Journal of Clinical Medicine

14 pages, 627 KB

Open AccessSystematic Review

Entero-Enteric Fistula Following Multiple Magnet Ingestion in Children: A Systematic Review

by Natalia Kelaidi, Konstantina Dimopoulou, Dimitra Dimopoulou, Aggeliki Krikri, Christina Siouli, Maria M. Berikopoulou, Nikolaos Zavras and Anastasia Dimopoulou

J. Clin. Med. 2025, 14(17), 6235; https://doi.org/10.3390/jcm14176235 (registering DOI) - 3 Sep 2025

Abstract

Background/Objectives: Entero-enteric fistula (EEF) formation following multiple magnet ingestion is a rare but severe complication among pediatric patients. The widespread availability of neodymium magnets in toys has increased incidence of ingestion and subsequent gastrointestinal injuries. This systematic review aims to summarize the clinical [...] Read more.

Background/Objectives: Entero-enteric fistula (EEF) formation following multiple magnet ingestion is a rare but severe complication among pediatric patients. The widespread availability of neodymium magnets in toys has increased incidence of ingestion and subsequent gastrointestinal injuries. This systematic review aims to summarize the clinical features, diagnostics, management and outcomes of pediatric EEF cases related to magnet ingestion and report our institution’s experience with four such cases. Methods: A systematic review was conducted using PubMed/Medline (January 1995–February 2025), focusing on EEF after ingestion of ≥2 magnets in patients ≤18 years old. Studies reporting original EEF cases were included. Data extraction included demographics, clinical presentation, diagnostic imaging, intervention type, fistula number/location, hospital stay, complications and outcomes. Four institutional cases were also analyzed. Results: Sixty-nine studies encompassing 130 pediatric patients were included. Median age was 3.3 years; 58% were male. The most common symptoms were abdominal pain (43%) and vomiting (29%). Abdominal X-ray identified magnets in all cases. Surgical intervention was required in 95.5%, while 5.5% were treated endoscopically. Ileal and jejunal fistulas were most common. Postoperative complications occurred in 19%, including bowel obstruction, infection and one death. Our four cases, aged 2 months to 5 years, each required surgery, with one patient readmitted for obstruction managed conservatively. Conclusions: Despite the case heterogeneity of this review, EEF is a potentially life-threatening complication of multiple magnet ingestion in children. Prompt diagnosis with abdominal X-ray and timely surgical management are essential. Increased clinical suspicion and public awareness are crucial for prevention and early intervention. Full article

(This article belongs to the Special Issue Advances and Trends in Pediatric Surgery)

19 pages, 5583 KB

Open AccessArticle

Relapse Patterns and Clinical Outcomes in Cardiac Sarcoidosis: Insights from a Retrospective Single-Center Cohort Study

by Arnaud Dominati, Geoffrey Urbanski, Philippe Meyer and Jörg D. Seebach

J. Clin. Med. 2025, 14(17), 6234; https://doi.org/10.3390/jcm14176234 - 3 Sep 2025

Abstract

Background/Objectives: Cardiac sarcoidosis (CS) is a granulomatous inflammatory cardiomyopathy with heterogeneous presentations, from palpitations to heart failure and sudden cardiac arrest. Despite advances in imaging and immunosuppressive (IS) therapy, relapse patterns and long-term outcomes remain poorly defined. This study aimed to characterize relapse [...] Read more.

Background/Objectives: Cardiac sarcoidosis (CS) is a granulomatous inflammatory cardiomyopathy with heterogeneous presentations, from palpitations to heart failure and sudden cardiac arrest. Despite advances in imaging and immunosuppressive (IS) therapy, relapse patterns and long-term outcomes remain poorly defined. This study aimed to characterize relapse and identify predictors of relapse and major adverse cardiac events (MACE) in a real-world CS cohort. Methods: This retrospective single-center study included 25 adults diagnosed with CS at Geneva University Hospitals between 2016 and 2024, classified per the 2024 American Heart Association diagnostic criteria. Relapse was defined as clinical, arrhythmic, or imaging deterioration requiring treatment escalation. MACE included cardiovascular hospitalization, device therapy, left ventricular assist device, heart transplant, or death. Statistical methods included Kaplan–Meier analysis with log-rank tests and multivariable Cox regression adjusted for age and sex. Results: Relapse occurred in 13 patients (56%), frequently subclinical (61.5%) and detected incidentally on routine PET-CT during IS tapering. In the multivariate model, predictors of relapse included right ventricular FDG uptake (aHR 13.1; 95% CI 1.3–133.7; p = 0.03) and second-line immunosuppression duration ≤24 months (aHR 20.1; 95% CI 1.1–363.8; p = 0.04). Relapse-free patients were more often maintained on dual or triple IS therapy (71.4% vs. 15.4%; p = 0.02) and low-dose prednisone (<10 mg/day) (57.1% vs. 7.7%; p = 0.03). Conclusions: Relapse is common in CS, often subclinical, and associated with PET-CT findings and premature IS tapering. Maintenance therapy may reduce risk. Multimodal imaging remains critical for disease monitoring, though tracers with higher specificity are needed. Further research should refine relapse definitions and support personalized treatment strategies. Full article

(This article belongs to the Special Issue Cardiac Sarcoidosis: Diagnosis and Emerging Therapeutic Strategies)

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15 pages, 846 KB

Open AccessArticle

Smartphone-Based 3D Surface Imaging: A New Frontier in Digital Breast Assessment? Smartphone-Based Breast Assessment

by Nikolas Chrobot, Philipp Unbehaun, Konstantin Frank, Michael Alfertshofer, Wenko Smolka, Tobias Ettl, Alexandra Anker, Lukas Prantl, Vanessa Brébant and Robin Hartmann

J. Clin. Med. 2025, 14(17), 6233; https://doi.org/10.3390/jcm14176233 - 3 Sep 2025

Abstract

Background: Three-dimensional surface imaging is widely used in breast surgery. Recently, smartphone-based approaches have emerged. This investigation examines whether smartphone-based three-dimensional surface imaging provides clinically acceptable data in terms of accuracy when compared to a validated reference tool. Methods: Three-dimensional surface [...] Read more.

Background: Three-dimensional surface imaging is widely used in breast surgery. Recently, smartphone-based approaches have emerged. This investigation examines whether smartphone-based three-dimensional surface imaging provides clinically acceptable data in terms of accuracy when compared to a validated reference tool. Methods: Three-dimensional surface models were generated for 40 patients who underwent breast reconstruction surgery using the Vectra H2 (Canfield Scientific, Fairfield, NJ, USA) and the LiDAR sensor of an iPhone 15 Pro in conjunction with photogrammetry. The generated surface models were superimposed using CloudCompare’s ICP algorithm, followed by 14 linear surface-to-surface measurements to assess agreement between the three-dimensional surface models. Statistical methods included absolute error calculation, paired t-test, Bland–Altman analysis, and Intra-Class Correlation Coefficients to evaluate intra- and inter-rater reliability. Results: The average landmark-to-landmark deviation between smartphone-based and Vectra-based surface models was M = 2.997 mm (SD = 1.897 mm). No statistical differences were found in 13 of the 14 measurements for intra-rater comparison and in 12 of the 14 for inter-rater comparison. The Intra-Class Correlation Coefficient for intra-rater reliability of the iPhone was good, ranging from 0.873 to 0.993. Intra-Class Correlation Coefficient values indicated good reliability, ranging from 0.873 to 0.993 (intra-rater) and 0.845 to 0.992 (inter-rater). Bland–Altman analyses confirmed moderate to reliable agreement in 13 of 14 measurements. Conclusions: Smartphone-based three-dimensional surface imaging presents promising possibilities for breast assessment. However, it may not yet be suitable for highly detailed breast assessments requiring accuracy below the 3 mm threshold. Full article

(This article belongs to the Special Issue Current Opinion of Reconstructive and Aesthetic Breast Surgery)

14 pages, 232 KB

Open AccessArticle

Retrospective Analysis of the Epidemiological and Clinical Characteristics of Acute Coronary Syndrome in a Tertiary Hospital Located at High Altitude

by Vladimir E. Ullauri-Solórzano, Christian Humberto Fierro Renoy, Juan Carlos Gaibor Barba, Diana Moreira-Vera, Henrry Oswaldo Jaramillo Prado, Ana Gabriela Finke Barriga, Víctor Arias Adriano, Francisco Xavier Castro Vega, Ana Cristina Chiliquinga, Kateherine Fonte Melendres, Luis Felipe Varela Pólit, Estefanía Chediak Pérez, Paulina Elizabeth Arteaga Yépez, Luis Alberto Paucar Rojas, Juan S. Izquierdo-Condoy, Jorge Vasconez-Gonzalez and Esteban Ortiz-Prado

J. Clin. Med. 2025, 14(17), 6232; https://doi.org/10.3390/jcm14176232 - 3 Sep 2025

Abstract

Background: Cardiovascular diseases (CVDs) are the leading global cause of death, responsible for 17.9 million deaths annually (32%) as of 2019. Acute coronary syndrome (ACS) significantly contributes to this burden, particularly in low- and middle-income countries. In Latin America, ACS accounts for 35% [...] Read more.

Background: Cardiovascular diseases (CVDs) are the leading global cause of death, responsible for 17.9 million deaths annually (32%) as of 2019. Acute coronary syndrome (ACS) significantly contributes to this burden, particularly in low- and middle-income countries. In Latin America, ACS accounts for 35% of deaths. In Ecuador, 36,058 deaths were reported between 2019 and 2021, underscoring its significant public health impact. Objectives: This study aimed to determine the epidemiological, clinical, and hospital management characteristics of ACS patients admitted to the Metropolitan Hospital of Quito, located at high altitude, from January 2021 to October 2023. Methodology: A retrospective observational study analyzed anonymized medical records of 133 ACS patients treated at a tertiary care hospital in Quito. Results: Among 133 ACS patients, 72.9% were male, with a mean age of 68.9 ± 13.9 years. Overweight was prevalent, with a mean BMI of 26.6 ± 3.0 kg/m². Hypertension (51.9%) and type 2 diabetes mellitus (26.3%) were common comorbidities. ST-segment elevation myocardial infarction (STEMI) was the most frequent ACS type (48.9%), followed by non-ST-segment elevation myocardial infarction (NSTEMI) (33.8%). Most patients (72.2%) underwent stent placement. Mortality was low (2.3%) and significantly associated with the presence of immunologic diseases (p = 0.015), TIMI risk score Grade IV (p = 0.009), and cardiac arrest on admission (p < 0.001). Conclusions: This study provides critical insights into the epidemiology and management of ACS in a high-altitude urban setting, emphasizing the importance of timely diagnosis and evidence-based therapies in improving patient outcomes. Full article

(This article belongs to the Special Issue Acute Coronary Syndromes: From Diagnosis to Treatment)

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Graphical abstract

12 pages, 371 KB

Open AccessReview

Diagnostic Applications of Artificial Intelligence in Liver Diseases

by Maria Consiglia Bragazzi, Rosanna Venere, Gloria Andriollo, Lorenzo Ridola and Domenico Alvaro

J. Clin. Med. 2025, 14(17), 6231; https://doi.org/10.3390/jcm14176231 - 3 Sep 2025

Abstract

Artificial intelligence encompasses the capacity of machines to emulate human faculties, including reasoning, learning, planning, and creativity. Presently, chronic liver disease, liver cirrhosis, primary liver tumors, and liver metastasis represent significant and escalating causes of mortality worldwide. Consequently, there is a growing demand [...] Read more.

Artificial intelligence encompasses the capacity of machines to emulate human faculties, including reasoning, learning, planning, and creativity. Presently, chronic liver disease, liver cirrhosis, primary liver tumors, and liver metastasis represent significant and escalating causes of mortality worldwide. Consequently, there is a growing demand for more efficient and minimally invasive tools to enhance the diagnostic and therapeutic approaches for these ailments. Over recent years, endeavors have been directed towards employing artificial intelligence within hepatology to advance the diagnosis and treatment of liver diseases. This paper aims to outline the latest developments in the application of artificial intelligence within the realm of liver disease. Full article

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

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29 pages, 1360 KB

Open AccessReview

The Role of Early Rehabilitation in Treatment of Acute Pulmonary Embolism—A Narrative Review

by Kamil Salwa, Karol Kaziród-Wolski, Dorota Rębak and Janusz Sielski

J. Clin. Med. 2025, 14(17), 6230; https://doi.org/10.3390/jcm14176230 - 3 Sep 2025

Abstract

Background/Objectives: Pulmonary embolism (PE) is a life-threatening condition that frequently results in persistent exertional dyspnea, reduced exercise tolerance, and psychological distress, even after acute-phase management. Despite growing recognition of post-PE impairments, structured early rehabilitation remains underutilized. This narrative review aims to evaluate [...] Read more.

Background/Objectives: Pulmonary embolism (PE) is a life-threatening condition that frequently results in persistent exertional dyspnea, reduced exercise tolerance, and psychological distress, even after acute-phase management. Despite growing recognition of post-PE impairments, structured early rehabilitation remains underutilized. This narrative review aims to evaluate current evidence on the role, components, and outcomes of early rehabilitation strategies following acute PE. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, a comprehensive literature search was conducted across PubMed, Embase, Scopus, Web of Science, Google Scholar, and the Cochrane Library. Articles published between 2020 and 2025 were screened for relevance to early rehabilitation in PE patients. Inclusion criteria prioritized randomized controlled trials, prospective studies, meta-analyses, and systematic reviews. Study quality was assessed using Cochrane, Newcastle–Ottawa, and AMSTAR 2 tools. Results: Out of 306 records, 158 studies were included. Early pulmonary rehabilitation—including aerobic and resistance exercise, inspiratory muscle training, and psychological support—demonstrated improvements in functional capacity, dyspnea, and quality of life, without adverse effects. Supplementation with omega-3 fatty acids and vitamin D may further mitigate thromboembolic risk via anti-inflammatory pathways. However, evidence remains predominantly observational, with limited high-quality data addressing timing, dosage, and patient stratification. Conclusions: Early, individualized rehabilitation appears safe and potentially beneficial in improving recovery and limiting complications after acute PE. Nonetheless, the absence of robust randomized trials underscores the urgent need for hypothesis-driven research to establish standardized, evidence-based rehabilitation protocols and guidelines tailored to risk stratification and patient phenotype, so as not to prolong recovery time and keep survivors from becoming disabled. Full article

(This article belongs to the Section Clinical Rehabilitation)

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12 pages, 502 KB

Open AccessArticle

Effect of COVID-19 on Falls in a Residential Care Facility for the Elderly: Longitudinal Observational Study

by Ana González-Castro, Raquel Leirós-Rodríguez, Marta Nistal-Martínez, Ernesto Bodero-Vidal, José Alberto Benítez-Andrades and Pablo Hernandez-Lucas

J. Clin. Med. 2025, 14(17), 6229; https://doi.org/10.3390/jcm14176229 - 3 Sep 2025

Abstract

Background/Objectives: During the Coronavirus Disease 2019 (COVID-19) pandemic, various safety measures were implemented in elderly care facilities in Spain. These measures led to a reduction in physical activity and increased supervision of residents, often resulting in the suspension of outings from the facility. [...] Read more.

Background/Objectives: During the Coronavirus Disease 2019 (COVID-19) pandemic, various safety measures were implemented in elderly care facilities in Spain. These measures led to a reduction in physical activity and increased supervision of residents, often resulting in the suspension of outings from the facility. The objective of this study was to assess the influence of COVID-19 preventive measures on the number and characteristics of falls among elderly individuals living in a residential care facility in Spain. Methods: A retrospective longitudinal observational study was conducted from 2018 to 2021. Over these four years, data related to falls were collected from a residential care facility for the elderly. Both patient characteristics and fall characteristics were recorded. Results: The average age of the 48 residents continuously institutionalized between 2018 and 2021 was 85.8 ± 5.1 years. A total of 364 falls occurred during the study period, with 68% of them taking place in 2019 and 2020. Although the number of falls increased during the COVID-19 pandemic, the characteristics of the falls did not change. However, residents who experienced falls were increasingly accompanied at the time of the event. Conclusions: Based on the data collected from the elderly care facility analyzed in this study, falls increased during the COVID-19 pandemic, but the measures implemented in residential care facilities do not appear to have altered the characteristics of the falls, except for the greater presence of companionship. Full article

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

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15 pages, 850 KB

Open AccessSystematic Review

Traumatic Bilateral Lumbosacral Jumped Facet Without Fracture in Childhood: Case Report and Systematic Review

by Maria Ilaria Borruto, Michele Pomponi, Calogero Velluto, Achille Marciano, Luca Proietti and Laura Scaramuzzo

J. Clin. Med. 2025, 14(17), 6228; https://doi.org/10.3390/jcm14176228 - 3 Sep 2025

Abstract

Background/Objectives: Traumatic dislocation of the lumbosacral facet joints without associated fractures is exceedingly rare in the pediatric population. Due to the unique anatomical and biomechanical features of the pediatric spine, such injuries present diagnostic and therapeutic challenges. This study aims to describe a [...] Read more.

Background/Objectives: Traumatic dislocation of the lumbosacral facet joints without associated fractures is exceedingly rare in the pediatric population. Due to the unique anatomical and biomechanical features of the pediatric spine, such injuries present diagnostic and therapeutic challenges. This study aims to describe a rare case of bilateral L5–S1 jumped facets without fracture in a 13-year-old boy and to review the existing literature on pediatric traumatic facet dislocations. Methods: We performed a systematic review according to PRISMA guidelines, searching PubMed, Embase, Scopus, and the Cochrane Library up to 16 January 2025. Keywords included “pediatric traumatic spondylolisthesis” and “pediatric traumatic facet joint”. Eligible studies reported traumatic lumbosacral or thoracolumbar facet dislocations in patients aged <18 years. In addition, we report the clinical course, surgical management, and outcome of a representative case from our institution. Results: The systematic review identified 14 pediatric cases across 11 studies. Most patients were male (71.4%), with high-energy trauma as the primary mechanism. The L5–S1 level was most frequently involved (57.1%). Neurological impairment was present in 57.1% of cases. All patients underwent surgical treatment, with posterior fixation being the most common approach. Our case involved bilateral L5–S1 jumped facets without fracture, successfully treated with open reduction and posterior fusion. Postoperative recovery was favorable, with neurological improvement. Conclusions: Traumatic bilateral facet dislocation without fracture is an extremely rare but serious condition in pediatric patients. Early recognition and surgical stabilization are essential to prevent permanent neurological damage. This study reinforces the importance of advanced imaging and prompt multidisciplinary management in optimizing outcomes. Full article

(This article belongs to the Special Issue New Concepts in the Diagnosis and Treatment of Orthopedic Diseases in Children)

11 pages, 1733 KB

Open AccessArticle

Outcomes of Atrial Fibrillation Ablation in Patients with Chronic Kidney Disease

by Aharon (Ronnie) Abbo, Ziad Arow, Allon Eyal, Robert M. Glueck, Adi Elias, Roy Beinart, Eyal Nof, Feras Haskiah, Yoav Michowitz, Michael Glikson, Yuval Konstantino, Moti Haim, David Luria, Alexander Omelchenko, Keren Cohen-Hagai, Maysam Shehab, Ibrahim Marai, Avishag Laish-Farkash and Mahmoud Suleiman

J. Clin. Med. 2025, 14(17), 6227; https://doi.org/10.3390/jcm14176227 - 3 Sep 2025

Abstract

Background: Limited and inconsistent information exist about how kidney function affects the outcomes of ablation procedures in patients with atrial fibrillation (AF). Therefore, the aim of this study was to investigate the effectiveness and safety of AF ablation in a large national study [...] Read more.

Background: Limited and inconsistent information exist about how kidney function affects the outcomes of ablation procedures in patients with atrial fibrillation (AF). Therefore, the aim of this study was to investigate the effectiveness and safety of AF ablation in a large national study across groups classified by varying levels of estimated glomerular filtration rates (eGFRs). Methods: The Israeli Catheter Ablation Registry (ICAR) is a prospective, multicenter cohort that includes patients who underwent pulmonary vein isolation (PVI) during the years 2019–2021 for the treatment of AF. Primary study endpoints were the recurrence of AF and the need for repeat ablation at 12 months. Secondary endpoints were rehospitalization and procedural complications after AF ablation. Results: Between January 2019 and December 2021, 1002 AF patients underwent PVI. Baseline creatinine was available in 929 patients, which comprised the study cohort. Of these patients, 226 (24%) had preserved eGFR (>90 mL/min/1.73 m²), 511 (55%) had mildly reduced eGFR (60–89 mL/min/1.73 m²), and 192 (21%) had moderately to severely reduced eGFR (<59 mL/min/1.73 m²). Patients with moderately to severely reduced eGFR were generally older and more likely to be female. There were no clinically meaningful differences in the use of antiarrhythmic medications among the eGFR groups, either before or after PVI. There were no significant differences in 12-month AF recurrence rates among the three study groups: 30%, 32%, and 40% in patients with preserved eGFR, mild, and moderately to severely reduced eGFR, respectively (p = 0.1). The one-year rehospitalization rate was higher in patients with moderately to severely reduced eGFR: 19%, 24%, and 32% in patients with preserved eGFR, mild, and moderately to severely reduced eGFR, respectively (p = 0.01). Periprocedural complications were infrequent across all the eGFR groups. Patients with an eGFR of <30 mL/min/1.73 m² were underrepresented (<1%), limiting applicability to this group. Conclusions: PVI is a safe and effective procedure that should be considered for CKD patients with AF who are deemed as suitable for the intervention, even in the presence of declined eGFR values. Future studies are still needed to evaluate the safety and effectiveness of the procedure in individuals with severely reduced eGFR or end-stage kidney disease. Full article

(This article belongs to the Special Issue Advanced Strategies and Innovations to Enhance Outcomes in Cardiac Ablation)

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10 pages, 476 KB

Open AccessArticle

Titolo: Mid-Term Outcomes of EVAR in Hostile Neck Anatomy: Impact of Graft Adaptability on Type III Endoleak, Aortic Remodeling, and Distal Sealing

by Alessandra Fittipaldi, Chiara Barillà, Narayana Pipitò, Domenico Squillaci, Giovanni De Caridi and Filippo Benedetto

J. Clin. Med. 2025, 14(17), 6226; https://doi.org/10.3390/jcm14176226 - 3 Sep 2025

Abstract

Aim: Hostile aortic neck anatomy—characterized by short neck length, severe angulation, conical shape, and mural thrombus or calcifications—represents a major limitation to the durability and applicability of standard endovascular aneurysm repair (EVAR). In response to these challenges, newer endografts with improved conformability [...] Read more.

Aim: Hostile aortic neck anatomy—characterized by short neck length, severe angulation, conical shape, and mural thrombus or calcifications—represents a major limitation to the durability and applicability of standard endovascular aneurysm repair (EVAR). In response to these challenges, newer endografts with improved conformability have been developed. This study aimed to evaluate the mid-term outcomes of EVAR using the GORE EXCLUDER Conformable AAA Endoprosthesis (CEXC) (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) in patients with hostile neck anatomy, with specific attention to type III endoleak occurrence, aortic sac remodeling, and maintenance of distal sealing. Methods: A retrospective observational analysis was conducted on 50 consecutive patients treated with the CEXC endograft between October 2019 and September 2023. Patients included had either elective or urgent indications for EVAR and were evaluated preoperatively using CT angiography. Hostile neck criteria were defined according to the 2019 Delphi Consensus. Procedural variables, imaging follow-up, and clinical outcomes were collected. The primary endpoints were technical and clinical success, while secondary outcomes included endoleak rates, aneurysm sac evolution, and reintervention-free survival. Results: Technical success was achieved in 100% of cases, with a clinical success rate of 98%. No type Ia, Ib, or III endoleaks were observed at a median follow-up of 23 months. Sac shrinkage (>5 mm reduction) occurred in 70% of patients, and distal sealing was preserved in 100% of cases. One perioperative death occurred in an emergency setting, and no late reinterventions or aneurysm-related mortalities were reported. The use of intravascular ultrasound (IVUS) and floppy guidewires contributed to precise deployment and sealing in angulated anatomies. Conclusions: The CEXC endograft proved to be a safe and effective option for EVAR in patients with hostile aortic anatomy, ensuring durable proximal and distal sealing, promoting favorable sac remodeling, and preventing type III endoleaks. These findings support the use of CEXC in anatomically complex settings, as long as procedures are meticulously planned and guided by appropriate intraoperative imaging and deployment techniques. Full article

(This article belongs to the Special Issue Diagnosis and Management of Aortic Diseases: Drafting from Theoretical Aspects to Clinical Practice—2nd Edition)

13 pages, 578 KB

Open AccessArticle

Coping as a Moderator for the Relationship Between Perceived Stress and Satisfaction with Life in the Group of Uniformed Personnel Treated in Mental Health Clinic

by Mateusz Curyło, Michał Zabojszcz, Lidia Tkaczyk, Jaromira Iwolska, Marcin Mikos, Łukasz Strzępek, Aleksandra Czerw, Olga Partyka, Monika Pajewska, Mariola Głowacka, Adrianna Frydrysiak-Brzozowska, Zofia Sienkiewicz, Grażyna Dykowska, Katarzyna Sygit, Oleh Lyubinets, Izabela Gąska, Magdalena Konieczny, Elżbieta Grochans, Anna M. Cybulska, Daria Schneider-Matyka, Ewa Bandurska, Weronika Ciećko, Jarosław Drobnik, Piotr Pobrotyn, Dorota Waśko-Czopnik, Julia Pobrotyn, Adam Wiatkowski, Michał Marczak, Petre Iltchev and Remigiusz Kozlowski Show full author list Hide full author list

J. Clin. Med. 2025, 14(17), 6225; https://doi.org/10.3390/jcm14176225 - 3 Sep 2025

Abstract

Background/Objectives: Uniformed personnel are highly exposed to occupational stress, which increases the risk of mental health problems. This study examined whether coping styles moderate the relationship between perceived stress and satisfaction with life among uniformed personnel treated for bodily distress disorder or post-traumatic [...] Read more.

Background/Objectives: Uniformed personnel are highly exposed to occupational stress, which increases the risk of mental health problems. This study examined whether coping styles moderate the relationship between perceived stress and satisfaction with life among uniformed personnel treated for bodily distress disorder or post-traumatic stress disorder. Methods: A cross-sectional study was conducted with 183 participants (81% male, aged 30–66 years). Standardized questionnaires were administered: the Perceived Stress Scale (PSS-10), Satisfaction with Life Scale (SWLS), and Coping Inventory for Stressful Situations (CISS). Pearson correlations with 95% confidence intervals were computed, and moderation analyses were conducted using separate regression models for each coping style with bootstrap estimation (1000 samples). Gender differences were examined using t-tests with Cohen’s d. Results: Perceived stress was negatively correlated with life satisfaction (r = −0.43, 95% CI [−0.54, −0.29], moderate effect). Emotion-oriented coping correlated negatively with life satisfaction (r = −0.28, 95% CI [−0.42, −0.14]), while social diversion correlated positively (r = 0.21, 95% CI [0.07, 0.35]). Women reported higher stress (Cohen’s d = 0.60) and lower life satisfaction (Cohen’s d = −0.50) than men. Moderation analysis revealed that emotion-oriented coping significantly intensified the negative effect of stress on life satisfaction (B = −0.01, p = 0.019). Conclusions: Perceived stress strongly impairs life satisfaction in uniformed personnel, particularly among those relying on emotion-oriented coping. Targeted interventions, such as emotion regulation training, mindfulness, and cognitive restructuring, may enhance resilience and mitigate stress-related declines in well-being in this high-risk occupational group. Full article

(This article belongs to the Section Mental Health)

15 pages, 918 KB

Open AccessArticle

Intraluminal 10-0 Nylon Stenting in PRESERFLO™ MicroShunt Surgery for Pseudoexfoliation Glaucoma

by Miranda Gehrke, Leonie F. Keidel, Lara Buhl, Siegfried G. Priglinger and Marc J. Mackert

J. Clin. Med. 2025, 14(17), 6224; https://doi.org/10.3390/jcm14176224 - 3 Sep 2025

Abstract

Background/Objectives: Early postoperative hypotony and complications like choroidal detachment can occur after Preserflo MicroShunt (MS) implantation in patients with pseudoexfoliation glaucoma (PEXG). To prevent these risks, outflow from the microshunt tube can be reduced by implementing a nylon stent. This study aims to [...] Read more.

Background/Objectives: Early postoperative hypotony and complications like choroidal detachment can occur after Preserflo MicroShunt (MS) implantation in patients with pseudoexfoliation glaucoma (PEXG). To prevent these risks, outflow from the microshunt tube can be reduced by implementing a nylon stent. This study aims to evaluate the impact of intraluminal stenting of the MS during the first four months after surgery. Methods: This retrospective study of 43 eyes investigated the incidence of intraocular hypotony in PEXG patients undergoing MS implantation with (n = 23) or without (n = 20) intraluminal stenting using a 10.0 nylon suture. The follow-up period was four months after surgery. Results: Our results demonstrated that intraluminal stenting significantly reduced the incidence of postoperative complications related to hypotony. Notably, no cases of choroidal detachment occurred in the nylon-stenting group (nsMS) compared to 30% (6 eyes) in the MS-only group (p = 0.0064). The hypotony rates between the nsMS (21.74%, 5 eyes) and the MS-only group (40%, 8 eyes) did not significantly differ (p = 0.3184). Both groups experienced significant reductions in intraocular pressure (p < 0.001) and a decrease in the number of antiglaucomatous medications (p < 0.001) up to four months after surgery. Conclusions: The use of an intraluminal stent (10.0 nylon suture) during MS implantation may be a promising strategy to reduce the risk of hypotony-related complications, particularly choroidal detachment, in patients with PEXG. Full article

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

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1 pages, 132 KB

Open AccessCorrection

Correction: Park, Y.-B.; Kim, J.-H. Efficacy and Safety of Celecoxib and a Korean SYSADOA (JOINS) for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis. J. Clin. Med. 2025, 14, 1036

by Yong-Beom Park and Jun-Ho Kim

J. Clin. Med. 2025, 14(17), 6223; https://doi.org/10.3390/jcm14176223 - 3 Sep 2025

Abstract

Text Correction [...] Full article

(This article belongs to the Section Orthopedics)

18 pages, 1471 KB

Open AccessArticle

Is Chronic Whiplash-Associated Disorder Associated with Central Nervous System Impairments? A Controlled Observational Study in a Lithuanian Cohort

by Gintaute Samusyte, Jolita Ciceliene, Evelina Pajediene, Kestutis Stasaitis, Kestutis Petrikonis and Indre Bileviciute-Ljungar

J. Clin. Med. 2025, 14(17), 6222; https://doi.org/10.3390/jcm14176222 - 3 Sep 2025

Abstract

Background/Objectives: The aim of this study was to investigate the natural course of a whiplash-associated disorder (WAD) in a Lithuanian population with low awareness of the condition. Methods: In this controlled observational study, 45 participants, enrolled during the acute period after [...] Read more.

Background/Objectives: The aim of this study was to investigate the natural course of a whiplash-associated disorder (WAD) in a Lithuanian population with low awareness of the condition. Methods: In this controlled observational study, 45 participants, enrolled during the acute period after motor vehicle accident, and 50 matched controls were followed up at 8 months. Clinical evaluation of WAD grades was combined with self-scored questionnaires for pain, WAD symptoms, disability, emotional state, and cognitive impairment. The Quebec Task Force Questionnaire was used to assess persistence or development of new symptoms at follow-up. Demographic and sick leave data were collected. Results: The WAD group showed a significant improvement in clinical signs and self-rated scores for pain and disability after 8 months and became largely comparable to the control group. However, only 13 out of 45 WAD participants were symptom-free at follow-up. Persistent neck pain and dizziness/unsteadiness as well as newly developed cognitive complaints were more frequent in the WAD group compared to controls, each reported by around a third of individuals. Logistic regression showed that new cognitive symptoms could be predicted by nausea/vomiting in the acute period and persisting neck pain at follow-up. None of the participants remained on sick leave at follow-up. Conclusions: In a country with low awareness of WAD, a larger proportion of individuals remain symptomatic months after acute whiplash injury but maintain their ability to work. The emergence of new cognitive complaints may suggest concomitant central nervous system involvement. Full article

(This article belongs to the Special Issue Recent Advances in Prevention, Management, and Rehabilitation of Head and Neck Injuries)

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10 pages, 1059 KB

Open AccessArticle

Outcomes of Vitrectomy for Macular Pathologies Associated with Idiopathic Vasoproliferative Retinal Tumor

by Masatoshi Shinozaki, Hiromi Ohara, Tomohiko Torikai, Takashi Koto and Makoto Inoue

J. Clin. Med. 2025, 14(17), 6221; https://doi.org/10.3390/jcm14176221 - 3 Sep 2025

Abstract

Background/Objectives: A vasoproliferative retinal tumor (VPT) is a rare, benign, vascular tumor that is found in the peripheral retina. We retrospectively investigated the clinical characteristics and the outcomes of pars plana vitrectomy (PPV) on idiopathic VPTs. Methods: The medical records of 13 eyes [...] Read more.

Background/Objectives: A vasoproliferative retinal tumor (VPT) is a rare, benign, vascular tumor that is found in the peripheral retina. We retrospectively investigated the clinical characteristics and the outcomes of pars plana vitrectomy (PPV) on idiopathic VPTs. Methods: The medical records of 13 eyes of 12 patients who underwent PPV for an idiopathic VPT were reviewed. The chief complaint of the patients, the location and size of the tumor, the presence of concomitant retinal disorders, the treatment procedures, and the best-corrected visual acuity (BCVA) were evaluated. Results: The mean age was 51.2 years, with 4 men and 8 women. The chief complaints at the initial visit were metamorphopsia in 6 eyes, decreased vision in 6 eyes, and blurry vision in 1 eye. A hemangioma was detected in the inferior-temporal quadrant in 11 eyes and in the superior-temporal quadrant in 2 eyes. An epiretinal membrane was present in all 13 eyes with tractional and exudative retinal detachment in 4 eyes, macular hole in 2 eyes, and vitreous hemorrhage in 3 eyes. During the vitrectomy, a posterior vitreous detachment was created in 10 eyes (77%), photocoagulation was performed for the hemangioma in all 13 eyes, cryotherapy in 4 eyes, and direct diathermy in 2 eyes. The visual acuity improved significantly from 0.51 ± 0.66 logMAR units at the baseline to 0.05 ± 0.21 logMAR units at the final examination (p = 0.002). Conclusions: Vitrectomy for idiopathic VPTs is effective in improving the visual acuity. Idiopathic VPTs are often associated with epiretinal membranes, and patients present with various types of visual disorders. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 1433 KB

Open AccessArticle

Hemoglobin Measurement by Point-of-Care Blood Gas Analysis Versus Central Laboratory in Hemodialysis Patients

by Haris Omić, Michael Eder, Simon Hoffmann and Daniela Gerges

J. Clin. Med. 2025, 14(17), 6220; https://doi.org/10.3390/jcm14176220 - 3 Sep 2025

Abstract

Background: In hemodialysis patients, precise hemoglobin (Hb) monitoring is essential for anemia management. Point-of-care blood gas analyzers (BGAs), such as the ABL800 Flex, offer rapid Hb determinations, but their accordance and comparability with central laboratory measurements remains to be assessed in the hemodialysis [...] Read more.

Background: In hemodialysis patients, precise hemoglobin (Hb) monitoring is essential for anemia management. Point-of-care blood gas analyzers (BGAs), such as the ABL800 Flex, offer rapid Hb determinations, but their accordance and comparability with central laboratory measurements remains to be assessed in the hemodialysis setting. Methods: We performed a retrospective analysis (April 2017–February 2024) of 10,802 paired Hb measurements from 291 hemodialysis patients. BGA and laboratory values within 90 min were compared using paired t-tests, non-inferiority testing (margin 0.5 g/dL), a Bland–Altman analysis, and linear regression. Results: The mean ± standard deviation Hb (g/dL) values were 10.14 ± 1.64 (BGA) versus 9.90 ± 1.55 (laboratory). The overall mean difference (BGA—laboratory) was 0.24 ± 0.49 g/dL (95% CI: 0.23–0.25), demonstrating non-inferiority (p < 0.0001). Measurement delay correlated with increasing analysis discrepancies (mean difference in g/dL: 0.22 at <30 min vs. 0.27 at 60–90 min; p < 0.001). We derived the equation of laboratory Hb = 0.90 × BGA Hb + 0.72; a simplified correction (BGA−0.3 g/dL) produced a mean absolute error (MAE) of 0.30 g/dL and root mean square error (RMSE) of 0.50 g/dL, and patient-level 10-fold cross-validation yielded MAE ≈ 0.30 and RMSE ≈ 0.49 g/dL. The Bland–Altman analysis confirmed a small systematic bias of 0.24 g/dL with 95% limits of agreement ranging from −0.73 to +1.21 g/dL. Conclusions: BGA Hb measurements via the ABL800 Flex are non-inferior to central laboratory values across clinical scenarios, with minimal bias. After regression correction, the estimated total error was ≈0.78 g/dL. If hemodialysis centers accept this level of total error and apply confirmatory testing near decision points, BGA could be used to guide anemia management. Full article

(This article belongs to the Special Issue Hemodialysis: Clinical Updates and Advances)

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16 pages, 1496 KB

Open AccessArticle

Empowering CKD and Hemodialysis Patients with mHealth: Implementation of the NephroGo App in Europe

by Giedrė Žulpaitė, Karolis Vyčius, Urtė Deinoravičiūtė, Edita Saukaitytė-Butvilė, Laurynas Rimševičius and Marius Miglinas

J. Clin. Med. 2025, 14(17), 6219; https://doi.org/10.3390/jcm14176219 - 3 Sep 2025

Abstract

Background/Objectives: Chronic kidney disease (CKD) requires intensive dietary and lifestyle management, yet patient engagement and access to tailored education remain limited, particularly outside clinical settings. This study describes the development and implementation of NephroGo, and evaluates its usability, user engagement, and perceived acceptability [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) requires intensive dietary and lifestyle management, yet patient engagement and access to tailored education remain limited, particularly outside clinical settings. This study describes the development and implementation of NephroGo, and evaluates its usability, user engagement, and perceived acceptability among patients with CKD. Methods: The app was developed based on clinical and dietary guidelines, incorporating personalized nutrient recommendations, dialysis tracking, and educational content. Technically, it features a Django backend, Flutter mobile frontend, and secure cloud-based hosting. User feedback was collected through one-time interviews (n = 10) and a standardized Mobile App Rating Scale (MARS) survey (n = 32). Longitudinal usage data over four years were also analyzed. Results: Initially, NephroGo was downloaded by 204 users, of whom 93.6% were considered active users based on defined behavioral engagement thresholds. Over a four-year period, the app accumulated a total of 1670 downloads. This study focuses on evaluating user engagement, usability, and perceived acceptability of the NephroGo app over a four-year period. Most users were female (52.3%) and aged 30–65. Stage 5 CKD patients and those undergoing peritoneal dialysis (PD) had the highest engagement. The most-used feature was the personalized nutrition calculator, with sodium being the most frequently exceeded nutrient. The average MARS score was 4.09 ± 0.66, with functionality rated highest (4.27 ± 0.74). App ratings were significantly higher among users referred by physicians (p = 0.039). Conclusions: NephroGo offers a scalable digital tool to support dietary management and health monitoring, with potential to complement standard nephrology care in a resource-conscious manner. Full article

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

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14 pages, 1042 KB

Open AccessSystematic Review

Multiple Drug Intolerance Syndrome and Arterial Hypertension—Systematic Review and Meta-Analysis

by Jakub Rusinek, Kinga Tyjas, Wiktoria Ziółek, Marek Rajzer and Katarzyna Stolarz-Skrzypek

J. Clin. Med. 2025, 14(17), 6218; https://doi.org/10.3390/jcm14176218 - 3 Sep 2025

Abstract

Background: Arterial hypertension (HT) is one of the most prevalent diseases, causing increased morbidity and mortality. Treatment of HT might be complicated by multiple drug intolerance syndrome (MDIS), defined as intolerance to three or more drug classes. This systematic review and meta-analysis aimed [...] Read more.

Background: Arterial hypertension (HT) is one of the most prevalent diseases, causing increased morbidity and mortality. Treatment of HT might be complicated by multiple drug intolerance syndrome (MDIS), defined as intolerance to three or more drug classes. This systematic review and meta-analysis aimed to assess the prevalence of MDIS in patients with hypertension and investigate its impact on disease control. Materials and Methods: MEDLINE, Scopus, Web of Science, and Embase were thoroughly searched in June 2024. The data concerning MDIS prevalence, MDIS risk factors, number of adverse drug reactions (ADRs), and types of reactions was extracted. Quality assessment was done with the use of the Newcastle-Ottawa Scale. Meta-analysis was conducted to determine the pooled prevalence of MDIS and ADRs. The study was conducted according to the PRISMA guidelines. Results: This review included four studies (2508 patients). The pooled prevalence of MDIS was 10% (95% CI: 4%–19%). Headache was the most frequent ADR reported in the studies (71.47%, 95% CI: 56.5%–84.44%), while pain in other body parts was present in 53.08% of patients. Female sex was found to increase the risk of MDIS in each included study. Other risk factors identified were older age, gastrointestinal disorders, anxiety disorders, panic attacks, and depression. Blood pressure was higher in the MDIS group, and in this group, more patients had uncontrolled hypertension. Conclusions: The prevalence of MDIS in the hypertensive population can be considered high. Furthermore, blood pressure control is worse in patients with MDIS. However, this phenomenon is still studied inadequately, and further research is necessary. Full article

(This article belongs to the Section Cardiology)

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11 pages, 487 KB

Open AccessArticle

Risk Factors for Clinically Negative Level II Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma

by Dongju Kim, Seunguk Bang and Gwangju Yu

J. Clin. Med. 2025, 14(17), 6217; https://doi.org/10.3390/jcm14176217 - 3 Sep 2025

Abstract

Objectives: Papillary thyroid carcinoma (PTC) frequently presents with cervical lymph node metastasis, even in small tumors, and lateral lymph node involvement serves as an important prognostic factor. Therapeutic lateral neck dissection is typically recommended when nodal metastasis is clinically evident, usually including [...] Read more.

Objectives: Papillary thyroid carcinoma (PTC) frequently presents with cervical lymph node metastasis, even in small tumors, and lateral lymph node involvement serves as an important prognostic factor. Therapeutic lateral neck dissection is typically recommended when nodal metastasis is clinically evident, usually including levels II–V. However, the necessity of routine level II dissection in patients without clinical or radiologic evidence of level II involvement remains controversial, given its association with increased surgical morbidity, particularly injury to the spinal accessory nerve. Identifying reliable clinicopathological predictors of occult level II metastasis may enable more selective surgical approaches that minimize unnecessary dissection while preserving oncologic safety. Therefore, this study aimed to identify clinicopathological risk factors associated with occult level II lymph node metastasis in patients with PTC who have clinically positive lateral nodes but no clinical evidence of level II involvement. Methods: We retrospectively analyzed 1247 patients who underwent thyroidectomy for PTC between 2015 and 2022. Of these, 67 patients with clinically positive lateral lymph node metastasis and clinically negative Level II nodes who underwent therapeutic lateral neck dissection were included. Clinicopathological features were compared between patients with and without occult Level II metastasis. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results: Among the 67 patients analyzed, 24 (35.8%) had occult Level II metastasis. Compared to those without, patients with occult Level II metastasis had significantly larger primary tumors (2.18 ± 1.31 cm vs. 1.51 ± 1.02 cm, p = 0.024), a greater number of central lymph node metastases (5.88 ± 4.41 vs. 3.37 ± 2.66, p = 0.005), larger maximum size of metastatic central lymph node (1.44 ± 1.07 cm vs. 0.87 ± 0.48 cm, p = 0.004), and a higher number of metastatic lateral lymph nodes (7.63 ± 3.75 vs. 3.19 ± 2.21, p < 0.001). Multivariate analysis identified the number of metastatic lateral lymph node as the only independent predictor of occult Level II involvement (OR = 1.57, 95% CI: 1.213–2.044, p = 0.001). The final multivariate model demonstrated a Nagelkerke R² of 0.46. ROC curve analysis confirmed good predictive performance (AUC = 0.85), and the optimal cut-off value was ≥ 5 metastatic lateral lymph nodes. Conclusions: A substantial proportion of patients with clinically negative Level II nodes harbor occult metastasis. The number of metastatic lateral lymph nodes is an independent predictor of occult Level II involvement and may assist in tailoring the extent of lateral neck dissection in patients with PTC. Full article

(This article belongs to the Section General Surgery)

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