Journal of Clinical Medicine

10 pages, 232 KiB

Open AccessArticle

Electric Scooter Trauma in Rome: A Three-Year Analysis from a Tertiary Care Hospital

by Bruno Cirillo, Mariarita Tarallo, Giulia Duranti, Paolo Sapienza, Pierfranco Maria Cicerchia, Luigi Simonelli, Roberto Cirocchi, Matteo Matteucci, Andrea Mingoli and Gioia Brachini

J. Clin. Med. 2025, 14(10), 3615; https://doi.org/10.3390/jcm14103615 - 21 May 2025

Viewed by 419

Abstract

Background: Electric motorized rental scooters (ES) were introduced in Italy in 2019 as an alternative form of urban transportation, aiming to reduce traffic congestion and air pollution. As their popularity has grown, a parallel increase in ES-related injuries has been observed. This study [...] Read more.

Background: Electric motorized rental scooters (ES) were introduced in Italy in 2019 as an alternative form of urban transportation, aiming to reduce traffic congestion and air pollution. As their popularity has grown, a parallel increase in ES-related injuries has been observed. This study aims to investigate the types and patterns of ES-related injuries and to identify potentially modifiable risk factors. Methods: We conducted a retrospective analysis of all consecutive patients admitted to the Emergency Department of Policlinico Umberto I in Rome between January 2020 and December 2022 following ES-related trauma. Collected data included demographics, injury mechanisms and types, helmet use, Injury Severity Score (ISS), blood alcohol levels, and patient outcomes. Results: A total of 411 individuals presented to the Emergency Department due to ES-related injuries, either as riders or pedestrians. The mean age was 31 years (range: 2–93); 38 patients (9%) were under 18 years of age. Fifty-six accidents (14%) occurred during work-related commutes. Only three riders (0.7%) wore helmets, and nine patients (2%) had blood alcohol levels > 0.50 g/L. Cranial injuries (134 cases, 32%) and upper limb fractures (93 cases, 23%) were the most frequently reported serious injuries. The mean ISS was 4.5; 17 patients (4%) had an ISS ≥ 16. A total of 270 orthopedic injuries and 118 (29%) maxillofacial injuries were documented. Head trauma was reported in 115 patients (28%), with 19 cases classified as severe traumatic brain injuries. Twenty-three patients (5.5%) were hospitalized, three (0.7%) required intensive care, and one patient (0.2%) died. Conclusions: ES-related injuries are becoming increasingly common and present a significant public health concern. A nationwide effort is warranted to improve rider safety through mandatory helmet use, protective equipment, alcohol consumption control, and stricter enforcement of speed regulations. Full article

(This article belongs to the Section General Surgery)

9 pages, 637 KiB

Open AccessArticle

The Characteristics of Severely Injured Trauma Patients Admitted to a Level I Trauma Center with Pre-Injury Use of Oral Anticoagulation (OAC) or Antiplatelet Therapy (APT)

by Valerie Weihs, Anna Antoni, Stephan Frenzel, Silke Aldrian, Stefan Hajdu and Lukas L. Negrin

J. Clin. Med. 2025, 14(10), 3614; https://doi.org/10.3390/jcm14103614 - 21 May 2025

Viewed by 293

Abstract

Background: Little is known about the impact of pre-injury OAC/APT on severely injured trauma patients admitted to a level I trauma center. Our study focused on impact of pre-injury OAC/APT on the outcomes of this specific cohort of patients. Methods: A [...] Read more.

Background: Little is known about the impact of pre-injury OAC/APT on severely injured trauma patients admitted to a level I trauma center. Our study focused on impact of pre-injury OAC/APT on the outcomes of this specific cohort of patients. Methods: A retrospective cohort study on 356 severely injured trauma patients admitted to the resuscitation room in a level I trauma center between 2015 and 2020 was carried out. Results: Of the 356 patients, 20.5% (n = 73) were admitted with pre-injury OAC/APT. Falls from lower heights, categorized as low-energy trauma, were the primary mechanism of injury in patients with pre-injury OAC/APT. Patients with pre-injury OAC/APT were older (p < 0.001), had a higher proportion of severe traumatic brain injuries (TBI) (p < 0.001), and experienced significantly higher mortality rates during their hospital stay (60.3% vs. 15.9%; p < 0.001). There were significant correlations between pre-injury OAC/APT and advanced age (p < 0.001) as well as the severity of head injury (p < 0.001). Patients with pre-injury OAC/APT exhibited significantly higher mortality rates; especially in patients with pre-injury oral anticoagulation therapy. The highest mortality rates were observed in patients with isolated TBI and pre-injury OAC/APT. Conclusions: Trauma patients with pre-injury OAC/APT presented with advanced age and low-energy trauma as the main mechanism of injury. Pre-injury OAC/APT significantly correlated with advanced age and the severity of head injuries, and it may serve as an additional prognostic factor for the outcome of severely injured trauma patients. Full article

(This article belongs to the Section Orthopedics)

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16 pages, 1613 KiB

Open AccessArticle

Clinical Value of Bioactive Adrenomedullin and Proenkephalin A in Patients with Left Ventricular Assist Devices: An Observational Study

by Leyla Dogan, Ahmad Abugameh, Alish Kolashov, Ajay Moza, Andreas Goetzenich, Christian Stoppe, Mohammed Shoaib, Deborah Bergmann, Jan Spillner, Mohammad Amen Khattab and Rashad Zayat

J. Clin. Med. 2025, 14(10), 3613; https://doi.org/10.3390/jcm14103613 - 21 May 2025

Viewed by 402

Abstract

Background/Objectives: In the context of acute heart failure, proenkephalin A (penKid) has emerged as a prognostic marker for acute kidney injury (AKI), whereas bioactive adrenomedullin (bio-ADM) has been identified as a significant biomarker linked to shock and organ dysfunction. This raises the [...] Read more.

Background/Objectives: In the context of acute heart failure, proenkephalin A (penKid) has emerged as a prognostic marker for acute kidney injury (AKI), whereas bioactive adrenomedullin (bio-ADM) has been identified as a significant biomarker linked to shock and organ dysfunction. This raises the question of whether they can serve as predictors of postoperative complications in patients receiving left ventricular assist devices (LVADs). Methods: This observational study prospectively enrolled patients who had received LVAD implantation. Routine laboratory values as well as plasma levels of penKid and bio-ADM were assessed at four time intervals, spanning from preinduction of anesthesia to 48 h post surgery. Clinical data, the HeartMate 3-risk-score (HM3RS), HeartMateII-risk-score (HMRS), Michigan-right-heart-failure risk score (MRHFS), Euromacs-RHFS (EURORHFS), and kidney failure risk score (KFR) were calculated. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were performed. We entered the biomarkers with the established risk scores into the models. Results: In 20 patients who had undergone LVAD implantation, preoperative penKid level was a predictor of postoperative AKI (OR: 1.05, 95%-CI: 1.0–1.09; p = 0.049) and 30-day mortality (OR: 1.01, 95%-CI: 1.0–1.02; p = 0.033). Bio-ADM was the only predictor of postoperative right heart failure (RHF) (OR: 1.11, 95%-CI: 1.01–1.23; p = 0.034) and rehospitalization (OR: 1.06, 95%-CI: 1.0–1.13; p = 0.047). In the ROC analysis, bio-ADM, as a predictor of post-LVAD RHF, had an area under the curve (AUC) of 0.88. When bio-ADM was added to the accepted clinical scores for post-LVAD RHF prediction (CRITT-score, MRHFS, and EURORHFS), the AUC reached 0.98. The AUC for preoperative penKid, as a predictor of postoperative AKI, was 0.95, and after adding its predictive value to the KFR score, the AUC reached 0.97. Conclusions: In the present study, the biomarkers penKid and bio-ADM predicted clinically significant patient outcomes after LVAD implantation such as AKI, RHF, and 30-day mortality. Adding biomarkers to well-established risk scores improved the AUC for prediction of postoperative complications. Full article

(This article belongs to the Section Cardiovascular Medicine)

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7 pages, 421 KiB

Open AccessArticle

Assessing Olfactory Acuity in Primary Ciliary Dyskinesia with the RSPH4A Founder Mutation

by Miguel A. De Jesús and Wilfredo De Jesús-Rojas

J. Clin. Med. 2025, 14(10), 3612; https://doi.org/10.3390/jcm14103612 - 21 May 2025

Viewed by 696

Abstract

Background/Objectives: Primary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by compromised mucociliary clearance and chronic respiratory manifestations. Anosmia, or the loss of smell, is a lesser-known but clinically relevant symptom that can significantly impact patient safety, nutritional status, and the [...] Read more.

Background/Objectives: Primary Ciliary Dyskinesia (PCD) is a rare genetic condition characterized by compromised mucociliary clearance and chronic respiratory manifestations. Anosmia, or the loss of smell, is a lesser-known but clinically relevant symptom that can significantly impact patient safety, nutritional status, and the overall quality of life. The RSPH4A (c.921+3_921+6delAAGT) founder mutation is highly prevalent among Puerto Rican individuals with PCD and may carry distinct phenotypic implications. This study aimed to evaluate olfactory function in Puerto Rican PCD patients with this mutation using the Brief Smell Identification Test (BSIT^®) and to assess associations with age and sex. Methods: We conducted a case–control study involving 30 participants, including 15 PCD patients with genetically confirmed RSPH4A mutations and 15 age- and sex-matched healthy controls. All participants completed the BSIT, and BSIT scores were compared by diagnosis, sex, and age. Results: PCD patients had significantly lower BSIT scores than controls (p = 0.0015). When stratified by sex, both male (p = 0.0289) and female (p = 0.0178) PCD patients demonstrated significantly lower BSIT scores compared to their respective healthy counterparts. Regression analysis showed a significant inverse correlation between age and BSIT score in the PCD group (r² = 0.2873; p = 0.0395), while no such relationship was observed in controls (r² = 0.0096; p = 0.7283). Among PCD patients, age-related decline in olfactory function was more pronounced in females (r² = 0.71; p = 0.005) than in males (r² = 0.31; p = 0.25). Conclusions: These findings demonstrate that the RSPH4A founder mutation is associated with measurable olfactory impairment in PCD patients, particularly in females and with advancing age. The routine assessment of olfactory function should be considered in the clinical evaluation of patients with PCD, as anosmia may represent a key phenotypic feature and contribute to disease burden. Full article

(This article belongs to the Special Issue Clinical Research in Olfactory and Gustatory Disorders: State of the Art)

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19 pages, 1644 KiB

Open AccessArticle

The Feasibility of a Guideline-Directed Medical Therapy Rapid Up-Titration Programme Among Real-World Heart Failure Patients: A Multicentre Observational Study

by Fanni Bánfi-Bacsárdi, Arnold Péter Ráduly, Attila Borbély, Noémi Nyolczas, Attila Szilágyi, Tamás G. Gergely, Zsolt Forrai, Judit Papp, Orsolya Rátosi, Tünde Rácz, Krisztina Hati, Ildikó Kocsis, Zoltán Csanádi, Gábor Zoltán Duray, Péter Andréka, Zsolt Piróth and Balázs Muk

J. Clin. Med. 2025, 14(10), 3611; https://doi.org/10.3390/jcm14103611 - 21 May 2025

Viewed by 569

Abstract

Background: The 2023 ESC Heart Failure (HF) Guidelines recommend the rapid up-titration of guideline-directed medical therapy (GDMT) for all patients after HF hospitalisation. Real-world data on the implementation of a rapid up-titration programme (RTP) are scarce. Methods: We aimed to summarise the [...] Read more.

Background: The 2023 ESC Heart Failure (HF) Guidelines recommend the rapid up-titration of guideline-directed medical therapy (GDMT) for all patients after HF hospitalisation. Real-world data on the implementation of a rapid up-titration programme (RTP) are scarce. Methods: We aimed to summarise the primary experiences of a six-week RTP in a multicentre observational study of five cardiology centres, evaluating the GDMT applied and the target doses (TDs) achieved during the RTP. The safety of RTP in relation to exceeding the “safety indicators” used in the STRONG-HF trial and any serious adverse events were observed. Changes in the left ventricular ejection fraction (LVEF) after RTP were evaluated. Results: Among the 90 consecutive patients (age: 56 [49–63] years, HFrEF: 96%, NT-proBNP at discharge: 1390 [735–2835] pg/mL; continuous variables are presented as median and interquartile ranges, while categorical variables are shown as absolute numbers and percentages, respectively), a remarkable proportion of patients received GDMT at hospital discharge; however, target doses were rarely achieved (RASi: 100%, TD RASi: 11%; βB: 97%, TD βB: 6%; MRA: 99%, TD MRA: 82%; SGLT2i: 98%, TD SGLT2i: 98%; triple therapy [TT: RASi + βB + MRA]: 96%, TD TT: 2%, quadruple therapy [QT: RASi + βB + MRA]: 94%, TD QT: 2%). After the six-week RTP, 100% of the total cohort (TC) were receiving RASi; 99–99–99% were receiving βB, MRA, and SGLT2i medications; and altogether, 98–98% were on TT and QT. In total, 78–78% of the patients received ≥50% of the TDs of TT and QT, while 51–51% of the TC were on TDs of TT and QT. During the RTP, no serious adverse events were observed. Between two and four months after the RTP, 51% of HFrEF patients evolved to the HFimpEF category. Conclusions: The present multicentre, observational study confirms that RTP is feasible and safe in real-world clinical practice, leading to a remarkably large proportion of patients receiving GDMT by the end of the six-week RTP, resulting in a significant increase in LVEF. Full article

(This article belongs to the Special Issue Clinical Updates on Cardiomyopathies and Heart Failure)

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Graphical abstract

20 pages, 839 KiB

Open AccessReview

Single-Incision Laparoscopy in Abdominal Trauma: Current Evidence, Clinical Applications, and Evolving Role—A Narrative Review

by Sebeom Jeon and Kang-Kook Choi

J. Clin. Med. 2025, 14(10), 3610; https://doi.org/10.3390/jcm14103610 - 21 May 2025

Viewed by 482

Abstract

Background/Objectives: Laparoscopic surgery plays a central role in the management of abdominal trauma, particularly in patients with hemodynamic stability. Recently, single-port laparoscopic surgery (SPLS) has emerged as a technique that further reduces access-related trauma while preserving the benefits of conventional laparoscopy. Thus, this [...] Read more.

Background/Objectives: Laparoscopic surgery plays a central role in the management of abdominal trauma, particularly in patients with hemodynamic stability. Recently, single-port laparoscopic surgery (SPLS) has emerged as a technique that further reduces access-related trauma while preserving the benefits of conventional laparoscopy. Thus, this review aimed to examine the current landscape of SPLS in trauma care, summarizing available clinical data and highlighting practical considerations for its use. Despite the limited experience, early evidence suggests that SPLS can achieve diagnostic and therapeutic outcomes comparable to those achieved by multi-port approaches in selected cases. Particular attention is given to a hybrid method that combines intracorporeal assessment with extracorporeal small bowel examination and repair through a single umbilical incision. This technique offers a pragmatic balance between thorough exploration and minimal invasiveness. Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar through December 2023 using the terms “single-port laparoscopy”, “single-incision laparoscopic surgery”, “trauma laparoscopy”, and related phrases. Case reports, case series, comparative studies, and reviews describing single-incision laparoscopic surgery in trauma were included in this narrative analysis. Results: SPLS may offer advantages in terms of postoperative pain, wound complications, and cosmetic outcomes, especially in younger patients. As familiarity with the approach increases and dedicated instrumentation becomes more accessible, its role in trauma protocols may expand. Conclusions: Further prospective research is needed to define long-term outcomes, refine patient selection, and integrate SPLS more systematically into trauma care protocols. Full article

(This article belongs to the Section General Surgery)

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20 pages, 642 KiB

Open AccessReview

Efficacy and Safety of Transcranial Magnetic Stimulation for Treating Late-Life Depression: A Scoping Review

by Ciprian-Ionuț Băcilă, Monica Cornea, Andrei Lomnasan, Claudia Elena Anghel, Andreea Maria Grama, Cristina Elena Dobre, Silvia Rusu and Bogdan Ioan Vintilă

J. Clin. Med. 2025, 14(10), 3609; https://doi.org/10.3390/jcm14103609 - 21 May 2025

Viewed by 503

Abstract

Background/Objectives: Transcranial magnetic stimulation (TMS) is a non-invasive and well-tolerated treatment, offering an effective alternative for elderly patients with depression, especially when side effects or comorbidities limit medication. Methods: This scoping review analyzes 16 studies published over the past seven years, [...] Read more.

Background/Objectives: Transcranial magnetic stimulation (TMS) is a non-invasive and well-tolerated treatment, offering an effective alternative for elderly patients with depression, especially when side effects or comorbidities limit medication. Methods: This scoping review analyzes 16 studies published over the past seven years, to evaluate the efficacy, safety, and clinical applications of TMS in older adults with depression. Results: The review examines various TMS modalities, including repetitive TMS (rTMS), deep TMS, and theta burst stimulation (TBS), with most protocols targeting the dorsolateral prefrontal cortex (DLPFC). Adverse effects were rare, mild, and transient, supporting the treatment’s safety profile. Pharmacological co-treatment was common but not essential for clinical improvement, highlighting TMS’s potential as a standalone therapy. A subset of studies used neuroplasticity (SICI, ICF, CSP) or neuroimaging measures (MRI and MRI-based neuronavigation), revealing that age-related cortical inhibition may limit plasticity rather than depression itself. Conclusions: Overall, TMS demonstrates promising effectiveness and tolerability in managing late-life depression. Across studies, remission rates varied from 20% to 63%, with higher efficacy generally observed in bilateral stimulation or high-frequency protocols. Standardization of protocols and further research into individualized targeting and long-term outcomes are warranted to support broader clinical adoption. Full article

(This article belongs to the Special Issue Innovations in the Treatment for Depression and Anxiety)

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20 pages, 3095 KiB

Open AccessReview

Drug-Coated Balloons in All-Comer Population—Are We There Yet?

by Florin-Leontin Lazar, Horea Laurentiu Onea, Calin Homorodean, Ioan Cornel Bitea, Diana Raluca Lazar, Mihai Claudiu Ober, Dan Tataru, Maria Olinic, Mihail Spinu, Teodor Paul Kacso and Dan-Mircea Olinic

J. Clin. Med. 2025, 14(10), 3608; https://doi.org/10.3390/jcm14103608 - 21 May 2025

Viewed by 405

Abstract

With the advancement of interventional coronary procedures, drug-coated balloons have become an increasingly common alternative to drug-eluting stents in the treatment of various lesions. This paradigm shift stems from several advantages that DCBs entail, including a reduction in stent length burden, the possibility [...] Read more.

With the advancement of interventional coronary procedures, drug-coated balloons have become an increasingly common alternative to drug-eluting stents in the treatment of various lesions. This paradigm shift stems from several advantages that DCBs entail, including a reduction in stent length burden, the possibility of late vessel positive remodeling, and the preservation of bifurcation anatomy. Conversely, several studies compared the efficacy of DCB treatment to stents or POBA in various scenarios. In this review, we will discuss the areas in which a DCB can be of paramount importance. We will begin by examining the role of DCBs in in-stent restenosis, for which the current practice guidelines do not clearly state the role of this technology, as opposed to the previous ones, in which it was mentioned as a first-line armamentarium. We will then discuss the indications and advantages of using DCBs in de novo lesions, concerning both small and large vessels, with growing emphasis on diffuse lesions. Lastly, we will address the current data on the use of DCBs in special scenarios such as the treatment of chronic total occlusion and left main and bifurcation lesions, without forgetting the primordial role of drug-eluting stents in all these lesions. Full article

(This article belongs to the Section Cardiovascular Medicine)

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17 pages, 1468 KiB

Open AccessReview

Optimizing Imaging Techniques for Left Atrial Appendage Closure: Insights and Emerging Directions

by Valentina Barletta, Mattia Alberti, Riccardo Agostini, Fausto Pizzino, Giancarlo Trimarchi, Maria Grazia D’Alfonso, Marco Solari, Giulio Zucchelli and Alberto Cresti

J. Clin. Med. 2025, 14(10), 3607; https://doi.org/10.3390/jcm14103607 - 21 May 2025

Viewed by 643

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and is associated with significant morbidity and mortality, including an increased risk of stroke, heart failure, dementia, and recurrent hospitalizations. As life expectancy rises, both the incidence and prevalence of AF [...] Read more.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in adults and is associated with significant morbidity and mortality, including an increased risk of stroke, heart failure, dementia, and recurrent hospitalizations. As life expectancy rises, both the incidence and prevalence of AF continue to grow. Stroke prevention remains a cornerstone of AF management, with oral anticoagulation being the primary strategy to reduce thromboembolic risk. However, despite their advantages, direct oral anticoagulants do not completely eliminate the risk of bleeding complications. For patients in whom anticoagulation is contraindicated, poorly tolerated, or ineffective at preventing AF-related stroke, interventional alternatives have gained traction. The left atrial appendage (LAA), a primary site of thrombus formation in AF, can be occluded through a catheter-based procedure known as left atrial appendage closure (LAAC) or left atrial appendage occlusion (LAAO). This review aims to provide imaging specialists with a comprehensive understanding of their role in LAAC, underscoring the importance of a multidisciplinary approach to enhance patient selection, procedural success, and long-term efficacy. Full article

(This article belongs to the Special Issue Echocardiographic Imaging in Transcatheter Structural Intervention: Current Practices and Future Directions)

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15 pages, 1350 KiB

Open AccessArticle

Attention-Deficit/Hyperactivity Disorder Symptoms Are Common and Associated with Worse Glycemic Control in Adults with Type 1 Diabetes

by Yanli Zhang-James, Dan Draytsel, Ben Carguello, Stephen V. Faraone and Ruth S. Weinstock

J. Clin. Med. 2025, 14(10), 3606; https://doi.org/10.3390/jcm14103606 - 21 May 2025

Viewed by 505

Abstract

Objective: to assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 [...] Read more.

Objective: to assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 depression scores were obtained from the electronic medical record. Results: In total, 292 (14.1%) individuals responded and 279 consented to medical records extraction. The average age was 47.4 years (SD: ±18.9), 64.2% were women, 95.7% were non-Hispanic white, and the mean HbA1c level was 7.7% (±1.5%). Of 273 completing ASRS, 87 med ADHD criteria (ASRS positive, 31.9%), and 42 (15.4%) had an ADHD diagnosis or medication. Women had higher scores than men. ADHD symptoms decreased with age, but remained significantly higher than the general population levels. HbA1c levels were positively associated with the ASRS scores (Spearman’s r = 0.28, p < 0.0001). ASRS positive individuals had worse glycemic control (HbA1c ≥ 8.0%, adjusted OR 2.3, 95%CI: 1.3–4.1, p < 0.0001) and higher PHQ-9 scores (10 ± 7.3 vs. 6.1 ± 6, χ²₍₁₎ = 9.2, p = 0.002) than the ASRS negative group. No associations were found between ASRS scores and cardiometabolic diseases, or other laboratory or clinical measurements. Conclusions: Many adults with T1D exhibit undiagnosed ADHD symptoms, which correlate with poorer glycemic control and depression. Further research with larger samples is needed to investigate ADHD prevalence and impacts in this group. Full article

(This article belongs to the Special Issue Attention-Deficit/Hyperactivity Disorder (ADHD): Advances in Diagnosis and Treatment)

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11 pages, 1939 KiB

Open AccessCase Report

Delayed Management of Concurrent Coronal Extrusions and Root Fractures in Two Traumatized Maxillary Immature Permanent Central Incisors: A Case Study

by Thi Thuy Tien Vo and Thi Ngoc Anh Do

J. Clin. Med. 2025, 14(10), 3605; https://doi.org/10.3390/jcm14103605 - 21 May 2025

Viewed by 399

Abstract

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root [...] Read more.

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root fractures accompanied by coronal extrusions in immature maxillary permanent central incisors, underscoring the necessity for tailored approaches when guidelines for intervention were unmet. Methods: The case involves an eight-year-old boy who delayed seeking care for approximately a year after suffering trauma to his upper front teeth in a fall accident at school. The clinical examination revealed partial displacement of two maxillary central incisors in an incisal direction, resulting in increased mobility. Radiographs further showed horizontal root fractures in the apical third of both extruded incisors. Encouragingly, the injured teeth exhibited a normal response to electric pulp testing without signs or symptoms of pulpal pathology, suggesting pulp vitality and eliminating the need for root canal treatment. The extruded coronal fragments were repositioned orthodontically using a utility arch. Results: At the 14-month follow-up, the affected incisors were clinically asymptomatic, functionally satisfactory, and esthetically pleasing. Conclusions: Conservative orthodontic management of extrusive luxation concomitant with root fracture in immature permanent teeth may prove effective in select cases, particularly when long-term follow-up and proper oral care are maintained. Full article

(This article belongs to the Section Clinical Pediatrics)

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14 pages, 2476 KiB

Open AccessReview

Epigenetic Clocks and EpiScore for Preventive Medicine: Risk Stratification and Intervention Models for Age-Related Diseases

by Hidekazu Yamada

J. Clin. Med. 2025, 14(10), 3604; https://doi.org/10.3390/jcm14103604 - 21 May 2025

Viewed by 617

Abstract

Aging is the primary risk factor for chronic diseases such as cardiovascular disease, cancer, and dementia. However, chronological age alone fails to capture individual variability in aging trajectories and disease susceptibility. Recent advances in epigenetic clocks—DNA methylation-based models that estimate biological age—have opened [...] Read more.

Aging is the primary risk factor for chronic diseases such as cardiovascular disease, cancer, and dementia. However, chronological age alone fails to capture individual variability in aging trajectories and disease susceptibility. Recent advances in epigenetic clocks—DNA methylation-based models that estimate biological age—have opened new possibilities for personalized and preventive medicine. This review explores the clinical potential of epigenetic clocks and EpiScores, composite biomarkers that predict health risks and physiological status. We present a comparative evaluation of widely used epigenetic clocks, including Horvath, GrimAge, PhenoAge, and DunedinPACE, and summarize their predictive performance for mortality, cognitive decline, and cardiovascular outcomes. EpiScores linked to inflammation, glycemic control, and immunosenescence are highlighted as tools for stratified risk assessment. When integrated with multi-omics data and electronic health records, these measures enhance the precision of population health management. Special emphasis is placed on applications in longevity clinics and anti-aging clinics, community-based care, and national health checkup systems. We also explore global standardization efforts and ethical considerations, as well as Japan’s unique initiatives—including the “Aging Measurement” project at the Osaka-Kansai Expo 2025. Furthermore, we propose the development of a Global Health and Aging Index that integrates the biological, functional, and subjective dimensions of aging, aligned with the WHO concept of Intrinsic Capacity. In conclusion, epigenetic clocks and EpiScores represent transformative tools for shifting from reactive treatment to proactive health optimization, and from chronological to biological metrics in aging science and public health policy. Full article

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29 pages, 2822 KiB

Open AccessArticle

Impact of Well-Controlled Type 2 Diabetes on Corneal Endothelium Following Cataract Surgery: A Prospective Longitudinal Analysis

by Aleksandra Opala, Łukasz Kołodziejski and Iwona Grabska-Liberek

J. Clin. Med. 2025, 14(10), 3603; https://doi.org/10.3390/jcm14103603 - 21 May 2025

Viewed by 388

Abstract

Background: The aim of this study was to evaluate corneal endothelial changes following phacoemulsification cataract surgery with intraocular lens implantation in patients with type 2 diabetes (study group) and without diabetes (control group). The study aimed to determine the extent of endothelial cell [...] Read more.

Background: The aim of this study was to evaluate corneal endothelial changes following phacoemulsification cataract surgery with intraocular lens implantation in patients with type 2 diabetes (study group) and without diabetes (control group). The study aimed to determine the extent of endothelial cell damage and the regenerative capacity of the cornea in patients with well-controlled diabetes. Methods: This study compared corneal endothelial parameters in 80 eyes (80 patients) with well-controlled type 2 diabetes and 80 eyes (80 patients) without diabetes, all of whom underwent uneventful phacoemulsification cataract surgery. Patients were examined preoperatively and at 14 days, 3 months, and 6–8 months postoperatively. Endothelial cell density (ECD), percentage of hexagonal cells (%HEX), cell size variability (CV), and central corneal thickness (CCT) were assessed using a specular microscope. Visual acuity, intraocular pressure (IOP), and cumulative dissipated energy (CDE) during phacoemulsification were also measured. Results: The study and control groups were matched for age and sex. Preoperatively, patients with type 2 diabetes had significantly lower endothelial cell density (2480.76 ± 303.48 cells/mm²) compared to the control group (2629.64 ± 304.73 cells/mm², p = 0.002). Visual acuity was also significantly lower in the study group (0.44 ± 0.18) than in the control group (0.50 ± 0.19, p = 0.049). No significant preoperative differences were observed in IOP, CV, %HEX, or CCT. Postoperatively, both groups experienced ECD decline: −18.44%, −18.77%, and −19.05% in the study group and −15.12%, −16.42%, and −16.73% in the control group at 14 days, 3 months, and 6–8 months, respectively. Differences between groups were not statistically significant (p = 0.285). A significant %HEX decrease was observed in both groups at all time points, with a greater decline in the study group at 14 days and 3 months. CV significantly increased in both groups at 14 days and 3 months postoperatively, but no significant difference was found between groups. A significant increase in CCT was observed at 14 days and 3 months postoperatively, with a greater increase in the study group at 14 days. Preoperative visual acuity negatively correlated with CDE in both groups. Additionally, CDE negatively correlated with ECD at all time points. Conclusions: Endothelial cell density is lower in patients with well-controlled type 2 diabetes than in non-diabetic individuals. Both groups are at risk of endothelial cell loss during phacoemulsification. Despite good glycemic control and comparable preoperative endothelial morphology, the cornea in diabetic patients is more vulnerable to damage, with a prolonged regeneration process. The impaired regenerative capacity of the corneal endothelium suggests the need for additional precautions during cataract surgery in diabetic patients. Despite ECD decline and delayed endothelial regeneration, the functional status of the cornea, as indicated by visual acuity and CCT, remains stable. The adequate corneal endothelial cell reserve in well-controlled type 2 diabetes patients allows for cataract surgery without significant corneal complications. Full article

(This article belongs to the Special Issue New Insights into Ocular Surface, Cornea, Cataract, and Refractive Surgery)

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18 pages, 1469 KiB

Open AccessArticle

Complications Associated with Immunosuppressive Agents in Solid Organ Transplant Recipients: A Nationwide Analysis

by Ah Young Lee, Jonghyun Jeong, Kyu-Nam Heo, Soyoung Park, Young-Mi Ah, Ji Min Han, Ju-Yeun Lee and Sang Il Min

J. Clin. Med. 2025, 14(10), 3602; https://doi.org/10.3390/jcm14103602 - 21 May 2025

Viewed by 417

Abstract

Background: Immunosuppressive therapies are vital for solid organ transplant (SOT) recipients to ensure graft survival, but long-term use can lead to complications. This study aimed to comprehensively evaluate the complications associated with immunosuppressive agents across different types of major SOTs. Methods: In a [...] Read more.

Background: Immunosuppressive therapies are vital for solid organ transplant (SOT) recipients to ensure graft survival, but long-term use can lead to complications. This study aimed to comprehensively evaluate the complications associated with immunosuppressive agents across different types of major SOTs. Methods: In a retrospective cohort study using a national claims database, we analyzed adult SOT recipients who began immunosuppressive therapy from 2007 to 2018. We identified complications such as infections, acute kidney injury, hypertensive emergencies, chronic kidney disease, hypertension, diabetes, dyslipidemia, and osteoporosis. These outcomes were determined through diagnostic codes, medication usage data, and hospital or emergency department visits. Results: Among 30,997 transplants with three-year follow up, complication rates varied by transplant type. Pancreatic transplant recipients had the lowest complication rate (225.9 per 1000 patient-years), while lung transplant recipients experienced the highest rate (823.9 per 1000 patient-years). Serious infections and chronic kidney disease were most common 2 to 6 months post transplant. Other complications, like acute kidney injury, hypertensive emergencies, hypertension, diabetes, dyslipidemia, and osteoporosis, were predominantly observed in the first month. Opportunistic infections peaked between 7 months and 1 year after transplantation. Conclusions: This study emphasizes the varied complications related to immunosuppressive therapy among different SOT recipients, delineating specific timeframes for each complication and maintenance regimen. Full article

(This article belongs to the Section Immunology)

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10 pages, 483 KiB

Open AccessArticle

Evaluation of Etiologies in Evisceration as Rare Cases: A 10-Year Single-Center Experience in the East Mediterranean Region of Türkiye

by Burak Ulaş, Altan Atakan Ozcan, Burak Mete, Hakan Demirhindi, Merve Ademoğlu Gök and Hülya Binokay

J. Clin. Med. 2025, 14(10), 3601; https://doi.org/10.3390/jcm14103601 - 21 May 2025

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Abstract

Objectives: Evisceration is a rarely performed surgical procedure, and literature information regarding the characteristics of patients undergoing this surgery is limited. This study aims to evaluate the demographic features and etiological factors of patients who underwent evisceration surgery in a tertiary clinic [...] Read more.

Objectives: Evisceration is a rarely performed surgical procedure, and literature information regarding the characteristics of patients undergoing this surgery is limited. This study aims to evaluate the demographic features and etiological factors of patients who underwent evisceration surgery in a tertiary clinic over 10 years. Methods: This descriptive study comprised the data of 134 patients who underwent evisceration surgery at the Department of Ophthalmology, Faculty of Medicine, Çukurova University, Adana, Türkiye, between 2011 and 2022. Demographic data of all patients, including age, sex, surgical indication, etiology, primary disease location, pathology results, and follow-up periods, were recorded and analyzed. Results: The mean age of the 134 patients included in the study was 56.18 ± 22.71 (min: 8–max: 91), with a male-to-female ratio of 65.2% to 34.8%. Evisceration etiologies included trauma (37%), endophthalmitis (37%), absolute blind eye (12.6%), and spontaneous perforation (11.9%). Endophthalmitis cases were more common in older ages and females, trauma patients in younger ages and males, and spontaneous perforation in older ages and males. Progression to panophthalmitis was observed in 6.6% of all cases, and all were found to originate from endophthalmitis. Culture growth was positive in 18.5% of the cases, with the most commonly grown microorganisms in culture being Pseudomonas aeruginosa, Streptococcus dysgalactiae and Aspergillus fumigatus. Escherichia coli and Staphylococcus epidermidis rates were significantly higher in cases progressing to panophthalmia. Acute inflammation was more prevalent in cases of endophthalmitis and spontaneous perforation, while chronic inflammation was in cases of trauma and absolute blind eyes. Conclusions: Trauma was the main etiology of evisceration in young males and endophthalmitis in older females. Considering trauma prevention measures is important for public health in terms of eyeball saving. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 1390 KiB

Open AccessArticle

A Nationwide Epidemiological Study of Chronic Kidney Disease Prevalence in a High-Risk Patient Population Without Prior Diagnosis in Primary Health Care in Poland

by Alicja Jazienicka, Mateusz Babicki, Magdalena Krajewska, Andrzej Oko, Karolina Kłoda, Aleksander Biesiada and Agnieszka Mastalerz-Migas

J. Clin. Med. 2025, 14(10), 3600; https://doi.org/10.3390/jcm14103600 - 21 May 2025

Viewed by 444

Abstract

Background/Objectives: Chronic kidney disease (CKD) affects 10 to 15% of the world population. Currently, there are no reliable epidemiological data on the prevalence of CKD in Poland. The aim of this study was to determine the prevalence of CKD in the population of [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) affects 10 to 15% of the world population. Currently, there are no reliable epidemiological data on the prevalence of CKD in Poland. The aim of this study was to determine the prevalence of CKD in the population of high-risk primary health care patients without a prior diagnosis of CKD in the Polish population. Methods: This multicenter retrospective study examined 5100 patients from 28 medical institutions. Patients were eligible for the study if they were 60–75 years old or had a history of the risk factors such as hypertension, kidney disease other than CKD, diabetes, cardiovascular disease, or obesity. The study was carried out in two stages, each of which included a determination of serum creatinine levels along with an estimation of eGFR and a determination of albuminuria in a urine sample. Results: In total, 5100 patients were included in the final analysis. In the univariate analysis, it was found that as age and body mass index values increased, the risk of developing CKD increased; the same correlation was observed when assessing the presence of hypertension, diabetes, or heart failure. In the multivariate analysis, the negative effects of hypertension, age 60–75 years, diabetes, heart failure, cardiovascular diseases, and kidney disease other than CKD on the development of CKD were confirmed. Conclusions: The results indicate that CKD is a significant social problem among the Polish population with risk factors. Full article

(This article belongs to the Section Nephrology & Urology)

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17 pages, 1263 KiB

Open AccessArticle

Clinical Manifestations of Temporomandibular Disorders and Their Relationship with Sleep Disturbances and Emotional Disorders in a Spanish Pediatric Population: A Cross-Sectional Study

by Fanny Esther Tapia-Sierra, Jesús Miguel Ticona-Flores, Guillermo Reichard-Monefeldt, Naomi Elvira-Tapia, Nuria Esther Gallardo-López and Montserrat Diéguez-Pérez

J. Clin. Med. 2025, 14(10), 3599; https://doi.org/10.3390/jcm14103599 - 21 May 2025

Viewed by 361

Abstract

The etiology of temporomandibular disorders (TMDs) has been linked to various factors, including functional and psychological factors, which makes it difficult to identify associations between a single etiological factor and the signs and symptoms of TMDs. Objectives: This study aimed to describe [...] Read more.

The etiology of temporomandibular disorders (TMDs) has been linked to various factors, including functional and psychological factors, which makes it difficult to identify associations between a single etiological factor and the signs and symptoms of TMDs. Objectives: This study aimed to describe the presence of TMD symptoms and their relationship with sleep disturbances and emotional disorders in children and adolescents. Methods: This observational study included Spanish children aged between 8 and 13 years. The measurement instruments consisted of the BRUNI survey for sleep disorders and the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD) survey. A clinical examination was subsequently performed following the DC/TMD guidelines for diagnosing TMDs. Frequencies, means, and standard deviations were applied, along with the prevalence ratio as a measure of association and the chi-square test. The significance level was set at 5%. Results: A total of 128 participants participated in the study with a mean age of 10.89 (±2.15) years. The prevalence of TMDs was 54%, while the most common symptoms were muscle pain at 26%, joint pain at 14%, and a combination of both at 14%. Children who presented muscle pain had a mean anxiety score of 44.87 (±11.85), whereas those without symptoms had a mean score of 36 (±10.78, and 0.03 p-value). The BRUNI index revealed that 78.13% of patients with TMDs had difficulty initiating and maintaining sleep, with a prevalence ratio (PR) of 3.57 (p-value 0.041). Conclusions: The present study reveals that temporomandibular disorders are common in children and adolescents, with 54% presenting at least one clinical sign or symptom. Emotional disturbances and sleep problems were also prevalent, affecting 41% and 56% of participants, respectively. Early interdisciplinary screening is essential to manage the co-occurrence of TMDs, emotional distress, and sleep problems in children. Full article

(This article belongs to the Special Issue Bruxism and Temporomandibular Disorders: Current Advances and Future Challenges)

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15 pages, 1486 KiB

Open AccessSystematic Review

Mineralocorticoid Receptor Antagonists in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

by Mithila Zaheen, Fardin Ferdous, Anjalee T. Amarasekera, Johannes Petutschnigg, Frank Edelmann and Timothy C. Tan

J. Clin. Med. 2025, 14(10), 3598; https://doi.org/10.3390/jcm14103598 - 21 May 2025

Viewed by 403

Abstract

Background/Objectives: Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome with limited therapeutic options. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF), but their use in [...] Read more.

Background/Objectives: Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome with limited therapeutic options. Mineralocorticoid receptor antagonists (MRAs) have been shown to improve clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF), but their use in patients with HFpEF remains controversial. The aim of this review is to evaluate whether the use of MRAs improves diastolic function, functional capacity, and quality of life in patients with HFpEF. Methods: A systematic literature search of scientific databases was performed to identify studies comparing the use of MRAs to placebo or no treatment in adult patients with HFpEF (2000–2024; English; PROSPERO registration CRD42022300783). Data were meta-analysed using a random-effects model for overall effect size measured as the standardised mean difference. Results: Pooled data revealed a significant benefit of MRA use compared to the control in decreasing E/e’ (SMD −0.21; 95% CI: −0.33 to −0.10, p = 0.00), with greater improvement seen with longer duration of treatment. A substantial reduction in systolic blood pressure (SMD −0.27; 95% CI: −0.53 to −0.02, p = 0.03) and diastolic blood pressure (SMD −0.18; 95% CI: −0.32 to −0.04, p = 0.01) was also noted. There was no significant difference in the 6 min walk distance, peak exercise capacity, or quality-of-life measures. Adverse events such as hyperkalaemia and worsening renal function were frequently reported in the MRA group. Conclusions: MRAs improve echocardiographic parameters of diastolic function and BP control; however, this did not translate into clinical outcomes of improved functional capacity or quality of life. Full article

(This article belongs to the Section Cardiology)

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11 pages, 626 KiB

Open AccessArticle

Incidence and Risk Factors for Incisional Hernia Following Ileostomy Takedown: A Retrospective Cohort Study

by Tamás Talpai, Flaviu-Ionuţ Faur, Cătălin-Alexandru Pîrvu, Daniela Marinescu, Cristi Tarta, Dragos Nicolae Margaritescu, Stelian Pantea, Cristian Nica, Rãzvan-Sorin Albu, Tudor-Alexandru Popoiu, Razvan Lazea, Larisa Balanoiu and Valeriu Șurlin

J. Clin. Med. 2025, 14(10), 3597; https://doi.org/10.3390/jcm14103597 - 21 May 2025

Viewed by 1546

Abstract

Background: Incisional hernias are a frequent complication following ileostomy closure, with rates reaching 24%. Protective ileostomies are commonly performed in colorectal surgery, but their closure presents a significant risk for abdominal wall defects. Identifying risk factors for incisional hernias at the ileostomy [...] Read more.

Background: Incisional hernias are a frequent complication following ileostomy closure, with rates reaching 24%. Protective ileostomies are commonly performed in colorectal surgery, but their closure presents a significant risk for abdominal wall defects. Identifying risk factors for incisional hernias at the ileostomy site is crucial for improving patient outcomes. Methods: This retrospective study analyzed data from 95 patients who underwent loop ileostomy closure at two Romanian hospitals between 2018 and 2023. Patient demographics, surgical details, and follow-up data were reviewed. Incisional hernias were diagnosed through clinical examination or radiological imaging. Statistical analyses, including univariate and multivariate regression, were performed to identify independent risk factors. Results: The incidence of incisional hernias at the ileostomy site was 13.7% (13/95). Univariate analysis identified BMI (HR 30.08; p = 0.007), previous hernia (HR 7.99; p = 0.059), radiotherapy (HR 299.15; p = 0.029), and chemotherapy (HR 0.004; p = 0.026) as significant factors. Multivariate analysis confirmed BMI > 30 kg/m² (HR 12.27; p = 0.002) and prior hernia (HR 8.14; p = 0.007) as independent risk factors. Conclusions: Obesity and previous hernias significantly increase the risk of incisional hernias following ileostomy closure. Radiological follow-up enhances early detection, and further studies should explore the benefits of prophylactic mesh reinforcement. Optimizing patient selection and surgical technique may reduce postoperative hernia rates, improving long-term outcomes. Full article

(This article belongs to the Special Issue Hernia Surgery and Postoperative Management)

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11 pages, 789 KiB

Open AccessArticle

Diagnostic Significance in Estimating Tumor Burden Using Extracellular Salivary Biomarkers in Gastric Cancer Patients

by Sung Eun Oh, Jong Bae Seo, Jeongeun Noh, Sung Kim, Yong Kim and Ji Yeong An

J. Clin. Med. 2025, 14(10), 3596; https://doi.org/10.3390/jcm14103596 - 21 May 2025

Viewed by 303

Abstract

Background: We investigated the possibility of predicting tumor burden with salivary extracellular RNA (exRNA) biomarkers in gastric cancer patients. Methods: Saliva samples were prospectively collected from 50 gastric cancer patients who underwent gastrectomy with curative intent. Approximately 5 mL of saliva was collected [...] Read more.

Background: We investigated the possibility of predicting tumor burden with salivary extracellular RNA (exRNA) biomarkers in gastric cancer patients. Methods: Saliva samples were prospectively collected from 50 gastric cancer patients who underwent gastrectomy with curative intent. Approximately 5 mL of saliva was collected before surgery and on the 5th to 7th days after surgery. The expression of three mRNAs (SPINK7, PPL, and SEMA4B) and two miRNAs (miR140-5p and miR301a) that were previously validated was determined by reverse transcription quantitative real-time PCR. Results: There were significant differences in the pre-operative expression of PPL (p = 0.025), SEMA4B (p = 0.012), and miR140-5p (p = 0.036) between pathologic stage I/II and III/IV groups. The area under the curve (AUC) of each respective multivariable model in predicting stage III/IV, which was adjusted for age and sex, was 75.4% (PPL), 82.5% (SEMA4B), and 75.5% (miR140-5p). In the multivariable model, including all three biomarkers, the AUC was 89.2%. On the other hand, none of the conventional tumor markers (CEA, CA19-9, and CA72-4) could predict tumor burden before surgery. The AUC of the multivariable model, including CEA, CA19-9, and CA72-4, was 67.2%, 66.2%, and 67.4%, respectively. When all three tumor markers were included in the multivariable model, the AUC was 70.5%. Conclusions: Noninvasively detected salivary biomarkers have been shown to have higher diagnostic accuracy than conventional tumor markers detected by invasive blood tests for estimating pre-operative tumor burden. This study demonstrates the potential utility of these biomarkers in pre-operative risk assessment and monitoring surgical treatment response to gastric cancer. Full article

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

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13 pages, 503 KiB

Open AccessSystematic Review

Consensus-Based Recommendations for Assessing Post-Intensive Care Syndrome: A Systematic Review

by Helmar Bornemann-Cimenti, Johanna Lang, Sascha Hammer, Kordula Lang-Illievich, Sebastian Labenbacher, Stefan Neuwersch-Sommeregger and Christoph Klivinyi

J. Clin. Med. 2025, 14(10), 3595; https://doi.org/10.3390/jcm14103595 - 21 May 2025

Viewed by 432

Abstract

Background: Post-intensive care syndrome encompasses physical, cognitive, and psychological impairments that persist in patients after discharge from an intensive care unit. There is considerable variation in the tools used for assessment. This systematic review aimed to summarize the consensus-based recommendations for assessing post-intensive [...] Read more.

Background: Post-intensive care syndrome encompasses physical, cognitive, and psychological impairments that persist in patients after discharge from an intensive care unit. There is considerable variation in the tools used for assessment. This systematic review aimed to summarize the consensus-based recommendations for assessing post-intensive care syndrome. Methods: A comprehensive literature search identified four consensus-based guidelines. A quality assessment carried out using the Appraisal of Guidelines for Research and Evaluation II tool demonstrated high methodological standards across all the included papers. Results: The guidelines consistently emphasize assessing cognition, mental health, and physical function as the core domains. However, there are notable differences in the specific tools recommended. Major et al. focused on physical examinations, while Mikkelsen et al. proposed a fundamental package of five tools covering the key domains. Spies et al. aimed for a pragmatic set of freely available instruments administrable within 30 min. Nakanishi et al. provided a detailed ranking of instruments for each domain. The availability of validated translations varied considerably across languages. Some tools developed specifically for post-intensive care syndrome were not considered by any consensus conference. Conclusions: Further work is needed to establish a universally accepted standard for assessing post-intensive care syndrome that considers practical implementation across diverse settings and languages. Full article

(This article belongs to the Special Issue Clinical Advances in Critical Care Medicine)

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16 pages, 400 KiB

Open AccessReview

Limus Devices for the Treatment of SFA: Latest Outcomes and Future Perspectives

by Genti Xhepa, Agostino Inzerillo, Ilinca Constantinescu, Pierre Faerber, Adrien Gleyzolle, Pierpaolo Biondetti, Filippo Del Grande, Edon Xhepa, Simone Mortellaro, Gianpaolo Carrafiello, Giuseppe Pellegrino and Alexis Ricoeur

J. Clin. Med. 2025, 14(10), 3594; https://doi.org/10.3390/jcm14103594 - 21 May 2025

Viewed by 379

Abstract

Globally, cardiovascular disease is a leading cause of disability and early death, affecting 422.7 million people and causing 17.9 million deaths (31% of global deaths) in 2015. Peripheral arterial disease, previously overlooked compared to coronary artery disease, is now recognised as a major [...] Read more.

Globally, cardiovascular disease is a leading cause of disability and early death, affecting 422.7 million people and causing 17.9 million deaths (31% of global deaths) in 2015. Peripheral arterial disease, previously overlooked compared to coronary artery disease, is now recognised as a major contributor to cardiovascular morbidity and mortality, with distinct characteristics. After noninvasive methods, the femoropopliteal segment is frequently treated with revascularisation, which is recommended for claudication and chronic limb-threatening ischemia (CLTI). Challenges such as mechanical stresses, chronic occlusions, extensive plaque, and calcification affect procedural success and vessel patency. Innovations were needed to address these issues, and vascular drug delivery devices have become integral to endovascular treatment. We review the current literature concerning a diverse range of these devices in clinical use and their role in managing symptomatic patients. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 660 KiB

Open AccessArticle

Retrospective Study on the Efficacy of Platelet-Rich Plasma Treatment in the Recovery of Quadriceps Muscle Strength After Anterior Cruciate Ligament Reconstruction in Non-Professional Athletes

by Roxana Mihaela Munteanu, Bogdan Voicu, Diana Șandru, Arpad Solyom, Pia Simona Făgăraș and Tudor Sorin Pop

J. Clin. Med. 2025, 14(10), 3593; https://doi.org/10.3390/jcm14103593 - 21 May 2025

Viewed by 360

Abstract

Background/Objectives: This retrospective study aimed to evaluate whether PRP infiltrations improve quadriceps muscle strength recovery following anterior cruciate ligament reconstruction (ACLR), while minimizing the recovery time required to resume daily activities and sports. Numerous studies have explored the use of platelet-rich plasma [...] Read more.

Background/Objectives: This retrospective study aimed to evaluate whether PRP infiltrations improve quadriceps muscle strength recovery following anterior cruciate ligament reconstruction (ACLR), while minimizing the recovery time required to resume daily activities and sports. Numerous studies have explored the use of platelet-rich plasma (PRP) in treating ACL injuries. PRP therapy has demonstrated high efficacy in accelerating ligament healing in animal models. However, clinical trials involving human participants have reported inconsistent results regarding the effects of PRP on ACL reconstruction outcomes. Methods: Between 2020 and 2024, a total of 68 subjects who underwent ACLR were included in the study. Participants were divided into two groups, namely a treatment group that followed a standard rehabilitation protocol and received PRP infiltrations, and a control group that followed the same protocol without PRP treatment. Muscle strength was assessed using the isometric max strength balance (IMSB) test and the concentric max strength balance (CMSB) test, both performed using the Kineo Intelligent Load device (Globus Kineo 7000, Italian Excellence, Rome, Italy). Results: The results of IMSB test showed a significant difference between treatment groups according to a two-way ANOVA test (F(1, 198) = 7.345; p = 0.0073). The PRP-treated group showed significantly higher quadriceps muscle strength at 6 months (34.9 ± 9.6 vs. 30.0 ± 8.2 kg). The CMSB test also showed a significant difference at 6 months (F(1, 198) = 5.976; p = 0.00154), with the PRP-treated group having significantly higher concentric muscle strength (35.5 ± 9.5 vs. 30.7 ± 8.5 kg). Conclusions: These findings suggest that post-ligamentoplasty PRP infiltrations may have beneficial effects on muscle strength recovery. However, further prospective studies with larger sample sizes are necessary to confirm these results. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL): Innovations in Clinical Management)

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25 pages, 818 KiB

Open AccessFeature PaperArticle

Mental Health and Metabolic Outcomes in Early Postpartum in Women with Prediabetes After Gestational Diabetes: A Secondary Analysis of the MELINDA Trial

by Yana Vanlaer, Caro Minschart, Karolijn Van den Keybus, Nele Myngheer, Toon Maes, Christophe De Block, Niels Bochanen, Inge Van Pottelbergh, Pascale Abrams, Wouter Vinck, Liesbeth Leuridan, Sabien Driessens, Jaak Billen, Christophe Matthys, Annick Bogaerts, Annouschka Laenen, Chantal Mathieu and Katrien Benhalima

J. Clin. Med. 2025, 14(10), 3592; https://doi.org/10.3390/jcm14103592 - 21 May 2025

Viewed by 359

Abstract

Aims: To examine the association between depressive symptoms and metabolic profile in women with prior gestational diabetes mellitus (GDM) and early postpartum prediabetes, and to explore whether a mobile-based lifestyle intervention affected mental health outcomes. Methods: Secondary, exploratory analysis of a multi-centric randomized [...] Read more.

Aims: To examine the association between depressive symptoms and metabolic profile in women with prior gestational diabetes mellitus (GDM) and early postpartum prediabetes, and to explore whether a mobile-based lifestyle intervention affected mental health outcomes. Methods: Secondary, exploratory analysis of a multi-centric randomized controlled trial (MELINDA), evaluating a mobile-based lifestyle intervention versus standard follow-up (control group) in women with prediabetes after GDM. The analysis included 166 participants who completed the Center for Epidemiologic Studies–Depression (CES-D) questionnaire [score of ≥16 being suggestive for (sub)clinical depression] at baseline (6–16 weeks postpartum) and one year post-randomization. Results: At one year, 26.5% of women (n = 44) reported depressive symptoms, with no significant difference between the intervention and control groups (30.5% vs. 22.6%, p = 0.293). Women with depressive symptoms (symptomatic women) were younger (30.9 ± 4.9 vs. 32.5 ± 3.8 years, p = 0.033) and were less often highly educated (61.4% vs. 80.3%, p = 0.028). At baseline, symptomatic women had a higher rate of metabolic syndrome (38.6% vs. 21.9%, p = 0.044), higher LDL-cholesterol [3.2 ± 0.8 vs. 2.8 ± 0.8 mmol/L, p = 0.009], lower quality of life (lower SF-36 scores, p < 0.050) and a higher level of anxiety based on the STAI-6 questionnaire (14.5 ± 3.6 vs. 11.2 ± 2.6, p < 0.001). These differences persisted at one year postpartum with worse metabolic profile, more anxiety and lower quality of life in symptomatic women. Conclusions: Depressive symptoms are common in women with prediabetes in early postpartum after GDM and are associated with a persistent worse metabolic profile, increased anxiety and lower quality of life postpartum. The mobile-based lifestyle intervention did not improve mental health. Full article

(This article belongs to the Special Issue Gestational Diabetes: Cutting-Edge Research and Clinical Practice)

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10 pages, 462 KiB

Open AccessArticle

Accuracy of Red Blood Cell Parameters in Predicting α⁰-Thalassemia Trait Among Non-Anemic Males

by Benchaya Phanthong, Pimlak Charoenkwan, Threebhorn Kamlungkuea, Suchaya Luewan and Threea Tongsong

J. Clin. Med. 2025, 14(10), 3591; https://doi.org/10.3390/jcm14103591 - 21 May 2025

Viewed by 342

Abstract

Background/Objectives: Red blood cell (RBC) parameters are routinely used to screen for α- and β-thalassemia traits as part of prenatal diagnosis for severe fetal thalassemia in countries with a high prevalence of the disease. In clinical practice, the same cut-off values for [...] Read more.

Background/Objectives: Red blood cell (RBC) parameters are routinely used to screen for α- and β-thalassemia traits as part of prenatal diagnosis for severe fetal thalassemia in countries with a high prevalence of the disease. In clinical practice, the same cut-off values for these parameters are applied to both females and males. However, given that the normal reference ranges for some RBC parameters differ significantly between sexes, sex-specific cut-off values may be more appropriate, especially in combination. To date, the effectiveness of RBC indices in males for predicting α- and β-thalassemia traits has not been evaluated. The objectives of this study are to assess the diagnostic performance of individual and combined RBC parameters in detecting α⁰-thalassemia traits among non-anemic males. Methods: This diagnostic study is a secondary analysis of prospectively collected data from our project on prenatal control of severe thalassemia. The study population comprised male partners of pregnant women who underwent thalassemia screening during their first antenatal visit. RBC parameters, including hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and RBC count, were measured for each participant. Carrier status for the α0-thalassemia Southeast Asian (SEA) genotype was confirmed by using a polymerase chain reaction (PCR)-based method. The diagnostic performance of each RBC parameter and their combinations, based on predictive models generated using logistic regression, was evaluated and compared using receiver operating characteristic (ROC) curves. Results: A total of 486 Thai males were recruited for the study, including 137 individuals with the α⁰-thalassemia trait and 349 with a normal α-thalassemia genotype (control group). All RBC parameters, except for Hct, differed significantly between the two groups. Among the individual indices, MCH exhibited the highest diagnostic accuracy, followed by MCV, with areas under the curve (AUCs) of 0.981 and 0.973, respectively. An MCH cut-off value of 26 pg and an MCV cut-off value of 80 fL provided a sensitivity of 100% for both indices, with specificities of 88.5% and 86.8%, respectively. The combination predictive model provided the best diagnostic performance, achieving an AUC of 0.987, which was slightly but significantly higher than that of any individual parameter. This model yielded a sensitivity of 100% and a significantly higher specificity of 90.8% at a cut-off probability of 7.0%. Conclusions: MCH and MCV demonstrated excellent screening performance for identifying α0-thalassemia carriers in males. However, the combination model exhibited even greater accuracy while reducing the false-positive rate. Implementing this model could minimize the need for unnecessary PCR testing, leading to substantial cost savings. Full article

(This article belongs to the Special Issue Clinical Trends and Prospects in Laboratory Hematology)

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12 pages, 494 KiB

Open AccessFeature PaperArticle

Virtual Reality as an Adjuvant Treatment for Acute Pain During an Interventional Process with Capsaicin: A Feasibility Study

by Anna Server, Maria Sonsoles Cepeda Diez, Carlos Suso-Ribera, Sara Guila Fidel Kinori, Diana Castilla, Francisco Javier Medel and Azucena García-Palacios

J. Clin. Med. 2025, 14(10), 3590; https://doi.org/10.3390/jcm14103590 - 21 May 2025

Viewed by 508

Abstract

Background/Objectives: This feasibility study explores the use of virtual reality (VR) as an adjunct therapy during capsaicin administration for individuals with chronic neuropathic pain. Chronic neuropathic pain poses significant management challenges due to its complex biopsychosocial nature. This study aimed to assess [...] Read more.

Background/Objectives: This feasibility study explores the use of virtual reality (VR) as an adjunct therapy during capsaicin administration for individuals with chronic neuropathic pain. Chronic neuropathic pain poses significant management challenges due to its complex biopsychosocial nature. This study aimed to assess the acceptability, usability, and preliminary effectiveness of VR in reducing pain, anxiety, aversiveness, and rumination during painful procedures. Methods: A total of 24 patients participated in the study and received either capsaicin treatment with VR (n = 12) or treatment as usual (n = 12). The VR group engaged with “SnowWorld”, an immersive, interactive environment designed to promote distraction and relaxation. Outcomes including pain (average and worst), aversiveness, rumination, and anxiety, were assessed via 11-point scales. Results: Participants in the VR condition reported significantly lower scores for worst pain (2.83 vs. 6.33), average pain (2.08 vs. 5.42), aversiveness (1.50 vs. 6.08), rumination (1.17 vs. 5.75), and anxiety (0.83 vs. 5.17) compared to the controls (all p < 0.001). Participants reported high satisfaction regarding the VR experience, noting its immersive nature and ease of use. The qualitative feedback highlighted the VR’s ability to foster relaxation and distraction during capsaicin administration. Conclusions: These findings support the feasibility and preliminary efficacy of VR as an adjunctive tool for acute pain management during capsaicin treatment. Further studies with larger samples are warranted to confirm these effects and explore long-term outcomes. Full article

(This article belongs to the Section Anesthesiology)

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11 pages, 1248 KiB

Open AccessArticle

Pulmonary Function and Nocturnal Hypoxemia Patterns in Patients with Obstructive Sleep Apnea

by Claudia Lucia Toma, Filip Radu, Dragos-Cosmin Zaharia, Ionela Belaconi and Stefan Dumitrache-Rujinski

J. Clin. Med. 2025, 14(10), 3589; https://doi.org/10.3390/jcm14103589 - 21 May 2025

Viewed by 318

Abstract

Background/Objective: Obesity is a documented risk factor for impaired pulmonary function and abnormal oxyhaemoglobin levels during sleep. This functional impairment becomes more significant when there are additional respiratory pathologies, such as obstructive sleep apnea (OSA) and/or chronic obstructive pulmonary disease (COPD). Overnight pulse [...] Read more.

Background/Objective: Obesity is a documented risk factor for impaired pulmonary function and abnormal oxyhaemoglobin levels during sleep. This functional impairment becomes more significant when there are additional respiratory pathologies, such as obstructive sleep apnea (OSA) and/or chronic obstructive pulmonary disease (COPD). Overnight pulse oximetry may offer an effective evaluation of nocturnal oxyhaemoglobin levels/waveform patterns. We evaluated the correlation between obesity, overnight pulse oximetry (parameters, waveform patterns) and pulmonary function in patients diagnosed with moderate–severe OSA and normal oxyhaemoglobin saturation levels during waking hours. We also compared the overnight oxyhaemoglobin saturation levels between patients with OSA alone and those with associated COPD. Methods: This was a retrospective, transversal, non-interventional study on consecutive patients with moderate–severe OSA diagnosed using overnight cardiorespiratory polygraphy over a period of 18 months. After analyzing the study population’s characteristics, the patients were divided into two subgroups: one consisting of patients with OSA alone (Group A), and the second with coexisting OSA and COPD (Group B). Results: Seventy-six patients were included in the study, and 18% were diagnosed with COPD. A higher body mass index (BMI) correlated with a higher number of ≥3% SpO₂ drops/h (ODI3) and percentage of time with oxyhaemoglobin saturation < 90% (t90) and a lower average nocturnal oxyhaemoglobin saturation (avgSpO₂). ODI3 correlated negatively with avgSpO₂ and positively with t90. After eliminating BMI as a confounding factor, lower values of forced expiratory volume in the first second (FEV1) were associated with lower avgSpO₂ and higher t90. FEV1 did not corelate with ODI3. After dividing the study population into the two subgroups, patients from Group B had a tendency towards lower average nocturnal SpO₂ levels compared to Group A. Conclusions: Different phenotypes/patterns of nocturnal hypoxemia can be identified using quantitative and qualitative analyses of overnight pulse oximetry: repetitive, consecutive obstructive respiratory events with a characteristic intermittent (saw-tooth) hypoxemia pattern and alveolar hypoventilation, resulting in a continuous (plateau) hypoxemia pattern. According to our findings, nocturnal hypoxemia is more important at lower FEV1 values (correlating with lower avgSpO₂/higher t90, but not with ODI3). The presence of a continuous hypoxemia pattern in patients with OSA may suggest that pulmonary function tests should be performed in order to differentiate patients with alveolar hypoventilation secondary to obesity (restrictive syndrome) from those with associated COPD (obstructive syndrome). This can have an impact on the management of the case and the therapeutic approach (positive pressure therapy with/without supplemental oxygen). Full article

(This article belongs to the Section Respiratory Medicine)

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22 pages, 830 KiB

Open AccessSystematic Review

Cluster Analysis in Diabetes Research: A Systematic Review Enhanced by a Cross-Sectional Study

by Binura Taurbekova, Radmir Sarsenov, Muhammad M. Yaqoob, Kuralay Atageldiyeva, Yuliya Semenova, Siamac Fazli, Andrey Starodubov, Akmaral Angalieva and Antonio Sarria-Santamera

J. Clin. Med. 2025, 14(10), 3588; https://doi.org/10.3390/jcm14103588 - 21 May 2025

Viewed by 559

Abstract

Background: Diabetes mellitus is a heterogeneous metabolic disorder that poses substantial challenges in the management of patients with diabetes. Emerging research underscores the potential of unsupervised cluster analysis as a promising methodological approach for unraveling the complex heterogeneity of diabetes mellitus. This systematic [...] Read more.

Background: Diabetes mellitus is a heterogeneous metabolic disorder that poses substantial challenges in the management of patients with diabetes. Emerging research underscores the potential of unsupervised cluster analysis as a promising methodological approach for unraveling the complex heterogeneity of diabetes mellitus. This systematic review evaluated the effectiveness of unsupervised cluster analysis in identifying diabetes phenotypes, elucidating the risks of diabetes-related complications, and distinguishing treatment responses. Methods: We searched MEDLINE Complete, PubMed, and Web of Science and reviewed forty-one relevant studies. Additionally, we conducted a cross-sectional study using K-means cluster analysis of real-world clinical data from 558 patients with diabetes. Results: A key finding was the consistent reproducibility of the five clusters across diverse populations, encompassing various patient origins and ethnic backgrounds. MOD and MARD were the most prevalent clusters, while SAID was the least prevalent. Subgroup analysis stratified by ethnic group indicated a higher prevalence of SIDD among individuals of Asian descent than among other ethnic groups. These clusters shared similar phenotypic traits and risk profiles for complications, with some variations in their distribution and key clinical variables. Notably, the SIRD subtype was associated with a wide spectrum of kidney-related clinical presentations. Alternative clustering techniques may reveal additional clinically relevant diabetes subtypes. Our cross-sectional study identified five subgroups, each with distinct profiles of glycemic control, lipid metabolism, blood pressure, and renal function. Conclusions: Overall, the results suggest that unsupervised cluster analysis holds promise for revealing clinically meaningful subgroups with distinct characteristics, complication risks, and treatment responses that may remain undetected using conventional approaches. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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10 pages, 197 KiB

Open AccessArticle

Post-Esophagectomy Dumping Syndrome: Assessing Quality of Life of Long-Term Survivors

by Dionysios Dellaportas, Ioannis Margaris, Eleftherios Tsalavoutas, Zoi Gkiafi, Anastasia Pikouli, Despoina Myoteri, Nikolaos Pararas, Panagis M Lykoudis, Constantinos Nastos and Emmanuel Pikoulis

J. Clin. Med. 2025, 14(10), 3587; https://doi.org/10.3390/jcm14103587 - 21 May 2025

Viewed by 353

Abstract

Background/Objectives: Survival rates for esophageal cancer patients have markedly improved. Inevitably, attention has been drawn to functional and quality-of-life problems. The aim of the current study was to investigate the prevalence of dumping syndrome in patients following esophageal resection and its correlation with [...] Read more.

Background/Objectives: Survival rates for esophageal cancer patients have markedly improved. Inevitably, attention has been drawn to functional and quality-of-life problems. The aim of the current study was to investigate the prevalence of dumping syndrome in patients following esophageal resection and its correlation with postoperative quality of life. Methods: This cross-sectional study involved disease-free patients who underwent a potentially curative resection for esophageal or gastroesophageal junction carcinoma between January 2019 and January 2024 in a single academic institution. Patients were asked to fill in two questionnaires: the Dumping Syndrome Rating Scale (DSRS) and the QLQ-OG25. A Composite Dumping Syndrome Index (CDSI) was calculated by adding the summary severity and frequency scores for each patient. Results: During the study period, 42 patients underwent esophagectomy for malignant esophageal or junctional tumors. In total, 14 eligible patients responded to the questionnaires at a mean time of 19.7 (±20.8) months following their operation. Three patients (21%) reported having at least quite severe problems related to at least two dumping symptoms. Six patients (43%) reported that they avoid certain foods in order to alleviate related problems. A high CDSI score was associated with significantly increased OG25 scores for dysphagia, eating restriction, odynophagia, pain and discomfort, and reflux (p < 0.05). Conclusions: Early dumping syndrome can occur in a significant proportion of patients following esophagectomy and may adversely affect quality of life. Full article

(This article belongs to the Special Issue Gastroesophageal Cancer: Advances in Clinical Diagnosis and Management)

14 pages, 1909 KiB

Open AccessOpinion

Open Mouth Posture Syndrome (OMPS): Classification

by Can-Florian Keleş, David Morais, Anand Marya, Omar Fawzi Chawshli, Adith Venugopal and Ute Ulrike Botzenhart

J. Clin. Med. 2025, 14(10), 3586; https://doi.org/10.3390/jcm14103586 - 21 May 2025

Viewed by 779

Abstract

Objectives: This narrative review aims to redefine Open Mouth Posture Syndrome (OMPS) as a multifactorial condition with overlapping symptoms and a cyclical pathophysiology. A novel classification system for OMPS subtypes is proposed to standardize research approaches and enhance clinical understanding. Methods: [...] Read more.

Objectives: This narrative review aims to redefine Open Mouth Posture Syndrome (OMPS) as a multifactorial condition with overlapping symptoms and a cyclical pathophysiology. A novel classification system for OMPS subtypes is proposed to standardize research approaches and enhance clinical understanding. Methods: An interdisciplinary literature review was conducted, focusing on structural, functional, and adaptive mechanisms underlying OMPS. Subtype definitions were refined based on recent findings. Results: OMPS is categorized into five subtypes: Obstructive, Habitual, Anatomical, Sleep-Disordered Breathing, and Tongue-Related Pathologies. These subtypes share interconnected etiologies and manifestations, contributing to a feedback loop that complicates diagnosis and management. Conclusions: This classification system lays the foundation for future research and clinical protocols, emphasizing the need for a systematic approach to understanding OMPS. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Recent Advances and Future Directions)

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J. Clin. Med., Volume 14, Issue 10 (May-2 2025) – 351 articles

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