Journal of Clinical Medicine

14 pages, 1662 KiB

Open AccessArticle

Morphometry of Intracranial Carotid Artery Calcifications in Patients with Recent Cerebral Ischemia

by Bernhard P. Berghout, Federica Fontana, Fennika Huijben, Suze-Anne Korteland, M. Eline Kooi, Paul J. Nederkoorn, Pim A. de Jong, Frank J. Gijsen, Selene Pirola, M. Kamran Ikram, Daniel Bos and Ali C. Akyildiz

J. Clin. Med. 2025, 14(10), 3274; https://doi.org/10.3390/jcm14103274 (registering DOI) - 8 May 2025

Abstract

Background: Intracranial artery calcification detected on CT imaging is a recognized risk factor for ischemic cerebrovascular diseases, but the underlying etiology of this association remains unclear. Differences in objective morphometric characteristics of these calcifications may partially explain this association, yet these measurements [...] Read more.

Background: Intracranial artery calcification detected on CT imaging is a recognized risk factor for ischemic cerebrovascular diseases, but the underlying etiology of this association remains unclear. Differences in objective morphometric characteristics of these calcifications may partially explain this association, yet these measurements are largely absent in the literature. We investigated intracranial artery calcification morphometry in patients with recent anterior ischemic stroke or TIA, assessing potential differences between calcifications in both intracranial carotid arteries (ICAs) located ipsilateral and contralateral to the cerebral ischemia. Methods: Among 100 patients (mean age 69.6 (SD 8.8) years) presenting to academic neurology departments, 3D reconstructions of both ICAs were based on clinical CT-angiography images. On these reconstructions, a luminal centerline and cross-sections perpendicular to this centerline were created, facilitating the assessment of calcification morphometry, spatial orientation and stenosis severity. Differences in calcification characteristics between ICAs were assessed using two-sided Wilcoxon signed-rank and χ² tests. Results: Among 200 arteries, a median of four (IQR 2–6) individual calcifications were counted, with a mean area of 1.8 (IQR 1.2–2.7) mm², a mean arc width of 43.5 (IQR 32.3–53.2) degrees, and median longitudinal extent of 15.4 (IQR 5.9–27.0) mm. Calcifications were most often present in the anatomical C4 section (56.0%), with predominantly posterosuperior orientation (38.5%) and 42.0% had a local stenosis severity > 70%. None of these aspects significantly differed between ICAs, and this remained after restricting analyses to patients with undetermined etiology. Conclusions: We found no differences in morphometrical or spatial aspects of calcifications between ICAs ipsilateral and contralateral to the cerebral ischemia. Full article

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

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16 pages, 2962 KiB

Open AccessReview

Emerging Therapies for Palmoplantar Pustulosis with a Focus on IL-23 Inhibitors

by Kyung-Hwa Nam and Yoon-Seob Kim

J. Clin. Med. 2025, 14(10), 3273; https://doi.org/10.3390/jcm14103273 (registering DOI) - 8 May 2025

Abstract

Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by recurrent pustules, erythema, and scaling on the palms and soles, leading to a significantly reduced quality of life. Although PPP shares some immunopathological features with psoriasis vulgaris, it is distinguished by unique [...] Read more.

Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease characterized by recurrent pustules, erythema, and scaling on the palms and soles, leading to a significantly reduced quality of life. Although PPP shares some immunopathological features with psoriasis vulgaris, it is distinguished by unique genetic predispositions, including a higher prevalence in East Asian populations, and a complex immune profile, particularly dysregulation of the IL-23/Th17 axis and IL-36 cytokines. Recent advances in psoriasis treatment have highlighted IL-23 inhibitors, which target the p19 subunit to suppress Th17 activation and inflammatory cytokines. Clinical trials show that IL-23 inhibitors significantly improve disease severity and patient-reported outcomes in PPP while maintaining favorable safety profiles. Notably, guselkumab and risankizumab have recently been approved for PPP treatment in Japan and Korea. In contrast, IL-17 inhibitors and IL-36 blockers have yielded mixed results. A recent phase 3 trial in Japan demonstrated the significant efficacy of apremilast in treating PPP, with a favorable safety profile, suggesting that apremilast may be a promising treatment option for PPP. Due to PPP’s lower prevalence compared with psoriasis vulgaris, clinical trials remain limited. Further large-scale, controlled studies are needed to clarify the efficacy and long-term safety of these therapies in diverse populations. This review summarizes emerging evidence on IL-23 inhibitors and other treatments for PPP, detailing their mechanisms of action, clinical efficacy, safety profiles, current challenges, and future perspectives in optimizing therapy. Full article

(This article belongs to the Section Dermatology)

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13 pages, 932 KiB

Open AccessArticle

An Increase in Mean Aortic Valve Gradients the Day After Transcatheter Aortic Valve Implantation: The Effects of Evolving Anesthesia Techniques

by Benjamin Fogelson, Raj Baljepally, Billy Morvant, Terrance C. Nowell, Robert Eric Heidel, Steve Ferlita, Stefan Weston, Aladen Amro, Zachary Spires, Kirsten Ferraro and Parth Patel

J. Clin. Med. 2025, 14(10), 3272; https://doi.org/10.3390/jcm14103272 (registering DOI) - 8 May 2025

Abstract

Background and Objectives: After transcatheter aortic valve implantation (TAVI), transvalvular gradients increase immediately following the procedure up to 24 h afterward. While factors such as anesthesia type and fluid status have been suggested as potential contributors, the underlying cause remains unclear. With [...] Read more.

Background and Objectives: After transcatheter aortic valve implantation (TAVI), transvalvular gradients increase immediately following the procedure up to 24 h afterward. While factors such as anesthesia type and fluid status have been suggested as potential contributors, the underlying cause remains unclear. With advancements in TAVI techniques, there has been a shift in anesthesia protocols from general anesthesia (GA) to monitored anesthesia care (MAC). This study aimed to assess the impact of GA and MAC on the increase in transvalvular gradients observed 24 h post-TAVI. Methods: A retrospective, single-center analysis was conducted on patients who underwent TAVI at our institution between 2011 and 2023 (n = 744, males = 421). The patients were divided into two groups: those who received GA (n = 201) and those who received MAC (n = 543). The GA group received either inhaled anesthetics, with or without propofol infusions, or propofol infusions at a rate of ≥100 mcg/kg/min. The MAC group received bolus doses and continuous infusions of dexmedetomidine. Transvalvular gradients were compared between immediate and 24 h post-procedure echocardiograms. Results: The average age of patients in the GA group (78 years [IQR 71–83]) was similar to that of the MAC group (77 years [IQR 71–83]). The GA group had a higher prevalence of comorbidities at baseline. Both groups exhibited stable, normotensive blood pressure levels during the procedure, though the GA group required more vasopressors and intravenous fluid. The GA group showed a 24 h post-TAVI mean transvalvular gradient change of +5.1 mmHg [IQR 3–8.1], while the MAC group had a 24 h mean transvalvular gradient change of +5.8 mmHg [IQR 3.2–9], with no significant difference between the groups (p = 0.139). Conclusions: Despite the greater cardiovascular depressive effects and increased need for vasopressors and fluid resuscitation in the GA group, there was no significant difference in the increase in transvalvular gradients between the GA and MAC groups at 24 h post-TAVI. Further research is needed to fully understand the reasons behind the increase in gradients observed after TAVI. Full article

(This article belongs to the Special Issue Anesthesia and Sedation for Out-of-Operating-Room Procedures)

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13 pages, 1051 KiB

Open AccessReview

The Brain Fatigue Syndrome—Symptoms, Probable Definition, and Pathophysiological Mechanisms

by Birgitta Johansson and Lars Rönnbäck

J. Clin. Med. 2025, 14(10), 3271; https://doi.org/10.3390/jcm14103271 (registering DOI) - 8 May 2025

Abstract

Fatigue is a common consequence of traumatic brain injury, neurological diseases or developmental disorders, and systemic inflammatory diseases, including autoimmune conditions that affect the brain. This condition is characterized by reduced endurance for cognitive tasks, diminished quality of life, and impaired work capacity. [...] Read more.

Fatigue is a common consequence of traumatic brain injury, neurological diseases or developmental disorders, and systemic inflammatory diseases, including autoimmune conditions that affect the brain. This condition is characterized by reduced endurance for cognitive tasks, diminished quality of life, and impaired work capacity. In addition to cognitive difficulties, individuals often experience disproportionately long recovery times after demanding tasks, emotional instability, stress sensitivity, sensory sensitivity, impaired ability to initiate activities, and sleep disturbances. Tension headaches frequently occur when the brain is excessively activated by mental activity. In this paper, we propose the term “Brain Fatigue Syndrome” (BFS) as a collective name for the symptoms closely associated with this pathological fatigue resulting from brain impact. BFS can be identified through interviews and measured using the self-assessment instrument, the Mental Fatigue Scale (MFS). We suggest potential underlying mechanisms at the cellular level for the BFS symptom complex, including astrocyte dysfunction with impaired glutamate signaling and glucose uptake, mitochondrial dysfunction, blood–brain barrier dysfunction, and the activation of microglia and mast cells. In conclusion, BFS suggests a general brain impact. The symptoms associated with BFS typically resolve when the injury or disease heals. However, in some individuals, BFS persists even after the injury or illness has ostensibly healed. Full article

(This article belongs to the Special Issue Traumatic Brain Injury: Current Treatment and Future Options)

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15 pages, 5968 KiB

Open AccessArticle

A Comparison of Ultra-Widefield Imaging Quality Obtained with Zeiss Clarus and Optos for Virtual Medical Retina Services

by Matthew Azzopardi, Sneha Gridhar, Chrysanthi Tsika, Georgios Koutsocheras, Michail Katzakis, Bahar Demir, Waheeda Rahman, Ling Zhi Heng, Yu Jeat Chong and Abison Logeswaran

J. Clin. Med. 2025, 14(10), 3270; https://doi.org/10.3390/jcm14103270 (registering DOI) - 8 May 2025

Abstract

Background: Virtual clinics (VCs) have proven to be an effective solution for the increasing strain on Medical Retina (MR) services, although imaging quality issues (IQIs) persist. Our aim was to compare the quality of two ultra-wide-field (UWF) imaging modalities (Optos and Clarus) in [...] Read more.

Background: Virtual clinics (VCs) have proven to be an effective solution for the increasing strain on Medical Retina (MR) services, although imaging quality issues (IQIs) persist. Our aim was to compare the quality of two ultra-wide-field (UWF) imaging modalities (Optos and Clarus) in real-world MR-VC settings. Methods: We conducted a real-world, prospective study. Data were collected from 6 Moorfields NHS Trust MR-VCs between September and October 2024. We obtained patient demographics and characteristics, primary diagnosis, UWF imaging types and images obtained, and follow-up outcomes. Results: Optos (California RG/RGB, and Monaco) was used for 56.7% (n = 152) and Zeiss Clarus 500 for 43.3% (n = 116) of the total cohort (n = 268). No statistically significant difference (p = 0.14) was found between the two in terms of the rates of IQIs. FAF (p = 0.001) acquisition was significantly higher when Optos was used. Of the patients affected by IQIs, 10 were examined in a face-to-face clinic (F2FC). No difference in IQI rates was observed when pathology-related poor image quality was considered (p = 0.561). A significantly (p = 0.001) higher rate of F2F follow-ups was found for red-flag pathologies and unexplained vision loss, with a statistically significantly higher rate of virtual follow-ups for non-red-flag pathologies (p = 0.001). Conclusions: A total of 7.5% of the clinical decisions were impacted by IQIs; 11.1% of F2FC follow-ups. Neither UWF imaging modality type was inferior in terms of IQI rates. FAF acquisition was higher with Optos, likely representing greater user-dependency for Clarus. The outcomes were not influenced by FAF acquisition, indicating that routine acquisition is not required in MR-VCs and instead should be obtained when clinically required. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 528 KiB

Open AccessPerspective

Pillars of Blood Pressure Management in Patients with Type 2 Diabetes Mellitus: Insights from Recent Trials and Emerging Perspectives

by Călin Pop, Antoniu Octavian Petriş, Lavinia Pop and Liliana Elisabeta David

J. Clin. Med. 2025, 14(10), 3269; https://doi.org/10.3390/jcm14103269 - 8 May 2025

Abstract

Hypertension (HTN) is prevalent among patients with type 2 diabetes mellitus (T2DM), and both conditions are well-established risk factors for cardiovascular diseases (CVDs) and microvascular complications. To mitigate the risk of CVD, a comprehensive management approach for both blood pressure (BP) and glycaemic [...] Read more.

Hypertension (HTN) is prevalent among patients with type 2 diabetes mellitus (T2DM), and both conditions are well-established risk factors for cardiovascular diseases (CVDs) and microvascular complications. To mitigate the risk of CVD, a comprehensive management approach for both blood pressure (BP) and glycaemic control is essential. The current therapeutic strategy should be structured around five pillars aimed at confirming HTN, establishing the 10-year CVD risk and its components and focusing on pharmacological treatment alongside lifestyle interventions to achieve BP targets. In clinical practice, the recommended BP target is 120–129/70–79 mmHg, while an optimal target of ≤120/70 mmHg is being explored under research conditions. Further, BP control should be re-evaluated in cases of resistant or uncontrolled HTN, in conjunction with antidiabetic therapies that have demonstrated cardiovascular and renal protective benefits. This five-pillar approach offers a comprehensive and evolving perspective on BP management in patients with T2DM, although certain aspects continue to be refined as new evidence emerges. Full article

(This article belongs to the Special Issue Hypertension in Adults: Current Updates on Diagnosis, Treatment and Management)

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21 pages, 497 KiB

Open AccessSystematic Review

Modern Conservative Management Strategies for Female Stress Urinary Incontinence: A Systematic Review

by Aida Petca, Andreea Fotă, Răzvan-Cosmin Petca and Ioana Cristina Rotar

J. Clin. Med. 2025, 14(10), 3268; https://doi.org/10.3390/jcm14103268 - 8 May 2025

Abstract

Stress urinary incontinence (SUI) is characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure. The management of SUI encompasses surgical treatments, such as colposuspension and sling procedures, and nonsurgical ones that involve pelvic floor muscle treatment, behavioral therapies, as [...] Read more.

Stress urinary incontinence (SUI) is characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure. The management of SUI encompasses surgical treatments, such as colposuspension and sling procedures, and nonsurgical ones that involve pelvic floor muscle treatment, behavioral therapies, as well as pharmacological interventions. By exploring nonsurgical options initially, individuals have the opportunity to address the root causes of stress urinary incontinence and strengthen pelvic floor muscles. Background/Objectives: This article delves into the conservative measures in managing SUI among women and the options of minimally invasive strategies for SUI, such as the injection of platelet-rich plasma, stem cells, bulking agents, and laser and radiofrequency therapy. Methods: A search of the literature from 2010 until January 2024 was carried out on PubMed, Cochrane Library, and Web of Science research databases. Results: A total of 34 studies on human females assessing the roles of platelet-rich plasma, laser and radiofrequency therapy, bulking agents, and stem cell therapy were included. Conclusions: The shortcoming of most conservative techniques seems to be represented by the temporary effects and the necessity of repeated treatments. To establish effective medical techniques, adopting more standardized procedures and conducting comprehensive randomized controlled trials is imperative. Full article

(This article belongs to the Special Issue Latest Advances in Lower Urinary Tract Symptoms and Pelvic Floor Dysfunction Diseases)

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14 pages, 2769 KiB

Open AccessSystematic Review

Effectiveness of Atrial Natriuretic Peptide in the Treatment of Critically Ill Patients: A Systematic Review and Meta-Analysis

by Peter Olujimi Odutola, Ayodeji Olarewaju and Priyank Shah

J. Clin. Med. 2025, 14(10), 3267; https://doi.org/10.3390/jcm14103267 - 8 May 2025

Abstract

Background: Atrial natriuretic peptide (ANP) has emerged as a potential therapeutic agent in critical care settings due to its physiological effects on diuresis, natriuresis, and vasodilation. Despite several promising preclinical data, their clinical utility remains controversial, necessitating a comprehensive evaluation of existing [...] Read more.

Background: Atrial natriuretic peptide (ANP) has emerged as a potential therapeutic agent in critical care settings due to its physiological effects on diuresis, natriuresis, and vasodilation. Despite several promising preclinical data, their clinical utility remains controversial, necessitating a comprehensive evaluation of existing evidence. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Searches were performed in PubMed, Google Scholar, and Cochrane databases. Fifteen studies (n = 7187) comparing ANP to placebo in critically ill patients were included. Primary outcomes included mortality, hospital length of stay, ICU length of stay, and serum creatinine level. Risk ratios and mean differences with 95% confidence intervals were calculated using random-effects models. Results: ANP therapy showed no significant impact on mortality (RR 1.03, 95% CI: 0.89–1.19, p = 0.72) but significantly reduced hospital length of stay (MD −1.81 days, 95% CI: −1.91 to −1.72, p < 0.00001). ICU length of stay showed no significant difference between groups in subgroup analysis (MD +0.10 days, 95% CI: −0.03 to 0.23, p = 0.15). Subgroup analysis revealed improved creatinine levels with ANP (MD −0.19, 95% CI: −0.20 to −0.19, p < 0.00001), though high heterogeneity was noted across outcomes. Conclusions: ANP therapy shows promise in shortening hospital stays and enhancing renal function in select patients, but its effectiveness varies widely across clinical settings. Large-scale, multicenter studies are necessary to determine the ideal patient groups for ANP therapy in critical care. Full article

(This article belongs to the Section Cardiovascular Medicine)

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10 pages, 426 KiB

Open AccessArticle

Affordable Sinskey Hook Goniotomy and Cataract Surgery in Black and Afro-Latino Patients Diagnosed with Glaucoma: Retrospective Real-World One-Year Results

by Idaima Calderon and Daniel Laroche

J. Clin. Med. 2025, 14(10), 3266; https://doi.org/10.3390/jcm14103266 - 8 May 2025

Abstract

Background/Objectives: This study aimed to evaluate the effectiveness of early phacoemulsification cataract surgery combined with goniotomy using a Sinskey hook in patients with glaucoma. Methods: This was a retrospective study conducted at Advanced Eye Care of New York; a private practice located [...] Read more.

Background/Objectives: This study aimed to evaluate the effectiveness of early phacoemulsification cataract surgery combined with goniotomy using a Sinskey hook in patients with glaucoma. Methods: This was a retrospective study conducted at Advanced Eye Care of New York; a private practice located in New York City. Most patients carried diagnoses of mild to moderate glaucoma and were mainly Black and Afro-Latino in origin. The patients included in this study were those who underwent early phacoemulsification cataract surgery combined with goniotomy performed with a reusable Sinskey hook (Ambler 200 μm tip) between January 2022 and August 2023 and completed 1 year of follow-up. The primary outcome measures were intraocular pressure, number of medications used, visual acuity, visual field indices, pre-/post-operative spherical refractive error, and adverse events. Results: A total of 121 eyes were identified with a 1-year follow-up that underwent this combined surgery. The mean age was 65. The mean medically treated pre-operative intraocular pressure ± standard deviation (SD) was lowered from 16.40 ± 4.5 mmHg at baseline to 14.66 ± 3.1 mmHg at 1 year, a statistically significant reduction of 10.6%. There was an 82% reduction in the mean ± SD number of intraocular pressure-lowering medications used, from 1.67 ± 1.2 at baseline to 0.30 ± 0.8 at 1 year. Out of the 121 eyes, 83% (103 eyes) remained medication-free at 1-year post-operation. Post-operatively, there were five IOP spikes (IOP ≥ 30 mmHg) and eight hyphemas that were noted, addressed, and resolved. Conclusions: Early cataract surgery combined with Sinskey hook goniotomy microinvasive surgery effectively reduced intraocular pressure and medication burden in this cohort of predominantly Black and Afro-Latino patients diagnosed with glaucoma with 1-year follow-up. Full article

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

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12 pages, 1114 KiB

Open AccessArticle

Relationship Between Health-Related Quality of Life and Exercise Tolerance Improvement in Remote Cardiac Rehabilitation: Sub-Analysis of RecRCR Study

by Mai Shimbo, Eisuke Amiya, Takahiro Jimba, Hidetaka Itoh, Koichi Narita, Masanobu Taya, Toshiaki Kadokami, Takanori Yasu, Hideki Oka, Masakazu Sogawa, Hiroyoshi Yokoi, Kazuo Mizutani, Shin-ichiro Miura, Tatsuo Tokeshi, Ayumi Date, Takahisa Noma, Daisuke Kutsuzawa, Soichiro Usui, Shigeo Sugawara, Masanori Kanazawa, Hisakuni Sekino, Miho Nishitani Yokoyama, Takahiro Okumura, Yusuke Ugata, Shinichiro Fujishima, Kagami Hirabayashi, Yuta Ishizaki, Koichiro Kuwahara, Yuko Kaji, Hiroki Shimizu, Teruyuki Koyama, Hitoshi Adachi, Yoko Kurumatani, Ryoji Taniguchi, Katsuhiko Ohori, Hirokazu Shiraishi, Takashi Hasegawa, Shigeru Makita, Issei Komuro, Norihiko Takeda, Yutaka Kimura and RecRCR Registry Investigators Show full author list Hide full author list

J. Clin. Med. 2025, 14(10), 3265; https://doi.org/10.3390/jcm14103265 - 8 May 2025

Abstract

Background: Remote cardiac rehabilitation (RCR) is emerging alternative to outpatient rehabilitation. However, evidence related to its effect on health-related quality of life (HRQOL) is limited. Methods: This is a sub-analysis of the RecRCR study, a multi-center, nonrandomized trial evaluating the efficacy and safety [...] Read more.

Background: Remote cardiac rehabilitation (RCR) is emerging alternative to outpatient rehabilitation. However, evidence related to its effect on health-related quality of life (HRQOL) is limited. Methods: This is a sub-analysis of the RecRCR study, a multi-center, nonrandomized trial evaluating the efficacy and safety of RCR with real-time telemonitoring in patients with CVD, after discharge. The Short-Form Health Survey-8 was employed to evaluate the HRQOL before and 2–3 months after RCR. Based on the improvement of exercise tolerance, the patients were divided into I group (>10% improvement) and NI group (≤10% improvement). Results: Of 57 patients who completed RCR, 31 patients were included for analysis of HRQOL, including 15 (I group) and 16 patients (NI group). The physical (PCS) (45.5 ± 8.0 to 52.5 ± 4.0, p < 0.001) and mental (MCS) component scores (47.5 ± 7.9 to 51.0 ± 5.6, p = 0.005) improved significantly in all populations following RCR. The PCS improved significantly in the I and NI groups, respectively. By contrast, only in the I group, the MCS improved. However, the change in PCS or MCS was not significantly different between the two groups. The increases of MCS significantly associated with days from admission to the beginning of RCR (rs = −0.51, p = 0.007). Conclusions: In multifaced contents of HRQOL, the scores in PCS or MCS changed differently from the change in exercise capacity. Full article

(This article belongs to the Special Issue Cardiac Rehabilitation: Clinical Challenges and New Insights)

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