Journal of Clinical Medicine

11 pages, 813 KiB

Open AccessArticle

Impact of Transcatheter Edge-to-Edge Repair on Tricuspid Annular Remodeling in Patients with Tricuspid Regurgitation

by Maddalena Widmann, Roberto Nerla, Fausto Castriota, Andrea Fisicaro, Valeria Maria De Luca, Gabriele Pesarini, Flavio Luciano Ribichini and Angelo Squeri

J. Clin. Med. 2025, 14(15), 5606; https://doi.org/10.3390/jcm14155606 - 7 Aug 2025

Viewed by 319

Abstract

Background: In recent years, multiple transcatheter devices have been developed for tricuspid valve intervention. The aim of this study was to evaluate acute tricuspid annular remodeling following percutaneous leaflet repair using a leaflet approximation device for the reduction of tricuspid regurgitation (TR). Methods: [...] Read more.

Background: In recent years, multiple transcatheter devices have been developed for tricuspid valve intervention. The aim of this study was to evaluate acute tricuspid annular remodeling following percutaneous leaflet repair using a leaflet approximation device for the reduction of tricuspid regurgitation (TR). Methods: This retrospective cohort study included 26 consecutive patients treated at two centers. Tricuspid annular geometry was assessed using three-dimensional transesophageal echocardiography during the procedure. Results: The mean age of the cohort was 79.3 years, and 88.5% were female. All patients had severe or greater TR pre-procedure, mostly due to annular dilation. The procedure was successful in all cases, with at least a one-grade reduction in TR observed prior to hospital discharge. Significant reductions were observed in the mean septal-lateral diameter (4.09 ± 0.44 cm vs. 3.54 ± 0.53 cm, p < 0.0001), mean major diameter (4.65 ± 0.63 cm vs. 4.28 ± 0.65 cm, p = 0.0002), planimetric area (14.00 ± 2.91 cm² vs. 11.25 ± 2.91 cm², p < 0.0001), and perimeter (13.62 ± 1.43 cm vs. 12.42 ± 1.62 cm, p < 0.0001) of the tricuspid annulus. Conclusions: In this small real-world cohort, transcatheter edge-to-edge repair was found to be both effective and safe. The use of a leaflet approximation device not only reduced TR severity but also led to significant reductions in annular dimensions. To our knowledge, this study provides additional evidence of acute tricuspid annulus remodeling following edge-to-edge repair, which may have significant therapeutic implications. Full article

(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques—2nd Edition)

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19 pages, 23946 KiB

Open AccessArticle

Biomarkers of Inflammation and Radiographic Progression in Axial Spondyloarthritis: A Clinical Evaluation of Leptin, Adiponectin, TNF-α, and IL-17A

by Alexandra-Diana Diaconu, Laurențiu Șorodoc, Cristina Pomîrleanu, Liliana Georgeta Foia, Victorița Șorodoc, Cătălina Lionte, Mara Russu, Vladia Lăpuște, Larisa Ghemiș and Codrina Ancuța

J. Clin. Med. 2025, 14(15), 5605; https://doi.org/10.3390/jcm14155605 - 7 Aug 2025

Viewed by 326

Abstract

Background/Objectives: Axial spondyloarthritis (axSpA) is a chronic immune-mediated inflammatory disorder affecting the spine and sacroiliac joints, with variable clinical expression. This study assessed serum levels of inflammatory (TNF-α, IL-17A) and metabolic (leptin, adiponectin) biomarkers and their associations with disease activity, inflammation, structural [...] Read more.

Background/Objectives: Axial spondyloarthritis (axSpA) is a chronic immune-mediated inflammatory disorder affecting the spine and sacroiliac joints, with variable clinical expression. This study assessed serum levels of inflammatory (TNF-α, IL-17A) and metabolic (leptin, adiponectin) biomarkers and their associations with disease activity, inflammation, structural damage, and comorbidities. Methods: This prospective cross-sectional study assessed 89 axSpA patients using clinical, laboratory, and radiological evaluations. Disease activity was measured using ASDAS-CRP and BASDAI scores. Radiographic damage was quantified using the Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). Serum concentrations of TNF-α, IL-17A, leptin, and adiponectin were quantified by enzyme-linked immunosorbent assay (ELISA). Clinical and imaging correlations were analyzed. Results: Serum leptin levels correlated significantly with higher disease activity scores, inflammatory markers (CRP, ESR), radiographic progression (syndesmophyte formation, mSASSS), and arterial hypertension. Adiponectin levels were inversely associated with disease activity, structural damage, and arterial hypertension, suggesting anti-inflammatory, bone- and cardio-protective properties. TNF-α levels showed an association with inflammatory markers and were higher in patients with peripheral enthesitis. IL-17A levels were weakly correlated with disease activity and structural severity and were significantly lower in patients with a history of anterior uveitis. Conclusions: Leptin and adiponectin may serve as complementary biomarkers in axSpA, reflecting both inflammatory burden and structural damage. While TNF-α and IL-17A remain key therapeutic targets, their correlation with structural changes appears limited. Biomarker profiling could support personalized disease monitoring. Longitudinal studies are needed to validate prognostic implications. Full article

(This article belongs to the Section Immunology)

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16 pages, 1082 KiB

Open AccessArticle

Endoscopic Verification of Transpapillary Access in Supine Percutaneous Nephrolithotomy: A Prospective Pilot Study Comparing Freehand Ultrasound and Fluoroscopy Guidance

by Fatih Bicaklioglu and Bilal Eryildirim

J. Clin. Med. 2025, 14(15), 5604; https://doi.org/10.3390/jcm14155604 - 7 Aug 2025

Viewed by 267

Abstract

Background/Objectives: Achieving renal access is a key step in percutaneous nephrolithotomy (PNL), with transpapillary access considered the safest anatomical approach. This prospective pilot study aimed to compare the effectiveness of freehand ultrasound-guided (F-UG) versus fluoroscopy-guided (FG) punctures in achieving anatomically accurate transpapillary [...] Read more.

Background/Objectives: Achieving renal access is a key step in percutaneous nephrolithotomy (PNL), with transpapillary access considered the safest anatomical approach. This prospective pilot study aimed to compare the effectiveness of freehand ultrasound-guided (F-UG) versus fluoroscopy-guided (FG) punctures in achieving anatomically accurate transpapillary access during supine PNL, confirmed by endoscopic visualization. Perioperative and postoperative outcomes were also evaluated. Methods: Forty-three patients undergoing supine PNL for renal pelvic or lower calyceal stones were prospectively enrolled and assigned to either the FG group (n = 23) or F-UG group (n = 20). Following renal access, intraoperative flexible ureteroscopy confirmed the anatomical nature of the puncture (transpapillary vs. nonpapillary). The puncture time, fluoroscopy time, operative time, complications (Clavien–Dindo classification), transfusion requirement, hospital stay, and one-month stone-free rates were recorded. Results: Transpapillary access was achieved in 95.7% of FG cases and 55.0% of F-UG cases (p = 0.003). Radiation exposure was significantly lower in the F-UG group (p < 0.001). Complication (15.0% vs. 0.0%) and transfusion rates (10.0% vs. 0.0%) were higher in the F-UG group but not statistically significant (p = 0.092 and p = 0.210, respectively). Other outcomes, including the operative time, hospital stay, and stone-free rates, were similar between groups. Conclusions: FG puncture is more effective for achieving transpapillary access, while F-UG significantly reduces radiation exposure. The endoscopic confirmation method may provide a reference for future comparative studies on access techniques in PNL. Full article

(This article belongs to the Special Issue New Challenges in Urolithiasis)

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17 pages, 1252 KiB

Open AccessReview

Interdisciplinary Perspectives on Dentistry and Sleep Medicine: A Narrative Review of Sleep Apnea and Oral Health

by Ramona Cioboata, Mara Amalia Balteanu, Denisa Maria Mitroi, Oana Maria Catana, Maria-Loredana Tieranu, Silviu Gabriel Vlasceanu, Eugen Nicolae Tieranu, Viorel Biciusca and Adina Andreea Mirea

J. Clin. Med. 2025, 14(15), 5603; https://doi.org/10.3390/jcm14155603 - 7 Aug 2025

Viewed by 244

Abstract

Obstructive sleep apnea syndrome (OSAS) is a prevalent disorder with significant systemic and oral health consequences. This narrative review synthesizes the current knowledge on the interplay between dental health and sleep apnea, highlighting the expanding role of dentists in the screening, early detection, [...] Read more.

Obstructive sleep apnea syndrome (OSAS) is a prevalent disorder with significant systemic and oral health consequences. This narrative review synthesizes the current knowledge on the interplay between dental health and sleep apnea, highlighting the expanding role of dentists in the screening, early detection, and management of OSAS. Validated questionnaires, anatomical assessments, and anthropometric measurements have enhanced dentists’ capacity for early screening. However, knowledge and training gaps remain, particularly in low- and middle-income countries. Dentists are uniquely positioned to identify anatomical and oral risk factors, facilitate referrals for diagnosis, and provide therapeutic interventions such as oral appliance therapy. Interdisciplinary collaboration between dental and medical professionals is essential to improve early detection, treatment outcomes, and patient quality of life. Enhancing education, standardizing protocols, and integrating dentists into multidisciplinary care pathways are critical steps for advancing the management of sleep apnea. Full article

(This article belongs to the Section Otolaryngology)

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18 pages, 922 KiB

Open AccessArticle

Steady Quiet Asthma Without Biologics: One-Year Outcomes of Single-Inhaler Triple Therapy for Severe Asthma with Small Airway Dysfunction

by Vitaliano Nicola Quaranta, Francesca Montagnolo, Andrea Portacci, Silvano Dragonieri, Maria Granito, Gennaro Rociola, Santina Ferrulli, Leonardo Maselli and Giovanna Elisiana Carpagnano

J. Clin. Med. 2025, 14(15), 5602; https://doi.org/10.3390/jcm14155602 - 7 Aug 2025

Viewed by 229

Abstract

Background: Small airway dysfunction (SAD) plays a critical role in the management of severe asthma, particularly in patients at risk of requiring biological therapies (BTs). Short-term studies have shown that switching to single-inhaler triple therapy (SITT) with extrafine beclomethasone–formoterol–glycopyrronium improves outcomes and helps [...] Read more.

Background: Small airway dysfunction (SAD) plays a critical role in the management of severe asthma, particularly in patients at risk of requiring biological therapies (BTs). Short-term studies have shown that switching to single-inhaler triple therapy (SITT) with extrafine beclomethasone–formoterol–glycopyrronium improves outcomes and helps achieve quiet asthma, a state marked by symptom control, no exacerbations or oral steroids, reduced inflammation, and better small airway function. This study investigated whether, over one year, patients could maintain this state as Steady Quiet Asthma (SQA) and whether baseline measures could predict this sustained response. Methods: Twenty-six patients with severe asthma and SAD were transitioned from open triple-inhaler therapy to a closed, single-inhaler triple therapy containing extrafine beclomethasone–formoterol–glycopyrronium. Assessments at baseline (T0) and at one-year follow-up (T12) included clinical evaluations, spirometry, and impulse oscillometry, with a focus on Fres as a predictor for the need for BT. When prescribed, biologic therapies included mepolizumab, benralizumab, and dupilumab. Results: Of the 26 patients, 9 (34.6%) achieved SQA and did not require biologic therapy at the one-year follow-up, while 17 patients (65.4%) initiated biologic treatment. At T0, patients who required biologics had significantly higher median Fres (21 (19.47; 24.58) vs. 17.61 (15.82; 20.63); p = 0.049) compared to those who remained biologic-free. They also exhibited higher residual volume to total lung capacity ratio (%RV/TLC) values and lower forced expiratory volume in one second/forced vital capacity ratios (FEV₁/FVC). At T12, patients spared from BT showed significant reductions in Fres (p = 0.014) and improvements in small airway function (difference in airway resistance between 5 Hz and 20 Hz (R5–20), forced expiratory flow between 25% and 75% of FVC (%FEF25–75), and better asthma control (ACT). In contrast, patients on BT demonstrated less favorable changes in these parameters. Conclusions: Baseline Fres, FEV1/FVC ratio, and %FEV25–75 are valuable predictors of achieving Steady Quiet Asthma (SQA) and sparing biologic therapy. These findings support the use of SITT in severe asthma and highlight the importance of early functional assessments to guide personalized management. Full article

(This article belongs to the Special Issue Advances in Allergic Diseases and Asthma: Clinical Insights and Emerging Therapies)

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12 pages, 582 KiB

Open AccessArticle

Changes in Retinal Nerve Fiber and Ganglion Cell Layers After Chemical Injury: A Prospective Study

by Justina Skruodyte, Justina Olechnovic and Pranas Serpytis

J. Clin. Med. 2025, 14(15), 5601; https://doi.org/10.3390/jcm14155601 - 7 Aug 2025

Viewed by 222

Abstract

Background: Chemical eye burns are a serious ophthalmic emergency that can lead to permanent vision loss in severe cases. This study aims to evaluate structural changes in the posterior segment of the eye in individuals who have experienced chemical burns. Methods: The study [...] Read more.

Background: Chemical eye burns are a serious ophthalmic emergency that can lead to permanent vision loss in severe cases. This study aims to evaluate structural changes in the posterior segment of the eye in individuals who have experienced chemical burns. Methods: The study included 64 eyes from 54 patients with chemical burns (chemical burn group) and 87 healthy eyes from 87 subjects (control group), matched by age and sex. Patients had confirmed burns with limbal ischemia, no glaucoma, normal intraocular pressure, and no major ocular or systemic diseases. Burned eyes were examined during the acute phase and again at 3 months, with some followed up at 6 months if significant retinal asymmetry was detected. Retinal nerve fiber layer (RNFL) thickness was assessed in four quadrants, and ganglion cell complex (GCL++) thickness was analyzed using automated segmentation of optical coherence tomography (OCT) maps. Results: This study compared measurements between the burn group, the control group, and timepoints. OCT analysis revealed no significant difference in total RNFL thickness between burn patients and controls (mean difference: −1.14 µm, 95% CI: −3.92 to 1.64). Similarly, GCL++ thickness did not differ significantly between groups (mean difference: −0.97 µm, 95% CI: −3.31 to 1.37). At 6-month follow-up, a non-significant decline in both RNFL and GCL++ thicknesses was observed. Logistic regression identified higher Dua grade as an independent predictor of RNFL thinning (OR: 4.816, 95% CI: 1.103–21.030; p = 0.037). Patients with severe ocular chemical burns (Dua grade ≥ 3) demonstrated reduced RNFL thickness in all quadrants compared to healthy controls. The most pronounced reductions were observed in the nasal and superior quadrants (p = 0.007 and p = 0.069, respectively); however, after applying Bonferroni correction for multiple comparisons, only the difference in the nasal quadrant remained statistically significant (adjusted p = 0.035). Conclusions: Although overall RNFL and GCL++ thicknesses did not differ significantly between burn patients and healthy controls, patients with severe ocular chemical burns (Dua grade ≥ 3) showed a significant reduction in RNFL thickness, in the nasal quadrant. Higher Dua grade was identified as an independent predictor of RNFL thinning. These findings suggest a potential association between burn severity and posterior segment changes, highlighting the need for further longitudinal studies with larger cohorts. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 333 KiB

Open AccessReview

Atrial Fibrillation and Cancer: Pathophysiological Mechanism and Clinical Implications

by Alfredo Mauriello, Adriana Correra, Vincenzo Quagliariello, Martina Iovine, Pierpaolo Di Micco, Egidio Imbalzano, Francesco Giallauria, Antonio Giordano, Vincenzo Russo, Antonello D’Andrea and Nicola Maurea

J. Clin. Med. 2025, 14(15), 5600; https://doi.org/10.3390/jcm14155600 - 7 Aug 2025

Viewed by 313

Abstract

Atrial fibrillation is the most frequent arrhythmia in elderly subjects. Cancer currently represents one of the most important causes of mortality and morbidity in the world. Often, the two pathologies coexist. Several pathophysiological mechanisms can lead to an increased risk of atrial fibrillation [...] Read more.

Atrial fibrillation is the most frequent arrhythmia in elderly subjects. Cancer currently represents one of the most important causes of mortality and morbidity in the world. Often, the two pathologies coexist. Several pathophysiological mechanisms can lead to an increased risk of atrial fibrillation and cancer. Additionally, the same therapies used for cancer can increase the risk of developing atrial fibrillation. Our review aims to describe the pathophysiological mechanisms that promote the development of atrial fibrillation in cancer patients and explain the therapeutic opportunities and challenges of treating atrial fibrillation in patients with cancer. Full article

(This article belongs to the Special Issue Atrial Fibrillation Rhythm Management: Outcomes, Innovations, and Future Directions)

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9 pages, 676 KiB

Open AccessArticle

Do All Fractures in the Ankylotic Spine Really Require Surgical Intervention?

by Moshe Stavsky, Elad Harats, Ahmad Sharabati, Amjad Hamad, Harel Arzi, Bilal Qutteineh and Yair Barzilay

J. Clin. Med. 2025, 14(15), 5599; https://doi.org/10.3390/jcm14155599 - 7 Aug 2025

Viewed by 226

Abstract

Background: Patients with ankylotic spines suffering from vertebral column fractures are frequently operated on to maintain spinal stability and prevent secondary displacement and nerve damage. The aim of this study was to identify a subset of patients that may be treated non-operatively, [...] Read more.

Background: Patients with ankylotic spines suffering from vertebral column fractures are frequently operated on to maintain spinal stability and prevent secondary displacement and nerve damage. The aim of this study was to identify a subset of patients that may be treated non-operatively, thus avoiding operative complications in this group of patients. Methods: Extension-type injuries in patients with DISH (diffuse idiopathic skeletal hyperostosis) not involving the posterior elements of the spine comprised the study group. Results: Twenty two extension fractures occurred in 21 patients with DISH in SZMC (Shaare Zedek Medical Cente) between 2014–2025. All patients were treated non-operatively. Patients were allowed free mobilization, and no orthosis was used. The only limitation was keeping the bed inclined to 20–30 degrees to prevent extension at the fracture site. All fractures healed uneventfully, and no patient required late surgical intervention, and no neurological complications were noted. Conclusions: Patients with DISH who sustain extension-type injuries of the thoracolumbar spine, with no involvement of the posterior elements, may be treated non-operatively, with good results. Full article

(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases: 2nd Edition)

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13 pages, 280 KiB

Open AccessReview

Integrating Peripheral Nerve Blocks in Multiple Trauma Care: Current Evidence and Clinical Challenges

by Liliana Mirea, Ana-Maria Dumitriu, Cristian Cobilinschi, Răzvan Ene and Raluca Ungureanu

J. Clin. Med. 2025, 14(15), 5598; https://doi.org/10.3390/jcm14155598 - 7 Aug 2025

Viewed by 252

Abstract

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their [...] Read more.

Pain management in multiple trauma patients presents a complex clinical challenge due to competing priorities such as hemodynamic instability, polypharmacy, coagulopathy, and the urgency of life-saving interventions. In this context, peripheral nerve blocks (PNBs) are increasingly recognized as a valuable asset for their role in managing pain in patients with multiple traumatic injuries. By reducing reliance on systemic opioids, PNBs support effective pain control and facilitate early mobilization, aligning with enhanced recovery principles. This narrative review summarizes current evidence on the use of PNBs in the context of polytrauma, focusing on their analgesic efficacy, integration within multimodal analgesia protocols, and contribution to improved functional outcomes. Despite these advantages, clinical application is limited by specific concerns, including the potential to mask compartment syndrome, the risk of nerve injury or local anesthetic systemic toxicity (LAST), and logistical barriers in acute trauma settings. Emerging directions in the field include the refinement of ultrasound-guided PNB techniques, the expanded use of continuous catheter systems, and the incorporation of fascial plane blocks for anatomically complex or multisite trauma. Parallel efforts are focusing on the development of decision-making algorithms, improved risk stratification tools, and integration into multimodal analgesic pathways. There is also growing emphasis on standardized clinical protocols, simulation-based training, and patient education to enhance safety and consistency in practice. As evidence continues to evolve, the long-term impact of PNBs on functional recovery, quality of life, and healthcare utilization must be further explored. With thoughtful implementation, structured training, and institutional support, PNBs may evolve into a cornerstone of modern trauma analgesia. Full article

(This article belongs to the Special Issue Anesthesia and Intensive Care in Orthopedic and Trauma Surgery)

21 pages, 1290 KiB

Open AccessFeature PaperReview

GLP-1 Receptor Agonists and Gastrointestinal Endoscopy: A Narrative Review of Risks, Management Strategies, and the Need for Clinical Consensus

by Javier Crespo, Juan Carlos Rodríguez-Duque, Paula Iruzubieta, Eliana C. Morel Cerda and Jose Antonio Velarde-Ruiz Velasco

J. Clin. Med. 2025, 14(15), 5597; https://doi.org/10.3390/jcm14155597 - 7 Aug 2025

Viewed by 347

Abstract

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes mellitus and obesity. However, their sustained effect on delaying gastric emptying raises new challenges in gastrointestinal endoscopy performed under sedation. This narrative review aims to summarize current [...] Read more.

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes mellitus and obesity. However, their sustained effect on delaying gastric emptying raises new challenges in gastrointestinal endoscopy performed under sedation. This narrative review aims to summarize current evidence on the impact of GLP-1 RAs on gastric motility and to propose clinical strategies to mitigate associated procedural risks. Methods: A narrative review was conducted integrating findings from scintigraphy, capsule endoscopy, gastric ultrasound, and existing clinical guidelines. Emphasis was placed on studies reporting residual gastric content (RGC), anesthetic safety outcomes, and procedural feasibility in patients undergoing endoscopy while treated with GLP-1 RAs. Results: GLP-1 RAs significantly increase the prevalence of clinically relevant RGC, despite prolonged fasting, with potential implications for airway protection and sedation safety. Although the risk of pulmonary aspiration remains low (≤0.15%), procedural delays, modifications, or cancellations can occur in up to 30% of cases without adapted protocols. Several professional societies (AGA, ASGE, AASLD) advocate for individualized management based on procedure type, symptomatology, treatment phase, and point-of-care gastric ultrasound (POCUS), in contrast to the systematic discontinuation recommended by the ASA. Conclusions: Effective management requires personalized fasting protocols, risk-based stratification, tailored anesthetic approaches, and interprofessional coordination. We propose a clinical decision algorithm and highlight the need for training in gastrointestinal pharmacology, POCUS, and airway management for endoscopists. Future priorities include prospective validation of clinical algorithms, safety outcome studies, and the development of intersocietal consensus guidelines. Full article

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

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11 pages, 227 KiB

Open AccessPerspective

Antipsychotic Potential of Opioids: Rethinking Substance-Induced Psychosis and Treatment Stratification

by Angelo G. I. Maremmani, Filippo Della Rocca, Silvia Bacciardi, Manuel Glauco Carbone and Icro Maremmani

J. Clin. Med. 2025, 14(15), 5596; https://doi.org/10.3390/jcm14155596 - 7 Aug 2025

Viewed by 300

Abstract

Substance-induced psychosis is a recognized clinical entity, commonly linked to cannabinoids, stimulants, hallucinogens, alcohol, and polysubstance use. These agents may provoke transient or persistent psychotic symptoms during intoxication or withdrawal. Opioids, however, constitute a noteworthy exception: psychosis is rarely observed during opioid intoxication, [...] Read more.

Substance-induced psychosis is a recognized clinical entity, commonly linked to cannabinoids, stimulants, hallucinogens, alcohol, and polysubstance use. These agents may provoke transient or persistent psychotic symptoms during intoxication or withdrawal. Opioids, however, constitute a noteworthy exception: psychosis is rarely observed during opioid intoxication, and emerging data suggest that opioid agonists might even exert antipsychotic-like effects. This article examines the paradoxical interaction between opioids and psychosis, with attention to clinical reports of psychotic symptoms arising following abrupt discontinuation of methadone or buprenorphine. In numerous cases, symptoms resolved swiftly after reintroduction of the opioid agonist, implying a neuromodulatory role. Opioids, unlike other substances of abuse, seem to lack intrinsic psychotogenic effects and may influence dopaminergic activity via kappa-opioid receptor antagonism and endorphinergic mechanisms. This challenges standard models of substance-induced psychosis and calls for a refined understanding of opioid pharmacodynamics in psychiatric contexts. In psychotic presentations among polysubstance users who also use opioids, restoring opioid agonist therapy should be prioritized, with antipsychotics reserved as second-line options—preferably agents with favorable receptor profiles. Where opioids are not involved, antipsychotics remain first-line, but should be applied judiciously, with efforts to taper when clinically appropriate. Full article

(This article belongs to the Section Mental Health)

19 pages, 306 KiB

Open AccessReview

Improving the Patient Experience in Breast Reconstruction: ERAS and Beyond

by Evan J. Haas, Bilal F. Hamzeh, Zain Aryanpour, Jason W. Yu, David W. Mathes and Christodoulos Kaoutzanis

J. Clin. Med. 2025, 14(15), 5595; https://doi.org/10.3390/jcm14155595 - 7 Aug 2025

Viewed by 276

Abstract

Background and Objectives: Breast reconstruction after mastectomy has been shown to significantly improve psychosocial wellbeing and quality of life. Enhanced Recovery After Surgery (ERAS) protocols, especially those tailored to breast reconstruction, have revolutionized recovery by reducing complications, pain, opioid use, and hospital [...] Read more.

Background and Objectives: Breast reconstruction after mastectomy has been shown to significantly improve psychosocial wellbeing and quality of life. Enhanced Recovery After Surgery (ERAS) protocols, especially those tailored to breast reconstruction, have revolutionized recovery by reducing complications, pain, opioid use, and hospital stay while improving patient satisfaction. The purpose of this narrative review was to present existing practices and supporting evidence within current ERAS protocols, as well as propose a modern ERAS framework centered around enhancing the patient experience following breast reconstruction. Methods: A focused literature search was conducted to identify studies investigating emerging approaches to patient care and surgical techniques adopted as part of a broader ERAS workflow Results: Some recent innovations include digital ERAS tracking, robot-assisted techniques, neurotization, and closed incision negative pressure therapy (ciNPT). These innovations show promise in reducing morbidity following reconstruction and may greatly improve sensory and functional outcomes. These advancements also reflect a shift toward more holistic, patient-centered care, extending beyond immediate clinical needs to address long-term wellbeing through psychosocial support and patient-reported outcome measures. Incorporating tools that validate patient perspectives helps guide interventions to optimize satisfaction and recovery. Conclusions: Future research should aim to standardize ERAS protocols by incorporating evidence-based practices, reinforcing breast reconstruction as a patient-centered, evidence-driven process that is focused on comprehensive recovery and improved quality of life. Full article

(This article belongs to the Special Issue Current State of the Art in Breast Reconstruction)

17 pages, 1476 KiB

Open AccessReview

Extracellular Vesicle-Derived Bioactive Molecules for Corneal and Ocular Surface Regeneration

by Ana Kolenc, Živa Dimnik, Miha Marzidovšek, Petra Schollmayer, Marko Hawlina, Elvira Maličev and Zala Lužnik Marzidovšek

J. Clin. Med. 2025, 14(15), 5594; https://doi.org/10.3390/jcm14155594 - 7 Aug 2025

Viewed by 208

Abstract

Cell-based therapies emerge as potential treatment options for various debilitating diseases. Preclinical research and clinical studies involving cells increased exponentially in the past decade. In addition to cell-based approaches, the use of extracellular vesicles (EVs), which are released by nearly all cell types, [...] Read more.

Cell-based therapies emerge as potential treatment options for various debilitating diseases. Preclinical research and clinical studies involving cells increased exponentially in the past decade. In addition to cell-based approaches, the use of extracellular vesicles (EVs), which are released by nearly all cell types, emerged as a promising cell-free alternative. Those approaches are also being explored in the field of ophthalmology. Several clinical trials involving EVs are underway to develop potential treatments for advanced ocular surface diseases, including corneal disorders, injuries, and dry eye disease. The cargo carried by EVs has been shown to include a diverse array of functional molecules such as transcription factors, cytokines, growth factors, mRNA, tRNA, rRNA, miRNA, and fragments of dsDNA. While the molecular composition of EVs is already well characterised, the specific activity of these molecules upon delivery to recipient cells remains poorly understood. In this review, we summarise recent studies investigating the bioactive molecules within EVs shown to influence or modulate cellular activity on the ocular surface. Among these, various miRNAs have most commonly been identified as therapeutic agents targeting distinct molecular pathways. The EVs studied were predominantly derived from various mesenchymal stem cells. Full article

(This article belongs to the Section Ophthalmology)

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24 pages, 4476 KiB

Open AccessArticle

Comprehensive Management of Different Types of Pelvic Fractures Through Multiple Disciplines: A Case Series

by Bharti Sharma, Samantha R. Kiernan, Christian Ugaz Valencia, Omolola Akinsola, Irina Ahn, Agron Zuta, George Agriantonis, Navin D. Bhatia, Kate Twelker, Munirah Hasan, Carrie Garcia, Praise Nesamony, Jasmine Dave, Juan Mestre, Zahra Shafaee, Suganda Phalakornkul, Shalini Arora, Saad Bhatti and Jennifer Whittington

J. Clin. Med. 2025, 14(15), 5593; https://doi.org/10.3390/jcm14155593 - 7 Aug 2025

Viewed by 287

Abstract

Background: Pelvic fractures are complex injuries often associated with significant morbidity and mortality, requiring multidisciplinary management. This case series highlights the presentation, management strategies, and outcomes of patients with pelvic fractures treated at our institution. Methods: The medical records of 13 patients diagnosed [...] Read more.

Background: Pelvic fractures are complex injuries often associated with significant morbidity and mortality, requiring multidisciplinary management. This case series highlights the presentation, management strategies, and outcomes of patients with pelvic fractures treated at our institution. Methods: The medical records of 13 patients diagnosed with pelvic fractures from 1 January 2020 through 31 December 2023 were retrospectively reviewed. Demographic data, mechanism of injury, fracture pattern, associated injuries, treatment modalities, and outcomes were analyzed. Results: A total of 13 patients were included in the study, with ages ranging from 18–95 years. Six of the patients were male and seven were female. The most common mechanisms of injury were falls and pedestrians struck by vehicles. Associated injuries included traumatic brain injury (TBI), fractures including extremities, ribs, and vertebrae, visceral injury, and spinal cord injury. Treatment strategies ranged from conservative, non-surgical management to operative intervention, including interventional radiology embolization, external traction, open reduction and internal fixation (ORIF), and percutaneous screw stabilization. Additional interventions included chest tube placement, exploratory laparotomy, and craniectomy. Two patients died while in the hospital, one was discharged to a shelter, and the remaining 10 were discharged to various inpatient rehab facilities. Conclusions: Pelvic fractures pose significant clinical challenges due to their complexity and associated injuries. This case series underscores the importance of multidisciplinary intervention and treatment strategies in optimizing outcomes. Further studies should focus on the effectiveness of interventions, utilization of new technology, and multidisciplinary team planning. Full article

(This article belongs to the Special Issue New Insights into Orthopedic Trauma Surgery—Pelvic and Acetabular Fracture Management)

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16 pages, 593 KiB

Open AccessSystematic Review

The Role of Proximal Femoral Osteotomy for the Treatment of Avascular Necrosis: A Systematic Review of Clinical and Patient-Reported Outcomes

by Paul L. Rodham, Jamila Tukur Jido, Hannah Bethell, Vasileios P. Giannoudis, Michalis Panteli, Nikolaos K. Kanakaris and Peter V. Giannoudis

J. Clin. Med. 2025, 14(15), 5592; https://doi.org/10.3390/jcm14155592 - 7 Aug 2025

Viewed by 348

Abstract

Background/Objectives: Avascular necrosis of the femoral head is a debilitating condition that, if left untreated, leads to progressive arthritis necessitating total hip replacement (THR). In the younger adult population, there is a drive towards joint-preserving procedures, particularly where alternative techniques such as [...] Read more.

Background/Objectives: Avascular necrosis of the femoral head is a debilitating condition that, if left untreated, leads to progressive arthritis necessitating total hip replacement (THR). In the younger adult population, there is a drive towards joint-preserving procedures, particularly where alternative techniques such as core decompression or vascularised bone grafting are anticipated to fail. Proximal femoral osteotomy is a technique that aims to remove the necrotic segment from the weight bearing area. The presented review aims to examine the efficacy of this technique in the management of avascular necrosis of the femoral head, reporting both rates of conversion to total hip replacement and patient reported outcomes. Methods: This systematic review was conducted according to PRISMA guidelines. A search was conducted of PubMed, Ovid Medline, EMBASE, and the Cochrane Library using pre-defined search terms. Data were extracted, and descriptive data presented. Quality of each study was assessed using the NIH quality assessment tool for case series studies. Results: Fifty-three studies with data for 2686 osteotomies are presented. Progression of radiological arthrosis was present in 40% of cases, with 20.3% of patients having undergone conversion to THR at a mean of 75.4 months (range 20–132 months). Patient-reported outcome measures were recorded in 1416 patients, of which the Harris Hip Score was the most commonly utilised. This score improved from a mean of 58.3 to 84.4 at a mean follow-up of 102 months. Conclusions: Osteotomy represented a valid head-preserving technique in the armamentarium against avascular necrosis of the femoral head, with conversion to THR required in 20.3% of patients at 7 years. In those patients who did not require THR, PROMS were similar to the arthroplasty population. Full article

(This article belongs to the Section Orthopedics)

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16 pages, 3102 KiB

Open AccessArticle

The Effect of Mild Exercise in the Chemotherapy Room on the Anxiety Level of Cancer Patients: A Prospective Observational Paired Cohort Study

by Christina Mavrogiannopoulou, Georgios Papastratigakis, Emmanouela Koutoulaki, Panagiotis Vardakis, Georgios Stefanakis, Athanasios Kourtsilidis, Kostantinos Lasithiotakis, Alexandra Papaioannou and Vasileia Nyktari

J. Clin. Med. 2025, 14(15), 5591; https://doi.org/10.3390/jcm14155591 - 7 Aug 2025

Viewed by 309

Abstract

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the [...] Read more.

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia “Agioi Anargyroi” in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State–Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline “moderate” range, dropping post-exercise to the “low” range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen’s d for paired samples = −0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy. Full article

(This article belongs to the Section Oncology)

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14 pages, 2353 KiB

Open AccessArticle

Combined Subacromial Bursal Stem Cell Therapy and Platelet-Rich Plasma Alongside Arthroscopic Rotator Cuff Surgery Reduces Postoperative Pain and Improves Functional Outcomes: A Retrospective Study

by Mladen Miškulin, Josip Savić, Oliver Dulić, Emili Dragaš and Andro Košec

J. Clin. Med. 2025, 14(15), 5590; https://doi.org/10.3390/jcm14155590 - 7 Aug 2025

Viewed by 242

Abstract

Background/Objectives: This study investigates the benefits of incorporating stem cell therapy into arthroscopic rotator cuff repair by evaluating its impact on postoperative pain and functional recovery. Methods: A retrospective, comparative analysis was conducted with a small cohort of patients undergoing rotator [...] Read more.

Background/Objectives: This study investigates the benefits of incorporating stem cell therapy into arthroscopic rotator cuff repair by evaluating its impact on postoperative pain and functional recovery. Methods: A retrospective, comparative analysis was conducted with a small cohort of patients undergoing rotator cuff surgery, divided into two groups: one receiving adjunctive combined PRP and bursal stem cell therapy and the other undergoing standard arthroscopic repair alone. The outcomes were assessed using visual analog scale (VAS) scores for pain and the Constant–Murley score (CMS), which includes strength of abduction, VAS pain, limitation and range of motion, evaluated at baseline, 1, 2, 3 and 6 months postoperatively. Results: Patients in the stem cell group experienced significantly greater reductions in pain scores and more substantial improvements in functional scores at the follow-up points compared to the control group. A linear mixed-effects analysis showed that in the early postoperative period, the use of PRP and bursal stem cell therapy was associated with significantly reduced postoperative VAS pain scores (F 4.8, p = 0.045) and an increased CMS regarding postoperative pain (F 8.6, p = 0.01), alongside painless elevation level (F 6.5, p = 0.022), forward flexion (F 8.5, p = 0.01) and abduction scores (F 8.3, p = 0.011). The effect of PRP and bursal stem cell therapy remains constant during late follow-up, from the fourth to sixth postoperative month, with postoperative CMS regarding pain remaining statistically significantly higher in the stem cell therapy group (F 4.8, p = 0.008), alongside reduced night-time pain (F 7.4, p = 0.015), improved recreation ability (F 4.8, p = 0.044) and reduced activity restriction (F 5.8, p = 0.028). Conclusions: The findings suggest that the addition of stem cell therapy to arthroscopic rotator cuff repair may enhance postoperative recovery by alleviating pain and promoting functional gains. Full article

(This article belongs to the Special Issue Current Trends and Innovations in Arthroscopic Shoulder Surgery)

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15 pages, 1362 KiB

Open AccessArticle

Surgical and Clinical Aspects Associated with Double-Valve Infective Endocarditis

by Sonia Lerta, Gloria Sangaletti, Vincenzo Antonio Villano, Flavia Puci, Eraldo Kushta, Pasquale Totaro, Filippo Amoroso, Giulia Magrini, Pietro Valsecchi, Raffaele Bruno and Elena Seminari

J. Clin. Med. 2025, 14(15), 5589; https://doi.org/10.3390/jcm14155589 - 7 Aug 2025

Viewed by 229

Abstract

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis and represents a challenge due to the increased incidence of embolic events and congestive heart failure compared to infective endocarditis (IE) affecting one valve. This study aims to evaluate patients’ characteristics, [...] Read more.

Background: Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis and represents a challenge due to the increased incidence of embolic events and congestive heart failure compared to infective endocarditis (IE) affecting one valve. This study aims to evaluate patients’ characteristics, surgical procedures, complications, and mortality associated with DVIE in our tertiary hospital in Italy. The Endocarditis Registry STEADY includes patients admitted with IE from January 2009 to March 2024 (n = 398). Sixty-three of them (16%) had DVIE. Methods: We conducted a retrospective single-center observational study, analyzing demographic, clinical, and microbiological data in DVIE patients, comparing those treated surgically (surgical group, SG) with those treated medically (non-surgical group, NSG). Results: The groups were homogeneous in age, microbiological yields, type of valve involved, and risk factors for infective endocarditis. The surgical group presented significantly more cancer history, intracardiac complications, and new-onset arrhythmias compared to the non-surgical group. Median hospital stay was similar in both groups. In SG, the most common postoperative complication was new rhythm disorders; other complications such as cardiac tamponade, pericardial effusion, and pneumothorax were rare. In-hospital mortality was similar between groups; however, one-year survival was higher in the surgical group (72% vs. 54%, p = 0.031). In our series, 16 patients were over 75 years old (25%), and 7 of them (44%) underwent cardiac surgery. One-year survival in the surgical group was also higher in this subgroup. Conclusions: Surgical treatment, when indicated, may improve the prognosis of patients with DVIE, including elderly patients. Full article

(This article belongs to the Special Issue Emerging Treatment Options in Aortic Valve Disease and Aortic Stenosis)

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14 pages, 1058 KiB

Open AccessArticle

Comparative Effectiveness of Ustekinumab and Vedolizumab as Maintenance Therapy After Tacrolimus-Induced Improvement in Patients with Acute Severe Ulcerative Colitis: A Retrospective Cohort Study

by Koji Kaku, Toshiyuki Sato, Jiro Takeuchi, Keiko Yokoyama, Soichi Yagi, Yasuhiro Takagi, Maiko Ikenouchi, Mikio Kawai, Koji Kamikozuru, Yoko Yokoyama, Tetsuya Takagawa, Toshihiko Tomita, Hirokazu Fukui and Shinichiro Shinzaki

J. Clin. Med. 2025, 14(15), 5588; https://doi.org/10.3390/jcm14155588 - 7 Aug 2025

Viewed by 287

Abstract

Background/Objectives: Acute severe ulcerative colitis (ASUC) is often managed by tacrolimus induction therapy followed by maintenance therapy. We compared the effectiveness of ustekinumab versus vedolizumab as maintenance therapies after tacrolimus induced improvement in patients with ASUC. Methods: This single-center retrospective cohort study included [...] Read more.

Background/Objectives: Acute severe ulcerative colitis (ASUC) is often managed by tacrolimus induction therapy followed by maintenance therapy. We compared the effectiveness of ustekinumab versus vedolizumab as maintenance therapies after tacrolimus induced improvement in patients with ASUC. Methods: This single-center retrospective cohort study included patients with ASUC who received tacrolimus induction therapy followed by ustekinumab or vedolizumab between January 2018 and November 2024. The primary outcome was clinical remission at week 16. Secondary and exploratory outcomes included clinical remission at week 8, biologic persistence, and relapse risk. An inverse probability of treatment weighting (IPTW) analysis was performed using the following covariates: male sex, prior biologics or JAK inhibitors, partial Mayo score, CRP, and albumin. Results: Among 235 tacrolimus-treated patients, 29 received ustekinumab and 22 received vedolizumab. After IPTW adjustment, the clinical remission rates were significantly higher in the ustekinumab group at both week 8 (82.1% vs. 51.8%, p = 0.02) and week 16 (85.4% vs. 36.8%, p = 0.02). Biologic persistence was significantly higher in the ustekinumab group (p = 0.004), and ustekinumab significantly reduced the hazard of relapse in multivariable analyses (HR 0.42 [95% CI: 0.20–0.88], p = 0.02). Conclusions: Ustekinumab showed greater effectiveness than vedolizumab in terms of achieving remission at 16 weeks after tacrolimus induction therapy in patients with ASUC. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)

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11 pages, 459 KiB

Open AccessReview

Suicidal Ideation in Individuals with Cerebral Palsy: A Narrative Review of Risk Factors, Clinical Implications, and Research Gaps

by Angelo Alito, Carmela De Domenico, Carmela Settimo, Sergio Lucio Vinci, Angelo Quartarone and Francesca Cucinotta

J. Clin. Med. 2025, 14(15), 5587; https://doi.org/10.3390/jcm14155587 - 7 Aug 2025

Viewed by 182

Abstract

Background: Cerebral palsy (CP) is a lifelong neurodevelopmental disorder characterised by motor impairment and commonly associated with comorbidities such as cognitive, communicative, and behavioural difficulties. While the physical and functional aspects of CP have been extensively studied, the mental health needs of this [...] Read more.

Background: Cerebral palsy (CP) is a lifelong neurodevelopmental disorder characterised by motor impairment and commonly associated with comorbidities such as cognitive, communicative, and behavioural difficulties. While the physical and functional aspects of CP have been extensively studied, the mental health needs of this population remain largely underexplored, particularly concerning suicidal ideation and self-injurious behaviours. The purpose of this review is to synthesise the existing literature on suicidality in individuals with CP, explore theoretical and clinical risk factors, and identify key gaps in the current evidence base. Methods: A narrative literature review was conducted focusing on studies addressing suicidal ideation, self-harm, or related psychiatric outcomes in individuals with CP. Additional literature on risks and protective factors was included to support theoretical inferences and clinical interpretations. Results: Only a limited number of studies addressed suicidality directly in CP populations. However, several reports document elevated rates of depression, anxiety, and emotional distress, particularly among adults and individuals with higher levels of functioning. Communication barriers, chronic pain, social exclusion, and lack of accessible mental health services emerged as critical risk factors. Protective elements included strong family support, inclusive environments, and access to augmentative communication. Conclusions: Suicidality in individuals with CP is a neglected yet potentially serious concern. Evidence suggests underdiagnosis due to factors such as communication barriers and diagnostic overshadowing. Future research should prioritise disability-informed methodologies and validated tools for suicidal ideation, while clinicians should incorporate routine, adapted mental health screening in CP care to ensure early detection and person-centred management. Full article

(This article belongs to the Special Issue Advances in Child Neurology)

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19 pages, 684 KiB

Open AccessArticle

Does the Timing of Response Impact the Outcome of Relapsed/Refractory Acute Myeloid Leukemia Treated with Venetoclax in Combination with Hypomethylating Agents? A Proof of Concept from a Monocentric Observational Study

by Ermelinda Longo, Fanny Erika Palumbo, Andrea Duminuco, Laura Longo, Daniela Cristina Vitale, Serena Brancati, Cinzia Maugeri, Marina Silvia Parisi, Giuseppe Alberto Palumbo, Giovanni Luca Romano, Filippo Drago, Francesco Di Raimondo, Lucia Gozzo and Calogero Vetro

J. Clin. Med. 2025, 14(15), 5586; https://doi.org/10.3390/jcm14155586 - 7 Aug 2025

Viewed by 238

Abstract

Background: Relapsed/refractory acute myeloid leukemia (R/R AML) remains a therapeutic challenge due to disease heterogeneity, resistance mechanisms, and poor tolerability to intensive regimens. Venetoclax (VEN), a BCL-2 inhibitor, has shown promise in combination with hypomethylating agents (HMAs), but data on response timing [...] Read more.

Background: Relapsed/refractory acute myeloid leukemia (R/R AML) remains a therapeutic challenge due to disease heterogeneity, resistance mechanisms, and poor tolerability to intensive regimens. Venetoclax (VEN), a BCL-2 inhibitor, has shown promise in combination with hypomethylating agents (HMAs), but data on response timing in the R/R setting are limited. The aim of this study was to assess the efficacy, safety, and kinetics of response to HMA-VEN therapy in a real-world cohort of R/R AML patients, with particular focus on early versus late responders. Methods: This prospective single-center study included 33 adult patients with R/R AML treated with VEN plus either azacitidine (AZA) or decitabine (DEC) from 2018 to 2021. The primary endpoint was the composite complete remission (cCR) rate and the rate of early and late response, respectively, occurring within two cycles of therapy or later; secondary endpoints included overall survival (OS), relapse-free survival (RFS), time to relapse (TTR), and safety. Results: The cCR was 58%, with complete remission (CR) or CR with incomplete recovery (CRi) achieved in 52% of patients. Median OS was 9 months. No significant differences in OS or TTR were observed between early (≤2 cycles) and late (>2 cycles) responders. Eight responders (42%) underwent allogeneic hematopoietic stem cell transplantation (HSCT), with comparable transplant rates in both groups of responders. Toxicity was manageable. Grade 3–4 neutropenia occurred in all patients, and febrile neutropenia occurred in 44% of patients. An Eastern Cooperative Oncology Group (ECOG) score >2 was associated with inferior response and shorter treatment duration. Conclusions: HMA-VEN therapy is effective and safe in R/R AML, including for patients with delayed responses. The absence of a prognostic disadvantage for late responders supports flexible treatment schedules and suggests that the continuation of therapy may be beneficial even without early blast clearance. Tailored approaches based on performance status and comorbidities are warranted, and future studies should incorporate minimal residual disease (MRD)-based monitoring to refine response assessment. Full article

(This article belongs to the Section Hematology)

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21 pages, 583 KiB

Open AccessReview

Diagnosis and Emerging Biomarkers of Cystic Fibrosis-Related Kidney Disease (CFKD)

by Hayrettin Yavuz, Manish Kumar, Himanshu Ballav Goswami, Uta Erdbrügger, William Thomas Harris, Sladjana Skopelja-Gardner, Martha Graber and Agnieszka Swiatecka-Urban

J. Clin. Med. 2025, 14(15), 5585; https://doi.org/10.3390/jcm14155585 - 7 Aug 2025

Viewed by 272

Abstract

As people with cystic fibrosis (PwCF) live longer, kidney disease is emerging as a significant comorbidity that is increasingly linked to cardiovascular complications and progression to end-stage kidney disease. In our recent review, we proposed the unifying term CF-related kidney disease (CFKD) to [...] Read more.

As people with cystic fibrosis (PwCF) live longer, kidney disease is emerging as a significant comorbidity that is increasingly linked to cardiovascular complications and progression to end-stage kidney disease. In our recent review, we proposed the unifying term CF-related kidney disease (CFKD) to encompass the spectrum of kidney dysfunction observed in this population. Early detection of kidney injury is critical for improving long-term outcomes, yet remains challenging due to the limited sensitivity of conventional laboratory tests, particularly in individuals with altered muscle mass and unique CF pathophysiology. Emerging approaches, including novel blood and urinary biomarkers, urinary extracellular vesicles, and genetic risk profiling, offer promising avenues for identifying subclinical kidney damage. When integrated with machine learning algorithms, these tools may enable the development of personalized risk stratification models and targeted therapeutic strategies. This precision medicine approach has the potential to transform kidney disease management in PwCF, shifting care from reactive treatment of late-stage disease to proactive monitoring and early intervention. Full article

(This article belongs to the Special Issue Cystic Fibrosis: Clinical Manifestations and Treatment)

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10 pages, 414 KiB

Open AccessArticle

Prevalence and Phenotype of Lower Urinary Tract Symptoms in Fibromyalgia: A Retrospective Observational Study at a Single Tertiary Medical Center

by Jackson McClain, Gustavo Capo, Martha Terris, Pablo Santamaria and Noelle A. Rolle

J. Clin. Med. 2025, 14(15), 5584; https://doi.org/10.3390/jcm14155584 - 7 Aug 2025

Viewed by 195

Abstract

Background: Fibromyalgia syndrome (FMS) is a complex condition with poorly understood pathophysiology, characterized by widespread pain and an increasing recognition of its associations with genitourinary symptoms. The objective of this study was to characterize the prevalence, phenotype, and common comorbidities of lower [...] Read more.

Background: Fibromyalgia syndrome (FMS) is a complex condition with poorly understood pathophysiology, characterized by widespread pain and an increasing recognition of its associations with genitourinary symptoms. The objective of this study was to characterize the prevalence, phenotype, and common comorbidities of lower urinary tract symptoms (LUTS) in women with FMS. Methods: A retrospective observational study was conducted using electronic medical records of 440 women diagnosed with FMS at a single institution between 1 January 2018, and 1 January 2024. Study subjects were evaluated for diagnoses associated with LUTS, including interstitial cystitis (IC), overactive bladder (OAB), and stress urinary incontinence (SUI), alongside comorbidities such as irritable bowel syndrome (IBS), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Multivariate analyses were performed to assess predictors of conditions associated with LUTS. Results: LUTS were identified in 37.0% of FM patients. GAD and IBS were significantly associated with conditions associated with LUTS (OR = 4.62; OR = 8.53, p < 0.001). SUI was present in 17.05% of patients, falling between survey-based and confirmed prevalence rates in the general population. IC was diagnosed in 2.95% of FMS patients. OAB was observed in 6.8% of patients and associated with GAD (OR = 5.98, p < 0.001). Conclusions: This study highlights a substantial burden of diagnoses associated with LUTS in patients with FMS. There is relatively high prevalence of SUI and IC in this dataset. IBS and GAD were commonly found to co-occur with one or more LUTS-associated condition. Future prospective studies are needed to investigate a multimodal approach to the treatment of LUTS in these patients. Full article

(This article belongs to the Section Nephrology & Urology)

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8 pages, 449 KiB

Open AccessArticle

Feasibility and Postoperative Outcome After Duet Procedure for Reversible Multifocality in Eyes with Co-Pathologies

by Barbara S. Brunner, Martin Dirisamer, Nikolaus Luft, Stefan Kassumeh and Siegfried G. Priglinger

J. Clin. Med. 2025, 14(15), 5583; https://doi.org/10.3390/jcm14155583 - 7 Aug 2025

Viewed by 259

Abstract

Objectives: To evaluate the safety and efficacy of the simultaneous implantation of a monofocal capsular bag-fixated and a trifocal supplementary sulcus-fixated intraocular lens (duet procedure) in eyes with co-existing pathologies undergoing cataract or refractive lens surgery. Methods: In total, 80 eyes [...] Read more.

Objectives: To evaluate the safety and efficacy of the simultaneous implantation of a monofocal capsular bag-fixated and a trifocal supplementary sulcus-fixated intraocular lens (duet procedure) in eyes with co-existing pathologies undergoing cataract or refractive lens surgery. Methods: In total, 80 eyes of 40 consecutive patients, who underwent refractive lens exchange or cataract surgery and received the duet procedure due to minor co-pathologies, were included in this retrospective case series. Preoperative assessment comprised slit-lamp biomicroscopy, optical biometry, posterior-segment optical coherence tomography, corneal endothelial specular microscopy, corneal tomography, manifest refraction and distance and near visual acuity testing. Three months postoperatively, uncorrected distance (UDVA) and uncorrected near visual acuity (UNVA) were recorded. Results: The preoperative manifest refractive spherical equivalent (MRSE) was −0.31 ± 4.29 diopters (D), with a mean refractive astigmatism of −0.80 ± 0.60 D. At three months postoperatively, monocular UDVA and binocular UNVA significantly improved from 0.52 ± 0.42 logMAR and 0.32 ± 0.27 logMAR to 0.05 ± 0.09 logMAR and −0.03 ± 0.10 logMAR, respectively (both p < 0.0001). Conclusions: Reversible multifocality provided by the duet procedure appears to be a feasible option in eyes with mild co-existing pathologies, as it yields satisfactory visual and refractive outcomes with high safety. Full article

(This article belongs to the Special Issue Cataract and Refractive Surgery, and Intraocular Lens (IOL) Implantation: Recent Advances and Perspectives)

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8 pages, 215 KiB

Open AccessArticle

Prospective Comparative Analysis of Simultaneous Microbiological Assessment in Septic Revision Arthroplasty: Can We Rely on Standard Diagnostics?

by Tobias Freitag, Marius Ludwig, Olivia Trappe, Moritz Oltmanns, Heiko Reichel and Michael Fuchs

J. Clin. Med. 2025, 14(15), 5582; https://doi.org/10.3390/jcm14155582 - 7 Aug 2025

Viewed by 194

Abstract

Background: Microbial analyses of tissue samples are of paramount importance for diagnostic and therapeutic purposes in the course of septic revision arthroplasty. Isolation and identification of the causative pathogens pave the way for successful treatment of periprosthetic joint infections, which necessitates a reliable [...] Read more.

Background: Microbial analyses of tissue samples are of paramount importance for diagnostic and therapeutic purposes in the course of septic revision arthroplasty. Isolation and identification of the causative pathogens pave the way for successful treatment of periprosthetic joint infections, which necessitates a reliable microbiological workup. It is unknown if there are inconsistencies in pathogen detection and differentiation between accredited laboratories in the context of septic revision arthroplasty. Methods: Tissue samples of forty consecutive patients undergoing septic total hip and knee revision surgery were sent to two different accredited and certified laboratories and tested for pathogen growth and bacterial differentiation. Results: Each institution analyzed 200 specimens. Twenty-five patients (62.5%) showed consistent results between laboratories. Diverging results were observed in 15 of 40 patients (37.5%). Of these, three individuals showed pathogen growth in only one laboratory. In 12 patients with discrepant results, laboratory analyses revealed a partly different pathogen spectrum. With regard to clinical impact and infection eradication, the respective differences implicated a therapeutic response by a change of the administered postoperative antibiotic treatment in five (12.5%) of the patients. The kappa correlation coefficient indicated a slight value in terms of data consistency between institutions (k = 0.227, p = 0.151). Conclusions: The majority of evaluated samples show comparable results with regard to microbiological evaluation. Nevertheless, a substantial number of specimens were classified differently. The observed discrepancies pose a challenge for postoperative decision-making. Against this background, standardized microbiological protocols remain mandatory for a conclusive clinical implication to eradicate PJI. Full article

(This article belongs to the Section Orthopedics)

9 pages, 678 KiB

Open AccessArticle

Rib Healing and Heterotopic Ossification After Surgical Stabilization of Rib Fractures

by Alexander Hoey, Daniel Akyeampong, Arjun Patel, Ronald Gross and Evert A. Eriksson

J. Clin. Med. 2025, 14(15), 5581; https://doi.org/10.3390/jcm14155581 - 7 Aug 2025

Viewed by 192

Abstract

Background: Little is known about the rate of rib fracture healing after Surgical Stabilization of Rib Fractures (SSRFs). We sought to evaluate the radiographic evidence of rib healing and hypertrophic ossification (HO) in patients after SSRFs. Methods: A single-center retrospective cohort study [...] Read more.

Background: Little is known about the rate of rib fracture healing after Surgical Stabilization of Rib Fractures (SSRFs). We sought to evaluate the radiographic evidence of rib healing and hypertrophic ossification (HO) in patients after SSRFs. Methods: A single-center retrospective cohort study was conducted on all patients who had undergone SSRFs from 1 January 2010 to 31 March 2023 and had a computed tomography (CT) of the chest performed greater than 6 months after SSRFs. The rib fracture locations were mapped on the initial trauma CT scan and evaluated on the follow-up CT scan for healing and HO formation. Results: A total of 254 SSRF cases were evaluated, 21 patients met the inclusion criteria; out of 208 fractures, 109 underwent SSRFs. The median time to follow-up CT scan was 17(7–88) months. Overall, 95% of the fractures healed completely. Seventy percent of the non-union fractures were in posterior or paraspinal locations on ribs 8–10. HO was noted in nine patients and seen as early as 8 months post-operatively. A significant association was identified between the fixation method used to perform SSRFs (89% vs. 11%, p = 0.024) and operative day (6(0–9) vs. 2(2–5), p = 0.023). Conclusions: Non-union of rib fractures is uncommon after SSRFs. Many of these fractures involve the posterior or paraspinal lower rib cage. HO between fractures is common after SSRFs. Full article

(This article belongs to the Special Issue Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions)

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11 pages, 678 KiB

Open AccessArticle

Evaluation of an Intraoral Camera with an AI-Based Application for the Detection of Gingivitis

by Cécile Ehrensperger, Philipp Körner, Leonardo Svellenti, Thomas Attin and Philipp Sahrmann

J. Clin. Med. 2025, 14(15), 5580; https://doi.org/10.3390/jcm14155580 - 7 Aug 2025

Viewed by 205

Abstract

Objective: With a global prevalence ranging from 50% to 100%, gingivitis is considered the most common oral disease in adults worldwide. It is characterized by clinical signs of inflammation, such as redness, swelling and bleeding, on gentle probing. Although it is considered a [...] Read more.

Objective: With a global prevalence ranging from 50% to 100%, gingivitis is considered the most common oral disease in adults worldwide. It is characterized by clinical signs of inflammation, such as redness, swelling and bleeding, on gentle probing. Although it is considered a milder form of periodontal disease, gingivitis plays an important role in overall oral health. Early detection and treatment are essential to prevent progression to more severe conditions. Typically, diagnosis is performed by dental professionals, as individuals are often unable to accurately assess whether they are affected. Therefore, the aim of the present study was to determine to what degree gingivitis is visually detectable by an easy-to-use camera-based application. Materials and methods: Standardized intraoral photographs were taken using a specialized intraoral camera and processed using a custom-developed filter based on a machine-learning algorithm. The latter was trained to highlight areas suggestive of gingivitis. A total of 110 participants were enrolled through ad hoc sampling, resulting in 320 assessable test sites. A dentist provided two reference standards: the clinical diagnosis based on bleeding on probing of the periodontal sulcus (BOP) and an independent visual assessment of the same images. Agreement between diagnostic methods was measured using Cohen’s kappa statistic. Results: The agreement between the application’s output and the BOP-based clinical diagnosis was low, with a kappa value of 0.055 [p = 0.010]. Similarly, the dentist’s visual assessment of clinical photos showed low agreement with BOP, with a kappa value of 0.087 [p < 0.001]. In contrast, the agreement between the application and the dentist’s photo-based evaluations was higher, with a kappa value of 0.280 [p < 0.001]. Conclusions: In its current form, the camera-based application is not able to reliably detect gingivitis. The low level of agreement between dentists’ visual assessments and the clinical gold standard highlights that gingivitis is difficult to identify merely visually. These results underscore the need to refine visual diagnostic approaches further, which could support future self-assessment or remote screening applications. Full article

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

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9 pages, 587 KiB

Open AccessCase Report

Sympathetic Ophthalmia as a Complication of Untreated Choroidal Melanoma

by Tomasz Chorągiewicz, Paweł Oszczędłowski, Joanna Dolar-Szczasny, Mario Damiano Toro, Olga Denysiuk, Adam Słoka, Alicja Chorągiewicz, Yacoub A. Yousef and Robert Rejdak

J. Clin. Med. 2025, 14(15), 5579; https://doi.org/10.3390/jcm14155579 - 7 Aug 2025

Viewed by 103

Abstract

We present a rare case of sympathetic ophthalmia in the fellow eye of a 59-year-old Caucasian male diagnosed with untreated malignant choroidal melanoma. Initially identified with a medium-sized choroidal melanoma, the patient declined recommended brachytherapy and did not seek medical attention for two [...] Read more.

We present a rare case of sympathetic ophthalmia in the fellow eye of a 59-year-old Caucasian male diagnosed with untreated malignant choroidal melanoma. Initially identified with a medium-sized choroidal melanoma, the patient declined recommended brachytherapy and did not seek medical attention for two years. Upon returning, he exhibited signs of sympathetic ophthalmia in the contralateral eye. Treatment with corticosteroid-based immunosuppression was initiated. After consenting to treatment for the melanoma, the affected left eye was enucleated, and histopathology confirmed spindle cell choroidal melanoma. This case underscores the uncommon development of sympathetic ophthalmia without prior ocular trauma or surgery, linked to untreated choroidal melanoma. Full article

(This article belongs to the Section Ophthalmology)

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12 pages, 1620 KiB

Open AccessArticle

Maxillary Sinus Puncture: A Traditional Procedure in Decline—Insights from SHIP

by Fabian Paperlein, Johanna Klinger-König, Chia-Jung Busch, Christian Scharf and Achim Georg Beule

J. Clin. Med. 2025, 14(15), 5578; https://doi.org/10.3390/jcm14155578 - 7 Aug 2025

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Abstract

Background: Maxillary sinus puncture (MSP), once a cornerstone for diagnosing and treating acute rhinosinusitis (ARS), has declined with the rise in less invasive techniques. This study explores MSP trends, its association with age, and long-term effects on quality of life using data from [...] Read more.

Background: Maxillary sinus puncture (MSP), once a cornerstone for diagnosing and treating acute rhinosinusitis (ARS), has declined with the rise in less invasive techniques. This study explores MSP trends, its association with age, and long-term effects on quality of life using data from the Study of Health in Pomerania (SHIP). Methods: Data from SHIP-START-2 (n = 2332), SHIP-START-3 (n = 1717), and SHIP-TREND-0 (n = 4420) cohorts were analyzed to assess MSP prevalence, demographic correlations, and quality- of-life impacts using SNOT-20-D, EQ-5D-3L, and SF-12. Results: MSP prevalence was higher in older SHIP-START cohorts (11.2% in START-2) compared to SHIP-TREND-0 (9.5%), reflecting its historical decline. The procedure was more frequently reported by participants aged > 60 years (e.g., 14.0% in START-2) than by younger groups (<40 years: 3.5% in START-2). MSP was associated with increased SNOT-20-D scores across cohorts (e.g., +0.28 in START-2, p < 0.001) and minor reductions in EQ-5D-3L and SF-12 mental health scores, indicating greater symptom burden but limited general health impact. The age- and time-related decline in MSP highlights its diminishing role in modern practice. Conclusions: While MSP offers diagnostic insights and serves as an indicator for ARS, its modest impact on long-term quality-of-life underscores the need for alternative, minimally invasive techniques for sinonasal conditions. Full article

(This article belongs to the Special Issue Current and Future Trends in Otorhinolaryngology–Head and Neck Surgery)

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A Review of the Current Clinical Aspects of Sjögren’s Disease: Geographical Difference, Classification/Diagnostic Criteria, Recent Advancements in Diagnostic Methods, and Molecular Targeted Therapy

by Yoshiro Horai, Shota Kurushima, Toshimasa Shimizu, Hideki Nakamura and Atsushi Kawakami

J. Clin. Med. 2025, 14(15), 5577; https://doi.org/10.3390/jcm14155577 - 7 Aug 2025

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Abstract

Sjögren’s Disease (SjD) is an autoimmune disorder characterized by sicca symptoms arising from impaired salivary and lacrimal gland function and accompanying extraglandular involvement. SjD is recognized as an illness of female dominance for which the 2002 American–European Consensus Group Classification Criteria and the [...] Read more.

Sjögren’s Disease (SjD) is an autoimmune disorder characterized by sicca symptoms arising from impaired salivary and lacrimal gland function and accompanying extraglandular involvement. SjD is recognized as an illness of female dominance for which the 2002 American–European Consensus Group Classification Criteria and the American College of Rheumatology/European Alliance of Associations for Rheumatology 2016 classification criteria are utilized for inclusion in clinical trials, and treatment recommendations from countries belonging to the American College of Rheumatology or the European Alliance of Associations for Rheumatology are globally recognized. It is presumed that there are geographical differences among female sufferers, and unique diagnostic criteria and recommendations are used in clinical practice in Japan. In addition to the items included in the classification criteria, several methods to measure saliva secretion, serum biomarkers, and artificial intelligence tools have recently been reported to be useful for the assessment of SjD. While symptomatic therapies including tear drops, artificial saliva, and muscarinic agonists are still the mainstay for treating SjD, several kinds of molecular targeted drugs, such as biological drugs and Janus kinase inhibitors, that are expected to improve the prognosis of SjD have been tested in recent clinical trials. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Sjogren’s Syndrome: 2nd Edition)

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J. Clin. Med., Volume 14, Issue 15 (August-1 2025) – 435 articles

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