Journal of Clinical Medicine

16 pages, 1239 KB

Open AccessArticle

Beyond the Scale: Changes in Pain, Physical Function (WOMAC), and Low-Grade Inflammation Following Semaglutide Treatment in Patients with Knee Osteoarthritis—Results from a Six-Month Real-World Cohort

by Alessandro Conforti, Linda Lucchetti, Francesca Ciampa, Marco Bonifacio, Marco Giuseppe Musorrofiti, Valerio Cipolloni and Filippo Messina

J. Clin. Med. 2026, 15(15), 5876; https://doi.org/10.3390/jcm15155876 - 27 Jul 2026

Abstract

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: [...] Read more.

Background: Knee osteoarthritis (KOA) in people with overweight or obesity is clinically heterogeneous, reflecting mechanical loading, synovial and systemic inflammation, metabolic dysfunction, structural severity, and pain-related factors. We evaluated multidomain outcomes after semaglutide initiation and characterized clinically relevant response patterns. Methods: This retrospective, self-controlled cohort included 93 adults treated in routine rheumatology care; 88 completed a six-month follow-up. There was no untreated concurrent comparator; within-patient changes and exposure–outcome associations were therefore interpreted as non-causal. Changes in pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, anthropometry, inflammatory markers, glycated hemoglobin (HbA1c), lipids, dose exposure, and safety were evaluated. Joint multivariable models included percentage weight loss and maximum achieved dose. Exploratory K-means phenotyping integrated dose, weight loss, body mass index (BMI) decrease, visual analog scale (VAS) and WOMAC improvement, and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and HbA1c reductions, with candidate solutions and resampling stability examined. Results: At six months, mean weight decreased by 10.88 kg, VAS pain score by 2.47 points, WOMAC total by 22.50 points, CRP by 2.67 mg/L, ESR by 7.62 mm/h, and HbA1c by 0.51 percentage points (all p < 0.001). Weight loss remained independently associated with WOMAC improvement, while achieved dose retained positive adjusted associations with pain, function, inflammatory, and metabolic changes. Exploratory clustering identified five clinically interpretable patterns along a broader response-intensity gradient, including high-burden multidomain response, high-dose concordant response, dose-modified intermediate response, inflammation-preserved response despite moderate weight loss, and dose-limited graded response. These observational coefficients and clusters cannot distinguish treatment-related effects from residual confounding or co-interventions. Conclusions: Substantial within-patient improvements were observed, but the uncontrolled design precludes causal attribution. The exploratory patterns may be compatible with contributions from baseline disease burden, dose exposure, mechanical unloading, and residual inflammatory variation; they do not establish weight-independent pharmacologic effects or validated patient subtypes. Prospective controlled, multicenter validation is required. Full article

(This article belongs to the Special Issue Beyond Efficacy and Trials: Real-World Value and Effectiveness in Autoimmune Rheumatic Joint Diseases)

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14 pages, 511 KB

Open AccessArticle

The Pilonidal Sinus Disease-Specific Quality of Life Questionnaire (SQoL): Reliability, Validity, and Utilisation

by Edvinas Dainius, Monika Vaiciute, Edgaras Burzinskis, Audrius Parseliunas, Tadas Latkauskas, Violeta Simatoniene, Silvija Ilgunaityte, Donatas Venskutonis and Algimantas Tamelis

J. Clin. Med. 2026, 15(15), 5875; https://doi.org/10.3390/jcm15155875 - 27 Jul 2026

Abstract

Background: Pilonidal sinus disease is an inflammatory condition characterised by formations ranging from minor cysts to extensive sinus tracts in the natal cleft in the sacrococcygeal area. Due to its complex and unique symptoms, the condition may not be adequately captured by the [...] Read more.

Background: Pilonidal sinus disease is an inflammatory condition characterised by formations ranging from minor cysts to extensive sinus tracts in the natal cleft in the sacrococcygeal area. Due to its complex and unique symptoms, the condition may not be adequately captured by the generic quality of life (QoL) instruments. In this study, we evaluated a newly developed pilonidal sinus disease-specific quality of life (SQoL) questionnaire, valuating its validity and applicability for measuring postoperative outcomes of pilonidal sinus disease. Materials and Methods: The study involved developing a SQoL. A total of 116 adult patients with chronic and acute symptomatic disease at the Kaunas Hospital of the Lithuanian University of Health Sciences (LUHS) were asked to complete both the SQoL and the SF-36v2 questionnaire. Key evaluation criteria for the SQoL questionnaire included internal consistency, measurement stability, as well as construct and discriminant validity. Results: 2 months after the procedure, 103 patients (response rate 88.79%) completed both questionnaires. Internal consistency was assessed 1 week after surgery, with the overall questionnaire achieving a Cronbach’s α coefficient of 0.919. The Spearman correlation coefficient for the total questionnaire score in the test–retest validation was 0.55 (CI 0.406–0.679), indicating a moderately significant correlation for all questions. Construct validity was evaluated by comparing the SQoL questionnaire with the results from various SF-36v2 domains 1 week after surgery. The highest inverse correlations were found between the corresponding domains of Physical Functioning and Role Physical Functioning (−0.770 and −0.600), with all correlations being statistically significant. Conclusions: A newly developed SQoL questionnaire has shown promise in assessing the impact of the disease and its treatment, particularly by addressing disease-specific symptoms. Standardising outcome measures can improve the reliability of meta-analyses and systematic reviews, which in turn helps to create more personalised care plans. The trial was registered in ClinicalTrials.gov with the identifier of NCT05982028. Full article

(This article belongs to the Special Issue Colorectal Surgery: Advances in Modern Clinical Management)

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13 pages, 527 KB

Open AccessArticle

Postoperative Pain, Swelling, and Trismus After Piezosurgery-Assisted Minor Oral Surgery in Patients with Coronary Artery Disease and Diabetes Mellitus: A Retrospective Cohort Study

by Mert Zeytinoğlu, Meltem Özden Yüce and Mehmet Cemal Akay

J. Clin. Med. 2026, 15(15), 5874; https://doi.org/10.3390/jcm15155874 - 27 Jul 2026

Abstract

Background/Objectives: This retrospective cohort study aimed to evaluate postoperative pain, swelling, and trismus following piezosurgery-assisted minor oral surgical procedures in patients with coronary artery disease and diabetes mellitus (CAD+DM) and to compare the outcomes with those of systemically healthy individuals. Methods: Medical records [...] Read more.

Background/Objectives: This retrospective cohort study aimed to evaluate postoperative pain, swelling, and trismus following piezosurgery-assisted minor oral surgical procedures in patients with coronary artery disease and diabetes mellitus (CAD+DM) and to compare the outcomes with those of systemically healthy individuals. Methods: Medical records of 60 patients who underwent piezosurgery-assisted minor oral surgery between 2018 and 2021 were retrospectively reviewed. Patients were allocated into two groups: CAD+DM (n = 30) and healthy controls (n = 30). Postoperative pain was assessed using a visual analog scale (VAS) at 6 h, 12 h, postoperative day 1, day 2, day 3, and day 7. Swelling and trismus were evaluated preoperatively and on postoperative days 2 and 7. Swelling and trismus data were analyzed using repeated-measures ANOVA and two-way repeated-measures ANOVA, whereas VAS scores were analyzed using the Friedman test, Dunn’s post hoc test, and Mann–Whitney U test. Results: Both groups demonstrated significant time-dependent changes in swelling and trismus (all p < 0.001). Swelling increased on postoperative day 2 and decreased by day 7 in both groups; however, swelling values were significantly higher in the CAD+DM group at all evaluation time points (all p < 0.0001). Trismus was greatest on postoperative day 2 and improved significantly by day 7 in both groups (all p < 0.0001). A significant time × group interaction was observed for trismus (p < 0.0001), whereas no significant between-group difference was detected on postoperative day 7 (p = 0.7729). VAS scores decreased significantly over time in both groups (Friedman test, p < 0.0001). Pain scores were significantly lower in the CAD+DM group at 6 h, day 1, day 2, day 3, and day 7 (all p < 0.001), while no difference was observed at 12 h (p = 0.633). Conclusions: Piezosurgery-assisted minor oral surgery was associated with favorable postoperative recovery in both CAD+DM and healthy patients. Although CAD+DM patients exhibited greater postoperative swelling, trismus recovery was comparable between groups, and postoperative pain remained low throughout follow-up. Piezosurgery appears to be a safe and effective surgical approach for medically compromised patients undergoing minor oral surgical procedures. Full article

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

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18 pages, 710 KB

Open AccessArticle

Comparative Cross-Sectional Assessment of Temporomandibular Dysfunction and Masticatory System Changes in Patients with Rheumatoid Arthritis and Temporomandibular Joint Osteoarthritis

by Anna Wydra-Karbarz, Zbigniew Guzera, Bogdan Batko, Mateusz Moskal and Katarzyna Błochowiak

J. Clin. Med. 2026, 15(15), 5873; https://doi.org/10.3390/jcm15155873 - 27 Jul 2026

Abstract

Background/Objectives: Although the etiology and pathomechanism of temporomandibular joint osteoarthritis (TMJ OA) and rheumatoid arthritis (RA) are different, they can both lead to serious structural and functional changes in the masticatory system. This study aimed to assess and compare the prevalence and [...] Read more.

Background/Objectives: Although the etiology and pathomechanism of temporomandibular joint osteoarthritis (TMJ OA) and rheumatoid arthritis (RA) are different, they can both lead to serious structural and functional changes in the masticatory system. This study aimed to assess and compare the prevalence and characteristics of functional changes in the masticatory system in RA and OA TMJ patients. Materials and Methods: This cross-sectional study included 40 RA patients meeting the 2010 ACR/EULAR criteria and 40 TMJ OA patients. Research diagnostic criteria for TMD (RDC/TMD) were used to assess functional changes. Results: Orofacial pain was a predominant TMD reported in 80% of RA patients and in 67.5% of OA TMJ patients. There was no difference in the orofacial pain intensity and degree of somatization between RA and OA TMJ patients (p = 0.114). Orofacial pain duration was statistically longer in OA TMJ patients than in RA patients (p = 0.003). The ranges of mandibular movement were limited but without any statistically significant differences between the groups compared for maximum active opening (p = 0.349) and maximum passive opening (p = 0.461). Patients with RA presented with more muscles affected with pain. The most painful muscles were the medial pterygoid muscles and the anterior belly of the digastric muscle for the right side (p = 0.006) and for the left side (p = 0.004), and the tendon of the temporal muscle (p = 0.011) and (p = 0.004). The pain intensity of these muscles was statistically higher in RA patients in comparison to OA TMJ patients. Predominant TMJ sounds were slight crepitations in both RA and OA TMJ patients, mainly during laterotrusion in OA (p = 0.000). Conclusions: Laterotrusion was the key movement differentiating TMD manifestations between the two groups. Early functional diagnosis of the temporomandibular joint and an interdisciplinary therapeutic approach, combining treatment of the underlying disease with therapy of the masticatory system disorders, are crucial to limit the progression of changes and improve masticatory function. Full article

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

11 pages, 1326 KB

Open AccessArticle

Effectiveness of Diosmin, Cumarin and Arbutin in Reducing Edema and Pain After Hip or Knee Arthroplasty

by Andrea Saini, Marco Gramaglia, Simonetta Piano and Alberto Mattioda

J. Clin. Med. 2026, 15(15), 5872; https://doi.org/10.3390/jcm15155872 - 27 Jul 2026

Abstract

Background/Objectives: To assess the efficacy of a product containing Diosmine, Cumarin and Arbutin (Linfadren^®) in reducing edema and pain and improving specific symptomatology in patients undergoing rehabilitation treatment after hip or knee arthroplasty. Methods: In this monocentric prospective study, [...] Read more.

Background/Objectives: To assess the efficacy of a product containing Diosmine, Cumarin and Arbutin (Linfadren^®) in reducing edema and pain and improving specific symptomatology in patients undergoing rehabilitation treatment after hip or knee arthroplasty. Methods: In this monocentric prospective study, fifty consecutive patients, hospitalized for rehabilitation, were administered Linfadren^® twice a day for 20 days. Limb circumference, pain and specific symptomatology were assessed at baseline and at the end of the treatment; the specific symptomatology was evaluated by means of the Western Ontario and McMaster Universities Arthritis Index (WOMAC), self-administered. Results: Baseline and final limb circumference showed a statistically significant difference with 60.42 ± 6.77 cm vs. 53.7 ± 6.37 cm; p < 0.0001. Baseline and final pain showed a statistically significant difference with NRS 4.0 ± 1.01 vs. 0.4 ± 0.70—p < 0.0001. Baseline and final specific symptomatology differed in a statistically significant manner with the respective scores 37.1 ± 14.4 vs. 18.1 ± 11.4; p < 0.0001. Correlations between the decrease in limb circumference, pain and specific symptomatology showed statistical significance. Conclusions: The product containing Diosmine, Cumarin and Arbutin demonstrates efficacy in reducing edema and pain and in improving specific symptomatology in patients undergoing rehabilitation treatment after hip or knee arthroplasty. This can translate to patients’ better ability to perform intensive physiotherapy protocols, thus enhancing the recovery. Full article

(This article belongs to the Section Clinical Rehabilitation)

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15 pages, 1775 KB

Open AccessArticle

Biliary Reconstruction in Liver Transplantation for Primary Sclerosing Cholangitis: Outcomes of an Anatomy-Driven Shift Towards Duct-to-Duct Anastomosis

by Felix Becker, Felicia Kneifel, Janna-Maria Keßling, Shadi Katou, Haluk Morgül, Andreas Pascher and Philipp Houben

J. Clin. Med. 2026, 15(15), 5871; https://doi.org/10.3390/jcm15155871 - 27 Jul 2026

Abstract

Background/Objectives: Selecting the optimal biliary reconstruction technique for liver transplantation (LT) in primary sclerosing cholangitis (PSC) remains challenging. Many centers have historically favored Roux-en-Y hepaticojejunostomy (RYHJ) to bypass potentially diseased recipient ducts, whereas duct-to-duct (D-D) anastomosis preserves endoscopic access and decreases cholangitis [...] Read more.

Background/Objectives: Selecting the optimal biliary reconstruction technique for liver transplantation (LT) in primary sclerosing cholangitis (PSC) remains challenging. Many centers have historically favored Roux-en-Y hepaticojejunostomy (RYHJ) to bypass potentially diseased recipient ducts, whereas duct-to-duct (D-D) anastomosis preserves endoscopic access and decreases cholangitis rates. We evaluated outcomes during an institutional, anatomy-driven transition toward D-D reconstruction. Methods: We retrospectively analyzed primary LTs for PSC performed at Münster University Hospital between January 2008 and February 2021. Patients were stratified by biliary reconstruction technique into a RYHJ and D-D group. The reconstruction strategy was based on the recipient’s bile duct anatomy (D-D when distal extrahepatic duct pathology was absent and duct quality was deemed suitable; RYHJ otherwise). Postoperative complications within 12 months, biliary complications, and long-term patient and graft survival were assessed. Results: Forty-six patients were included (RYHJ n = 24; D-D n = 22). Overall biliary complication rates and patient and graft survival were comparable between the groups. Anastomotic strictures occurred more frequently after D-D reconstruction, whereas the rates of bile leakage, cholangitis, and revision surgery were similar between the two groups. In exploratory multivariable analyses, reconstruction type was not associated with mortality or overall biliary complications, whereas recipient age and male donor sex were associated with biliary complications. Conclusions: In selected patients with PSC undergoing LT with an anatomy-driven reconstruction strategy, D-D anastomosis achieved outcomes comparable to those of RYHJ, with a higher rate of anastomotic strictures but preserved potential for endoscopic management. Full article

(This article belongs to the Special Issue Clinical Advances in Liver Transplantation and Organ Perfusion)

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21 pages, 5853 KB

Open AccessReview

Preventive Strategies to Reduce Sarcopenia Risk During GLP-1-Based Anti-Obesity Therapy

by Andrej Belančić, Kristina Skroče, Elvira Meni Maria Gkrinia, Mihaela Marinović Glavić and Man Ki Kwok

J. Clin. Med. 2026, 15(15), 5870; https://doi.org/10.3390/jcm15155870 - 27 Jul 2026

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related incretin-based therapies are highly effective anti-obesity treatments, but weight loss may also include reductions in fat-free mass, raising concern for selected patients at risk of sarcopenia. This narrative review summarizes current evidence and practical, evidence-informed [...] Read more.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related incretin-based therapies are highly effective anti-obesity treatments, but weight loss may also include reductions in fat-free mass, raising concern for selected patients at risk of sarcopenia. This narrative review summarizes current evidence and practical, evidence-informed strategies to support muscle health during GLP-1 RA-based anti-obesity therapy. Particular emphasis is placed on identifying higher-risk patients, including older adults, frail individuals, patients with low baseline muscle mass or strength, sarcopenic obesity, chronic kidney disease, low physical activity, or rapid weight loss. Preventive strategies include baseline assessment of body composition and muscle function, individualized resistance and multicomponent exercise, adequate protein intake, attention to nutritional adequacy, and periodic monitoring of body composition, strength, and physical performance. Treatment pace and dose escalation may also be individualized in higher-risk patients when unfavorable changes in fat-free mass or function occur. Current evidence remains limited, and many recommendations are extrapolated from weight-loss, nutrition, exercise, and sarcopenia literature rather than GLP-1 RA-specific trials. Overall, a risk-stratified and multidisciplinary approach may help preserve muscle mass and function while maintaining the cardiometabolic benefits of GLP-1 RA-based therapy. Full article

(This article belongs to the Special Issue Obesity in the 2020s and Beyond: A Multidisciplinary Overview)

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12 pages, 726 KB

Open AccessArticle

Postpartum Depressive Symptoms Among Women with Elevated Prenatal Anxiety in Kazakhstan: Prospective Observational Cohort Study

by Gulzhanat Aitmurzinova, Arailym Baurzhan, Akmaral Mussakhanova, Gulnar Shalgumbayeva, Balday Issenova, Fatima Bagiyarova, Sayat Tanatarov, Lazzat Yermentayeva, Saparkul Arinova, Naslizat Rakhmatullina and Aida Kassymova

J. Clin. Med. 2026, 15(15), 5869; https://doi.org/10.3390/jcm15155869 - 27 Jul 2026

Abstract

Background: Postpartum depression (PPD) is a common mental health condition, and women with elevated prenatal anxiety are at increased risk. Evidence from Kazakhstan remains limited. This study aimed to describe postpartum depressive symptoms and associated factors among women with elevated prenatal anxiety who [...] Read more.

Background: Postpartum depression (PPD) is a common mental health condition, and women with elevated prenatal anxiety are at increased risk. Evidence from Kazakhstan remains limited. This study aimed to describe postpartum depressive symptoms and associated factors among women with elevated prenatal anxiety who received routine perinatal care and participated in the PRISM prenatal psychoeducational program. Methods: This prospective single-arm cohort study with postpartum follow-up was conducted in Astana, Kazakhstan. Of 1232 pregnant women screened, 234 women with elevated prenatal anxiety participated in the PRISM program, and 226 completed the postpartum assessment. Because no control group was included, the study was not designed to evaluate the effectiveness of PRISM or establish causal effects. Postpartum depressive symptoms were assessed using the Postpartum Depression Screening Scale–Short Form (PDSS-SF). Descriptive statistics were calculated, and associations with age, parity, and postpartum assessment period were examined using Spearman’s rank correlation and non-parametric tests. Results: The mean PDSS-SF score was 20.65 ± 6.00. Using a cut-off score of ≥17, 158 of 226 participants screened positive for clinically significant depressive symptoms, corresponding to 69.9% (95% confidence interval (CI): 63.6–75.5%). Scores were highest among women assessed between 6 weeks and 6 months postpartum (p < 0.001). Age showed a weak negative correlation with depressive symptoms, whereas parity was not significantly associated. The most frequently reported symptoms were sleep disturbance, loneliness, and depressed mood. Conclusions: A substantial burden of postpartum depressive symptoms was observed in this high-risk cohort. The findings support early identification of prenatal anxiety, continued postpartum screening, and access to appropriate psychological and psychiatric care. Controlled studies are needed to evaluate PRISM and similar preventive programs. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 1035 KB

Open AccessArticle

Post-Exercise Nasal Patency, Spirometry, and CBCT-Derived Lund–Mackay Scores in Competitive Swimmers: A Multivariate Analysis

by Małgorzata Stachowicz, Mateusz Żbikowski, Aleksandra Stachowicz, Anna Kęska, Michał Stachowicz and Grzegorz Wójcik

J. Clin. Med. 2026, 15(15), 5868; https://doi.org/10.3390/jcm15155868 - 27 Jul 2026

Abstract

Background/Objectives: Competitive swimmers present simultaneously with supranormal lung function and a high prevalence of upper-airway structural pathology. This study examined whether CBCT-quantified sinus mucosal burden and post-exercise peak nasal inspiratory flow (PNIF) are related, and whether their combination with spirometry identifies distinct ventilatory [...] Read more.

Background/Objectives: Competitive swimmers present simultaneously with supranormal lung function and a high prevalence of upper-airway structural pathology. This study examined whether CBCT-quantified sinus mucosal burden and post-exercise peak nasal inspiratory flow (PNIF) are related, and whether their combination with spirometry identifies distinct ventilatory subgroups, in competitive swimmers. Methods: Twenty-nine competitive swimmers (18 male, 11 female; age 20.7 ± 2.8 yr) underwent nasal endoscopy (n = 29), CBCT with Lund–Mackay (LM) scoring (n = 20), bilateral PNIF at rest (T3) and ≤60 s post-sprint (T4), spirometry (FVC, FEV₁, PEF, FEF_25–75; GLI-2012 norms), and a 30 s maximal tethered sprint (Fmax, N). Principal component analysis (PCA) and hierarchical cluster analysis were applied to ΔPNIF, LM score, resting spirometry, and Fmax. Results: LM score and ΔPNIF were not significantly correlated (Spearman ρ = 0.32; p = 0.17). PCA yielded two components (63.1% of variance) that did not cleanly separate a mucosal-reactivity dimension from ventilatory reserve: LM score loaded together with Fmax on the second component, while ΔPNIF loaded moderately on both components. Hierarchical clustering identified three subgroups (silhouette coefficient 0.38), but none combined reduced ΔPNIF with elevated LM score; the subgroup with the highest mean LM score (n = 7) showed the highest mean ΔPNIF (+29.3 L/min) of the three. Resting spirometry was supranormal throughout (FEV₁% 115.3 ± 14.2%) and did not differ between subgroups. Exercise-induced bronchodilation was pronounced across the cohort (ΔFEV₁ +9.6 pp; d = 0.84), and tethered force (Fmax) was the sole correlate of World Aquatics performance (r = 0.560; p = 0.002). Conclusions: In this cohort, CBCT-derived sinus mucosal burden and post-exercise nasal decongestion were not significantly associated, and clustering did not identify a subgroup analogous to a “dysfunctional” ventilatory–sinonasal phenotype. Post-exercise PNIF and resting spirometry appear to capture largely independent aspects of exercise physiology in competitive swimmers, but neither, alone or combined with LM score, discriminated a distinct clinical subgroup in this sample. Tethered force remains the strongest correlate of competitive performance identified. Full article

(This article belongs to the Section Sports Medicine)

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12 pages, 1347 KB

Open AccessArticle

Prediagnostic Urinary Tract-Related Manifestations and Recurrence Risk in Colorectal Cancer with Bladder Involvement

by Yi-Huei Chang, Yi-Chang Chen, Wen-Chi Chen, Tao-Wei Ke, Chi-Ping Huang, Laing-You Wu, Hui-Tsung Hsu and Chi-Jung Chung

J. Clin. Med. 2026, 15(15), 5867; https://doi.org/10.3390/jcm15155867 - 27 Jul 2026

Abstract

Background/Objectives: Colorectal cancer (CRC) with bladder involvement represents a distinct subgroup of locally advanced disease frequently accompanied by urinary tract-related manifestations (UTRMs). However, the clinical relevance of prediagnostic UTRMs in this high-risk population remains unclear. This study investigated the association between UTRMs and [...] Read more.

Background/Objectives: Colorectal cancer (CRC) with bladder involvement represents a distinct subgroup of locally advanced disease frequently accompanied by urinary tract-related manifestations (UTRMs). However, the clinical relevance of prediagnostic UTRMs in this high-risk population remains unclear. This study investigated the association between UTRMs and oncologic outcomes in patients with bladder-involved CRC. Methods: We conducted a population-based retrospective cohort study using the National Health Insurance Research Database and Catastrophic Illnesses Database (2000–2020). A total of 2608 patients with CRC involving the bladder were included. Patients with prediagnostic UTRMs, including urinary frequency, urgency, dysuria, hematuria, and urinary tract infections, were identified using diagnostic codes recorded within 6 months before CRC diagnosis. Inverse probability of treatment weighting was applied to balance baseline characteristics. Patients were followed from CRC diagnosis until disease recurrence, death, or end of the study period. Weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Patients with UTRMs had a significantly higher risk of disease recurrence than those without UTRMs (adjusted HR 1.57). Patients with UTRMs requiring antibiotic treatment exhibited an even greater recurrence risk (adjusted HR 4.17), although this finding should be interpreted cautiously because of the limited sample size. Associations between UTRMs and recurrence were generally consistent across subgroup analyses. In contrast, UTRMs were not significantly associated with CRC-specific mortality. Conclusions: Prediagnostic UTRMs were associated with an increased risk of recurrence in patients with CRC involving the bladder. These readily obtainable preoperative clinical manifestations may provide supplementary information for postoperative surveillance in this high-risk population. Further studies are warranted to validate these findings. Full article

(This article belongs to the Section Nephrology & Urology)

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15 pages, 392 KB

Open AccessSystematic Review

Pulsed Field Ablation for Atrial Fibrillation in Obesity: Reassessing Risk, Safety, and Success

by Ridwan R. Waliyuddin, Dony Y. Hermanto, Sunu B. Raharjo, Dicky A. Hanafy and Yoga Yuniadi

J. Clin. Med. 2026, 15(15), 5866; https://doi.org/10.3390/jcm15155866 - 27 Jul 2026

Abstract

Background: Obesity is a major independent risk factor for atrial fibrillation (AF), contributing to adverse outcomes and complicating rhythm control. While lifestyle modification is recommended, catheter ablation remains central to management. Conventional thermal ablation techniques often yield suboptimal results in obese patients due [...] Read more.

Background: Obesity is a major independent risk factor for atrial fibrillation (AF), contributing to adverse outcomes and complicating rhythm control. While lifestyle modification is recommended, catheter ablation remains central to management. Conventional thermal ablation techniques often yield suboptimal results in obese patients due to anatomical and biophysical challenges. Pulsed field ablation (PFA), a novel non-thermal modality, may overcome these limitations. Methods: A systematic search of PubMed, Scopus, and Embase identified observational cohort studies (2017–2026) evaluating PFA outcomes in obese AF patients or across BMI categories. Four cohort studies met the inclusion criteria. Results: Findings on AF recurrence were heterogeneous. Recurrence rates appeared lower with PFA compared to radiofrequency ablation (RFA), though differences were not statistically significant. In a PFA-only study, freedom from arrhythmia recurrence did not vary across BMI categories. Compared with cryoballoon ablation (CBA), one matched-cohort study demonstrated significantly higher one-year freedom from AF with PFA-PVI, whereas another reported no difference. Left atrial epicardial adipose tissue (LA EAT) emerged as the only independent predictor of recurrence in PFA patients, suggesting electrical field perturbation by fat tissue. Radiation exposure was lower with PFA than CBA, while fluoroscopy time and periprocedural complications were comparable across groups. Conclusions: Current observational evidence suggests that PFA may be a feasible and safe option for AF ablation in overweight and obese patients, with outcomes comparable to conventional ablation techniques. However, comparative efficacy and long-term safety remain uncertain. Obesity-related adipose hypertrophy, systemic inflammation, and atrial remodeling may alter electric field distribution, contributing to variable recurrence outcomes. Larger prospective and randomized trials are warranted to define the long-term role of PFA in this high-risk population. Full article

(This article belongs to the Section Cardiovascular Medicine)

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23 pages, 1766 KB

Open AccessReview

Reducing Diabetic Ketoacidosis in Pediatric Type 1 Diabetes: The Impact of Screening Programs and Early Disease-Modifying Treatment

by Yung-Yi Lan, Rujith Kovinthapillai, Andrzej Kędzia and Elżbieta Niechciał

J. Clin. Med. 2026, 15(15), 5865; https://doi.org/10.3390/jcm15155865 - 27 Jul 2026

Abstract

Background: Diabetic ketoacidosis (DKA) remains a preventable yet frequent complication at the onset of type 1 diabetes (T1D) in children, driven by delayed symptom recognition, socioeconomic disparities, and inconsistent access to care. Early identification of presymptomatic T1D through autoantibody-based screening, together with emerging [...] Read more.

Background: Diabetic ketoacidosis (DKA) remains a preventable yet frequent complication at the onset of type 1 diabetes (T1D) in children, driven by delayed symptom recognition, socioeconomic disparities, and inconsistent access to care. Early identification of presymptomatic T1D through autoantibody-based screening, together with emerging disease-modifying therapies, may reduce the incidence of DKA. This review synthesizes evidence on epidemiology, risk determinants, screening strategies, and immunological interventions relevant to DKA prevention. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar (2011–2026). Eligible sources included clinical studies, guidelines, systematic reviews, meta-analyses, and prevention trials addressing staging, screening, epidemiology, and disease-modifying treatments in pediatric T1D. Landmark publications outside this timeframe were included when essential. Evidence was integrated to identify determinants of DKA and strategies to reduce its occurrence. Results: DKA risk is influenced by younger age, socioeconomic disadvantage, rural residence, misdiagnosis, and limited access to specialized care. Sustained public awareness and community-based education reduce DKA incidence, whereas short-term campaigns show transient effects. Structured screening programs, including TrialNet and TEDDY, demonstrate near-elimination of DKA among monitored children. Teplizumab delayed progression from stage 2 to stage 3 T1D by a median of approximately 24 months in the original TN-10 trial, with extended follow-up demonstrating a median delay of 32.5 months. It is approved for individuals with stage 2 T1D aged ≥ 1 year and has recently gained approval for selected patients with newly diagnosed T1D, expanding opportunities for early disease modification. Global networks such as INNODIA strengthen prevention through coordinated biomarker-driven research. Conclusions: Reducing DKA at T1D onset requires integrated, sustained strategies combining public awareness, systematic autoantibody screening, structured follow-up, and access to emerging immunotherapies. Coordinated care across primary providers, pediatric endocrinologists, and research networks is essential to advance a proactive, prevention-oriented model of pediatric T1D care. Full article

(This article belongs to the Special Issue Modern Challenges in Pediatric Endocrinology: From Growth Disorders to Metabolic Dysregulation)

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13 pages, 622 KB

Open AccessArticle

Association of General Anesthesia Exposure with Cognitive Outcomes in Older Adults: A Cross-Sectional Study in a Korean Cohort

by Kayoung Song, Min-Seung Park and Seong Yoon Kim

J. Clin. Med. 2026, 15(15), 5864; https://doi.org/10.3390/jcm15155864 - 27 Jul 2026

Abstract

Background: The relationship between general anesthesia (GA) exposure and cognitive function remains controversial. This study aimed to investigate the association between GA exposure and cognitive severity, as measured using the Clinical Dementia Rating Sum of Boxes (CDR-SB) and Global Deterioration Scale (GDS), [...] Read more.

Background: The relationship between general anesthesia (GA) exposure and cognitive function remains controversial. This study aimed to investigate the association between GA exposure and cognitive severity, as measured using the Clinical Dementia Rating Sum of Boxes (CDR-SB) and Global Deterioration Scale (GDS), across different diagnostic groups. Methods: We used a de-identified dataset from the Korea Dementia Research Center’s Trial Ready Registry (KDRC TRR). Participants were classified as having normal cognition, mild cognitive impairment (MCI), or dementia. Logistic regression analyses were performed to identify the variables associated with CDR-SB and GDS scores within each group. Linear regression analyses were also performed for the amyloid positron emission tomography standardized uptake value ratios (SUVRs). Results: Among 688 participants, 258 were classified as having normal cognition, 245 as MCI, and 185 as dementia. In the normal group, GA exposure was associated with higher CDR-SB (OR = 2.33 [95% CI: 1.06–5.08, p = 0.032]) and GDS scores (OR = 2.29 [95% CI: 1.16–4.55, p = 0.017]). In addition, in this group, GA exposure was significantly associated with higher SUVRs in multivariable analyses (β = 0.09, 95% CI: 0.004–0.18, p = 0.040). No consistent associations were observed in the MCI or dementia groups. Conclusions: GA exposure after the age of 50 was associated with greater cognitive severity and higher amyloid burden in cognitively normal individuals. Prospective longitudinal studies incorporating detailed anesthetic, surgical, and perioperative data are required to clarify the nature of this association. Full article

(This article belongs to the Special Issue Towards an Improved Understanding of Alzheimer's and Related Dementias: Interdisciplinary and Clinical Progress)

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21 pages, 2145 KB

Open AccessArticle

EEG Microstate Alterations in Eyes-Open and Eyes-Closed Resting States Across the Alzheimer’s Disease Continuum

by Chanda Simfukwe, Seong Soo A. An and Young Chul Youn

J. Clin. Med. 2026, 15(15), 5863; https://doi.org/10.3390/jcm15155863 - 27 Jul 2026

Abstract

Background/Objective: Quantitative electroencephalography (qEEG) microstates, recorded under both eyes-open (EOR) and eyes-closed (ECR) resting conditions, provide a powerful neurophysiological approach for capturing the temporal dynamics of cognitive processing. Nevertheless, microstate syntax remains poorly delineated in mild cognitive impairment (MCI) and Alzheimer’s disease [...] Read more.

Background/Objective: Quantitative electroencephalography (qEEG) microstates, recorded under both eyes-open (EOR) and eyes-closed (ECR) resting conditions, provide a powerful neurophysiological approach for capturing the temporal dynamics of cognitive processing. Nevertheless, microstate syntax remains poorly delineated in mild cognitive impairment (MCI) and Alzheimer’s disease (AD). The present study seeks to identify potential drivers of altered microstate topography and temporal dynamics across advancing stages of cognitive decline. Methods: Resting-state EEG (rEEG) was recorded from 60 participants (40–90 years old) in each of three groups: MCI, AD, and healthy controls (HC), under both EOR and ECR conditions. After artifact rejection with EEGLAB in MATLAB R2024a, the final dataset comprised 180 clean recordings per condition (EOR and ECR) and 360 recordings in total. Microstate analysis was performed using the MICROSTATELAB toolbox. Potential group differences in microstate topography were examined with topographic analysis of variance (TANOVA). Four canonical microstates were extracted and labeled A, B, C, and E, following the well-established classification scheme. Results: Analysis of microstate topographies revealed significant group-level differences in the EOR condition for Microstate A (auditory network; p = 0.003), Microstate C (salience network; p = 0.004), and Microstate E (executive network; p = 0.036). In contrast, no significant between-group differences emerged under the ECR condition (all p > 0.05). Within-group comparisons indicated that Microstate B (visual network) was the only class to differ between the two resting conditions in healthy controls and patients with MCI. In the AD group, however, condition-related differences extended to Microstates A, C, and E, suggesting a more distributed disruption of network dynamics in advanced disease. Temporally, Microstate B coverage was the only parameter to show a significant between-group difference, being greater in MCI than in AD under the EOR condition (p = 0.031); visual trends of increasing Microstate A duration and decreasing Microstate C occurrence toward AD did not reach statistical significance. Conclusions: This study’s rEEG microstate analysis uncovered condition-dependent and disease-sensitive alterations across the HC, MCI, and AD groups. The EOR condition proved more diagnostically informative, with significant group-level topographic differences emerging for Microstates A, C, and E, whereas the ECR condition yielded no reliable between-group effects. Microstate B coverage showed the only significant temporal alteration, distinguishing MCI from AD under EOR, while Microstate A and Microstate C showed non-significant trends warranting replication in larger cohorts. Full article

(This article belongs to the Section Clinical Neurology)

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15 pages, 577 KB

Open AccessArticle

Interpretable Machine Learning Analysis of Factors Associated with Postoperative Hemoglobin Reduction After Total Knee Arthroplasty: A Standardized-Protocol Cohort Study in Non-Transfused Patients

by Jae Bum Kwon, Seung Jae Yoo, Junhee Lee, Sang Gyu Kwak and Won Kee Choi

J. Clin. Med. 2026, 15(15), 5862; https://doi.org/10.3390/jcm15155862 - 27 Jul 2026

Abstract

Background: Postoperative hemoglobin (Hb) reduction reflects the physiologic extent of perioperative blood loss after total knee arthroplasty (TKA). Whereas previous studies have relied on transfusion as a binary endpoint, transfusion decisions are highly variable across institutions, obscuring the underlying hematologic trajectory. This study [...] Read more.

Background: Postoperative hemoglobin (Hb) reduction reflects the physiologic extent of perioperative blood loss after total knee arthroplasty (TKA). Whereas previous studies have relied on transfusion as a binary endpoint, transfusion decisions are highly variable across institutions, obscuring the underlying hematologic trajectory. This study aimed to develop and interpret machine learning (ML) models to characterize and quantify the determinants of postoperative Hb reduction in a standardized cohort of non-transfused TKA patients. Methods: A retrospective cohort of 866 patients who underwent primary TKA under a standardized operative protocol—with identical cemented posterior-stabilized implants and uniform cementing technique—was analyzed (1 January 2014–31 March 2024). During the study period, a consistent 1 g intra-articular tranexamic acid (TXA) regimen administered through the drain was introduced and applied to a subset of patients, allowing TXA use to be modeled as a binary predictor. Four ML algorithms (Linear Regression, Random Forest, XGBoost, and Stacking Regressor) were trained using preoperative, demographic, and perioperative variables. Fivefold cross-validation assessed model performance, and SHapley Additive exPlanations (SHAP) values were used to identify influential predictors and enhance interpretability. Results: Across all ML models, preoperative Hb emerged as the strongest determinant of postoperative Hb reduction, followed by TXA use, body mass index (BMI), and platelet count. Ensemble models captured non-linear and interacting effects more effectively than linear regression. Test-set performance was modest (best R² = 0.330), consistent with the influence of unmeasured physiologic factors such as hidden blood loss, fluid dynamics, and inflammatory responses. Accordingly, the primary value of the framework lies in the exploratory and transparent assessment of determinant importance rather than in individual-level prediction. Conclusions: This study provides an interpretable, exploratory ML framework for identifying factors associated with percentage Hb reduction after TKA. Preoperative Hb was the dominant determinant, while TXA use and higher BMI were recurrently associated with smaller predicted percentage reductions. Given the modest test-set performance and the absence of external validation and clinical utility assessment, the models should not be interpreted as tools for individual-level prediction or clinical decision making. Full article

(This article belongs to the Section Orthopedics)

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26 pages, 5082 KB

Open AccessTechnical Note

Single-Position Minimally Invasive Retropleural Asymmetric Vertebral Column Resection and Percutaneous Pedicle Screw Fixation in the Lateral Position for Congenital Kyphoscoliosis

by Piotr Kowalski, Gergely Bodon, Michael A. Galgano, Justyna Walczak, Michał Grabala, Krzysztof Zakrzewski and Paweł Grabala

J. Clin. Med. 2026, 15(15), 5861; https://doi.org/10.3390/jcm15155861 - 27 Jul 2026

Abstract

Background: Congenital thoracic kyphoscoliosis caused by vertebral malformations is a challenging condition that may progress during skeletal growth, leading to spinal imbalance, pain, cosmetic deformity, and neurological compromise. Conventional correction often requires extensive anterior, posterior, or combined approaches associated with substantial surgical morbidity. [...] Read more.

Background: Congenital thoracic kyphoscoliosis caused by vertebral malformations is a challenging condition that may progress during skeletal growth, leading to spinal imbalance, pain, cosmetic deformity, and neurological compromise. Conventional correction often requires extensive anterior, posterior, or combined approaches associated with substantial surgical morbidity. We describe a single-position surgical technique combining a lateral retropleural asymmetric vertebral resection with percutaneous posterior instrumentation performed entirely in the lateral decubitus position. Methods: A 15-year-old boy with progressive congenital thoracic kyphoscoliosis secondary to a T10 butterfly vertebra underwent surgical correction after failure of conservative treatment. The procedure was performed entirely in the left lateral decubitus position under multimodal intraoperative neurophysiological monitoring. Bilateral percutaneous pedicle screws were inserted from T7 to L1 under fluoroscopic guidance without repositioning the patient. A muscle-sparing lateral retropleural approach was then used to perform T10 asymmetric vertebral column resection, anterior column reconstruction with an expandable cage, and definitive deformity correction using posterior rod compression. The technical rationale, operative workflow, and reconstruction strategy are described. Results: The procedure was completed without intraoperative neurological deterioration or the need for patient repositioning. Postoperative imaging demonstrated satisfactory restoration of coronal and sagittal alignment, appropriate implant positioning, and spinal canal decompression. The patient experienced marked improvement in pain, shoulder balance, rib hump deformity, and overall posture while maintaining normal neurological function. The main thoracic curve improved from 32° to 6°, thoracic kyphosis from 78° to 63°, VAS from 5 to 0, ODI from 42 to 5, and SRS-22R from 3.85 to 4.85. Solid fusion was confirmed at 3 years. A postoperative pneumothorax, attributed to pleural violation during exposure, represented the only complication and resolved completely following pleural drainage. At 36-month follow-up, radiographs and computed tomography confirmed maintenance of deformity correction, stable instrumentation, and solid anterior and posterior fusion without implant failure or loss of correction. Conclusions: Single-position lateral retropleural asymmetric vertebral resection combined with percutaneous pedicle screw fixation is a technically feasible option for selected patients with congenital thoracic kyphoscoliosis. Avoiding intraoperative repositioning while combining anterior reconstruction and posterior stabilization through a reduced-access retropleural approach may simplify the surgical workflow and minimize soft-tissue disruption without compromising deformity correction. Further clinical experience is required to establish its reproducibility and comparative advantages. Full article

(This article belongs to the Special Issue Spinal Disorders: Current Treatment and Future Opportunities: Third Edition)

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11 pages, 837 KB

Open AccessArticle

Evaluation of the Efficacy and Safety of Collagen Mesotherapy in the Course of Chronic Cervicocephalic Syndrome—A Retrospective Observational Study

by Kamil Koszela, Massimo Mammucari, Michał Słupiński, Barbara Stypińska, Agnieszka Guz and Karol Myszel

J. Clin. Med. 2026, 15(15), 5860; https://doi.org/10.3390/jcm15155860 - 27 Jul 2026

Abstract

Background/Objectives: The number of patients with cervical spine pain has been increasing in recent years, and some have been diagnosed with chronic cervicocephalic syndrome (CCS). Collagen mesotherapy of the spine is increasingly being used to treat chronic pain syndromes. This retrospective observational [...] Read more.

Background/Objectives: The number of patients with cervical spine pain has been increasing in recent years, and some have been diagnosed with chronic cervicocephalic syndrome (CCS). Collagen mesotherapy of the spine is increasingly being used to treat chronic pain syndromes. This retrospective observational study was conducted to evaluate the efficacy and safety of collagen mesotherapy in the course of CCS. Methods: The study included 31 patients (19 women and 12 men; mean age, 45.0 ± 10.1) with chronic CCS (>12 weeks) who underwent cervical spine mesotherapy using injectable collagen. Mesotherapy was performed at weekly intervals, in 5 (in 18 patients) and 6 (in 13 patients) sessions. Patients were assessed using the Visual Analogue Scale (VAS) for cervical spine pain, pain radiating to the occipital region, dizziness, and tinnitus before the start of mesotherapy, one week after its completion, and 3 months later during a follow-up visit. Changes over time were analyzed using the Friedman test for repeated measures and Cochran’s Q test for binary outcomes. Results: Following collagen mesotherapy, cervical pain on the VAS decreased from 7 (IQR 6–8) at baseline to 2 (IQR 1–3) after treatment and remained at 2 (IQR 1–2) after the 3-month follow-up (p < 0.001). The proportion of patients with occipital pain decreased from 100% to 38.7%, dizziness from 83.9% to 38.7%, and tinnitus from 19.4% to 6.5%. No adverse effects related to the therapy were observed. Conclusions: Collagen mesotherapy was associated with improvements in pain and accompanying symptoms in patients with chronic cervicocephalic syndrome, with no treatment-related adverse events observed. Nevertheless, further research in this area is necessary. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 1628 KB

Open AccessArticle

The Relationship Between Reduced Glomerular Filtration Rate and Hearing Impairment: A Study Based on Western and Eastern Population

by Mingdong Wang, Jing Cui, Yishan Zhang, Yongjun Quan, Yingwei Xie, Li Chen, Yongchen Jin, Xiaoxuan Bai, Yuexin Liu, Xiaobo Ma, Dongning Chen, Dan Liu and Hao Ping

J. Clin. Med. 2026, 15(15), 5859; https://doi.org/10.3390/jcm15155859 - 27 Jul 2026

Abstract

Objectives: To explore potential strategies for the early detection of renal function impairment, we investigated the association between renal function impairment and hearing loss, as early-stage renal impairment often presents with few clinical manifestations, making it challenging to detect. Methods: We [...] Read more.

Objectives: To explore potential strategies for the early detection of renal function impairment, we investigated the association between renal function impairment and hearing loss, as early-stage renal impairment often presents with few clinical manifestations, making it challenging to detect. Methods: We included data including western and eastern population for 3154 participants from the NHANES database in 2009–12 and 2015–18, and for 5958 participants in the Beijing Tongren hospital between January 2019 and January 2023, with a median follow-up of 30.0 months. Then, we comprehensively evaluated the relationship between renal function and hearing impairment, using linear regression, Logistics regression, Cox regression, and Mann–Whitney U test. Results: People with reduced eGFR were more likely to show speech-frequency hearing loss than those with normal eGFR (HR 1.54; 95% CI 1.20–1.97; p < 0.001). People with speech-frequency hearing loss were more likely to have reduced eGFR (HR 1.49; 1.18–1.89; p < 0.001). Hearing acuity in women with reduced eGFR may improve with the amelioration of renal function (OR 1.10; 1.01–1.20; p = 0.037). Conclusions: Renal function examinations may be considered in people with self-perceived or tested hearing loss to detect potential early renal injury. People with reduced eGFR should also place attention on hearing protection, given the observed association. Whether a causal relationship exists between hearing function and eGFR remains to be elucidated through further in-depth studies. Full article

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

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22 pages, 1953 KB

Open AccessArticle

Perilesional and Contextual Radiomic Features Improve Differentiation of Odontogenic Cysts on Panoramic Radiographs

by Barbara Obuchowicz, Joanna Zarzecka, Marzena Jakubowska, Rafał Obuchowicz and Julia Lasek

J. Clin. Med. 2026, 15(15), 5858; https://doi.org/10.3390/jcm15155858 - 27 Jul 2026

Abstract

Background: Radiographic differentiation of odontogenic cysts remains challenging due to overlapping imaging features and limited specificity of conventional assessment. Radiomics offers a quantitative approach to extract imaging biomarkers that may improve non-invasive lesion characterization. Accurate differentiation among cyst subtypes is clinically relevant, as [...] Read more.

Background: Radiographic differentiation of odontogenic cysts remains challenging due to overlapping imaging features and limited specificity of conventional assessment. Radiomics offers a quantitative approach to extract imaging biomarkers that may improve non-invasive lesion characterization. Accurate differentiation among cyst subtypes is clinically relevant, as different odontogenic cysts may warrant different management and follow-up strategies. Methods: This study included 63 patients with histopathologically confirmed odontogenic cysts (odontogenic keratocyst [OKC], n = 33; radicular cyst [RC], n = 12; dentigerous cyst [DC], n = 10; odontogenic cyst, not otherwise specified [OC-NOS], n = 8). Panoramic radiographs were manually segmented to define cyst and anatomical regions of interest. Radiomic features were extracted using three groups: agnostic texture features, morphological/intensity descriptors, and perilesional features. Classification was performed using logistic regression with leave-one-out cross-validation. Pairwise and four-class classification analyses were conducted, and feature importance was evaluated. Results: Radiomic features demonstrated significant differences between cyst and anatomical regions, with approximately 60% of features remaining significant after correction. Pairwise classification performance varied across lesion types, achieving the highest balanced accuracy for DC vs. OC-NOS (0.838) and OKC vs. OC-NOS (0.752), while comparisons involving OKC vs. RC (0.602) and OKC vs. DC (0.644) were less discriminative. Texture-based features, particularly NGTDM-derived metrics, were among the most informative. The integration of morphological and perilesional features improved performance: four-class balanced accuracy increased from 0.416 with texture-only features to 0.487 with the combined feature set (p = 0.002). Conclusions: Radiomics-based analysis of panoramic radiographs enables moderate but preliminary differentiation of odontogenic cysts, with performance comparable to prior studies. The inclusion of perilesional and spatial features enhances classification, highlighting the importance of contextual information. Despite these advances, substantial overlap between cyst types persists, underscoring the need for multimodal diagnostic approaches and further validation in larger cohorts. Full article

(This article belongs to the Topic Machine Learning and Deep Learning in Medical Imaging)

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