With the increasing incidence of lung cancer worldwide and the critical role of bronchoscopy in diagnosis/staging/restaging, large multicenter studies are needed to identify these risk factors and develop strategies for early detection, treatment, and prevention. Full article
(This article belongs to the Section Respiratory Medicine)
20 pages, 802 KiB  
Article
Glycemic Control, Inflammatory Mediators, and Periodontal Health: A Cross-Sectional Study in Patients with Diabetes
by Vanessa Bolchis, Daniela Jumanca, Ramona Dumitrescu, Octavia Balean, Nicoleta A. Toderas, Simona Popescu, Anca Marcu, Catalin Marian and Atena Galuscan
J. Clin. Med. 2025, 14(8), 2847; https://doi.org/10.3390/jcm14082847 - 21 Apr 2025
Abstract
Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care [...] Read more.
Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients’ awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes–periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations. Full article
(This article belongs to the Special Issue Periodontal and Other Associated Oral Diseases: Diagnosis and Management in the Context of Systemic Pathology, 2nd Edition)
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32 pages, 2143 KiB  
Systematic Review
Short-Term and Long-Term Effects of Inhaled Ultrafine Particles on Blood Markers of Cardiovascular Diseases: A Systematic Review and Meta-Analysis
by Joanna Izabela Lachowicz and Paweł Gać
J. Clin. Med. 2025, 14(8), 2846; https://doi.org/10.3390/jcm14082846 - 21 Apr 2025
Abstract
Background/Objectives: Air pollution is the highest environmental risk factor of mortality and morbidity worldwide, leading to over 4 million deaths each year. Among different air pollutants, ultrafine particles (UFPs) constitute the highest risk factor of cardiovascular diseases (CVDs). Epidemiological studies have associated UFPs [...] Read more.
Background/Objectives: Air pollution is the highest environmental risk factor of mortality and morbidity worldwide, leading to over 4 million deaths each year. Among different air pollutants, ultrafine particles (UFPs) constitute the highest risk factor of cardiovascular diseases (CVDs). Epidemiological studies have associated UFPs with the short- and long-term imbalance of numerous blood markers. Our objective was to systematically review the short-term and long-term impact of UFP exposure on blood markers of CVDs. Methods: We prepared the systematic review of CVD blood markers and meta-analyses of the short- and long-term effects of UFP exposure on high-sensitivity C-reactive protein (hsCRP) concentration. The eligibility criteria were established with the use of the Provider, Enrollment, Chain, and Ownership System (PECOS) model, and the literature search was conducted in Web of Science, PubMed, and Scopus databases from 1 January 2013 to 9 January 2025. The risk of bias (RoB) was prepared according to a World Health Organization (WHO) template. Results: The results showed an increase in hsCRP as a result of both short-term and long-term UFPs. Moreover, IL-6 and IL-1β together with other inflammatory markers increased after short-term UFP exposure. In addition, different nucleic acids, among which were miR-24-3p and let-7d-5p, were differentially expressed (DE) as a result of short-term UFP exposure. Chronic exposure to UFPs could lead to a persistent increase in hsCRP and other blood markers of CVDs. Conclusions: Our findings underline that UFPs may lead to the development and/or worsening of cardiovascular outcomes in fragile populations living in air-polluted areas. Full article
(This article belongs to the Section Cardiology)
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2 pages, 161 KiB  
Reply
Reply to van Bruggen, F.H.; Luijendijk, H.J. Comment on “Chwal et al. On-Target Low-Density Lipoprotein Cholesterol in Adults with Diabetes Not at High Cardiovascular Disease Risk Predicts Greater Mortality, Independent of Early Deaths or Frailty. J. Clin. Med. 2024, 13, 7667”
by Bruna C. Chwal, Rodrigo C. P. d. Reis, Maria I. Schmidt, Antonio L. P. Ribeiro, Sandhi M. Barreto, Rosane H. Griep, Paulo A. Lotufo and Bruce B. Duncan
J. Clin. Med. 2025, 14(8), 2845; https://doi.org/10.3390/jcm14082845 - 21 Apr 2025
Abstract
We thank Drs [...] Full article
(This article belongs to the Section Endocrinology & Metabolism)
14 pages, 1242 KiB  
Review
Utilization of Platelet-Rich Plasma in Oral Surgery: A Systematic Review of the Literature
by Andrea Giannelli, Marta Forte, Giuseppe D’Albis, Giulia Cianciotta, Luisa Limongelli, Laura Stef, Ramona Feier, Abdulrahman Omar Alrashadah, Massimo Corsalini and Saverio Capodiferro
J. Clin. Med. 2025, 14(8), 2844; https://doi.org/10.3390/jcm14082844 - 20 Apr 2025
Abstract
Introduction: The physiological process of wound healing is a complex and dynamic series of events that aims to restore damaged tissues to their original structure and function. Platelet-rich plasma (PRP), an autologous blood-derived product, is characterized by a high concentration of platelets suspended [...] Read more.
Introduction: The physiological process of wound healing is a complex and dynamic series of events that aims to restore damaged tissues to their original structure and function. Platelet-rich plasma (PRP), an autologous blood-derived product, is characterized by a high concentration of platelets suspended in a small volume of plasma, along with a complete array of coagulation factors at physiological concentrations. Beyond platelets, PRP contains a significant quantity of bioactive growth factors, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β), all of which are crucial mediators of tissue repair and osteogenesis. Due to these properties, PRP has garnered considerable attention in oral surgery, where the efficient regeneration of both hard and soft tissues is critical for the optimal therapeutic outcomes. Objectives: This systematic review aimed to critically evaluate the efficacy of PRP in oral surgical procedures, with particular emphasis on its role in the regeneration of both soft and hard tissues, as well as its clinical outcomes. Furthermore, the review sought to identify the diverse surgical applications of PRP and assess the impact of its use in conjunction with grafting materials on regenerative outcomes. Methods: A comprehensive systematic review was conducted, analyzing articles published within the last decade regarding the application of PRP in oral surgery, specifically focusing on periodontal, regenerative, and implant-related procedures. Studies were selected based on rigorous inclusion criteria, assessing the utilization of PRP across different clinical settings. Results: Thirteen relevant studies were included, which were categorized as follows: three studies involving implant surgery, three studies focusing on third molar extractions, two studies on regenerative surgery, two studies addressing periodontal surgery, one study examining intrabony periodontal defects, and two studies on ridge augmentation procedures. The majority of studies reported modest improvements in clinical parameters such as periodontal probing depth and clinical attachment level (CAL). Furthermore, significant positive outcomes were observed in soft tissue healing, with notable enhancements in bone density. These results suggest that PRP may facilitate the healing process, particularly in soft tissues, while also promoting bone regeneration to a degree. Conclusions: The findings of this systematic review underscore the potential of PRP as a valuable adjunct in oral surgery, demonstrating significant benefits in the regeneration of soft tissues and, to a lesser extent, hard tissues. Notably, the standalone application of PRP did not yield substantial improvements in regenerative outcomes. However, when PRP was used in combination with grafting materials, more pronounced benefits were observed, indicating a synergistic effect that enhances both soft and hard tissue regeneration. These findings support the rationale for incorporating PRP into clinical practice, particularly in conjunction with grafting materials, to optimize patient outcomes in oral surgery. Further research, particularly involving larger sample sizes and long-term follow-ups, is necessary to fully elucidate the optimal clinical applications and mechanistic pathways of PRP in oral regenerative procedures. Full article
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
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21 pages, 4096 KiB  
Systematic Review
Efficacy of Radiofrequency by the Topaz Technique for Chronic Plantar Fasciopathy: Systematic Review and Meta-Analysis
by Sandra Domingo-Marques, Eduardo Nieto-García, Nadia Fernández-Erhling, Leonor Ramírez-Andrés, Juan Vicente-Mampel and Javier Ferrer-Torregrosa
J. Clin. Med. 2025, 14(8), 2843; https://doi.org/10.3390/jcm14082843 - 20 Apr 2025
Abstract
Background/Objectives: Chronic plantar fasciopathy is a degenerative pathology that elicits persistent heel pain, significantly impacting quality of life. When conservative treatments fail to yield satisfactory outcomes, radiofrequency microtenotomy utilizing the Topaz technique presents a minimally invasive alternative with regenerative potential. This study aims [...] Read more.
Background/Objectives: Chronic plantar fasciopathy is a degenerative pathology that elicits persistent heel pain, significantly impacting quality of life. When conservative treatments fail to yield satisfactory outcomes, radiofrequency microtenotomy utilizing the Topaz technique presents a minimally invasive alternative with regenerative potential. This study aims to evaluate its efficacy in pain reduction, functional improvement, and complication rate compared to other treatments. Methods: A systematic review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD4202525648314). PubMed, EBSCOhost, Web of Science, and Scopus (2014–2024) were comprehensively searched to identify studies on the Topaz technique for refractory chronic plantar fasciopathy. Clinical trials, cohort studies, and case series were included, and a meta-analysis was performed using a random-effects model to assess pain, the Visual Analog Scale (VAS), American Orthopaedic Foot & Ankle Society function(AOFAS), and complications. Results: Fifteen studies encompassing 1576 patients were analyzed. The meta-analysis demonstrated a significant reduction in pain of 5.90 points on the VAS scale (95% CI: 5.03 to 6.77, p < 0.001) and a functional improvement of 0.28 points on the AOFAS scale (95% CI: 0.27 to 0.28, p < 0.001). The complication rate was low (3.00%), with high patient satisfaction (90%) and rapid recovery. Conclusions: The findings suggest that the Topaz technique is a safe and effective option for chronic plantar fasciopathy, demonstrating significant improvements and minimal complications. Full article
(This article belongs to the Section General Surgery)
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20 pages, 2994 KiB  
Article
Role of MRI in the Diagnosis of Ductal Carcinoma In Situ: A Retrospective Study
by Cristina García Ruiz, Laila Zitan Saidi, Lucía Zambrana Aguilar, Maricela Moreira Cabrera, Carolina Carvia Ponsaille, Rosa Vázquez Sousa, Carmen Martínez Porras and Antonio Fernando Murillo-Cancho
J. Clin. Med. 2025, 14(8), 2842; https://doi.org/10.3390/jcm14082842 - 20 Apr 2025
Abstract
Background: The use of dynamic magnetic resonance imaging (MRI) for the evaluation, detection, and characterization of ductal carcinoma in situ (DCIS) has been increasing; however, its application in this context remains controversial and uncertain. Materials: A retrospective study including women with pure DCIS, [...] Read more.
Background: The use of dynamic magnetic resonance imaging (MRI) for the evaluation, detection, and characterization of ductal carcinoma in situ (DCIS) has been increasing; however, its application in this context remains controversial and uncertain. Materials: A retrospective study including women with pure DCIS, confirmed between January 2012 and December 2022 using ultrasound-guided core-needle biopsy (CNB) or stereotaxy-guided vacuum-assisted biopsy (VAB), was conducted. Mammography, ultrasound (US), and MRI of DCIS lesions were evaluated according to histological grade. The size of the DCIS, as assessed by mammography, US, MRI, and final surgical histopathology, was compared using Lin’s concordance correlation and Bland–Altman plots. Results: A total of 144 women (mean age 55.5 ± 10.3 years) with histopathological diagnoses of pure DCIS and no evidence of infiltration in the percutaneous biopsy were included in the study. Microcalcifications were the most prevalent feature observed in mammography (82.63%). Round/punctate morphology was more common in low-grade lesions, while fine pleomorphic morphology was more frequent in medium- and high-grade lesions. Lesions manifesting as microcalcifications only on mammography were significantly associated with intermediate and high-nuclear grade DCIS (p = 0.005). The most common MRI manifestation of DCIS was non-mass enhancement (86.11%). A total of 141 lesions showed enhancement with MRI (sensibility 97.92%). There were no significant differences (p = 0.29) between negative and positive enhancement with MRI and the histological grade of the lesions. There were no significant differences (p = 0.49) between the type of enhancement curve with MRI and the histological grade. Preoperative MRI detected additional malignancies (multifocal, multicentric, or bilateral) in 35 patients (24.31%). Conclusions: DCIS demonstrated enhancement with MRI regardless of histological grade but overestimated the size of the lesions in low-nuclear-grade DCIS. Preoperative MRI identified additional malignancies (multifocal, multicentric, and bilateral lesions) in 24 patients (16.67%), which were confirmed by histopathological examination. These malignancies were either undetected or not visible with mammography and ultrasound. However, MRI also overestimated the size of the DCIS, leading to three unnecessary mastectomies in our study. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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9 pages, 861 KiB  
Article
Synovial Glucose and Serum-to-Synovial Glucose Predict Failure After Acute Postoperative Infection in Total Knee Arthroplasty
by Marta Sabater-Martos, Laia Boadas, Laura Morata, Alex Soriano and Juan Carlos Martínez-Pastor
J. Clin. Med. 2025, 14(8), 2841; https://doi.org/10.3390/jcm14082841 - 20 Apr 2025
Abstract
Background: The treatment of periprosthetic joint infection (PJI) involves various strategies, with debridement, antibiotic, and implant retention (DAIR) being a preferred method for acute infections due to its lower morbidity. However, DAIR success rates vary widely from 30% to 80%. This study [...] Read more.
Background: The treatment of periprosthetic joint infection (PJI) involves various strategies, with debridement, antibiotic, and implant retention (DAIR) being a preferred method for acute infections due to its lower morbidity. However, DAIR success rates vary widely from 30% to 80%. This study investigates the predictive value of synovial glucose and the serum-to-synovial glucose ratio for DAIR outcomes in acute postoperative PJI following total knee arthroplasty (TKA). Methods: This is a retrospective study of 32 DAIR cases, diagnosed with acute postoperative PJI after TKA. Synovial joint aspirations were performed on all patients. We collected all serological and synovial glucose levels. The serum-to-synovial glucose ratio was calculated. Results: Patients with synovial glucose levels below 44 mg/dL and a serum-to-synovial glucose ratio above 50% were identified as high risk for DAIR failure. High-risk patients exhibited a 31.3% failure rate, with half occurring within the first three months post-DAIR. No failures were observed in the low-risk group. Multivariate analysis did not find other significant predictors such as CRP levels, gender, or microbial cultures. Conclusions: Low synovial glucose levels and high serum-to-synovial glucose ratios are predictive of unsuccessful outcomes following DAIR procedures. Patients exhibiting lower synovial concentrations experienced early treatment failure. Full article
(This article belongs to the Special Issue Advancements in Total Joint Arthroplasty: Innovations, Outcomes and Challenges)
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13 pages, 1199 KiB  
Article
The Role of the Cerebellum in Multiple Sclerosis-Related Fatigue and Disability
by Nicola Manocchio, Ornella Argento, Michela Bossa, Barbara Spanò, Leonardo Pellicciari, Calogero Foti and Ugo Nocentini
J. Clin. Med. 2025, 14(8), 2840; https://doi.org/10.3390/jcm14082840 - 20 Apr 2025
Abstract
Background: Fatigue is a prevalent and debilitating symptom in people with multiple sclerosis (pwMS), significantly impairing quality of life. While the cerebellum is traditionally associated with motor control, emerging evidence suggests its involvement in cognitive, emotional, and integrative functions. This study aimed [...] Read more.
Background: Fatigue is a prevalent and debilitating symptom in people with multiple sclerosis (pwMS), significantly impairing quality of life. While the cerebellum is traditionally associated with motor control, emerging evidence suggests its involvement in cognitive, emotional, and integrative functions. This study aimed to explore the relationship between fatigue components (physical, cognitive, and psychosocial), clinical disability, and cerebellar structural changes in pwMS acquired via magnetic resonance imaging (MRI). Methods: Participants of this cross-sectional study underwent clinical assessments for fatigue (Modified Fatigue Impact Scale) and disability (Expanded Disability Status Scale). Cerebellar volumes were measured using high-resolution MRI and voxel-based morphometry (VBM) to identify correlations between fatigue subdomains and specific cerebellar subregions. Statistical analyses included group comparisons and correlation tests. Results: Forty-four pwMS were included. Fatigued MS patients exhibited reduced sensorimotor cerebellar volumes compared to non-fatigued counterparts. Physical fatigue correlated negatively with sensorimotor cerebellum volume, while cognitive fatigue showed an inverse relationship with limbic cerebellum regions. Interestingly, psychosocial fatigue was positively associated with limbic cerebellum volume, contrary to initial hypotheses. Higher disability scores were linked to atrophy in cognitive and limbic cerebellar regions. Conclusions: The findings highlight the cerebellum’s multifaceted role in MS-related fatigue, with distinct subregions contributing to physical, cognitive, and psychosocial fatigue components. These results underscore the cerebellum’s critical function as a hub for motor, cognitive, and emotional integration. Future longitudinal studies incorporating objective measures and advanced imaging are essential to elucidate these relationships further and inform targeted therapeutic strategies for pwMS. Full article
(This article belongs to the Special Issue Multiple Sclerosis: Diagnosis, Treatment and Clinical Management)
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13 pages, 1761 KiB  
Article
Evaluation of the Effectiveness of Animated Images in First Aid for Infants with Foreign Body Airway Obstruction: A Simulation Study
by Taekgeun Ohk, Junhwi Cho, Hyunseok Cho, Goeun Yang, Kicheol You and Taehun Lee
J. Clin. Med. 2025, 14(8), 2839; https://doi.org/10.3390/jcm14082839 - 20 Apr 2025
Abstract
Background: Foreign body airway obstruction is a sudden emergency that can occur unexpectedly in healthy people, leading to severe consequences if immediate first aid is not provided. Unlike the Heimlich maneuver for adults, the first aid for infant choking is less widely known [...] Read more.
Background: Foreign body airway obstruction is a sudden emergency that can occur unexpectedly in healthy people, leading to severe consequences if immediate first aid is not provided. Unlike the Heimlich maneuver for adults, the first aid for infant choking is less widely known and more complex, making it difficult to explain verbally. This study aimed to assess the efficiency of using an animated graphics interchange format (GIF) to teach first aid for infant choking due to foreign bodies. Methods: Eighty adults who had not received recent training in choking first aid within the last two years were randomly assigned to either the auditory (n = 40) or audiovisual (n = 40) groups. The participants were asked to perform first aid on an infant manikin under the guidance of a researcher using a smartphone in a separate room. The auditory group received verbal instructions only, while the audiovisual group received animated GIFs on their smartphones along with verbal instructions simultaneously. The entire process was recorded with two cameras, and two emergency physicians reviewed the videos to assess the adequacy of the first aid administered. Results: The “infant position”, “supporting arm posture”, and “head tilt” were more adequate in the audiovisual group. The Instruction Performance scores were higher in the audiovisual group. There was no significant difference in the time required to administer first aid between the two groups. Conclusions: Audiovisual guidance using animated GIFs has been shown to effectively enhance the adequacy of first-aid performance for infant airway obstruction caused by foreign bodies. Full article
(This article belongs to the Special Issue "Italian Resuscitation Council" on Resuscitation Science and Emergencies—2nd Edition)
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12 pages, 897 KiB  
Review
Review Article: Contemporary Transcatheter Heart Valves for TAVI in Bicuspid Aortic Anatomy
by Chrysavgi Simopoulou, Omar Oliva, Vincenzo Cesario, Nicolas Dumonteil, Didier Tchetche and Chiara De Biase
J. Clin. Med. 2025, 14(8), 2838; https://doi.org/10.3390/jcm14082838 - 20 Apr 2025
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5–2% of the population and often leading to early aortic valve degeneration. While surgical aortic valve replacement (SAVR) remains the gold standard for treating severe bicuspid aortic stenosis (AS), transcatheter aortic [...] Read more.
Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5–2% of the population and often leading to early aortic valve degeneration. While surgical aortic valve replacement (SAVR) remains the gold standard for treating severe bicuspid aortic stenosis (AS), transcatheter aortic valve implantation (TAVI) is emerging as a viable alternative in selected BAV anatomies. Initial experiences with first-generation transcatheter heart valves (THVs) showed the feasibility of this technique, but were associated with lower device success rates and higher complications, such as paravalvular leak (PVL) and pacemaker implantation. Advancements in second- and third- generation THVs, together with better pre-procedural imaging assessment and growing operator experience, have significantly enhanced TAVI outcomes in BAV patients, with results now comparable to those seen in tricuspid aortic valves (TAVs). Proper patient selection, pre-procedural sizing, and device implantation are key to improving TAVI success in BAV. Recent registry data on contemporary THV platforms demonstrate improved procedural success, hemodynamic performance, and the safety of TAVI in BAV. However, higher rates of PVL, pacemaker implantation, and strokes remain concerns. Ongoing advancements in THV design and procedural techniques will further enhance outcomes for this challenging population. Up to the present, there are no dedicated THVs for BAV, but the latest-generation THVs offer promising results. Full article
(This article belongs to the Special Issue Current Trends and Future Challenges in Transcatheter Aortic Valve Replacement)
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9 pages, 4159 KiB  
Article
The Diagnostic Value of Point-of-Care Ultrasonography in the Differential Diagnosis of Azoospermia: Introducing a Concept
by Shlomi Barak, Netanel Waldenberg, Guy Bar, Oshri Barel and Snir Dekalo
J. Clin. Med. 2025, 14(8), 2837; https://doi.org/10.3390/jcm14082837 - 20 Apr 2025
Abstract
Purpose: The aim of this study was to investigate the effectiveness and reliability of point-of-care ultrasonography (POCUS) in the differential diagnosis of azoospermia. Materials and methods: Records of 175 patients who had previously been diagnosed with normal-volume, normal-PH azoospermia and who [...] Read more.
Purpose: The aim of this study was to investigate the effectiveness and reliability of point-of-care ultrasonography (POCUS) in the differential diagnosis of azoospermia. Materials and methods: Records of 175 patients who had previously been diagnosed with normal-volume, normal-PH azoospermia and who had undergone surgical sperm retrieval were reviewed retrospectively. Patients’ preoperative evaluations included a comprehensive history and physical examination and a routine scrotal POCUS performed during their initial consultation by a non-radiologist treating andrologist in a clinic setting. Positive scrotal imaging revealed ectasia of the rete testis and/or dilation of the epididymal ductules. Based on their preoperative assessments, patients were guided to undergo either testicular sperm aspiration (TESA)/microsurgical sperm aspiration (MESA) procedures for those with suspected obstructive azoospermia (OA) or microdissection testicular sperm extraction (micro-TESE) for those with suspected non-obstructive azoospermia (NOA). Results: Of the 175 patients, 58 patients had normal follicle-stimulating hormone (FSH) levels (≤12 IU/L) and normal testicular volume. Thirty of them had no secondary signs of obstruction in their scrotal POCUS and subsequently underwent micro-TESE. All were confirmed to have NOA. Twenty-eight patients demonstrated at least two secondary signs of obstruction on scrotal POCUS. Of these, 15 underwent TESA, and 13 underwent MESA procedures. Twenty-seven patients were confirmed to have OA, and one was confirmed as having NOA. Among this cohort of men, the sensitivity of scrotal POCUS in diagnosing OA was 100%, whereas the specificity was 96.8%. Positive and negative predictive values (PPVs and NPVs) were 96.4 and 100%, respectively. Conclusions: Scrotal POCUS is an effective clinical diagnostic tool for distinguishing obstructive and non-obstructive azoospermia. Being noninvasive, safe, and affordable makes it an ideal bedside clinical tool that can serve the skilled non-radiologist clinician reliably. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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14 pages, 1833 KiB  
Article
Prognostic Impact of Long-Term Sodium Zirconium Cyclosilicate-Integrated Medical Therapy in Patients with Systolic Heart Failure
by Yuki Hida, Teruhiko Imamura and Koichiro Kinugawa
J. Clin. Med. 2025, 14(8), 2836; https://doi.org/10.3390/jcm14082836 - 20 Apr 2025
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Abstract
Background: Sodium zirconium cyclosilicate (SZC) is a novel potassium-binding agent with strong evidence supporting its efficacy in normalizing hyperkalemia. However, the long-term prognostic impact of SZC-integrated medical therapy in patients with systolic heart failure and baseline hyperkalemia remains uncertain. Methods: This study included [...] Read more.
Background: Sodium zirconium cyclosilicate (SZC) is a novel potassium-binding agent with strong evidence supporting its efficacy in normalizing hyperkalemia. However, the long-term prognostic impact of SZC-integrated medical therapy in patients with systolic heart failure and baseline hyperkalemia remains uncertain. Methods: This study included patients with heart failure and a left ventricular ejection fraction (LVEF) of <50% who were prescribed SZC for hyperkalemia between July 2020 and February 2025. Patients who continued SZC therapy for two years or until February 2025 were classified into the SZC continuation group and followed from the initiation of SZC. Those who discontinued SZC during the study period were assigned to the SZC discontinuation group, with follow-up commencing from the point of cessation. The two-year cumulative incidence of all-cause mortality or hospital readmission was compared between the groups. Results: A total of 61 patients (median age: 79 years; 33 men; median LVEF: 42%) were included in the analysis. Serum potassium levels significantly decreased in the SZC continuation group (p < 0.001) but remained unchanged in the SZC discontinuation group (p = 0.23). The SZC continuation group demonstrated a trend toward a lower cumulative incidence of the primary outcome compared to the SZC discontinuation group (29% vs. 47%, p = 0.079). Additionally, in the SZC continuation group, the daily doses of renin-angiotensin system inhibitors and mineralocorticoid receptor antagonists increased significantly (p < 0.05 for both). Furthermore, LVEF improved significantly with SZC-integrated medical therapy (p = 0.011), whereas no such changes were observed in the SZC discontinuation group (p > 0.05 for all). Conclusions: Long-term SZC-integrated medical therapy was associated with the sustained normalization of hyperkalemia, optimization of heart failure pharmacotherapy, and improved clinical outcomes in patients with systolic heart failure and baseline hyperkalemia. These findings underscore the need for prospective randomized controlled trials in carefully selected patient populations to validate the benefits of SZC and establish its optimal supportive role in the management of systolic heart failure. Full article
(This article belongs to the Section Cardiology)
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20 pages, 1242 KiB  
Systematic Review
Challenges and Opportunities in Achieving Asthma Remission
by Elena Cojocaru, Raluca Ioana Arcana, Steluta Radu, Antigona Carmen Trofor and Cristian Cojocaru
J. Clin. Med. 2025, 14(8), 2835; https://doi.org/10.3390/jcm14082835 - 20 Apr 2025
Viewed by 63
Abstract
Background: Asthma is a chronic inflammatory disorder in millions of individuals across the globe with high morbidity, mortality, and health care costs. Despite advances in asthma treatment, long-term remission is a challenging target to achieve. Objectives: This review will address the path [...] Read more.
Background: Asthma is a chronic inflammatory disorder in millions of individuals across the globe with high morbidity, mortality, and health care costs. Despite advances in asthma treatment, long-term remission is a challenging target to achieve. Objectives: This review will address the path to remission in asthma with focus on the role of biologic agents in severe asthma management and on the question as to whether long-term disease control and remission are a reality. Methods: A systematic literature review from 1971 to 2025 was conducted through databases such as PubMed, MEDLINE, Scopus, and Web of Science. Clinical trials, meta-analyses, and real-world evidence concerning biologic therapies, such as monoclonal antibodies targeting interleukin -5 (IL-5), IL-4/IL-13, immunoglobulin E, and thymic stromal lymphopoietin, were considered. Symptom control, exacerbation frequency, lung function, and oral corticosteroid (OCS) use were some of the outcomes considered. Results: Biologic treatments have yielded significant gains in asthma control and reduction of exacerbation. Complete remission—long-term resolution of symptoms, inflammation, and drug dependence—is still difficult to achieve. Early intervention with biologics may prevent irreversible airway remodeling, but long-term remission is not in sight. These drugs reduce OCS dependency, but sustainability of remission remains to be investigated. Conclusions: Biologic therapies have advanced asthma treatment, particularly in severe cases, by improving symptoms and reducing exacerbations. However, complete remission remains a distant goal. The development of standardized remission criteria, better patient stratification, and long-term clinical studies are necessary to help achieve sustained asthma control and remission. Full article
(This article belongs to the Special Issue Advances in Asthma: 2nd Edition)
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17 pages, 1732 KiB  
Article
Laparoscopic vs. Open-Groin Hernia Repair in Romania—A Populational Study
by Nicolae Dragos Garofil, Mihai Zurzu, Mircea Nicolae Bratucu, Vlad Paic, Anca Tigora, Cristian Vladescu, Silviu Badoiu, Victor Dan Eugen Strambu, Petru Adrian Radu and Sandu Ramboiu
J. Clin. Med. 2025, 14(8), 2834; https://doi.org/10.3390/jcm14082834 - 19 Apr 2025
Viewed by 136
Abstract
Background/Objectives: Groin hernia repair is a common surgical procedure worldwide, with increasing adoption of minimally invasive techniques. However, the adoption of laparoscopic repair varies significantly across healthcare systems. This study aims to analyze trends in laparoscopic versus open-groin hernia repair in Romania over [...] Read more.
Background/Objectives: Groin hernia repair is a common surgical procedure worldwide, with increasing adoption of minimally invasive techniques. However, the adoption of laparoscopic repair varies significantly across healthcare systems. This study aims to analyze trends in laparoscopic versus open-groin hernia repair in Romania over a five-year period (2019–2023), assessing differences in hospital types, reimbursement policies, and patient outcomes. Methods: This nationwide retrospective study examined 76,553 groin hernia repairs from the National Diagnosis-Related Group (DRG) database, including 231 public and 41 private hospitals. Patients were categorized as laparoscopic (13,282 cases) or open repair (63,271 cases). Statistical analysis included logistic regression and non-parametric tests to assess factors influencing surgical approach selection, hospitalization duration, and case complexity. Results: Laparoscopic repair accounted for 17.3% of all groin hernia procedures, with higher adoption in private hospitals (54.7%) than in public hospitals (14.6%). Laparoscopic procedures increased from 14.1% in 2019 to 20% in 2023. Hospitalization was shorter in private hospitals (1.78 vs. 4.80 days in public hospitals). Reimbursement rates showed minimal differentiation between laparoscopic and open repair, suggesting no financial incentive for minimally invasive surgery in public hospitals. Conclusions: Despite a steady increase in laparoscopic hernia repair, its adoption in Romania remains limited compared to Western Europe. Private hospitals lead in minimally invasive surgery, while public hospitals predominantly rely on open repair due to reimbursement policies and resource constraints. Adjusting DRG-based reimbursement, expanding training, and implementing a national hernia registry could improve outcomes and access to minimally invasive surgery. Full article
(This article belongs to the Section General Surgery)
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28 pages, 5892 KiB  
Review
Cardiovascular–Kidney–Metabolic Syndrome: A New Paradigm in Clinical Medicine or Going Back to Basics?
by Victoria Mutruc, Cristina Bologa, Victorița Șorodoc, Alexandr Ceasovschih, Bianca Codrina Morărașu, Laurențiu Șorodoc, Oana Elena Catar and Cătălina Lionte
J. Clin. Med. 2025, 14(8), 2833; https://doi.org/10.3390/jcm14082833 - 19 Apr 2025
Viewed by 158
Abstract
Cardiovascular, renal, and metabolic diseases are pathophysiologically interdependent, posing a significant global health challenge and being associated with a substantial increase in morbidity and mortality. In 2023, the American Heart Association (AHA) defined this complex network of interconnected health conditions as the cardiovascular–kidney–metabolic [...] Read more.
Cardiovascular, renal, and metabolic diseases are pathophysiologically interdependent, posing a significant global health challenge and being associated with a substantial increase in morbidity and mortality. In 2023, the American Heart Association (AHA) defined this complex network of interconnected health conditions as the cardiovascular–kidney–metabolic (CKM) syndrome. This syndrome is based on common pathophysiological mechanisms, including chronic inflammation, oxidative stress, hyperglycemia and insulin resistance, activation of the renin–angiotensin–aldosterone system (RAAS), and neurohormonal dysfunction, which trigger a vicious cycle where the impairment of one organ contributes to the progressive deterioration of the others. An integrated approach to these conditions, rather than treating them as separate entities, supports a holistic management strategy that helps to reduce the burden on public health and improve patients’ quality of life. Existing management focuses on lifestyle modification, glycemic and lipid control, and the use of nephroprotective and cardioprotective therapies. This narrative review aims to synthesize and contextualize existing information on the complex interactions between these systems and on diagnostic approaches, as well as to provide an overview of the available therapeutic options. Full article
(This article belongs to the Section Cardiovascular Medicine)
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27 pages, 849 KiB  
Review
Historical Gaps in the Integration of Patient-Centric Self-Management Components in HFrEF Interventions: An Umbrella Narrative Review
by Pupalan Iyngkaran, Fareda Fazli, Hayden Nguyen, Taksh Patel and Fahad Hanna
J. Clin. Med. 2025, 14(8), 2832; https://doi.org/10.3390/jcm14082832 - 19 Apr 2025
Viewed by 62
Abstract
Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to [...] Read more.
Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to which these components are consistently reported and integrated into studies remains unclear. This umbrella narrative review aims to analyze systematic reviews to assess the consistency of reporting on patient-centric self-management components implemented in trials and studies. Methods: This umbrella narrative review synthesized findings from systematic reviews and meta-analyses published between 2000 and 2023 for CDSM tools in HF. Eligible studies were assessed for the presence and consistency of reporting on education, self-monitoring, and goal setting in self-management interventions for HFrEF. Data extraction focused on the frequency of reporting these components and the gaps in reporting long-term patient outcomes. Results: Among the included systematic reviews, education was the most consistently reported component (100%), while self-monitoring and goal setting were each reported in around 50% of studies. Reporting of long-term outcomes, such as mortality and quality of life, was highly variable and often absent. These inconsistencies highlight significant gaps in the evidence base for CDSM interventions. Conclusions: This review identifies gaps in the consistent reporting of key CDSM components in systematic reviews of HFrEF interventions. The inconsistent inclusion of all three components together and limited reporting of long-term outcomes may hinder the development of a robust evidence base for the adoption of these tools in HF guidelines. Future studies should prioritize comprehensive reporting to strengthen the foundation for patient-centric self-management strategies in HF care. PROSPERO registration number CRD42023431539. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)
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10 pages, 1131 KiB  
Article
Predictive Risk Factors for Low Anterior Resection Syndrome (LARS) in Rectal Cancer—An Observational Cohort Study
by Sorinel Lunca, Stefan Morarasu, Constantin Osman, Fadi Al Shatarat, Tudor Gramada, Mara Razniceanu, Monica Buzemurga, Emanuel Baltig, Raluca Zaharia, Wee Liam Ong and Gabriel Mihail Dimofte
J. Clin. Med. 2025, 14(8), 2831; https://doi.org/10.3390/jcm14082831 - 19 Apr 2025
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Abstract
Background/Objectives: The improved long-term survival of rectal cancer patients has led to a major increase in the prevalence of functional complications. Understanding which patients are prone to develop major LARS is important for their preoperative counselling and follow-up. Herein, we aimed to [...] Read more.
Background/Objectives: The improved long-term survival of rectal cancer patients has led to a major increase in the prevalence of functional complications. Understanding which patients are prone to develop major LARS is important for their preoperative counselling and follow-up. Herein, we aimed to assess the risk factors for LARS. Methods: This is a retrospective cohort study on rectal cancer patients. All patient and tumour variables, management plan, type of neoadjuvant therapy, radiation dose to anal sphincter, and perioperative outcomes were collected from the hospital electronic databases. We quantified LARS and compared the score before and after surgery (mean follow-up of 42.2 ± 32 months). Results: A total of 182 patients were included for the final analysis. LARS was present in 43.4% (n = 79) of patients, with 14.8% (n = 27) having minor LARS and 28.5% (n = 52) having major LARS. Age (p = 0.03), male gender (p < 0.00001), smoking (p = 0.04), neoadjuvant radiotherapy (p = 0.02), rectal stump length (p = 0.008), end-to-end anastomosis (p = 0.008), and ileostomy (p = 0.002) were found to significantly increase the rate of LARS. A logistic regression model based on the above variables was able to predict major LARS with good predictive value (AUC 0.700). Conclusions: LARS is highly common after sphincter-preserving surgery, and it is significantly more common in young, male patients with a history of smoking, having mid-lower rectal cancers with neoadjuvant radiotherapy, and undergoing TME surgery with end-to-end low anastomosis and ileostomy. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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18 pages, 1565 KiB  
Article
The Effects of Joint Mobilization and Myofascial Release on Muscle Thickness in Non-Specific Low Back Pain: A Randomized Clinical Trial
by Hafiz Muhammad Waseem Javaid, Syed Shakil Ur Rehman, Muhammad Kashif, Muhammad Salman Bashir and Wajeeha Zia
J. Clin. Med. 2025, 14(8), 2830; https://doi.org/10.3390/jcm14082830 - 19 Apr 2025
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Abstract
Background: Non-specific low back pain is a discomfort that affects individuals at any point in their lives. This study’s aim was to determine the effects of myofascial release and joint mobilization on muscle thickness via ultrasonography in individuals experiencing non-specific low back [...] Read more.
Background: Non-specific low back pain is a discomfort that affects individuals at any point in their lives. This study’s aim was to determine the effects of myofascial release and joint mobilization on muscle thickness via ultrasonography in individuals experiencing non-specific low back pain. Methods: This double-blinded randomized clinical trial was conducted on 84 participants in three groups: joint mobilization, myofascial release, and a combination of joint mobilization and myofascial release. Data were collected during a two-week treatment regimen (days 1, 4, 8, and 12) and at a one-month follow-up. Ultrasound evaluations were used to measure the thickness of deep lumbar muscles at rest and contraction, i.e., the transverse abdominis (rTrA and cTrA) and lumbar multifidus (rLM and cLM). Repeated-measures ANOVA was utilized to analyze the follow-ups within the groups and among the groups, with post hoc tests conducted to identify specific differences. Results: Significant increases in muscle thickness were observed over time in the transverse abdominis, with improvements in both rTrA (right, p = 0.001; left, p = 0.001) and cTrA (right, p = 0.001; left, p = 0.008). The lumbar multifidus also demonstrated significant changes, with increases in the rLM (right, p = 0.001; left, p = 0.047) and cLM (right, p = 0.004; left, p = 0.037). However, the main effects showed no significant differences in muscle thickness among the groups. Conclusions: Joint mobilization demonstrated increased effectiveness in improving muscle thickness relative to myofascial release and a combination of both treatments for individuals with non-specific low back pain. Full article
(This article belongs to the Section Clinical Rehabilitation)
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11 pages, 2414 KiB  
Article
Wrist Joint Restriction: Impact on Foot Pressure, Center of Gravity, and the Role of the Dominant Hand
by Leire Cruz Gambero, Gabriel A. Gijón-Noguerón, Salvador Díaz Miguel, Javier Barón-López and Cantero-Téllez Raquel
J. Clin. Med. 2025, 14(8), 2829; https://doi.org/10.3390/jcm14082829 - 19 Apr 2025
Viewed by 116
Abstract
Background: Wrist immobilization is a common clinical intervention for wrist injuries; however, its repercussions on gait parameters and plantar support have not been extensively investigated. Objectives: The purpose of the study was to determine whether wrist immobilization causes alterations in foot [...] Read more.
Background: Wrist immobilization is a common clinical intervention for wrist injuries; however, its repercussions on gait parameters and plantar support have not been extensively investigated. Objectives: The purpose of the study was to determine whether wrist immobilization causes alterations in foot pressure and center of gravity, considering hand dominance and visual conditions (eyes open or closed). Methods: The research experiment was conducted using the PodoPrint S4 platform. Basic descriptive statistics were calculated to summarize the variables. Additionally, in the mixed linear model (t-tests use Satterthwaite’s method) an analysis of variance for repeated measures (ANOVA-RM) was conducted for the determination of the objectives of the study. Results: This study included a total of 44 participants (29 females and 15 males), with an average age of 36.5 years (SD = 17.5). Immobilization, independent of eye condition, resulted in significant alterations in antero-posterior oscillation and in a larger plantar support area. In addition, the results suggest that the eye state significantly influences plantar support, independent of limb immobilization or dominance. Conclusions: Our findings reveal significant alterations in antero-posterior oscillation and plantar support due to immobilization, suggesting a dynamic interplay between wrist function and lower limb biomechanics. Full article
(This article belongs to the Special Issue Clinical Updates in Physiotherapy for Musculoskeletal Disorders)
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