Journal of Clinical Medicine

13 pages, 545 KiB

Open AccessArticle

The Hungry Heart: Managing Cardiogenic Shock in Patients with Severe Anorexia Nervosa—A Case Report Series

by Manuela Thienel, Rainer Kaiser, Jonas Gmeiner, Martin Orban, Stefan Kääb, Tobias Petzold, Steffen Massberg and Clemens Scherer

J. Clin. Med. 2025, 14(11), 4011; https://doi.org/10.3390/jcm14114011 (registering DOI) - 5 Jun 2025

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Abstract

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such [...] Read more.

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial. Full article

(This article belongs to the Section Cardiology)

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10 pages, 962 KiB

Open AccessArticle

IOL Power Calculation After Laser-Based Refractive Surgery: Measured vs. Predicted Posterior Corneal Astigmatism Using the Barrett True-K Formula

by Giacomo De Rosa, Daniele Criscuolo, Laura Longo, Davide Allegrini and Mario R. Romano

J. Clin. Med. 2025, 14(11), 4010; https://doi.org/10.3390/jcm14114010 - 5 Jun 2025

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Abstract

Background/Objectives: This study assessed the reliability of the Barrett True-K formula in patients who had undergone laser-based corneal refractive surgery by comparing outcomes using measured vs. predicted posterior corneal astigmatism (PCA) within the Barrett True-K No History formula. Methods: We selected 49 [...] Read more.

Background/Objectives: This study assessed the reliability of the Barrett True-K formula in patients who had undergone laser-based corneal refractive surgery by comparing outcomes using measured vs. predicted posterior corneal astigmatism (PCA) within the Barrett True-K No History formula. Methods: We selected 49 eyes out of 41 patients with a history of uncomplicated laser visual correction (LVC) that underwent cataract surgery between 2020 and 2024. The Front K1 and K2, the Back K1 and K2, the anterior chamber depth, the lens thickness, the horizontal white-to-white, and the central corneal thickness were measured using Pentacam. The axial length was measured using the IOL Master 500 or NIDEK AL-Scan. These data were then imported into the freely available online Barrett True-K calculator for post-LVC eyes, and the postoperative results were compared with the predicted IOL target. The cumulative distribution of the refractive prediction error, absolute refractive prediction error, and refractive prediction error were calculated as the difference between the postoperative spherical equivalent and the expected spherical equivalent for both the predicted and measured PCA calculations. Results: The results suggest improved accuracy with the Barrett True-K formula when incorporating measured PCA values, supporting the use of corneal tomography for optimized refractive outcomes in post-LVC cataract patients. Conclusions: It is always advisable to measure the posterior corneal surface using corneal tomography in all patients who have undergone LVC to achieve better refractive outcomes after cataract surgery. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 441 KiB

Open AccessReview

Use of Digital and Telemedicine Tools for Postoperative Pain Management at Home: A Scoping Review of Health Professionals’ Roles and Clinical Outcomes

by Gianluca Azzellino, Ernesto Aitella, Lia Ginaldi, Patrizia Vagnarelli and Massimo De Martinis

J. Clin. Med. 2025, 14(11), 4009; https://doi.org/10.3390/jcm14114009 - 5 Jun 2025

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Abstract

Postoperative pain management after hospital discharge remains one of the main clinical challenges. The use of digital and telemedicine tools offers new opportunities for the continuous monitoring of, and timely intervention in, patients discharged and followed at home. This scoping review, conducted according [...] Read more.

Postoperative pain management after hospital discharge remains one of the main clinical challenges. The use of digital and telemedicine tools offers new opportunities for the continuous monitoring of, and timely intervention in, patients discharged and followed at home. This scoping review, conducted according to the PRISMA-ScR checklist and the Joanna Briggs Institute methodology, analyzed 26 studies selected through a search of PubMed, Scopus, and Web of Science databases. Inclusion criteria comprised studies published between 2015 and 2025 that involved patients discharged home after surgery, that used digital or telemedicine tools for pain management, and that included active involvement of healthcare professionals and reported clinical outcomes. Studies show the use of a variety of digital tools, including mobile applications, web platforms, wearable sensors, automated messaging systems, and virtual reality technologies, alternating across settings for the assessment and management of pain at home, educational and therapeutic support, and to enhance communication between healthcare professionals and patients. Most reported outcomes focus on improved home-based pain control, a reduction in opioid consumption, and a high level of patient satisfaction. However, some challenges remain, particularly the low level of digital literacy among certain segments of the population. In conclusion, the implementation of telemedicine and digital technologies for managing postoperative pain at home proves to be a promising strategy. Nonetheless, it requires further scientific investigation and, from policymakers, significant investments in professional training and technological infrastructure to ensure an increasingly equitable and sustainable distribution of home healthcare services. Full article

(This article belongs to the Section Anesthesiology)

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8 pages, 426 KiB

Open AccessCase Report

A Case of Horseshoe Kidney and Autosomal Dominant Polycystic Kidney Disease with PKD1 Gene Mutation

by Hyeongwan Kim, Soo Jin Lee and Won Kim

J. Clin. Med. 2025, 14(11), 4008; https://doi.org/10.3390/jcm14114008 - 5 Jun 2025

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Abstract

Background/Objectives: Horseshoe kidney is a congenital anomaly characterized by the fusion of the kidneys at the lower pole. Polycystic kidney disease with horseshoe kidney is called polycystic horseshoe kidney. Genetic testing is essential for the diagnosis of polycystic horseshoe kidney disease because [...] Read more.

Background/Objectives: Horseshoe kidney is a congenital anomaly characterized by the fusion of the kidneys at the lower pole. Polycystic kidney disease with horseshoe kidney is called polycystic horseshoe kidney. Genetic testing is essential for the diagnosis of polycystic horseshoe kidney disease because it can result from a number of genetic disorders. Fewer than 20 cases of polycystic horseshoe kidney have been reported to date. However, polycystic horseshoe kidney disease was mostly diagnosed via autopsy or radiologic imaging techniques including computed tomography, magnetic resonance imaging, and angiography. Because polycystic kidney disease has various causes, genetic testing is essential for the diagnosis of autosomal dominant polycystic kidney disease (ADPKD) in patients with polycystic horseshoe kidney disease. At present, the diagnosis of ADPKD is made using genetic approaches, including next-generation sequencing. We reported a potentially pathogenic polycystin 1 (PKD1) gene in a patient with ADPKD and horseshoe kidney. Methods: We performed the sequencing of the PKD1 gene and radiological examinations (computed abdominal tomography). Results: Computed abdominal tomography revealed enlarged kidneys with multiple cysts fused at the lower poles, indicating polycystic HSK. The sequencing of the PKD1 gene revealed a heterozygous pathogenic variant c.165_171del (p.Leu56ArgfsTer15), which genetically confirmed the diagnosis of ADPKD. The patient was treated with an angiotensin II receptor blocker. Conclusions: In this case report, we suggest that genetic testing becomes the key approach to the diagnosis of ADPKD with horseshoe kidney. Additionally, this approach offers the benefit of avoiding the possibility of the condition being mistakenly diagnosed or diagnosed late due to its uncommon occurrence and nonspecific symptoms. Full article

(This article belongs to the Section Nephrology & Urology)

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16 pages, 1223 KiB

Open AccessArticle

Oxidative Stress and Risk Factors in Adult Patients with Bronchial Asthma: A Clinical Analysis of Representative Biomarkers

by Oana-Elena Melinte, Emanuel Ioan Stavarache, Mona Elisabeta Dobrin, Andrei Tudor Cernomaz, Ionel-Bogdan Cioroiu, Daniela Robu Popa, Ionela-Alina Grosu-Creanga, Andreea Zabara Antal and Antigona Carmen Trofor

J. Clin. Med. 2025, 14(11), 4007; https://doi.org/10.3390/jcm14114007 - 5 Jun 2025

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Abstract

Background: Asthma is a chronic inflammatory airway disease in which oxidative stress and antioxidant imbalance play a critical role in disease progression and therapeutic response. This study aimed to evaluate oxidative stress and antioxidant status in relation to asthma control levels. Methods: [...] Read more.

Background: Asthma is a chronic inflammatory airway disease in which oxidative stress and antioxidant imbalance play a critical role in disease progression and therapeutic response. This study aimed to evaluate oxidative stress and antioxidant status in relation to asthma control levels. Methods: A total of 106 patients admitted to the Clinical Hospital of Pulmonary Diseases, Iași, between March and May 2024 were included in this study. Patients were classified into three groups based on asthma control: well-controlled (AB-TCG), partially controlled (AB-PCG), and uncontrolled asthma (AB-UCG). Demographic, biochemical, and hematological parameters were assessed, with attention to oxidative stress markers and antioxidant defenses. Results: The study population was predominantly female (75%), with a mean age ranging from 50.75 to 64.38 years, and the majority residing in rural areas (73–75%). The AB-UCG group showed significantly elevated inflammatory markers, including a white blood cell count of 9.33 × 10³/µL (p = 0.005) and eosinophil percentage of 4.20% (p = 0.03), compared with the other groups. This group also exhibited an unfavorable lipid profile, with increased total cholesterol (207.40 mg/dL) and triglyceride levels (157.21 mg/dL). Oxidative stress was notably higher in the AB-UCG group, as indicated by elevated malondialdehyde (MDA) levels (2.86 mmol/L) versus 2.35 mmol/L in the AB-PCG group (p < 0.005), along with decreased serum uric acid (4.64 mg/dL) and reduced glutathione (GSH) levels (275.41 µmol/L), leading to a lower GSH/GSSG ratio. Environmental exposures, including tobacco smoke and occupational chemicals, were associated with exacerbated oxidative imbalance. Conclusions: The findings highlight the critical involvement of oxidative stress and compromised antioxidant defenses in poorly controlled asthma. Biomarkers such as MDA, white blood cell count, eosinophil percentage, and the GSH/GSSG ratio may act as valuable tools for personalized asthma management and therapeutic monitoring. Full article

(This article belongs to the Special Issue Advances in Asthma: 2nd Edition)

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15 pages, 335 KiB

Open AccessArticle

Heart Failure, Kidney Function, and Elderly Age, Rather than Levofloxacin Therapy, Are Associated with QTc Prolongation in COVID-19 Patients

by Katarzyna Wilk-Śledziewska, Rafał Śledziewski, Małgorzata Gryciuk, Piotr Jan Sielatycki, Aleksandra Zbroch, Franciszek Kukliński and Edyta Zbroch

J. Clin. Med. 2025, 14(11), 4006; https://doi.org/10.3390/jcm14114006 - 5 Jun 2025

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Abstract

Background: Prolongation of the QT interval is directly related to the risk of ventricular arrhythmias and sudden cardiac death. Age, comorbidities, and treatment schemes have been shown to influence its prolongation and may also significantly affect the course of SARS-CoV-2 infection. Fluoroquinolones, widely [...] Read more.

Background: Prolongation of the QT interval is directly related to the risk of ventricular arrhythmias and sudden cardiac death. Age, comorbidities, and treatment schemes have been shown to influence its prolongation and may also significantly affect the course of SARS-CoV-2 infection. Fluoroquinolones, widely used during the COVID-19 pandemic, are known for their ability to prolong the QT interval. Risk of ventricular arrhythmias has also been reported in patients with infectious diseases, and this risk may have been associated with high levels of interleukin-6 (IL-6). Purpose: The aim of this study is to evaluate the effect of levofloxacin on the corrected QT interval in patients with COVID-19, as well as to identify sociodemographic, clinical, and biochemical parameters associated with QTc interval prolongation among patients with COVID-19. Patients and Methods: The medical records of 93 patients hospitalized for COVID-19 were retrospectively analyzed, focusing on the presence of comorbidities and treatment with levofloxacin. Selected sociodemographic, clinical, and biochemical parameters were then statistically analyzed, with emphasis on their effect on the corrected QTc interval. The QTc interval was calculated according to the Bazett formula. Results: Levofloxacin use was not significantly associated with QTc interval. Statistical analysis identified creatinine, heart failure and atrial fibrillation as significant predictors of QTc interval prolongation. The trends towards QTc interval prolongation observed with hypokalaemia and hypertension suggest that these factors may also contribute to QTc interval variability and should be taken into account when assessing arrhythmia risk. Conclusions: Our retrospective study indicates that QTc prolongation results from the interplay of multiple factors. Full article

(This article belongs to the Section Cardiovascular Medicine)

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Graphical abstract

47 pages, 2409 KiB

Open AccessSystematic Review

Optimizing Infrazygomatic Miniscrew Insertion Parameters: Systematic Review and Meta-Regression Analysis of Bone Thickness by Insertion Height, Angulation, and Anatomical Position

by Kais Hijazi Muwaquet, Susana Muwaquet Rodriguez, Marcela Ferrer Molina and Tawfiq Hijazi Alsadi

J. Clin. Med. 2025, 14(11), 4005; https://doi.org/10.3390/jcm14114005 - 5 Jun 2025

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Abstract

Introduction: Infrazygomatic crest (IZC) miniscrews are widely used for skeletal anchorage in orthodontics. Despite their growing popularity, the optimal insertion parameters—such as height, angulation, and anatomical position—remain controversial, with existing studies offering inconsistent and fragmented data. Aim: To determine the optimal insertion position, [...] Read more.

Introduction: Infrazygomatic crest (IZC) miniscrews are widely used for skeletal anchorage in orthodontics. Despite their growing popularity, the optimal insertion parameters—such as height, angulation, and anatomical position—remain controversial, with existing studies offering inconsistent and fragmented data. Aim: To determine the optimal insertion position, height, and angulation of infrazygomatic miniscrews to maximize bone insertion using cone-beam computed tomography (CBCT) analysis and to investigate the influence of facial skeletal patterns on IZC bone morphology. Methods: This review was conducted according to the PRISMA 2020 guidelines. A comprehensive electronic search was performed across six databases: PubMed, Scopus, Web of Science, Cochrane, EBSCO, and Google Scholar. Studies reporting CBCT-based IZC bone thickness were included. A meta-analysis was conducted using a random-effects model, and meta-regression was applied to assess the relationship between insertion height, angulation, and bone thickness. The STROBE checklist was used to assess the quality of the included observational studies. Results: Seventeen studies comprising a total of 1840 CBCT-based measurements were included. The meta-regression revealed a significant inverse relationship between insertion height and bone thickness (β = −0.53; p < 0.001) and a positive correlation with angulation (β = 0.09; p < 0.001). The U67 region refers to the anatomical area between the maxillary first and second molars, adjacent to the infrazygomatic crest and zygomatic buttress, which with an insertion height of 9.9 mm and 80° angulation, demonstrated the highest mean cortical bone thickness (3.52 mm). There was no evidence of a significant association between facial pattern and bone thickness (p = 0.878). Conclusions: This review presents the first predictive model for IZC miniscrew placement based on meta-regression. The findings support the U67 site at 9.9 mm height and 80° angulation as the optimal insertion protocol. These data-driven guidelines provide clinicians with practical, evidence-based direction for improving miniscrew stability and minimizing complications. Full article

(This article belongs to the Special Issue Clinical Innovations in Dental Implant: Expanding Possibilities for Oral Rehabilitation)

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12 pages, 1910 KiB

Open AccessArticle

Diagnostic Utility of Intratumoral Susceptibility Signals in Adult Diffuse Gliomas: Tumor Grade Prediction and Correlation with Molecular Markers Within the WHO CNS5 (2021) Classification

by José Ignacio Tudela Martínez, Victoria Vázquez Sáez, Guillermo Carbonell, Héctor Rodrigo Lara, Florentina Guzmán-Aroca and Juan de Dios Berna Mestre

J. Clin. Med. 2025, 14(11), 4004; https://doi.org/10.3390/jcm14114004 - 5 Jun 2025

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Abstract

Background/Objectives: This study evaluates intratumoral susceptibility signals (ITSS) as imaging markers for glioma grade prediction and their association with molecular and histopathologic features, in the context of the fifth edition of the World Health Organization Classification of Tumors of the Central Nervous [...] Read more.

Background/Objectives: This study evaluates intratumoral susceptibility signals (ITSS) as imaging markers for glioma grade prediction and their association with molecular and histopathologic features, in the context of the fifth edition of the World Health Organization Classification of Tumors of the Central Nervous System (WHO CNS5). Methods: We retrospectively analyzed patients with adult diffuse gliomas who underwent pretreatment magnetic resonance imaging. ITSS were semiquantitatively graded by two radiologists: grade 0 (no signal), grade 1 (1–5), grade 2 (6–10), and grade 3 (≥11). Relative cerebral blood volume (rCBV) and tumor volume were also obtained. Histopathologic features included tumor grade, Ki-67, mitotic count, necrosis, microvascular proliferation, and molecular alterations (isocitrate dehydrogenase [IDH], 1p/19q, cyclin-dependent kinase inhibitors 2A and 2B [CDKN2A/B], and p53). Regression models predicted tumor grade (low: 1–2, high: 3–4) using ITSS, tumor volume, and rCBV. ROC curves and diagnostic performance metrics were analyzed. Results: 99 patients were included. ITSS grading correlated with rCBV, tumor volume, mitotic count, Ki-67, and tumor grade (p < 0.001). ITSS grades 0–1 were associated with oligodendrogliomas and astrocytomas (p < 0.001), IDH mutations (p < 0.001), and 1p/19q co-deletions (p = 0.01). ITSS grades 2–3 were linked to glioblastomas (p < 0.001), necrosis (p < 0.001), microvascular proliferation (p < 0.001), and CDKN2A/B homozygous deletions (p = 0.02). Models combining ITSS with rCBV and volume showed AUC of 0.94 and 0.96 (p < 0.001), outperforming univariate models. Conclusions: Semiquantitative ITSS grading correlates with key histopathologic and molecular glioma features. Combined with perfusion and volumetric parameters, ITSS enhance non-invasive glioma grading, in alignment with WHO CNS5. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

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Graphical abstract

13 pages, 1369 KiB

Open AccessArticle

Temporal Patterns of Air Leak Resolution in Secondary Spontaneous Pneumothorax: A Hazard Function Analysis for Optimal Intervention Timing

by Ryo Takeyama, Yoshikane Yamauchi, Shinya Kohmaru, Shizuka Morita, Hikaru Takahashi, Tomoki Nishida, Yuichi Saito and Yukinori Sakao

J. Clin. Med. 2025, 14(11), 4003; https://doi.org/10.3390/jcm14114003 - 5 Jun 2025

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Abstract

Objectives: This study was aimed to identify risk factors for persistent air leak after chest tube placement for secondary spontaneous pneumothorax and to determine the optimal timing of treatment. Methods: We retrospectively analyzed 221 cases of secondary spontaneous pneumothorax in patients [...] Read more.

Objectives: This study was aimed to identify risk factors for persistent air leak after chest tube placement for secondary spontaneous pneumothorax and to determine the optimal timing of treatment. Methods: We retrospectively analyzed 221 cases of secondary spontaneous pneumothorax in patients aged ≥50 years who were treated with chest tube drainage. Patients were categorized into the observation group or additionally treated group based on whether they received interventional treatment beyond chest tube drainage. Air leak resolution patterns were analyzed using hazard function analysis. Risk factors were evaluated using univariate and multivariate analyses. Results: Hazard function analysis revealed that the probability of air leak resolution decreased by approximately 50% within the first 5 days after the initiation of chest tube drainage, with only 33% of cases resolving by day 7. Beyond days 7–10, resolution probability stabilized at a minimal level. Multivariate analysis identified previous pneumothorax history (HR: 0.422, p = 0.007) and low geriatric nutritional risk index (GNRI) (HR: 2.521, p < 0.001) as significant independent risk factors for persistent air leak. Further analysis of early resolution (within 7 days) identified female sex (HR: 0.24, p = 0.003), absence of previous pneumothorax (HR: 0.21, p = 0.003), and higher GNRI values (HR: 1.04, p = 0.008) as positive predictors. Conclusions: Risk stratification based on pneumothorax history and nutritional status enables the optimization of the timing of intervention for persistent air leak. We recommend considering additional treatment between days 7 and 10 of chest tube drainage, with earlier intervention for high-risk patients. This approach may improve patient outcomes while avoiding unnecessarily prolonged conservative management. Full article

(This article belongs to the Section General Surgery)

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15 pages, 2678 KiB

Open AccessSystematic Review

Adjuvant Radiotherapy for Intermediate-Risk Early-Stage Cervical Cancer Post Radical Hysterectomy: A Systematic Review and Meta-Analysis

by Pedro Henrique Costa Matos da Silva, Gabriela Oliveira Gonçalves Molino, Maírla Marina Ferreira Dias, Ana Gabriela Alves Pereira, Nicole dos Santos Pimenta, Deivyd Vieira Silva Cavalcante, Ana Clara Felix de Farias Santos, Sarah Hasimyan Ferreira, Rodrigo da Silva Santos and Angela Adamski da Silva Reis

J. Clin. Med. 2025, 14(11), 4002; https://doi.org/10.3390/jcm14114002 - 5 Jun 2025

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Abstract

Background: The risk of recurrence of early-stage cervical cancer (CC) is associated with prognostic factors such as tumor size, lymphovascular space invasion (LVSI), and deep stromal invasion (DSI). However, the adjuvant pelvic radiotherapy (RT) following surgery to reduce the risk of recurrence in [...] Read more.

Background: The risk of recurrence of early-stage cervical cancer (CC) is associated with prognostic factors such as tumor size, lymphovascular space invasion (LVSI), and deep stromal invasion (DSI). However, the adjuvant pelvic radiotherapy (RT) following surgery to reduce the risk of recurrence in “intermediate risk” remains controversial. This study aims to evaluate the role of adjuvant RT in the recurrence and identify prognostic factors. Methods: A systematic search of PubMed, Embase, and Cochrane databases was performed to identify studies comparing adjuvant RT versus no adjuvant treatment in early-stage CC patients with intermediate-risk factors defined by GOG-92 criteria. Outcomes were recurrence, local recurrence, death, 5-year overall survival (5y-OS), and 5-year disease-free survival (5y-DFS). Tumor size ≥ 4 cm, LVSI, and DSI were also evaluated as prognostic factors for recurrence. Statistical analysis was performed using Review Manager 7.2.0. Heterogeneity was assessed with I² statistics. Results: A total of 1504 patients from nine studies were included; only one study was a randomized controlled trial, while the others were retrospective cohorts. Adjuvant RT was used to treat 781 patients (52%). Median follow-up ranged from 48 to 120 months. Recurrence (OR 0.75; 95% CI 0.38–1.46; p = 0.39), local recurrence (OR 0.73; 95% CI 0.44–1.20; p = 0.22), death (OR 0.97; 95% CI 0.52–1.80; p = 0.91), 5y-OS (OR 1.22; 95% CI 0.36–4.18; p = 0.75), and 5y-DFS (OR 0.78; 95% CI 0.42–1.43 p = 0.42) revealed no statistically significant differences between adjuvant RT and observation groups. TS ≥ 4 cm was an independent prognostic risk factor for recurrence (HR 1.83; 95% CI 1.12–2.97; p = 0.02). Conclusions: Our findings suggest that adjuvant RT does not reduce recurrence risk in early-stage cervical cancer. Consider TS ≥ 4 cm as a significant prognostic factor for recurrence. Adjuvant RT in intermediate-risk patients should be considered with caution due the lack of significant improvement in recurrence until the CERVANTES and GOG-0263 trial results become available. Full article

(This article belongs to the Special Issue Gynecological Cancers—Surgical Management, Prognosis, and Quality of Life: 2nd Edition)

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22 pages, 2869 KiB

Open AccessReview

Intraoperative Hemostatic Agents in Thoracic Aortic Surgery—A Scoping Review

by Maite M. T. van Haeren, Caitlin Bozic, Jennifer S. Breel, Susanne Eberl, Faridi S. Jamaludin, Denise P. Veelo, Marcella C. A. Müller, Alexander P. J. Vlaar and Henning Hermanns

J. Clin. Med. 2025, 14(11), 4001; https://doi.org/10.3390/jcm14114001 - 5 Jun 2025

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Abstract

Background/Objectives: Patients undergoing open thoracic aortic surgery have the highest bleeding complication rates within cardiac–vascular surgery, but research on coagulation management mostly targets general cardiac surgery. This scoping review evaluates current evidence on intraoperative hemostatic agents and their effect on bleeding and blood [...] Read more.

Background/Objectives: Patients undergoing open thoracic aortic surgery have the highest bleeding complication rates within cardiac–vascular surgery, but research on coagulation management mostly targets general cardiac surgery. This scoping review evaluates current evidence on intraoperative hemostatic agents and their effect on bleeding and blood transfusions in these patients. Methods: We searched MEDLINE (PubMed), Embase, and Cochrane Library on 2 July 2024. Eligible studies included randomized controlled (RCT) and observational trials with a comparison group and at least a sub-analysis regarding thoracic aortic surgery (excluding thoracoabdominal and isolated descending aorta surgery). Results: Our search yielded 4697 articles, with 33 included. These covered antifibrinolytics (3 RCTs, 10 observational studies), fibrinogen supplementation (3 RCTs, 4 observational studies), recombinant factor VIIa (rFVIIa, 8 observational studies), blood products (3 observational studies), and factor eight inhibitor bypassing activity (FEIBA, 1 RCT, 1 observational study). The impact of blood product transfusion on bleeding control is unclear due to a lack of placebo or no-transfusion comparisons, though it appears associated with more complications. Both FEIBA studies suggest reduced blood product use in aortic dissection surgery—one as rescue therapy, the other as standard treatment. Evidence on fibrinogen supplementation is mixed: a multicenter RCT showed increased transfusions, while smaller RCTs and observational studies showed reductions, possibly due to differences in pretreatment fibrinogen levels and patient selection. Observational studies on rFVIIa show conflicting results, likely due to selection bias. Two small RCTs—one on TXA, one on aprotinin—suggest reduced transfusions and blood loss. Comparative studies of different types of antifibrinolytics yielded conflicting results. Conclusions: Evidence on hemostatic agents in thoracic aortic surgery is limited. Small studies suggest potential for the routine use of antifibrinolytics, FEIBA, and fibrinogen supplementation—but only in bleeding patients with hypofibrinogenemia. High-quality RCTs focused on thoracic aortic procedures are needed to determine optimal coagulation management. Full article

(This article belongs to the Section Anesthesiology)

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38 pages, 607 KiB

Open AccessSystematic Review

Children and Adolescents with Co-Occurring Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Systematic Review of Multimodal Interventions

by Carmela De Domenico, Angelo Alito, Giulia Leonardi, Erica Pironti, Marcella Di Cara, Adriana Piccolo, Carmela Settimo, Angelo Quartarone, Antonella Gagliano and Francesca Cucinotta

J. Clin. Med. 2025, 14(11), 4000; https://doi.org/10.3390/jcm14114000 (registering DOI) - 5 Jun 2025

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Abstract

Background/Objectives: The co-occurrence of Attention-deficit/hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) is very common and worsens adaptive functioning. This systematic review evaluates both pharmacological and non-pharmacological interventions in this underserved population. Methods: Registered on PROSPERO (CRD42024526157), a systematic search was [...] Read more.

Background/Objectives: The co-occurrence of Attention-deficit/hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) is very common and worsens adaptive functioning. This systematic review evaluates both pharmacological and non-pharmacological interventions in this underserved population. Methods: Registered on PROSPERO (CRD42024526157), a systematic search was conducted on PubMed, Embase, and Web of Science until 5 April 2025. The review includes (a) pilot studies and RCTs, (b) participants aged <18 years, (c) diagnoses of ASD and ADHD based on DSM-IV/V or ICD-9/10, (d) at least one group receiving any intervention, and (e) publications in English, Italian, Spanish, or German. Newcastle Ottawa Scale tools for non-randomized studies and the Cochrane Risk of Bias Tools for randomized controlled trials were used to assess studies’ quality. Results: A total of 32 studies were included: 87.5% concerning pharmacological treatments. Specifically, methylphenidate (MPH, n = 11), atomoxetine (ATX, n = 11), guanfacina (n = 4), clonidine (n = 1), or atypical antipsychotics (n = 1) were examined. MPH and ATX were most frequently studied, with both showing positive effects in reducing ADHD core symptoms compared to placebo. ATX also reduces stereotyped behaviors and social withdrawal, although more withdrawals due to adverse events (AEs) were reported for ATX than MPH. Four studies (12.5%) examined non-pharmacological interventions, including treatment with virtual reality tools, digital platforms, educational animations, and biomedical protocols; improvements in emotion recognition, behavioral regulation, attention, and social functioning were found. Conclusions: While limited data prevent definitive conclusions, MPH and ATX appear to be relatively safe and effective on hyperactivity-impulsivity symptoms, even in individuals with ASD. Evidence on non-pharmacological treatments is limited, and further studies are needed to better establish their therapeutic potential. Full article

(This article belongs to the Special Issue Management in Autism Spectrum Disorder: From Biomarkers to Precision Medicine)

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10 pages, 1138 KiB

Open AccessArticle

Results of Cochlear Implantation in Patients with Congenital Rubell—Retrospective Study

by Aleksandra Kolodziejak, Natalia Czajka, Rita Zdanowicz, Henryk Skarżyński and Piotr Henryk Skarżyński

J. Clin. Med. 2025, 14(11), 3999; https://doi.org/10.3390/jcm14113999 - 5 Jun 2025

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Abstract

Background/Objectives: Congenital rubella syndrome (CRS) is an infection caused by rubella virus transmitted to the fetus during pregnancy, which can cause congenital hearing loss. Cochlear implant can be an effective therapy in patients with severe to profound bilateral hearing loss. The aim of [...] Read more.

Background/Objectives: Congenital rubella syndrome (CRS) is an infection caused by rubella virus transmitted to the fetus during pregnancy, which can cause congenital hearing loss. Cochlear implant can be an effective therapy in patients with severe to profound bilateral hearing loss. The aim of this study was to evaluate the benefits of cochlear implantation in patients with profound hearing loss caused by congenital rubella syndrome. Methods: In total, 38 patients with profound hearing loss caused by intrauterine rubella virus infection were considered for cochlear implantation. Patients ranged in age from 8 to 72 years on the day of surgery, with a mean age of 27 years and median of 25 years (SD = 13.2). Preoperatively, all patients underwent pure-tone audiometry, and free-field speech audiometry was conducted in a quiet environment with the patient wearing a fitted hearing aid. Postoperatively, patients underwent pure-tone audiometry to assess residual hearing, and free-field speech audiometry was conducted when the patients had an active implant. Results: The average preoperative hearing threshold (averaged across the seven frequencies from 0.125 to 8 kHz) was 99.2 dB HL (SD = 6.79), while the average postoperative hearing threshold was 103.4 dB HL (SD = 5.74). Twelve months after the operation, patients achieved a WRS in quiet scores ranging from 10% to 90%, with an average of 59.1% and median of 70% (SD = 25.8). Conclusions: Rubella during pregnancy can lead to severe congenital defects, with sensorineural hearing loss being the most common. Cochlear implants appear to be an effective treatment for profound hearing loss caused by congenital rubella syndrome. Full article

(This article belongs to the Special Issue Current Challenges and Opportunities in Oto-Rhino-Laryngological Surgery)

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16 pages, 797 KiB

Open AccessStudy Protocol

Corporal Composition and Gut Microbiome Modification Through Exclusion Dietary Intervention in Adult Patients with Crohn’s Disease: Protocol for a Prospective, Interventional, Controlled, Randomized Clinical Trial

by Rosario Paloma Cano-Mármol, Virginia Esperanza Fernández-Ruiz, Cristina Martínez-Pascual, Inmaculada Ros-Madrid, Gala Martín-Pozuelo, Alba Oliva-Bolarín, María Antonia Martínez-Sánchez, Juan Egea-Valenzuela, María Ángeles Núñez-Sánchez, Bruno Ramos-Molina, Antonio José Ruiz-Alcaraz and Mercedes Ferrer-Gómez

J. Clin. Med. 2025, 14(11), 3998; https://doi.org/10.3390/jcm14113998 - 5 Jun 2025

Viewed by 255

Abstract

Background: Crohn’s disease (CD) is an inflammatory bowel disease in which there is an alteration in the homeostasis and functionality of the intestinal mucosa accompanied by a dysbiosis of the commensal microbiota. The analysis of different dietary strategies to achieve CD remission and [...] Read more.

Background: Crohn’s disease (CD) is an inflammatory bowel disease in which there is an alteration in the homeostasis and functionality of the intestinal mucosa accompanied by a dysbiosis of the commensal microbiota. The analysis of different dietary strategies to achieve CD remission and reduce gastrointestinal symptoms concludes that it is necessary to restrict the intake of ultra-processed products and to promote the consumption of those with anti-inflammatory effects that improve intestinal permeability and dysbiosis. Methods: Based on previous studies conducted in other cohorts, mainly pediatric, we propose an experimental, prospective, randomized study in patients with active CD who do not show improvement with conventional pharmacological treatment. The control group will receive standard nutritional recommendations while the intervention group will be prescribed an exclusion diet supplemented with enteral nutrition. Results: Patients in the intervention group are expected to exhibit increased lean body mass and reduced visceral fat, as measured by bioelectrical impedance analysis (BIA), alongside higher rates of clinical remission (CDAI), decreased inflammatory markers, and improved gut microbiota composition. Additionally, improvements in health-related quality of life are anticipated, as assessed by validated questionnaires. Conclusions: In the present project, we plan to conduct a detailed study to determine the potential of the exclusion diet for the treatment and remission of CD in adult patients, with the hypothesis that this nutritional intervention will be able to modify and improve intestinal dysbiosis, inflammatory status, and clinical and body composition markers in these patients. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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20 pages, 1697 KiB

Open AccessArticle

Periradicular Temperature Changes and Risk Management During Heat-Inducing Endodontic Disinfection Procedures In Vitro

by Theresia Saban, Lea Külzer, Andreas Braun and Johannes-Simon Wenzler

J. Clin. Med. 2025, 14(11), 3997; https://doi.org/10.3390/jcm14113997 - 5 Jun 2025

Viewed by 159

Abstract

Background/Objectives: The aim of this study was to investigate the effects of periodontal blood flow on the periapical region during various endodontic disinfection procedures. The hypothesis that periodontal blood flow reduces the increase in root surface temperature during disinfection procedures was tested. [...] Read more.

Background/Objectives: The aim of this study was to investigate the effects of periodontal blood flow on the periapical region during various endodontic disinfection procedures. The hypothesis that periodontal blood flow reduces the increase in root surface temperature during disinfection procedures was tested. Methods: One hundred and twenty extracted human teeth were shortened to 11 mm and the root canal was prepared using the F4 ProTaper Gold system. The specimens were covered with wax and then sealed in a thermoforming sheet, leaving a gap of 0.2 mm. Cannulas were attached to simulate stable fluid circulation. Thermographic evaluation was carried out using an infrared camera. The following methods were chosen for disinfection: I, λ445 nm diode laser (0.6 W, cw); II, λ445 nm diode laser, 3 W, pulsed, duty cycle 50%, 10 Hz; III, λ445 nm diode laser, 3 W, pulsed, duty cycle 75%, 10 Hz; IV, λ970 nm diode laser, 2 W, pulsed, duty cycle 50%, 10 Hz; V, λ970 nm diode laser, 2 W, pulsed, duty cycle 75%, 10 Hz; VI, experimental plasma device (2.5 W, 3.7 V); VII, heat plugger (200.0 °C); VIII, NaOCl 3% (60 °C). The results were analyzed statistically using the Kruskal–Wallis test. When there were significant differences between the groups (p < 0.05), the pairwise Mann–Whitney test with sequential Bonferroni correction was applied. Results: The smallest temperature changes, with a median value of 0.82 °C (max. 2.02 °C, min. 0.15 °C, IQR 0.87 °C), were observed using the laser at a setting of λ445 nm, 0.6 W cw, and a circulation rate of 6 mL/min. The highest temperature changes were measured at a fluid circulation rate of 0 mL/min with a laser setting of λ445 nm, 3 W, pulsed, duty cycle 75% with a median value of 21.7 °C (max. 25.02 °C, min. 20.29 °C, IQR 2.04 °C). Conclusions: Disinfection procedures with laser, NaOCl, and an experimental plasma device can lead to an increase in root surface temperature. With the exception of the heat plugger, no significant temperature changes were observed. This study was conducted in vitro, which may limit the direct applicability of the results to clinical scenarios. Nevertheless, the simulation of blood flow showed a thermally protective effect, suggesting that clinical protocols should consider this variable when selecting thermal disinfection methods. These results support the hypothesis that periodontal blood flow may have a potentially positive influence on temperature changes during disinfection procedures. Full article

(This article belongs to the Special Issue Current Advances in Endodontics and Dental Traumatology)

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12 pages, 576 KiB

Open AccessArticle

Validation of the Italian Version of the Visual Function and Corneal Health Status (V-FUCHS) Questionnaire: A Patient-Reported Visual Disability Instrument for Fuchs’ Endothelial Corneal Dystrophy

by Matilde Buzzi, Alberto Carnicci, Martina Maccari, Silvia Magherini, Sanjay V. Patel, Gianni Virgili, Fabrizio Giansanti and Rita Mencucci

J. Clin. Med. 2025, 14(11), 3996; https://doi.org/10.3390/jcm14113996 - 5 Jun 2025

Viewed by 177

Abstract

Background/Objectives: The Visual Function and Corneal Health Status (V-FUCHS) questionnaire assesses vision-related quality of life in patients affected by Fuchs endothelial corneal dystrophy (FECD) through 15 items, which are divided into the “visual acuity (VA) Factor” and “glare Factor” domains. The purpose [...] Read more.

Background/Objectives: The Visual Function and Corneal Health Status (V-FUCHS) questionnaire assesses vision-related quality of life in patients affected by Fuchs endothelial corneal dystrophy (FECD) through 15 items, which are divided into the “visual acuity (VA) Factor” and “glare Factor” domains. The purpose of this study was to translate and validate the Italian version of the V-FUCHS instrument. Methods: The original V-FUCHS questionnaire was translated into Italian using certified forward and backward translation methods and administered to patients with FECD undergoing a unilateral or bilateral Descemet membrane endothelial keratoplasty (DMEK) for FECD and healthy controls. Its test–retest reliability was assessed by administering the questionnaire twice, four weeks apart. Modified Krachmer grade, best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were also measured. Results: A total of 74 participants, aged 45 to 83 years, were prospectively enrolled and divided into five subgroups: mild-to-moderate FECD (n = 18), advanced FECD (n = 15), unilateral DMEK (n = 9), bilateral DMEK (n = 12), and healthy controls (n = 20). Retest reliability confirmed the consistency and agreement of their responses (intraclass correlation coefficient > 0.90 for both factors). The Italian V-FUCHS effectively discriminated between different stages of FECD severity, with significant differences in VA and glare factor scores across all subgroups (p < 0.001). While both BCVA and CCT showed correlations with V-FUCHS scores, only the association between the VA factor and BCVA was statistically significant (p < 0.05), indicating that the VA factor meaningfully reflects patients’ measured VA. Conclusions: The proposed Italian version of the V-FUCHS questionnaire is a valid and reliable tool for assessing visual disability in patients with FECD before and after DMEK. This instrument may aid in optimizing endothelial keratoplasty timings and evaluating postoperative symptomatic improvements in FECD patients. Full article

(This article belongs to the Special Issue Advancements in Cornea Transplantation)

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12 pages, 679 KiB

Open AccessArticle

Comparative Assessment of Halitosis and Oral Health-Related Quality of Life Among Children and Young Adults with Clear Aligners, Those with Lingual Orthodontics, and Non-Orthodontic Controls: A Cross-Sectional Study with Dietary Subgroup Analyses

by Hamsah Musa, Dana-Cristina Bratu, Ioana Georgiana Pașca, Malina Popa, Magda Mihaela Luca, Octavia Balean, Ramona Dumitrescu, Ruxadra Sava Rosianu, Atena Galuscan and Roxana Oancea

J. Clin. Med. 2025, 14(11), 3995; https://doi.org/10.3390/jcm14113995 - 5 Jun 2025

Viewed by 150

Abstract

Background and Objectives: Halitosis poses a clinical and psychosocial burden, particularly in orthodontic contexts where plaque retention can exacerbate odor production. This cross-sectional study aimed to compare halitosis and oral health-related quality of life (OHRQoL) in three distinct groups: patients wearing removable clear [...] Read more.

Background and Objectives: Halitosis poses a clinical and psychosocial burden, particularly in orthodontic contexts where plaque retention can exacerbate odor production. This cross-sectional study aimed to compare halitosis and oral health-related quality of life (OHRQoL) in three distinct groups: patients wearing removable clear aligners, patients with lingual orthodontic brackets, and non-orthodontic controls. We further explored dietary factors (frequent snacking vs. infrequent snacking) to identify their influence on halitosis severity and self-perceived well-being. Methods: A total of 162 participants (55 aligners, 58 lingual brackets, 49 controls) were recruited. Halitosis was assessed by the Halitosis Associated Life-Quality Test (HALT) questionnaire (range 0–100) and an organoleptic evaluation (range 0–5). OHRQoL was examined with the OHIP-14 instrument (range 0–56). Data on frequent vs. infrequent snacking were also recorded. One-way ANOVAs with Tukey’s post hoc and chi-square tests were utilized for group comparisons. Spearman’s correlation examined relationships between HALT scores, organoleptic measures, and OHIP-14. A significance threshold of p < 0.05 was adopted. Results: Aligner users demonstrated lower mean HALT scores (31.7 ± 5.8) compared to the lingual group (37.4 ± 6.2, p = 0.001) and controls (34.6 ± 6.0, p = 0.039). Lingual bracket wearers had the highest mean organoleptic score (2.4 ± 0.6, p < 0.001). Frequent snackers exhibited worse HALT outcomes (36.9 ± 6.3) than infrequent snackers (32.6 ± 5.9, p = 0.005). A correlation analysis showed a moderate positive correlation (r = +0.52, p < 0.001) between HALT and organoleptic scores and a strong negative relationship (r = –0.63, p < 0.001) between HALT and OHIP-14. Conclusions: Removable aligner use correlated with lower self-reported halitosis and better OHRQoL relative to lingual brackets. Frequent snacking appeared to aggravate halitosis across all groups. These findings emphasize the importance of tailored oral hygiene measures, dietary counseling, and orthodontic appliance selection to mitigate halitosis and enhance overall well-being. Full article

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

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14 pages, 941 KiB

Open AccessSystematic Review

Vitamin C as an Adjuvant Analgesic Therapy in Postoperative Pain Management

by Wioletta Mędrzycka-Dąbrowska, Sandra Lange, Sebastian Dąbrowski, Klaudia Długoborska and Renata Piotrkowska

J. Clin. Med. 2025, 14(11), 3994; https://doi.org/10.3390/jcm14113994 - 5 Jun 2025

Viewed by 229

Abstract

Background/Objectives: Postoperative pain occurs in approximately 80% of patients undergoing surgery. Although opioids remain the mainstay of postoperative pain management, their side effects have led to the development of multimodal analgesia strategies that aim to limit their use. Some studies have shown a [...] Read more.

Background/Objectives: Postoperative pain occurs in approximately 80% of patients undergoing surgery. Although opioids remain the mainstay of postoperative pain management, their side effects have led to the development of multimodal analgesia strategies that aim to limit their use. Some studies have shown a correlation between vitamin C supplementation and a reduction in postoperative pain. The aim of this review was to describe the effect of vitamin C administration on postoperative pain intensity and opioid consumption. Methods: A systematic review was conducted in the fourth quarter of 2024. Results: Two authors systematically searched PubMed, CINAHL, Web of Science, and Cochrane Library databases. A total of 14 studies were included in the analysis. In these studies, the visual analog scale (VAS) was most often used to assess the postoperative pain intensity. In all studies, regardless of the measurement time, a reduction in the pain intensity was demonstrated compared to control or placebo groups. The analysis showed that intraoperative or preoperative vitamin C infusion reduced opioid consumption. The administered vitamin C doses ranged from 1 g to 3 g or 50 mg/kg intravenously during the perioperative period. Conclusions: The results showed a reduction in opioid requirements and pain intensity in patients receiving perioperative vitamin C, suggesting that vitamin C can be incorporated into multimodal postoperative analgesia strategies for surgical patients. Full article

(This article belongs to the Section Anesthesiology)

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15 pages, 1539 KiB

Open AccessCommunication

High-Complexity Questions and Their Answers for Everyday Heart Failure

by Amelia Campos-Saénz de Santamaría, Javier Pérez-Santana, François Croset, Laura Karla Esterellas-Sánchez, Victoria Lobo-Antuña, Miriam Ripoll-Martínez, Sofia Russo-Botero, Henar Gómez-Sacristán, José Pérez-Silvestre, José María Fernández-Rodriguez, Marta Sánchez-Marteles, Prado Salamanca-Bautista and Jorge Rubio-Gracia

J. Clin. Med. 2025, 14(11), 3993; https://doi.org/10.3390/jcm14113993 - 5 Jun 2025

Viewed by 468

Abstract

As part of the “2nd Training Conference on Heart Failure and Atrial Fibrillation for Residents”, held in Madrid in November 2024, a collaborative initiative was launched to address the most common practical challenges in the management of heart failure (HF) in daily practice. [...] Read more.

As part of the “2nd Training Conference on Heart Failure and Atrial Fibrillation for Residents”, held in Madrid in November 2024, a collaborative initiative was launched to address the most common practical challenges in the management of heart failure (HF) in daily practice. This document is the result of the joint efforts of residents from various hospitals nationwide, in collaboration with senior physicians with extensive HF expertise and members of the Working Group of the Spanish Society of Internal Medicine. Our aim is to provide a useful tool that promotes learning and collaboration among professionals interested in this field. The structure of this document is based on a compilation of the most interesting and challenging questions raised during the conference. Each question is addressed with a concise and practical response, supported by updated references to ensure scientific rigor and facilitate consultation. Full article

(This article belongs to the Section Cardiovascular Medicine)

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10 pages, 1365 KiB

Open AccessArticle

Elastographic Histogram Analysis as a Non-Invasive Tool for Detecting Early Intestinal Remodeling in Experimental IBD

by Rareș Crăciun, Marcel Tanțău and Cristian Tefas

J. Clin. Med. 2025, 14(11), 3992; https://doi.org/10.3390/jcm14113992 - 5 Jun 2025

Viewed by 182

Abstract

Background/Objectives: Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is characterized by cycles of inflammation and tissue remodeling that can culminate in fibrosis. Differentiating between early inflammatory and fibrotic bowel wall changes remains a diagnostic challenge due to overlapping imaging [...] Read more.

Background/Objectives: Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is characterized by cycles of inflammation and tissue remodeling that can culminate in fibrosis. Differentiating between early inflammatory and fibrotic bowel wall changes remains a diagnostic challenge due to overlapping imaging features. This study aimed to assess the potential of elastography, specifically pixel histogram analysis, as a non-invasive method to identify acute inflammatory changes in a rat model of 2,4,6-trinitrobenzenesulfonic (TNBS)-induced colitis. Methods: Female CRL:Wi rats were randomized into control and experimental groups, with the latter receiving intracolonic TNBS to induce acute colitis. On day 7 post-induction, all animals underwent ultrasonographic and strain elastographic assessment of the distal colon using a standardized protocol. Histogram-based analysis of red, green, and blue pixel distributions was performed on elastographic video frames. Results were compared with histologic grading of inflammation and fibrosis using hematoxylin-eosin and Masson’s trichrome staining. Results: Rats with TNBS-induced colitis exhibited significant weight loss, increased bowel wall thickness (31.5% vs. controls, p < 0.01), and elevated elastographic pixel intensity across all color channels (p < 0.05). Histologically, experimental animals showed severe inflammation and early submucosal fibrosis. A strong positive correlation was found between elastographic histogram values and histologic fibrosis scores (r = 0.86, p < 0.01), confirming the technique’s diagnostic relevance. Conclusions: Elastographic pixel histogram analysis is a reproducible, non-invasive approach capable of distinguishing acute inflammatory changes and early fibrotic remodeling in experimental colitis. These findings support its potential application as a diagnostic adjunct in the early assessment and monitoring of IBD-related bowel wall changes. Full article

(This article belongs to the Special Issue Novel Insights into the Diagnosis and Management of Inflammatory Bowel Disease (IBD))

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17 pages, 2716 KiB

Open AccessReview

Morphological Variability and Clinical Significance of the Fibularis Tertius Muscle: An Extensive Literature Review

by Marta Pośnik, Andrzej Węgiel, Nicol Zielinska, Kacper Ruzik, Łukasz Olewnik, George Triantafyllou, Maria Piagkou and Michał Podgórski

J. Clin. Med. 2025, 14(11), 3991; https://doi.org/10.3390/jcm14113991 - 5 Jun 2025

Viewed by 153

Abstract

Background: The muscles and their tendons exhibit considerable morphological variations. While the anterior leg compartment may seem uniform, several well-documented variants of the tibialis anterior, extensor hallucis longus (EHL) and extensor digitorum longus (EDL) exist. In contrast, little is known about the fibularis [...] Read more.

Background: The muscles and their tendons exhibit considerable morphological variations. While the anterior leg compartment may seem uniform, several well-documented variants of the tibialis anterior, extensor hallucis longus (EHL) and extensor digitorum longus (EDL) exist. In contrast, little is known about the fibularis tertius muscle (FT). This literature review aims to compile existing data on the FT and its variations and assess this structure’s clinical significance. Material and Methods: This comprehensive literature review is based on scientific articles obtained from PubMed. All relevant papers were included, and citation tracking was conducted to ensure a thorough examination of the topic. Results: This detailed literature review synthesizes the latest scientific findings regarding the FT, exploring its variable morphology, functional anatomy, evolutionary significance and clinical relevance. A high morphological variability of the FT is described including its origin, insertion and accessory form. Nevertheless, the FT has been described in cadaveric studies between adults and fetuses, while few classification systems have been proposed. Conclusions: The FT is an intriguing structure that has garnered interest from researchers across various fields, including medicine, clinical practice and biological sciences. There are few clinical implications of the muscle such as FT syndrome or tendon tear. Adequate knowledge of its anatomy is of paramount importance for clinicians. Full article

(This article belongs to the Section Orthopedics)

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14 pages, 549 KiB

Open AccessArticle

The Role of VibraPlus on Fatigue in Multiple Sclerosis Patients: A Randomized Controlled Trial

by Caterina Formica, Desirée Latella, Lilla Bonanno, Antonino Lombardo Facciale, Giuseppe Paladina, Antonino Leo, Luca Pergolizzi, Bartolo Fonti, Angelo Quartarone, Roberta Cellini and Rocco Salvatore Calabrò

J. Clin. Med. 2025, 14(11), 3990; https://doi.org/10.3390/jcm14113990 - 5 Jun 2025

Viewed by 150

Abstract

Background and Objective: Fatigue represents a hallmark symptom in Multiple Sclerosis (MS), but its diagnosis and clinical evaluation is difficult because it is described as a subjective feeling of exhausted physical and mental sensation. Studies have also shown that approaches based on assisted [...] Read more.

Background and Objective: Fatigue represents a hallmark symptom in Multiple Sclerosis (MS), but its diagnosis and clinical evaluation is difficult because it is described as a subjective feeling of exhausted physical and mental sensation. Studies have also shown that approaches based on assisted therapies and robotics, as well as the use of vibration, which are used to improve sensory integration, reduce fatigue. The primary outcome in this study is to evaluate the effects of the application of focal vibrations on the reduction in fatigue, muscle strength, and endurance in MS patients with moderate disability. The secondary outcome is to assess the effects on quality of life, cognitive status, and mood. Methods: We enrolled 40 MS patients. The study was designed as a parallel randomized controlled trial: 20 patients were assigned to the experimental group (EG), who received vibration training, and 20 to the control group (CG), who received traditional physical exercise. Results: We found significant differences in the EG in fatigue, motor, and cognitive outcome and improvement of some aspects of quality of life (QoL). There are correlations between perceived multidimensional fatigue and cadence, step length, and health quality of life composite. Conclusions: Our study demonstrated the potential effectiveness of vibration training in balance, walking endurance, and reduction in the risk of falls in patients with Multiple Sclerosis. In addition, we added evidence about fatigue, non-motor outcomes, in particular promoting mental and physical QoL and individual life satisfaction. The name of the registry is clinicaltrial.gov; the number of registration id NCT05783999; and the date of registration is 14 March 2023. Full article

(This article belongs to the Special Issue Recent Advances in Rehabilitation of Patients with Multiple Sclerosis (MS))

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17 pages, 455 KiB

Open AccessReview

Advances in 3D Printing Applications for Personalized Orthopedic Surgery: From Anatomical Modeling to Patient-Specific Implants

by Marcin Prządka, Weronika Pająk, Jakub Kleinrok, Joanna Pec, Karolina Michno, Robert Karpiński and Jacek Baj

J. Clin. Med. 2025, 14(11), 3989; https://doi.org/10.3390/jcm14113989 - 5 Jun 2025

Viewed by 207

Abstract

Three-dimensional (3D) printing has gained substantial interest among scientists and surgeons over the past decade due to its broad potential in medical applications. Its clinical utility has been increasingly recognized, demonstrating promising outcomes for patient care. Currently, 3D printing technology enables surgeons to [...] Read more.

Three-dimensional (3D) printing has gained substantial interest among scientists and surgeons over the past decade due to its broad potential in medical applications. Its clinical utility has been increasingly recognized, demonstrating promising outcomes for patient care. Currently, 3D printing technology enables surgeons to enhance operative precision by facilitating the creation of patient-specific anatomical models, customized implants, biological tissues, and even surgical instruments. This personalization contributes to improved surgical outcomes, reduced operative times, and shorter postoperative recovery periods. Furthermore, 3D printing significantly aids in the customization of prostheses to conform closely to individual anatomical structures. Beyond therapeutic applications, 3D printing serves as a valuable educational tool in medical training. It enhances case-specific visualization, elucidates fracture mechanisms, and provides tangible models for simulation-based practice. Although the use of 3D printing might be seen as useful mostly in orthopedics, it has expanded into multiple medical specialties, including plastic surgery, dentistry, and emergency medicine. Presently, 3D-printed constructs are routinely employed for preoperative planning, prosthetic development, fracture management, and the fabrication of patient-specific surgical tools. Futuristically, the integration of 3D printing into clinical practice is expected to play a pivotal role in the advancement of personalized medicine, offering substantial benefits for both healthcare providers and patients. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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13 pages, 814 KiB

Open AccessArticle

Demographic and Sleep Study Factors Influencing Short-Term Adherence to Positive Airway Pressure Therapy in Obstructive Sleep Apnea

by Ji Ho Choi, Yeji Lee, Sungkyoung Shin, Tae Kyoung Ha and Sooyeon Suh

J. Clin. Med. 2025, 14(11), 3988; https://doi.org/10.3390/jcm14113988 - 5 Jun 2025

Viewed by 140

Abstract

Objective: Positive airway pressure (PAP) therapy effectively treats obstructive sleep apnea (OSA), yet adherence to the therapy presents significant challenges. This study identifies demographic and sleep study factors that influence short-term adherence to PAP therapy among patients with OSA by comparing data from [...] Read more.

Objective: Positive airway pressure (PAP) therapy effectively treats obstructive sleep apnea (OSA), yet adherence to the therapy presents significant challenges. This study identifies demographic and sleep study factors that influence short-term adherence to PAP therapy among patients with OSA by comparing data from adherent and non-adherent groups. Methods: Patients diagnosed with OSA via polysomnography who commenced PAP therapy after titration were divided into adherent and non-adherent groups. We employed propensity score matching in a 1:1 ratio based on age, gender, and body mass index (BMI), including a total of 150 patients in the analysis. Logistic regression analyses were conducted on all pertinent variables, excluding those with high multicollinearity. Non-significant variables were omitted from the final model, whose performance was evaluated using a receiver operating characteristic (ROC) curve, calculating the area under the curve (AUC). Results: Data from 150 participants (mean age 49.56 ± 14.31 years, 79% males, mean BMI 28.96 ± 5.11) were analyzed. Significant predictors of adherence included smoking status (odds ratio [OR] 0.267; 95% confidence interval [CI], 0.116–0.580; p = 0.001), Epworth sleepiness scale (OR 1.080; 95% CI, 1.004–1.166; p = 0.042), oxygen desaturation index (ODI) during titration (OR 0.906; 95% CI, 0.829–0.975, p = 0.015), and optimal PAP levels (OR 1.240; 95% CI, 1.007–1.119; p = 0.029). The ROC curve analysis indicated an AUC of 0.765, confirming the model’s effectiveness in distinguishing between adherent and non-adherent patients. Conclusions: Adherence is negatively affected by smoking, whereas higher daytime sleepiness, optimal PAP levels, and a lower ODI during titration are associated with better adherence, underscoring the importance of personalized treatment approaches. Full article

(This article belongs to the Special Issue Clinical Advances in Obstructive Sleep Apnea)

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23 pages, 683 KiB

Open AccessReview

Endometriosis and Nutrition: Therapeutic Perspectives

by Francesco Giuseppe Martire, Eugenia Costantini, Claudia d’Abate, Giovanni Capria, Emilio Piccione and Angela Andreoli

J. Clin. Med. 2025, 14(11), 3987; https://doi.org/10.3390/jcm14113987 - 5 Jun 2025

Viewed by 187

Abstract

Endometriosis is a chronic, hormone-dependent disorder characterized by an inflammatory response. The disease affects approximately 10% of the general female population, with prevalence rates reaching 30–40% in women with dysmenorrhea and 50–60% in those experiencing infertility. In addition to pelvic pain and reproductive [...] Read more.

Endometriosis is a chronic, hormone-dependent disorder characterized by an inflammatory response. The disease affects approximately 10% of the general female population, with prevalence rates reaching 30–40% in women with dysmenorrhea and 50–60% in those experiencing infertility. In addition to pelvic pain and reproductive issues, gastrointestinal symptoms, such as acute abdominal pain, constipation, diarrhea, or alternating bowel habits, are frequently reported and can be highly disabling. Emerging evidence indicates that dietary patterns may modulate the inflammatory environment associated with endometriosis, potentially influencing symptom severity by affecting oxidative stress, estrogen metabolism, and levels of sex hormone-binding globulin (SHBG). Diets rich in antioxidants, polyunsaturated fatty acids (PUFAs), and vitamins D, C, and E—alongside the avoidance of processed foods, red meat, and animal fats—may offer beneficial effects. This narrative review explores the relationship between nutrition and endometriosis, emphasizing the therapeutic potential of dietary interventions as a complementary strategy. Notably, dietary approaches may serve not only to alleviate pain and improve fertility outcomes but also to reduce lesion growth and recurrence, particularly in patients seeking pregnancy or those unable to undergo hormonal therapy due to contraindications. Furthermore, nutritional strategies may enhance postoperative recovery and act as a viable first-line therapy when conventional treatments are not applicable. A total of 250 studies were initially identified through PubMed and Scopus. After removing duplicates and non-relevant articles, 174 were included in this review. Our findings underscore the urgent need for further studies to develop evidence-based, personalized nutritional interventions for managing endometriosis-related symptoms. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 586 KiB

Open AccessReview

Congenital Rubella Syndrome in the Post-Elimination Era: Why Vigilance Remains Essential

by Livian Cássia De Melo, Marina Macruz Rugna, Talita Almeida Durães, Stefany Silva Pereira, Gustavo Yano Callado, Pedro Pires, Evelyn Traina, Edward Araujo Júnior and Roberta Granese

J. Clin. Med. 2025, 14(11), 3986; https://doi.org/10.3390/jcm14113986 - 5 Jun 2025

Viewed by 160

Abstract

Congenital Rubella Syndrome (CRS) results from maternal infection with the rubella virus during pregnancy, particularly in the first trimester, when the risk of vertical transmission and severe fetal damage is highest. CRS is characterized by a broad spectrum of congenital anomalies, including sensorineural [...] Read more.

Congenital Rubella Syndrome (CRS) results from maternal infection with the rubella virus during pregnancy, particularly in the first trimester, when the risk of vertical transmission and severe fetal damage is highest. CRS is characterized by a broad spectrum of congenital anomalies, including sensorineural hearing loss, congenital heart defects, cataracts, neurodevelopmental delay, and behavioral disorders. Despite the absence of specific antiviral therapies, active immunization remains the only effective strategy to prevent rubella infection and its congenital consequences. Global immunization efforts, particularly in the Americas, have led to the elimination of rubella and CRS in several countries. However, challenges persist in the post-elimination era, including declining vaccine coverage, vaccine hesitancy, and setbacks caused by the COVID-19 pandemic. Diagnosis relies on maternal serology, fetal imaging, postnatal antibody testing, and molecular techniques. Management requires long-term, multidisciplinary follow-up due to the complex and lifelong sequelae affecting sensory, motor, and cognitive development. This review highlights the clinical, epidemiological, and pathophysiological aspects of CRS, while emphasizing the urgent need to maintain high vaccination coverage and strengthen surveillance systems. Sustained public health commitment is essential to prevent the reemergence of rubella and protect future generations from this preventable syndrome. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 615 KiB

Open AccessReview

Treatment of Benign Pigmented Lesions Using Lasers: A Scoping Review

by Aurore D. Zhang, Janelle Clovie, Michelle Lazar and Neelam A. Vashi

J. Clin. Med. 2025, 14(11), 3985; https://doi.org/10.3390/jcm14113985 - 5 Jun 2025

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Abstract

Lasers are widely employed in the treatment of melanocytic lesions. This scoping review evaluates 77 studies on the efficacy and safety of laser treatments for café-au-lait macules (CALMs), nevus of Ota (NOA), Becker’s nevus (BN), lichen planus pigmentosus (LPP), and other pigmented lesions. [...] Read more.

Lasers are widely employed in the treatment of melanocytic lesions. This scoping review evaluates 77 studies on the efficacy and safety of laser treatments for café-au-lait macules (CALMs), nevus of Ota (NOA), Becker’s nevus (BN), lichen planus pigmentosus (LPP), and other pigmented lesions. The Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG), particularly the 1064 nm, is the most frequently utilized laser, demonstrating strong efficacy for NOA and other dermal pigmentary disorders. Medium-wavelength lasers, including the Q-switched ruby and Alexandrite lasers, also show promise, though results vary based on lesion depth, skin type, and treatment protocols. Recurrence and adverse effects, including post-inflammatory hyperpigmentation (PIH) and hypopigmentation, are common, particularly in patients with darker skin tones. Future studies should standardize and optimize laser parameters across lesion types and skin tones, improve long-term efficacy, and prioritize inclusion of patients with diverse Fitzpatrick skin types to evaluate differential outcomes and promote equitable treatment efficacy. Full article

(This article belongs to the Special Issue Facial Plastic and Cosmetic Medicine)

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13 pages, 851 KiB

Open AccessArticle

Antiplatelet Treatment Strategy in MINOCA Patients: Predictors of Decision Making in Clinical Practice and Prognostic Implications

by Emmanouil Mantzouranis, Ioannis Leontsinis, Panayotis K. Vlachakis, Constantinos Mihas, Panagiotis Iliakis, Eirini Dri, Athanasios Sakalidis, Stergios Soulaidopoulos, Christos Fragoulis, Anastasios Milkas, Eleftherios Tsiamis, Dimitrios Tsiachris, Kyriakos Dimitriadis and Konstantinos Tsioufis

J. Clin. Med. 2025, 14(11), 3984; https://doi.org/10.3390/jcm14113984 - 5 Jun 2025

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Abstract

Background/Objectives: Large clinical trials have established the optimal antiplatelet strategy in the wide spectrum of coronary artery disease. However, data are scarce regarding MINOCA and the aim of our study is to present data from the current clinical practice. Methods: A total [...] Read more.

Background/Objectives: Large clinical trials have established the optimal antiplatelet strategy in the wide spectrum of coronary artery disease. However, data are scarce regarding MINOCA and the aim of our study is to present data from the current clinical practice. Methods: A total of 151 patients were included in this study after exclusion of 27 patients with myocarditis and other diagnoses. A cardiac magnetic resonance (CMR) performed at 123/151 patients demonstrated an ischemic pattern of late gadolinium enhancement (LGE) confirming the diagnosis of true acute myocardial infarction (AMI) in 42 cases (28%). Based on multimodality imaging and clinical judgement, Takotsubo syndrome (TTS) was diagnosed in 55 patients (36%), whereas CMR failed to reveal abnormal findings in 54 cases (36%), categorized as MINOCA of unknown origin. Results: Regarding antithrombotic prescriptions at discharge, 38% of patients received dual antiplatelet (DAPT) or dual antithrombotic therapy (DAT, 1 antiplatelet plus 1 anticoagulant), 49.7% received single antiplatelet (SAPT) or anticoagulant, and 12% received no antithrombotic treatment. Univariate analysis showed that the likelihood of prescribing DAPT or DAT was associated with left ventricular ejection fraction (LVEF) (r = 0.202, p = 0.013), atherosclerotic lesions on coronary angiography (r = 0.303, p < 0.001), prior use of anticoagulants (r = −0.258, p = 0.001), and marginally with the INTERTAK score (r = −0.198, p = 0.044). A multivariable model, adjusted for age, LVEF, ECG abnormalities, and history of anticoagulant use, confirmed the independent association between angiographic evidence of atherosclerosis and the decision for DAPT/DAT (OR: 0.334, 95% CI: 0.307–0.813, p < 0.001). However, the initial treatment decision did not seem to impact 2-year prognosis in our population. Conclusions: Our study results reveal that decision making in the antithrombotic strategy for MINOCA patients poses a challenge in clinical practice. More robust data are required for definite conclusions on the prognostic implications. Full article

(This article belongs to the Special Issue Advances in Anticoagulant and Antiplatelet Therapy for Coronary Artery Disease)

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32 pages, 1222 KiB

Open AccessReview

Platelet-Rich Plasma for Knee Osteoarthritis: A Comprehensive Narrative Review of the Mechanisms, Preparation Protocols, and Clinical Evidence

by Wojciech Michał Glinkowski, Grzegorz Gut and Dariusz Śladowski

J. Clin. Med. 2025, 14(11), 3983; https://doi.org/10.3390/jcm14113983 - 5 Jun 2025

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Abstract

Background: Platelet-rich plasma (PRP) is increasingly utilized for managing knee osteoarthritis (KOA), yet its clinical value remains debated due to the variability in preparation protocols and outcome measures. Methods: This narrative review synthesizes current evidence from 40 high-quality studies published between 2013 and [...] Read more.

Background: Platelet-rich plasma (PRP) is increasingly utilized for managing knee osteoarthritis (KOA), yet its clinical value remains debated due to the variability in preparation protocols and outcome measures. Methods: This narrative review synthesizes current evidence from 40 high-quality studies published between 2013 and March 2025, including randomized controlled trials, systematic reviews, and meta-analyses. The biological mechanisms, clinical effectiveness, safety, and implementation challenges of PRP therapy in KOA are examined. Results: PRP injections—particularly leukocyte-poor PRP—demonstrate superior pain relief and functional improvement compared to hyaluronic acid and corticosteroids, especially in patients with mild to moderate KOA (Kellgren–Lawrence grades I–III). However, heterogeneity in PRP formulations (platelet/leukocyte content and activation protocols), injection regimens, and follow-up durations limits direct comparability across studies. Evidence from high-quality placebo-controlled trials shows inconsistent long-term benefits, with some failing to demonstrate superiority over saline beyond 6–12 months. The GRADE assessment rates the overall certainty of evidence as moderate. PRP appears safe, with few adverse events reported, but remains costly and variably reimbursed. Guidelines from major societies remain cautious or inconclusive. Conclusions: PRP is a promising, safe, and well-tolerated option for early to moderate KOA. However, the standardization of preparation protocols, patient selection criteria, and outcome reporting is essential to improve comparability and guide clinical practice. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 1176 KiB

Open AccessArticle

Clinically Important Decrease in Liver Stiffness Following Treatment for Hepatitis C: Outcome of the TraP HepC Nationwide Elimination Program

by Smári Freyr Kristjánsson, Sigurdur Olafsson, Magnús Gottfredsson, Thorvardur Jon Love and Einar Stefán Björnsson

J. Clin. Med. 2025, 14(11), 3982; https://doi.org/10.3390/jcm14113982 - 5 Jun 2025

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Abstract

Background/Objectives: Direct-acting antiviral (DAA) therapy has been highly successful in treating chronic hepatitis C (CHC). The nationwide Treatment as Prevention of Hepatitis C (TraP HepC) initiative that was launched in Iceland in 2016 utilized liver stiffness measurements (LSM) to assess liver fibrosis at [...] Read more.

Background/Objectives: Direct-acting antiviral (DAA) therapy has been highly successful in treating chronic hepatitis C (CHC). The nationwide Treatment as Prevention of Hepatitis C (TraP HepC) initiative that was launched in Iceland in 2016 utilized liver stiffness measurements (LSM) to assess liver fibrosis at baseline and follow-up. We aimed to determine changes in liver stiffness among patients following treatment with DAAs and evaluate risk factors associated with hepatic fibrosis. Methods: Eligible CHC patients with liver stiffness of >9.5 kilopascals (kPa) before DAA treatment were invited for a follow-up visit in 2024. Risk factors for cirrhosis were registered, LSM performed, and liver enzymes, blood lipids, and glucose levels measured. Changes in liver stiffness were compared to baseline measurements, and correlations with risk factors were analyzed. Results: A total of 96 patients had LSMs > 9.5 kPa at treatment initiation. During the follow-up period, 61 were eligible for participation, 38 consented, and 34 (35%) died. The total follow-up was 258.3 person-years. The median follow-up period between measurements was 7.1 years. The median liver stiffness decreased from 17.2 kPa to 7.3 kPa (p < 0.01), and 80% of those with cirrhosis (>12.5 kPa) regressed to non-cirrhotic values. High BMI and daily alcohol consumption were significantly associated with increased liver stiffness in 8% of patients. Conclusions: In this single-arm, pre-post pilot study, liver stiffness regressed significantly in 92% of patients who were cured of CHC. Patients with other persistent risk factors following cure, such as obesity and alcohol abuse, were the only patients who had increased liver stiffness at the end of follow-up. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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J. Clin. Med., Volume 14, Issue 11 (June-1 2025) – 396 articles

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