Journal of Clinical Medicine

13 pages, 1403 KB

Open AccessArticle

Uveitis in Longstanding Axial Spondyloarthritis and Its Association with Biologic Therapy Initiation: Data from the REGISPON-3 Cohort

by Ana María Sánchez-León, María Lourdes Ladehesa-Pineda, María Ángeles Puche-Larrubia, María Carmen Ábalos-Aguilera, Desirée Ruiz-Vilchez, Alejandro Escudero-Contreras, Eduardo Collantes-Estévez, Carlos M. Collantes-Sánchez, Clementina López-Medina and REGISPON-3 Study Group

J. Clin. Med. 2025, 14(19), 7128; https://doi.org/10.3390/jcm14197128 - 9 Oct 2025

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Abstract

Objectives: To assess the incidence rate of anterior acute uveitis (AAU) in patients with longstanding axial spondyloarthritis (axSpA); to evaluate demographic and clinical characteristics associated with AAU development; and to determine the influence of AAU on bDMARD initiation and retention in this [...] Read more.

Objectives: To assess the incidence rate of anterior acute uveitis (AAU) in patients with longstanding axial spondyloarthritis (axSpA); to evaluate demographic and clinical characteristics associated with AAU development; and to determine the influence of AAU on bDMARD initiation and retention in this population. Methods: This two-timepoint cohort study analysed data from patients enrolled in the Spanish SpA registry REGISPONSER (2004–2007), who were re-evaluated 17 years later in the REGISPON-3 follow-up study (2021–2023). Information on the date of first AAU episode and bDMARD initiation was collected. Kaplan–Meier and Cox proportional hazards models were used to assess AAU incidence, predictors, and its association with time to bDMARD initiation and treatment retention. Results: A total of 299 patients with longstanding axSpA were included, of whom 33.4% experienced at least one episode of AAU, corresponding to an incidence rate of 1.15 per 100 person-years. The cumulative probability of a first episode of AAU increased with disease duration. The relative risk for developing a second episode after the first, compared to the overall risk of any episode in the total population, was 1.85 (95% CI: 1.34–2.57). In multivariable cox analysis, female sex and baseline enthesitis were independently associated with a higher risk of AAU. AAU did not significantly affect the likelihood of subsequent bDMARD initiation, with similar cumulative treatment probabilities in patients with and without AAU. Among treated patients, adalimumab was more frequently prescribed in those with a history of AAU. bDMARD retention rates at two and five years were comparable regardless of AAU status, suggesting that AAU was not associated with long-term treatment persistence. Conclusions: In patients with longstanding axSpA, the incidence of AAU increased steadily over time. However, the presence of AAU did not significantly influence bDMARD initiation or long-term retention in routine clinical practice. Full article

(This article belongs to the Section Immunology & Rheumatology)

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13 pages, 242 KB

Open AccessArticle

Psychological Adjustment in Patients with Anorexia Nervosa and Binge Eating Disorder Following a 3-Week Inpatient Multidisciplinary Rehabilitation Program

by Anna Guerrini Usubini, Sara Ducale, Adele Bondesan, Diana Caroli, Francesca Frigerio, Sandra Savino, Laura Abbruzzese, Gianluca Castelnuovo and Alessandro Sartorio

J. Clin. Med. 2025, 14(19), 7127; https://doi.org/10.3390/jcm14197127 - 9 Oct 2025

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Abstract

Background: This study examined changes in psychological adjustment among patients with Anorexia Nervosa (AN) and Binge Eating Disorder (BED) following a 3-week inpatient multidisciplinary (disease-tailored) rehabilitation program. Methods: twenty consecutive Italian female adults with a diagnosis of AN (mean age ± SD: [...] Read more.

Background: This study examined changes in psychological adjustment among patients with Anorexia Nervosa (AN) and Binge Eating Disorder (BED) following a 3-week inpatient multidisciplinary (disease-tailored) rehabilitation program. Methods: twenty consecutive Italian female adults with a diagnosis of AN (mean age ± SD: 25.9 ± 9.4 years; mean Body Mass Index: BMI: kg/m²: 15.8 ± 1.61) and fifteen consecutive Italian female adults with diagnosis of BED (mean age ± SD: 43.5 ± 15.3 years; mean Body Mass Index: BMI: kg/m²: 41.1 ± 7.82) were admitted to the study. Psychological functioning and well-being were assessed pre- and post-intervention using the Strengths and Difficulties Questionnaire and the Psychological General Well-Being Index. Results: Significant improvements in emotional symptoms [F(1, 31) = 21.1973, p < 0.001, ƞ²p = 0.406] and overall psychological functioning [F(1, 31) = 10.0062, p = 0.373, ƞ²p = 0.026] were observed in both groups, with the most pronounced changes in internalizing symptoms, such as anxiety and depression. Changes in BMI were significantly associated with emotional symptoms, vitality [F(1, 31) = 4.89, p = 0.035, ƞ²p = 0.136], and total well-being scores [F(1, 31) = 6.341, p = 0.017, ƞ²p = 0.170]. By contrast, no significant changes were observed in domains such as behavioral problems, hyperactivity/inattention, and peer relationships, probably indicating the need for more prolonged and targeted, domain-specific interventions. Conclusions: A 3-week inpatient multidisciplinary program was associated with improvements in internalizing symptoms and psychological well-being in women with AN and BED. Domains such as behavioral regulation and social functioning showed limited change, indicating the need for longer and targeted psychosocial components. Full article

(This article belongs to the Special Issue Eating Disorders: Current Epidemiology and Advances in Diagnosis and Treatment—Second Edition)

7 pages, 1491 KB

Open AccessBrief Report

Evaluation and Management of Recurrent Atrial Flutter in Neonates

by Nandini Aravindan, Peter R. A. Gaskin and Sudhir Vashist

J. Clin. Med. 2025, 14(19), 7126; https://doi.org/10.3390/jcm14197126 - 9 Oct 2025

Viewed by 554

Abstract

Background: Fetal tachyarrhythmias occur in less than 0.1% pregnancies, with atrial flutter accounting for one-third of cases. Atrial flutter results from a reentrant circuit within the atrium with atrial rates in fetal atrial flutter ranging from 300 to 540 beats per minute. [...] Read more.

Background: Fetal tachyarrhythmias occur in less than 0.1% pregnancies, with atrial flutter accounting for one-third of cases. Atrial flutter results from a reentrant circuit within the atrium with atrial rates in fetal atrial flutter ranging from 300 to 540 beats per minute. The fetal atrial flutter is most often an isolated finding; however, it may also be associated with maternal diabetes, neonatal macrosomia, cardiac rhabdomyoma, maternal substance use, Turner syndrome, congenital heart disease, and the presence of accessory pathways. The majority of cases of atrial flutter in the neonatal period are isolated; however, only a few cases of recurrent atrial flutter have been described. Methods: This is a single-institution, retrospective chart review of neonates with recurrent atrial flutter. Results: Four neonates with recurrent atrial flutter were identified, each linked either to a correctable trigger or to an underlying substrate, guiding individualized therapy. When no clear trigger was present, antiarrhythmic medication was required. Conclusions: These cases highlight the importance of the recognition of potential triggers of recurrent neonatal atrial flutter, tailoring therapy accordingly and considering antiarrhythmic agents when necessary. Full article

(This article belongs to the Special Issue Clinical Management of Pediatric Heart Diseases)

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13 pages, 216 KB

Open AccessArticle

Content Validity Assessment of a Newly Developed Emergency Medical Dispatch and Triage Protocol in Thailand

by Thongpitak Huabbangyang, Duangpon Thepmanee, Phudit Buaprasert, Pit Chansomboon, Jiraporn Sri-on and Rapeeporn Rojsaengroeng

J. Clin. Med. 2025, 14(19), 7125; https://doi.org/10.3390/jcm14197125 - 9 Oct 2025

Viewed by 705

Abstract

Background/Objectives: Accurate telephone triage of emergency medical cases plays a crucial role in improving outcomes for critically ill patients. Effective triage enables emergency medical dispatchers to provide appropriate pre-arrival instructions and to deploy operational units according to the patient’s severity level. This study [...] Read more.

Background/Objectives: Accurate telephone triage of emergency medical cases plays a crucial role in improving outcomes for critically ill patients. Effective triage enables emergency medical dispatchers to provide appropriate pre-arrival instructions and to deploy operational units according to the patient’s severity level. This study aimed to develop and assess the content validity of the Emergency Medical Triage Protocol and Criteria-Based Dispatch Code (EMTP-CBDC) for Thailand. The objective was to ensure the tool’s content accuracy and applicability in prioritizing emergency responses in line with medical urgency, considering global changes and universal standards. Methods: A cross-sectional descriptive study was conducted from 15–30 April 2024. The content validity of the newly developed EMTP-CBDC, comprising 30 symptom groups, was evaluated by five emergency physician experts with at least 1 year of experience in emergency medical oversight. The assessment focused on four aspects: relevance, clarity, simplicity, and ambiguity. The Content Validity Index (CVI) was calculated at both the item level (I-CVI) and the scale level using the average index (S-CVI/Ave). To adjust for chance agreement, the probability of chance agreement (Pc) and the modified kappa coefficient (k*) were calculated for each item. Results: The content validation revealed I-CVI values ranging from 0.80 to 1.00 across all items. The S-CVI/Ave scores were 0.97 for relevance, 0.93 for clarity, 0.98 for simplicity, and 0.94 for ambiguity. These values surpassed the accepted thresholds for content validity. Conclusions: The EMTP-CBDC developed for Thailand demonstrated good content validity across relevance, clarity, simplicity, and ambiguity. Further studies are needed to establish its reliability and field performance before routine implementation. Full article

(This article belongs to the Special Issue Advancements in Emergency Medicine Practices and Protocols)

14 pages, 659 KB

Open AccessArticle

CGM-Based Glycemic Metrics Support Estimating Nutritional Risk After Total Pancreatectomy: An Exploratory Retrospective Study

by Ryoma Nakamura, Miyuki Yanagimachi, Kento Mitsuhashi, Masato Yamaichi, Wataru Onodera, Atsufumi Matsumoto, Eri Sato, Yusuke Tando and Yukihiro Fujita

J. Clin. Med. 2025, 14(19), 7124; https://doi.org/10.3390/jcm14197124 - 9 Oct 2025

Viewed by 546

Abstract

Introduction: After total pancreatectomy, patients inevitably develop pancreatogenic diabetes with marked glycemic variability and high risk of malnutrition due to both endocrine and exocrine insufficiency. Weight loss and malnutrition can occur even in those with adequate dietary intake and plausible pancreatic enzyme replacement. [...] Read more.

Introduction: After total pancreatectomy, patients inevitably develop pancreatogenic diabetes with marked glycemic variability and high risk of malnutrition due to both endocrine and exocrine insufficiency. Weight loss and malnutrition can occur even in those with adequate dietary intake and plausible pancreatic enzyme replacement. We hypothesized that glycemic variability is associated with nutritional decline. Methods: We retrospectively analyzed 14 patients who underwent continuous glucose monitoring (CGM) after total pancreatectomy. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), and patients were classified into malnutrition-risk progression or nutrition-maintaining groups. Then, we evaluated glycemic indices, dietary intake, anthropometry, and pancreatic enzyme replacement therapy (PERT). Results: Insulin use, PERT dose, and dietary intake were approximately comparable between groups. In contrast, the malnutrition-risk progression group showed significantly higher mean glucose and time above range, and lower time in range (TIR). Importantly, TIR consistently showed an inverse association with malnutrition-risk progression across models adjusted for clinical covariates, including time since pancreatectomy, primary diagnosis, insulin regimen, and pancrelipase dose. These findings indicate that the observed relationship between lower TIR and worsening GNRI was independent of dietary intake and adequacy of enzyme replacement therapy, underscoring TIR as a clinically meaningful indicator of nutritional decline in this population. Conclusions: Hyperglycemia and reduced TIR were significantly associated with worsening GNRI after total pancreatectomy, independent of dietary intake or PERT. CGM-based glycemic metrics may help identify patients at risk of malnutrition and guide postoperative management. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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12 pages, 457 KB

Open AccessArticle

Impaired Kidney Function, Subclinical Myocardial Injury, and Their Joint Associations with Cardiovascular Mortality in the General Population

by Ahmed E. Shatta, Mohamed A. Mostafa, Mohamed A. Attia, Tarek Ahmad Zaho, Richard Kazibwe and Elsayed Z. Soliman

J. Clin. Med. 2025, 14(19), 7123; https://doi.org/10.3390/jcm14197123 - 9 Oct 2025

Viewed by 597

Abstract

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. We aimed to evaluate their individual and joint associations with cardiovascular mortality. Methods: We analyzed data from 6057 participants (mean age [...] Read more.

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. We aimed to evaluate their individual and joint associations with cardiovascular mortality. Methods: We analyzed data from 6057 participants (mean age 57.0 ± 13.0 years) in the U.S. Third National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Electrocardiographic SCMI was defined as a cardiac infarction/injury score ≥ 10. CV mortality was determined from the National Death Index. Multivariable logistic regression assessed baseline cross-sectional associations between eGFR and SCMI. Cox proportional hazards models were used to examine the individual and combined associations of eGFR and SCMI with CV mortality. Results: At baseline, 1297 participants (21.4%) had SCMI. In multivariable logistic regression analysis, eGFR < 45 mL/min/1.73 m² (vs. ≥45) was not associated with SCMI (OR [95% CI]: 1.10 [0.84–1.45]). Over a median follow-up of 18.4 years, 690 CV deaths occurred. In separate Cox models, both SCMI (vs. no SCMI) and eGFR < 45 (vs. ≥45) were associated with increased CV mortality risk (HR [95% CI]: 1.36 [1.16–1.60] and 1.56 [1.24–1.99], respectively). Compared with participants with eGFR ≥ 45 and no SCMI, those with both eGFR < 45 and SCMI had the highest CV mortality risk (HR [95% CI]: 2.36 [1.65–3.36]), followed by eGFR < 45 alone (1.47 [1.09–1.96]) and SCMI alone (1.33 [1.11–1.58]). Conclusions: Both reduced eGFR and SCMI were independently associated with CV mortality. Their coexistence showed the highest risk, but without statistical significance compared with each alone, possibly reflecting limited power and distinct mechanisms. Full article

(This article belongs to the Section Cardiovascular Medicine)

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15 pages, 561 KB

Open AccessArticle

Cognitive Impairment in Patients with Severe COPD: A Cross-Sectional Study

by Kristina Kock Hansen, Ingeborg Farver-Vestergaard, Hanne Irene Jensen, Anders Løkke and Ole Hilberg

J. Clin. Med. 2025, 14(19), 7122; https://doi.org/10.3390/jcm14197122 - 9 Oct 2025

Viewed by 585

Abstract

Background/Objectives: Cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD) has been associated with reduced physical activity and decreased adherence to inhalation therapy. The primary aim of this study is to examine the prevalence of CI in patients with severe [...] Read more.

Background/Objectives: Cognitive impairment (CI) in patients with chronic obstructive pulmonary disease (COPD) has been associated with reduced physical activity and decreased adherence to inhalation therapy. The primary aim of this study is to examine the prevalence of CI in patients with severe COPD and secondly compare outcomes with non-COPD comparators. Methods: Patients with severe COPD defined as forced expiratory volume in first second (FEV₁) <50% were recruited between January 2021 to January 2023 along with non-COPD comparators. CI was defined as a MoCA score < 26, adding one point for participants with ≤12 years of education. Additionally, two functional cognitive tests were included: the Continuous Reaction Time test (CRT) and a driving simulator. Results: Eighty patients with COPD (mean age 64 years) and 22 non-COPD comparators (mean age 61 years) participated. CI was identified in 32 patients with COPD (40%) and six non-COPD comparators (27%) with a 0.87 non-significant difference (95% CI: −0.15–1.88). The functional tests showed a 0.267 difference in CRT index (95% CI: 0.023–0.511) and a 0.056 difference in standard deviation from center of the road (95% CI: 0.002–0.11) revealing a significantly poorer performance in functional tests among patients compared to non-COPD comparators. Nineteen patients with COPD and one non-COPD comparator failed the driving test (p = 0.04). Conclusions: CI was found in 40% of patients with severe COPD based on MoCA score. While MoCA score did not differ between the two groups, functional tests demonstrated significantly reduced abilities in patients compared with non-COPD comparators. Full article

(This article belongs to the Section Respiratory Medicine)

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22 pages, 1046 KB

Open AccessEditor’s ChoiceArticle

Sleep Quality and Sex-Specific Physical Activity Benefits Predict Mental Health in Romanian Medical Students: A Cross-Sectional Analysis

by Catalin Plesea-Condratovici, Alina Plesea-Condratovici, Silvius Ioan Negoita, Valerian-Ionut Stoian, Lavinia-Alexandra Moroianu and Liliana Baroiu

J. Clin. Med. 2025, 14(19), 7121; https://doi.org/10.3390/jcm14197121 - 9 Oct 2025

Viewed by 722

Abstract

Background: Evidence on how everyday walking and sleep relate to mood in health profession students from Central–Eastern Europe remains limited. Methods: We conducted a cross-sectional study among 277 Romanian medical students. Data were collected using validated instruments for physical activity (IPAQ-SF), [...] Read more.

Background: Evidence on how everyday walking and sleep relate to mood in health profession students from Central–Eastern Europe remains limited. Methods: We conducted a cross-sectional study among 277 Romanian medical students. Data were collected using validated instruments for physical activity (IPAQ-SF), sleep quality (PSQI), and depressive/anxiety symptoms (HADS). Associations were examined using bivariate and multivariable regression models, including sex-stratified analyses. Results: In bivariate analysis, total physical activity was inversely correlated with depressive symptoms (ρ = −0.19, p < 0.001). However, in the multivariable model, this effect was not statistically significant after controlling for other factors. Poor sleep quality emerged as the dominant independent predictor of both depression (β = 0.37, p < 0.001) and anxiety (β = 0.40, p < 0.001). Walking time and frequency were specifically protective against depressive symptoms. Sex-stratified analyses revealed distinct patterns: female students benefited more from walking, whereas male students showed stronger associations between overall physical activity and lower depressive symptoms. Conclusions: Within the constraints of a cross-sectional design, this study provides novel evidence from Eastern Europe that sleep quality and physical activity are central to student mental health. Psychological benefits of walking appear sex-specific, and the null mediation finding suggests benefits operate via direct or unmodelled pathways. Sleep is a critical independent target for tailored, lifestyle-based strategies. Full article

(This article belongs to the Special Issue Clinical Perspectives on Physical Activity and Health Across the Lifespan)

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17 pages, 396 KB

Open AccessArticle

The Association Between Cardiorespiratory Fitness Directly Assessed by the Cardiopulmonary Stress Test and the Perception of Stress

by Gianluigi Oggionni, Marcello Rizzi, Giuseppina Bernardelli, Mara Malacarne, Massimo Pagani and Daniela Lucini

J. Clin. Med. 2025, 14(19), 7120; https://doi.org/10.3390/jcm14197120 - 9 Oct 2025

Viewed by 505

Abstract

Background/Objectives: Cardiorespiratory fitness (CRF) represents a strong and consistent predictor of mortality among adults. It is ideally expressed as the maximum or peak rate of oxygen consumption per kilogram of body mass (VO_2max) determined by the cardiopulmonary exercise test (CPX). Variance [...] Read more.

Background/Objectives: Cardiorespiratory fitness (CRF) represents a strong and consistent predictor of mortality among adults. It is ideally expressed as the maximum or peak rate of oxygen consumption per kilogram of body mass (VO_2max) determined by the cardiopulmonary exercise test (CPX). Variance in CRF is mainly attributable to genetics and physical training; nevertheless, strong behavioral and socioeconomic confounders need to be considered. Among those, psychosocial stress may play an important role. Some papers show an association between low CRF and chronic stress conditions; nevertheless, CRF is generally estimated by indirect assessment and not directly measured by CPX. Methods: CRF was directly assessed by performing a CPX in 145 consecutive subjects (56 male, 89 female) (age 19–65 years) who attended our Exercise Medicine unit for health check-ups. Weekly total volume of physical activity (PA) was evaluated using a validated questionnaire (IPAQ); perceptions of stress, fatigue, and somatic symptoms were assessed using a self-administered questionnaire. Results: VO_2max was negatively correlated with perception of stress (p = 0.03), fatigue (p < 0.001), and somatic symptoms (p < 0.001); as expected, it was positively correlated with the weekly volume of PA (p < 0.001). This link was further evidenced by the observation that subjects who did not meet the PA goals as indicated by WHO guidelines presented a higher perception of stress, fatigue, and symptoms, as compared to physically active subjects. Conclusions: This direct link might, on the one hand, corroborate the role of exercise as a tool to manage stress and, on the other hand, focus on the role of stress as a possible determinant of CRF. Full article

(This article belongs to the Special Issue Advancements in Diagnostic Innovations in Sports Cardiology)

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34 pages, 1361 KB

Open AccessReview

Sleep Disorders in Neurodegenerative Diseases with Dementia: A Comprehensive Review

by Natalia Siwecka, Michał Golberg, Dominika Świerczewska, Beata Filipek, Karolina Pendrasik, Adrianna Bączek-Grzegorzewska, Mariusz Stasiołek and Mariola Świderek-Matysiak

J. Clin. Med. 2025, 14(19), 7119; https://doi.org/10.3390/jcm14197119 - 9 Oct 2025

Viewed by 1267

Abstract

Dementia is a growing problem of global relevance, currently affecting over 55 million people worldwide. The number of new dementia cases is still increasing, primarily due to the aging of society. Dementia is defined as a substantial decline in cognitive function, and it [...] Read more.

Dementia is a growing problem of global relevance, currently affecting over 55 million people worldwide. The number of new dementia cases is still increasing, primarily due to the aging of society. Dementia is defined as a substantial decline in cognitive function, and it is inherently associated with neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies, frontotemporal dementia, and vascular dementia. Of note, most patients suffering from neurodegenerative conditions, in addition to cognitive impairment, often experience various types of sleep disorders, including insomnia, rapid eye movement sleep behavior disorder, sleep-disordered breathing, and circadian rhythm disturbances. There is increasing evidence of a bidirectional interaction between sleep disturbances and mental health. Disrupted sleep may directly aggravate neuropsychiatric symptoms, like depression, anxiety, agitation, and hallucinations, and conversely, such symptoms can make sleeping more difficult. This creates a feedback loop that inevitably leads to disease progression and deterioration in quality of life. In this review, we provide an up-to-date overview of the nature and mechanisms behind sleep disorders in major neurodegenerative diseases, summarize treatment strategies for handling sleep disturbances, and discuss the clinical relevance of sleep–mental health interactions in the context of neurodegeneration-associated dementia. Neurodegeneration is a complex problem on the border between neurology and psychiatry, and it poses a challenge to the healthcare system, as it requires multidisciplinary approaches for optimal management. Understanding the connection between sleep and neuropsychiatric symptoms offers further opportunities for better symptom control, improved quality of life, and slower cognitive decline. Full article

(This article belongs to the Special Issue The Association Between Sleep Disorders and Metabolic and Mental Health)

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12 pages, 1079 KB

Open AccessArticle

Transpancreatic Sphincterotomy Is a Safe and Effective Pancreatic Guidewire-Assisted Cannulation Method: Real-World Data Analysis of the Hungarian ERCP Registry

by Dániel Pécsi, Nelli Farkas, Szilárd Gódi, Péter Hegyi, Andrea Szentesi, István Altorjay, Tamás Bakucz, Ákos Orbán-Szilágyi, Zoltán Szepes, László Czakó, Árpád Patai, Tibor Gyökeres, Roland Fejes, Zsolt Dubravcsik and Áron Vincze

J. Clin. Med. 2025, 14(19), 7118; https://doi.org/10.3390/jcm14197118 - 9 Oct 2025

Viewed by 509

Abstract

Background/Objectives: Difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) poses significant challenges and increases the risk of adverse events. Pancreatic guidewire (PGW)-assisted techniques offer potential solutions, but real-world comparative data are limited. Methods: This cohort study of prospectively collected data analyzed 234 ERCP [...] Read more.

Background/Objectives: Difficult biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) poses significant challenges and increases the risk of adverse events. Pancreatic guidewire (PGW)-assisted techniques offer potential solutions, but real-world comparative data are limited. Methods: This cohort study of prospectively collected data analyzed 234 ERCP cases from the Hungarian ERCP Registry, focusing on three PGW-assisted methods: transpancreatic sphincterotomy (TPS), double-guidewire technique (DGW), and prophylactic pancreatic stent-assisted cannulation (PPS-C). Results: TPS demonstrated the highest primary cannulation success rate (83.1%), significantly outperforming DGW (67.7%) and PPS-C (67.6%) (p < 0.001). With salvage methods, cannulation success was high across all groups. Post-ERCP pancreatitis rates were low (5.0% TPS, 5.6% DGW, 3.9% PPS-C), but prophylactic measures (pancreatic stents, indomethacin) were underutilized. Conclusions: Our findings suggest that TPS is a safe and effective alternative for difficult biliary cannulation in ERCP. Routine considerations of post-ERCP pancreatitis prophylaxis (prophylactic pancreatic stents and non-steroidal suppositories) are recommended in all PGW-assisted cannulations to minimize complications. Full article

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

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11 pages, 217 KB

Open AccessArticle

Evaluation of Ganglion Cell–Inner Plexiform Layer Thickness in the Diagnosis of Preperimetric and Early Perimetric Glaucoma

by Ilona Anita Kaczmarek, Marek Edmund Prost and Radosław Różycki

J. Clin. Med. 2025, 14(19), 7117; https://doi.org/10.3390/jcm14197117 - 9 Oct 2025

Viewed by 440

Abstract

Background: Optical coherence tomography (OCT) is the main diagnostic technology used to detect damage to the retinal ganglion cells (RGCs) in glaucoma. However, it remains unclear which OCT parameter demonstrates the best diagnostic performance for eyes with early, especially preperimetric glaucoma (PPG). We [...] Read more.

Background: Optical coherence tomography (OCT) is the main diagnostic technology used to detect damage to the retinal ganglion cells (RGCs) in glaucoma. However, it remains unclear which OCT parameter demonstrates the best diagnostic performance for eyes with early, especially preperimetric glaucoma (PPG). We determined the diagnostic performance of ganglion cell–inner plexiform layer (GCIPL) parameters using spectral-domain OCT (SD-OCT) in primary open-angle preperimetric and early perimetric glaucoma and compared them with optic nerve head (ONH) and peripapillary retinal nerve fiber layer (pRNFL) parameters. Methods: We analyzed 101 eyes: 36 normal eyes, 33 with PPG, and 32 with early perimetric glaucoma. All patients underwent Topcon SD–OCT imaging using the Optic Disc and Macular Vertical protocols. The diagnostic abilities of the GCIPL, rim area, vertical cup-to-disc ratio (CDR), and pRNFL were assessed using the area under the receiver operating characteristic curve (AUC). Results: For PPG, the AUCs ranged from 0.60 to 0.63 (GCIPL), 0.82 to 0.86 (ONH), and 0.49 to 0.75 (pRNFL). For early perimetric glaucoma, the AUCs for GCIPL and pRNFL ranged from 0.81 to 0.88 and 0.57 to 0.91, respectively, whereas both ONH parameters demonstrated an AUC of 0.89. The GCIPL parameters were significantly lower than both ONH parameters in detecting preperimetric glaucoma (p < 0.05). For early perimetric glaucoma, comparisons between the AUCs of the best-performing mGCIPL parameters and those of the best-performing pRNFL and ONH parameters revealed no significant differences in their diagnostic abilities (p > 0.05). Conclusions: GCIPL parameters exhibited a diagnostic performance comparable to that of ONH and pRNFL parameters for early perimetric glaucoma. However, their ability to detect preperimetric glaucoma was significantly lower than the ONH parameters. Full article

(This article belongs to the Section Ophthalmology)

14 pages, 1307 KB

Open AccessArticle

Diagnostic Value of Machine Learning Models in Inflammation of Unknown Origin

by Selma Özlem Çelikdelen, Onur Inan, Sema Servi and Reyhan Bilici

J. Clin. Med. 2025, 14(19), 7116; https://doi.org/10.3390/jcm14197116 - 9 Oct 2025

Viewed by 654

Abstract

Background: Inflammation of unknown origin (IUO) represents a persistent clinical challenge, often requiring extensive diagnostic efforts despite nonspecific inflammatory findings such as elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The complexity and heterogeneity of its etiologies—including infections, malignancies, and rheumatologic diseases—make [...] Read more.

Background: Inflammation of unknown origin (IUO) represents a persistent clinical challenge, often requiring extensive diagnostic efforts despite nonspecific inflammatory findings such as elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The complexity and heterogeneity of its etiologies—including infections, malignancies, and rheumatologic diseases—make timely and accurate diagnosis essential to avoid unnecessary interventions or treatment delays. Objective: This study aimed to evaluate the potential of machine learning (ML)-based models in distinguishing the major etiologic subgroups of IUO and to explore their value as clinical decision support tools. Methods: We retrospectively analyzed 300 IUO patients hospitalized between January 2023 and December 2024. Four binary one-vs-rest Linear Discriminant Analysis (LDA) models were first developed to independently classify infection, malignancy, rheumatologic disease, and undiagnosed cases using clinical and laboratory parameters. In addition, a multiclass LDA framework was constructed to simultaneously differentiate all four diagnostic groups. Each model was evaluated across 10 independent runs using standard performance metrics, including accuracy, sensitivity, specificity, precision, F1 score, and negative predictive value (NPV). Results: The malignancy model achieved the highest performance, with an accuracy of 91.7% and specificity of 0.96. The infection model demonstrated high specificity (0.88) and NPV (0.86), supporting its role in ruling out infection despite lower sensitivity (0.71). The rheumatologic model showed high sensitivity (0.81) but lower specificity (0.73), reflecting the clinical heterogeneity of autoimmune conditions. The undiagnosed model achieved very high accuracy (96.7%) and specificity (0.98) but limited precision and recall (0.50 each). The multiclass LDA framework reached an overall accuracy of 73.3% (mean 66%) with robust specificity (0.90) and NPV (0.89). Conclusions: ML-based LDA models demonstrated strong potential to support the diagnostic evaluation of IUO. While malignancy and infection could be predicted with high accuracy, rheumatologic diseases required integration of additional serological and clinical data. These models should be viewed not as stand-alone diagnostic tools but as complementary decision-support systems. Prospective multicenter studies are warranted to externally validate and refine these approaches for broader clinical application. Full article

(This article belongs to the Section Immunology & Rheumatology)

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27 pages, 2516 KB

Open AccessEditor’s ChoiceReview

Multiple Myeloma Laboratory Diagnostics Made Simple: Practical Insights and Key Recommendations

by Ana Marta Pires, João Pedro Barreto, Joana Caetano, Maria José Soares, Catarina Geraldes, Bruno Fernandes, Margarida Coucelo, Sérgio Chacim, Henrique Coelho, Cecília Correia, Ana Paula Cruz, Manuel Cunha, Maria Rosário Cunha, Nuno Cunha, Patrícia Ferraz, José Guilherme Freitas, Rui Henrique, Susana Lisboa, Paulo Lúcio, Artur Paiva, Cláudia Pedrosa, Inês Ramos, Ana Bela Sarmento-Ribeiro, Patrícia Seabra, Joana Sevilha, Maria José Rego de Sousa, Sara Sousa, Teresa Sousa, Márcio Tavares, Fernanda Trigo, Adriana Roque, Rui Bergantim, Cristina João and on behalf of the Portuguese Multiple Myeloma Group Show full author list Hide full author list

J. Clin. Med. 2025, 14(19), 7115; https://doi.org/10.3390/jcm14197115 - 9 Oct 2025

Viewed by 1007

Abstract

Multiple myeloma is a clonal plasma cell malignancy with a highly variable range of clinical manifestations. Over recent decades, substantial progress has been made in laboratory diagnostics, which has deepened our understanding of disease biology, improved risk stratification, and informed treatment strategies. In [...] Read more.

Multiple myeloma is a clonal plasma cell malignancy with a highly variable range of clinical manifestations. Over recent decades, substantial progress has been made in laboratory diagnostics, which has deepened our understanding of disease biology, improved risk stratification, and informed treatment strategies. In an era of transformation and innovation, conventional laboratory methods remain essential, as cutting-edge technologies might not be immediately accessible to all laboratories. Nonetheless, even widely used laboratory methodologies present many challenges, such as variability in assay performance, interpretative criteria, and standardization. This review by the Portuguese Multiple Myeloma Group of the Portuguese Society of Hematology provides a comprehensive overview and practical appraisal of current conventional laboratory methods employed for multiple myeloma diagnosis. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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13 pages, 842 KB

Open AccessArticle

Surgery in Staphylococcus aureus Infective Endocarditis: Clinical Outcomes, Neurological Sequelae, and Prognostic Implications

by Ahmed Elderia, Julian Hinzmann, Patricia Soehne, Walid Bennour, Thorsten Wahlers and Carolyn Weber

J. Clin. Med. 2025, 14(19), 7114; https://doi.org/10.3390/jcm14197114 - 9 Oct 2025

Viewed by 495

Abstract

Background:Staphylococcus aureus infective endocarditis (SA-IE) is believed to provoke higher rates of complications compared to other organisms that commonly cause IE (non-SA-IE). We believe that Staphylococcus aureus (S. aureus) has a high propensity to cause embolic events and cerebrovascular neurological [...] Read more.

Background:Staphylococcus aureus infective endocarditis (SA-IE) is believed to provoke higher rates of complications compared to other organisms that commonly cause IE (non-SA-IE). We believe that Staphylococcus aureus (S. aureus) has a high propensity to cause embolic events and cerebrovascular neurological complications. Methods: We conducted a single-center retrospective analysis, encompassing 529 patients who had undergone valve surgery for IE. Patients were divided according to causative microorganism into SA-IE and non-SA-IE groups. Subsequently, analyses of outcome differences between the two groups were performed, with a focus on neurological complications. Results: In the examined population, 128 (24.2%) had IE mediated by S. aureus. Patients with SA-IE were mostly male (69.3%) but had a higher proportion of females compared to non-SA-IE patients (30.7% vs. 21.8%; p = 0.039) and were significantly younger (61.1 [45.8–69.9] vs. 66.1 [54.3–74.4]; p = 0.002). Patients with SA-IE had comparable comorbidities to patients with non-SA-IE. Neurological complications were much more common in SA-IE (42.2%) compared to non-SA-IE (22.9%); (p < 0.001). Postoperative neurological complications were nearly equal in both groups—SA-IE 5.5% vs 6.2% in non-SA-IE (p = 0.752); 30-day mortality was significantly higher in patients with SA-IE vs. non-SA-IE (20.3% vs 12.5%; p = 0.028). However, the 1-year mortality rate did not differ between groups (29.4% vs. 22.2%; p = 0.121). Conclusions: Patients with SA-IE are subject to a higher incidence of neurological events prior to surgery and almost twice the short-term mortality rate compared to IE caused by other microorganisms. However, no observable discrepancy in the incidence of neurological events was found between SA- and non-SA-IE cases post-surgery. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiovascular Interventions)

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12 pages, 1405 KB

Open AccessArticle

Femoral Closure with Single ProGlide^® in Transcatheter Aortic Valve Implantation: A Registry-Based Study

by Kévin Roulot, Marion Kibler, Antonin Trimaille, Adrien Carmona, Amandine Granier, Philoktimon Plastaras, Jérome Rischner, Stéphane Greciano, Pierre Leddet, Fabien De Poli, Mohamad Kanso, Ulun Crimizade, Karen Boyer, Minh Hoang, Michel Kindo, Laurence Jesel, Olivier Morel and Patrick Ohlmann

J. Clin. Med. 2025, 14(19), 7113; https://doi.org/10.3390/jcm14197113 - 9 Oct 2025

Viewed by 533

Abstract

Background: Vascular closure of the femoral artery during transcatheter aortic valve implantation (TAVI) remains a critical step prone to complications, despite advancements in introducer technology. The traditional technique involves using two ProGlide^® suture closure devices (2P), but alternative approaches, such as employing [...] Read more.

Background: Vascular closure of the femoral artery during transcatheter aortic valve implantation (TAVI) remains a critical step prone to complications, despite advancements in introducer technology. The traditional technique involves using two ProGlide^® suture closure devices (2P), but alternative approaches, such as employing a single ProGlide^® device (1P), have emerged. Aims: We sought to evaluate the efficacy and safety of the 1P strategy compared to the standard 2P closure technique during transfemoral TAVI procedures. Methods: A registry-based study was conducted at the University Hospitals of Strasbourg, France, from January 2020 to December 2023. Consecutive patients who underwent TAVI via the transfemoral approach were deemed eligible. Results: The study cohort consisted of 1303 patients, with a mean age of 81.7 years and 47% female. The 1P strategy was used in 733 cases (56.3%), while the 2P technique was employed in 570 patients (43.7%). Hemostasis was achieved in the catheterization laboratory without additional devices in 30.4% of the single-ProGlide^® pre-closing cases. Vascular complication rates were similar in both groups, at 11.3% for the 1P technique and 11.4% for the 2P technique (p = 0.964). However, vascular closure device failure was significantly less frequent in the 1P group (1.6%) compared to the 2P group (5.3%). Conclusions: The 1P strategy for pre-closing during TAVI is as effective and safe as the conventional 2P approach. The 1P method offers potential advantages in terms of simplicity and cost-effectiveness. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 730 KB

Open AccessArticle

Clinical Value of Transcutaneous PCO₂ in Free Flap Blood Supply

by Fangfang Liu, Nannan Han, Lei Wang, Jinxiu Dong, Min Ruan and Youguo Ying

J. Clin. Med. 2025, 14(19), 7112; https://doi.org/10.3390/jcm14197112 - 9 Oct 2025

Viewed by 540

Abstract

Background: Transcutaneous PCO₂ (TcPCO₂) effectively represents the partial pressure of carbon dioxide in deep tissues, providing us with more accurate information regarding deep tissue perfusion and oxygen metabolism. Based on this, we aimed to explore the clinical value of TcPCO [...] Read more.

Background: Transcutaneous PCO₂ (TcPCO₂) effectively represents the partial pressure of carbon dioxide in deep tissues, providing us with more accurate information regarding deep tissue perfusion and oxygen metabolism. Based on this, we aimed to explore the clinical value of TcPCO₂ in assessing free flap blood supply during oral cancer surgery. Methods: A total of 27 patients undergoing oral cancer reconstruction with free flap reconstruction were enrolled. For enrolled patients, continuous monitoring was conducted before, during, and after free flap transplantation surgery. Results: A total of 121 measurements were taken, comprising 93 instances in the normal flap group and 28 instances in the insufficient flap group. The TcPCO₂ levels were significantly higher and transcutaneous PO₂ (TcPO₂) levels were lower in the insufficient group (p < 0.001). The cutoff values for TcPCO₂ and TcPO₂, calculated using the Youden index, were 66 mmHg and 16 mmHg, respectively. TcPCO₂ exhibits high specificity in monitoring the blood supply of free flaps. The area under the ROC curve (AUC) for TcPCO₂ in predicting insufficient flap perfusion was calculated to be 0.912. Conclusions: TcPCO₂ demonstrates high specificity in assessing blood supply in free flaps for patients undergoing oral cancer surgery and has diagnostic significance for early identification of insufficient flap. Full article

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

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13 pages, 605 KB

Open AccessEditor’s ChoiceReview

Functional Capacity Evaluation and Rehabilitation Strategies in Cardiac Amyloidosis: A Comprehensive Review

by Anthoula Plevritaki, Konstantinos Volaklis, Eleni Nakou, Constantinos Davos, Ioannis Kopidakis, Eleftherios Kallergis, Eirini Savva, Emmanouil Simantirakis, Aneta Aleksova and Maria Marketou

J. Clin. Med. 2025, 14(19), 7111; https://doi.org/10.3390/jcm14197111 - 9 Oct 2025

Viewed by 1789

Abstract

Cardiac amyloidosis (CA) is an increasingly recognized cause of restrictive cardiomyopathy characterized by amyloid fibril deposition in the heart, leading to severe functional impairments and poor prognosis. This review aims to provide a comprehensive overview of the pathophysiology of CA, emphasizing the mechanisms [...] Read more.

Cardiac amyloidosis (CA) is an increasingly recognized cause of restrictive cardiomyopathy characterized by amyloid fibril deposition in the heart, leading to severe functional impairments and poor prognosis. This review aims to provide a comprehensive overview of the pathophysiology of CA, emphasizing the mechanisms underlying functional capacity limitations and highlighting the importance of precise physiological assessment tools. We focus on objective measures such as cardiopulmonary exercise testing, field-based functional tests, and frailty evaluations that are vital for prognosis and tailoring patient care. With recent advances in disease-modifying therapies extending survival, maintaining and improving functional status through multidisciplinary rehabilitation emerges as a crucial therapeutic target. Evidence suggests that structured aerobic and resistance training can enhance exercise tolerance, strength, and quality of life in CA patients, although further research is needed to optimize rehabilitation protocols. By integrating clinical, physiological, and rehabilitative insights, this review underscores the value of a patient-centered approach aimed at preserving functional capacity and improving outcomes in this complex and systemic disease. Full article

(This article belongs to the Special Issue The Role of Cardiac Rehabilitation After Myocardial Infarction, Coronary Artery Bypass Surgery, and in Other Cardiac Diseases)

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15 pages, 1849 KB

Open AccessEditor’s ChoiceArticle

Prevalence of Sleep Disturbance and Associated Risk Factors in Degenerative Cervical Myelopathy

by Salim Yakdan, Karan Joseph, Jingyi Zhang, Miguel A. Ruiz-Cardozo, Aryan Pradhan, Alisha Dhallan, Faraz Arkam, Willliam Mualem, Garrison Bentz, Diogo P. Moniz Garcia, Benjamin Plog, Alexander T. Yahanda, Daniel Hafez, Wilson Z. Ray, Camilo A. Molina and Jacob K. Greenberg

J. Clin. Med. 2025, 14(19), 7110; https://doi.org/10.3390/jcm14197110 - 9 Oct 2025

Viewed by 685

Abstract

Study Design: Retrospective Case–Control. Objectives: Sleep disturbances negatively impact quality of life and increase illness susceptibility. Chronic pain is a risk factor for sleep disruption, particularly in patients with degenerative spinal conditions. Existing studies suggest that degenerative cervical myelopathy (DCM) patients often experience [...] Read more.

Study Design: Retrospective Case–Control. Objectives: Sleep disturbances negatively impact quality of life and increase illness susceptibility. Chronic pain is a risk factor for sleep disruption, particularly in patients with degenerative spinal conditions. Existing studies suggest that degenerative cervical myelopathy (DCM) patients often experience sleep disturbances, possibly due to spinal cord compression and pain. However, most research is limited to small, single-center studies, creating a need for broader analyses. Methods: We utilized the Merative Explorys Dataset, focusing on electronic health record data of patients diagnosed with DCM and sleep disorders identified via ICD codes. Comorbidities analyzed included depression/bipolar disorder, chronic pulmonary disease, migraine, osteoarthritis, hypertension, malignancy, diabetes, and cerebrovascular disease. Patient demographic information (age, race, sex, and body mass index (BMI)) was included as covariates. Logistic regression analyses were performed to evaluate the association between each comorbidity and the risk of sleep disturbance. Results: Among 40,551 DCM patients, significant predictors of sleep disturbance included higher BMI (OR: 1.05, 95% CI: 1.05–1.06), depression/bipolar disorder (OR: 1.65, 95% CI: 1.56–1.74), chronic pulmonary disease (OR: 1.26, 95% CI: 1.20–1.33), migraine (OR: 1.32, 95% CI: 1.22–1.43), and hypertension (OR: 1.16, 95% CI: 1.10–1.23). Conclusions: This large-scale analysis demonstrates the multifactorial nature of sleep disturbances in DCM, highlighting strong associations with BMI and respiratory conditions, suggesting a contributory role of sleep-disordered breathing. The identification of migraines as a risk factor highlights the need for multidisciplinary management. Addressing modifiable risk factors such as BMI and mental health may improve sleep quality in DCM patients. Full article

(This article belongs to the Special Issue Emerging Trends in Cervical Spine Surgery)

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27 pages, 627 KB

Open AccessEditor’s ChoiceArticle

Multidimensional Impulsivity Profile in Young Adults Aged 16 to 25 with Borderline Personality Disorder: A Study Based on the UPPS-P Model

by Anaïs Mungo, Marie Delhaye and Matthieu Hein

J. Clin. Med. 2025, 14(19), 7109; https://doi.org/10.3390/jcm14197109 - 9 Oct 2025

Viewed by 817

Abstract

Background: Borderline Personality Disorder (BPD) often emerges during adolescence and young adulthood, a period marked by heightened vulnerability to impulsivity and affective dysregulation. While impulsivity is a core feature of BPD, its multidimensional expression in this age group remains insufficiently documented. This [...] Read more.

Background: Borderline Personality Disorder (BPD) often emerges during adolescence and young adulthood, a period marked by heightened vulnerability to impulsivity and affective dysregulation. While impulsivity is a core feature of BPD, its multidimensional expression in this age group remains insufficiently documented. This study examined impulsivity traits in young adults with BPD, their associations with depressive and anxiety symptoms, and their links to risk behaviors. Methods: A total of 160 participants aged 16–25 were recruited in Belgium between 2021 and 2023: 44 with BPD from inpatient and outpatient psychiatric services and 116 healthy controls from schools and universities. Assessments included the short UPPS-P, Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI-T), and the Diagnostic Interview for Borderlines–Revised (DIB-R). Logistic regressions with robust errors and Kendall’s tau-b correlations were used. Results: Compared with controls, individuals with BPD scored higher on all UPPS-p subscales except Sensation Seeking (e.g., Negative Urgency: 14 vs. 10, p < 0.001). Logistic regression identified Negative Urgency (OR = 5.31, 95% CI: 2.07–13.62, p = 0.001) and Positive Urgency (OR = 3.26, 95% CI: 1.37–7.75, p = 0.007) as independent predictors of BPD. Within the BPD group, depressive and anxiety symptoms correlated with several UPPS-P dimensions, notably Negative Urgency and Lack of Perseverance. Suicide attempts were associated with the DIB-R total score, BDI-II, and STAI-T, while substance use was linked to the DIB-R impulsivity subscale and STAI-T. Conclusions: Emotional impulsivity—particularly Negative Urgency—emerges as a central feature of BPD in emerging adulthood. Its interplay with depressive and anxiety symptoms, and its associations with suicidal and addictive behaviors, support a dual-level conceptualization of impulsivity as both a dispositional trait and a state-dependent clinical risk factor. Full article

(This article belongs to the Special Issue (Recent Advances) Treating Psychiatry Disorders in Children and Adolescents: From Theory to Practice: 2nd Edition)

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19 pages, 1316 KB

Open AccessArticle

Physician Empathy as Perceived by Parents of Children with Psychiatric Disorders: A Quantitative Analysis of Pediatric Consultations

by Elisabeta-Oana Avram, Lavinia-Alexandra Moroianu, Cecilia Curis, Oana-Maria Isaila, Elena-Alexandra Bratu, Iulian Bounegru, Alexandru Paul Baciu and Eduard Drima

J. Clin. Med. 2025, 14(19), 7108; https://doi.org/10.3390/jcm14197108 - 9 Oct 2025

Viewed by 561

Abstract

Background: Clinician empathy is associated with family satisfaction and reduced anxiety, but quantitative data from the parents’ perspective in pediatric psychiatry are limited. Objective: To assess parent-perceived physician empathy in pediatric psychiatry consultations and explore its associations with clinical and demographic [...] Read more.

Background: Clinician empathy is associated with family satisfaction and reduced anxiety, but quantitative data from the parents’ perspective in pediatric psychiatry are limited. Objective: To assess parent-perceived physician empathy in pediatric psychiatry consultations and explore its associations with clinical and demographic factors. Methods: Cross-sectional, consecutive sample of parents attending an outpatient pediatric psychiatry clinic (n = 163 parents). A 10-item behavioral empathy scale (range 10–40) was used. Analyses included reliability testing, group comparisons, correlations, OLS regression, and exploratory PCA. Results: The mean total empathy score was 34.5 (SD 4.2); most parents rated physicians as highly empathic (65%). Parents of children with ASD reported lower empathy compared to those with anxiety/depression. Empathy increased modestly with child age and was associated with a calmer state at the end of the visit. PCA suggested exploratory evidence of potential subdimensions, including child-centered communication and listening/facilitation. Conclusions: Parent-perceived empathy in this sample was generally high; however, behaviors that directly involve and facilitate the child (listening, encouraging questions) may need strengthening, particularly for children with ASD. Results should be interpreted in light of the single-center design, the absence of a recorded participation rate, parent-proxy reporting, and the exploratory nature of the PCA. Full article

(This article belongs to the Special Issue Advances in Stigma and Discrimination in Pediatric Mental Health)

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27 pages, 407 KB

Open AccessEditor’s ChoiceSystematic Review

Beyond Racial Categorization in Sports Cardiology: A Systematic Review of Cardiac Adaptations in Athletes

by Douglas Corsi, Rafael Hernandez, Jasmine Yimeng Bao, Stephen Garrova and David Shipon

J. Clin. Med. 2025, 14(19), 7107; https://doi.org/10.3390/jcm14197107 - 9 Oct 2025

Viewed by 626

Abstract

Background/Objectives: Race-based cardiac screening criteria in sports cardiology, including the “Black athlete’s heart” concept, assume biological distinctions that may not reflect physiological reality. This systematic review evaluates whether geographic ancestry provides more clinically relevant predictors of cardiac adaptation than racial categorization. Methods: PubMed [...] Read more.

Background/Objectives: Race-based cardiac screening criteria in sports cardiology, including the “Black athlete’s heart” concept, assume biological distinctions that may not reflect physiological reality. This systematic review evaluates whether geographic ancestry provides more clinically relevant predictors of cardiac adaptation than racial categorization. Methods: PubMed was searched (January 2005–July 2025) for studies examining cardiac adaptations in athletes by ethnicity. Data extraction captured demographics, geographic origin, cardiac assessments, and outcomes. Narrative synthesis was employed due to methodological heterogeneity. Results: Forty-seven studies (n = 66,130) revealed substantial within-race heterogeneity. The “Black athlete repolarization variant” prevalence ranged from 1.8% (Brazilian) to 30% (Ghanaian) Black athletes. Left ventricular wall thickness >12 mm (normal <11 mm) occurred in 7.1% of Black versus 0.4% of White athletes, yet varied significantly within Black populations—10.8 ± 1.2 mm in Sub-Saharan versus 9.4 ± 1.1 mm in African-American athletes (p < 0.001). Relative wall thickness ≥0.44 (normal ≤0.42) was presented in 43% of West/Middle African, 23% of East African, and 7% of White athletes. T-wave inversion showed four-fold variation within Black populations (3.6–8.5% West African versus 0.5–2.0% African-American/Caribbean). Current International Criteria demonstrated inequitable specificity: 3.3% false-positive rate in Black versus 1.4% in White athletes. Conclusions: Geographic ancestry explains more cardiac variation than racial categories, supporting contemporary understanding of race as a sociopolitical construct. The persistent diagnostic disparities in ECG screening specificity highlight the need for reform. Transitioning toward protocols incorporating continental origin, anthropometric factors, and social determinants of health—while eliminating terminology like “Black athlete’s heart”—represents an important step toward achieving equity in cardiovascular care for diverse athletic populations. Full article

(This article belongs to the Section Sports Medicine)

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15 pages, 349 KB

Open AccessReview

Optimizing Aesthetic Results in Implant-Based Breast Reconstruction: Patient Factors, Surgical Techniques, and Adjunctive Strategies

by Elisa Bertulla and Edoardo Raposio

J. Clin. Med. 2025, 14(19), 7106; https://doi.org/10.3390/jcm14197106 - 9 Oct 2025

Viewed by 630

Abstract

Background: Breast reconstruction following mastectomy plays a crucial role in breast cancer management, restoring physical form and significantly impacting psychological well-being and quality of life. Implant-based breast reconstruction (IBBR) is the most performed technique worldwide due to its relative simplicity, shorter operative [...] Read more.

Background: Breast reconstruction following mastectomy plays a crucial role in breast cancer management, restoring physical form and significantly impacting psychological well-being and quality of life. Implant-based breast reconstruction (IBBR) is the most performed technique worldwide due to its relative simplicity, shorter operative times, and avoidance of donor site morbidity. Achieving satisfactory aesthetic outcomes, however, remains challenging, as multiple factors—including patient characteristics, surgical technique, implant selection, timing of reconstruction, and adjuvant therapies—can influence the final appearance. Methods: Literature research was performed via PubMed, Scopus and Cochrane Library Database, focusing on studies examining aesthetic outcomes in implant-based breast reconstruction published between 2015 and 2025. Data on type of study, sample size, aesthetic evaluation methods, and duration of follow-up were collected and summarized. Results: Among 747 articles identified, only 25 articles fulfilled inclusion criteria, including mostly retrospective studies, but also prospective studies, randomized clinical trials, and reviews. Factors such as BMI, inframammary fold management, and implant selection were consistently reported to influence aesthetic outcomes. Surgical techniques including ADM use, axillary advancement sutures, hybrid reconstruction with fat grafting, and prepectoral implant placement were associated with improved patient satisfaction. Patient satisfaction often differs from surgeon-assessed outcomes, emphasizing the importance of subjective evaluation. Conclusions: Despite the heterogeneity and retrospective nature of many studies, evidence indicates that optimizing aesthetic outcomes in IBBR relies on careful patient selection, tailored surgical planning, and meticulous use of evidence-based techniques, including implant selection, flap-based support, and adjunctive strategies. Patient-reported outcomes are essential for evaluating success, and future research should focus on standardized outcome measures and prospective studies to further refine reconstructive approaches and maximize both cosmetic satisfaction and quality of life. Full article

(This article belongs to the Special Issue Advances in Breast Reconstruction: New Technologies Improving Clinical Outcomes)

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12 pages, 829 KB

Open AccessArticle

Unraveling the Easix Score: Its Association with Vasopressor Need in Critically Ill Septic Pediatric Hematology–Oncology Patients

by Lama Elbahlawan, Majd Khiami, Chad Blackshear, Saad Ghafoor, Alexandra Schaller, Sherry Johnson, Gabriela Maron, Raktima Datta, Amr Qudeimat and Jennifer McArthur

J. Clin. Med. 2025, 14(19), 7105; https://doi.org/10.3390/jcm14197105 - 9 Oct 2025

Viewed by 529

Abstract

Background: Sepsis is a common and serious complication in pediatric hematology oncology (PHO) patients. The Endothelial Activation and Stress Index (EASIX) score offers a potentially accessible tool for risk stratification in septic patients. Our objective was to evaluate the association of the [...] Read more.

Background: Sepsis is a common and serious complication in pediatric hematology oncology (PHO) patients. The Endothelial Activation and Stress Index (EASIX) score offers a potentially accessible tool for risk stratification in septic patients. Our objective was to evaluate the association of the EASIX score with adverse clinical outcomes among septic PHO patients. Methods: A retrospective review was conducted for all PHO patients admitted to the intensive care unit (ICU) with sepsis from July 2022 to December 2024. Results: A total of 53 patients with 65 sepsis events were included in this analysis. The median age was 14.9 [IQR 9.9] y and the most common disease was hematologic malignancy. In our cohort, 60% needed vasopressors, 36% required invasive mechanical ventilation, and 22% underwent renal replacement therapy (RRT). Log2-EASIX > 2.5 was associated with higher vasopressor requirements (87% versus 45% in the low log2-EASIX group, p = 0.001) and an increased need for RRT (39% versus 12%, p = 0.024). Septic PHO patients with log2-EASIX > 2.5 were 6.9 times more likely to require vasopressor support [(95% CI 1.7–27.8) p = 0.007]. In addition, PHO patients with log2-EASIX > 2.5 had a longer ICU stay (7 d versus 2 d in the low log2-EASIX group, p = 0.024) and an extended overall hospitalization (33 d versus 25 d, p = 0.029). Conclusions: A higher EASIX score was associated with adverse outcomes in critically ill septic PHO patients. Our findings suggest that the EASIX score can be used as a tool for identifying septic patients at an increased risk of clinical deterioration and poor outcomes. Prospective studies in larger cohorts are warranted to validate and expand upon these findings. Full article

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

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29 pages, 2125 KB

Open AccessEditor’s ChoiceReview

Hungry Bone Syndrome After Parathyroidectomy for Secondary Hyperparathyroidism: Pathogenesis and Contemporary Clinical Considerations

by Adina Coman, Cristi Tarta, Marco Marian, Daian Ionel Popa, Sorin Olariu, Mihai Rosu, Diana Utu, Florina Buleu, Anca-Monica Macovei-Oprescu, Dorin Novacescu, Flavia Zara and Marius Murariu

J. Clin. Med. 2025, 14(19), 7104; https://doi.org/10.3390/jcm14197104 - 9 Oct 2025

Viewed by 1101

Abstract

Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone [...] Read more.

Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)—a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL/OPG dysregulation, Wnt/β-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery. Full article

(This article belongs to the Special Issue Endocrine Surgery: Current Developments and Trends)

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16 pages, 521 KB

Open AccessArticle

Triple-Negative Apocrine Carcinoma: Largest Cohort Highlights Unique Biology and Survival Advantage

by Tugba Basoglu, Ugur Ozkerim, Sila Oksuz, Oguzcan Kinikoglu, Sedat Yildirim, Sermin Kokten, Heves Surmeli, Deniz Isik, Ozlem Nuray Sever, Seval Ay Ersoy, Hatice Odabas and Nedim Turan

J. Clin. Med. 2025, 14(19), 7103; https://doi.org/10.3390/jcm14197103 - 9 Oct 2025

Viewed by 653

Abstract

Background/Objectives: Triple-negative breast cancer (TNBC) is a heterogeneous entity lacking ER, PR, and HER2, with aggressive biology and high recurrence risk. Neoadjuvant chemotherapy (NACT) is the standard of care, and a pathological complete response (pCR) is a surrogate marker for survival. Within [...] Read more.

Background/Objectives: Triple-negative breast cancer (TNBC) is a heterogeneous entity lacking ER, PR, and HER2, with aggressive biology and high recurrence risk. Neoadjuvant chemotherapy (NACT) is the standard of care, and a pathological complete response (pCR) is a surrogate marker for survival. Within TNBC, apocrine differentiation (TNAC) is a distinct subtype, often androgen receptor (AR)-positive, with lower chemosensitivity but a favorable prognosis. Comparative studies of TNAC versus classical TNBC remain limited. This study aimed to define clinical and biological differences between TNAC and non-apocrine TNBC (NA-TNBC), representing the largest TNAC cohort to date. Methods: This retrospective study included 129 non-metastatic TNBC patients treated with NACT and surgery (2010–2020). Patients were classified as TNAC or NA-TNBC. Demographic, clinicopathological, and immunohistochemical data (including Ki-67 and AR) were collected. Tumor-infiltrating lymphocytes (TILs), delta Ki-67, pathological complete response (pCR), and survival outcomes were evaluated. Results: Of 129 TNBC patients, 45 (34.9%) were TNAC. AR positivity occurred in 64.4% of TNACs. TNAC patients were predominantly postmenopausal. pCR rates were significantly lower in TNAC (6.6% vs. 30.9%, p = 0.002). TNACs exhibited lower baseline Ki-67, delta Ki-67, and TIL positivity (13.3% vs. 30%). Despite this, 5-year overall survival was higher in TNAC (86% vs. 78%). Delta Ki-67 > 20% strongly predicted pCR across the cohort (p < 0.001). Carboplatin was rarely used in TNAC (8.3%), but was associated with a higher pCR rate (50% vs. 2.4%, p = 0.018). Conclusions: TNAC represents a biologically distinct TNBC subtype, characterized by low pCR but favorable survival. Recognition of its unique features may guide treatment de-escalation and exploration of AR-targeted therapies. Prospective studies focusing on TNAC are warranted. Full article

(This article belongs to the Topic Triple-Negative Breast Cancer: Genetic Vulnerabilities and Emerging Targets for Precision Oncology)

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12 pages, 880 KB

Open AccessReview

The Role of Inflammasomes in LPS and Gram-Negative Bacterial Sepsis

by Eduardo Hernández-Cuellar, Kohsuke Tsuchiya, Oscar Medina-Contreras and Ricardo Valle-Ríos

J. Clin. Med. 2025, 14(19), 7102; https://doi.org/10.3390/jcm14197102 - 9 Oct 2025

Viewed by 849

Abstract

Background/Objectives: Sepsis is a life-threatening condition characterized by an uncontrolled immune response due to systemic infections. It is responsible for millions of deaths worldwide. Although inflammasomes play an important role in host defense, they have a detrimental role in sepsis induced by [...] Read more.

Background/Objectives: Sepsis is a life-threatening condition characterized by an uncontrolled immune response due to systemic infections. It is responsible for millions of deaths worldwide. Although inflammasomes play an important role in host defense, they have a detrimental role in sepsis induced by LPS or Gram-negative bacteria. We aimed to revise the molecular mechanisms of inflammasome activation in sepsis by LPS and Gram-negative bacteria other than cytokine release as treatments blocking TNF-α and IL-1 cytokines have been ineffective even though cytokine storm is associated with lethality. Results: Studies with knockout mice deficient in inflammasome-derived cytokines have shown contrasting results on the role of these proinflammatory cytokines in the lethality of LPS- and Gram-negative-induced sepsis. However, DAMPs released after non-canonical inflammasome activation such as extracellular DNA, histones, HMGB1, and tissue factor result in disseminated-intravascular coagulation (DIC) and mortality in mice. Blocking these products in preclinical studies with animal models showed improved clinical scores and survival after LPS-induced sepsis or polymicrobial sepsis induced by Cecal Ligation and Puncture. Conclusions: Even though immunomodulatory drugs have shown inconclusive results as therapies for sepsis, blocking DAMPs associated with DIC may be considered for clinical trials in the future, especially in patients presenting biomarkers of coagulopathies. Full article

(This article belongs to the Special Issue Sepsis: New Insights into Diagnosis and Treatment)

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9 pages, 723 KB

Open AccessSystematic Review

A Relationship Between Atrial Fibrillation and Dizziness

by Rodica Urs, Luigi Geo Marceanu, Horatiu Rus, Alexandru Covaciu, Christian Gabriel Strempel and Elena Bobescu

J. Clin. Med. 2025, 14(19), 7101; https://doi.org/10.3390/jcm14197101 - 9 Oct 2025

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Abstract

Background: Vertigo and dizziness have been observed in patients with atrial fibrillation (AF), yet their role as possible early manifestations of AF remains insufficiently understood. Methods: A systematic review of five relevant studies, comprising a total of 2102 patients, was conducted [...] Read more.

Background: Vertigo and dizziness have been observed in patients with atrial fibrillation (AF), yet their role as possible early manifestations of AF remains insufficiently understood. Methods: A systematic review of five relevant studies, comprising a total of 2102 patients, was conducted to evaluate the relationship between vestibular symptoms and AF. Results: Dizziness and vertigo were frequently reported, particularly in acute presentations, although they were rarely considered primary symptoms. Evidence suggests a potential correlation between vestibular manifestations and AF, with vertigo possibly acting as an autonomic or inflammatory trigger in selected cases. Conclusions: The findings highlight the clinical relevance of including vertigo and dizziness in the routine assessment of patients with AF. Proper recognition of these symptoms may reduce underdiagnosis, improve treatment adherence, and prevent complications associated with misattribution of vertigo to non-cardiac causes. Full article

(This article belongs to the Special Issue Novel Developments on Diagnosis and Treatment of Atrial Fibrillation)

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13 pages, 656 KB

Open AccessArticle

In Vitro Evaluation of Antimicrobial Effects of Endodontic Irrigants Containing Disodium Edetate and Chlorhexidine Gluconate, Octenidine Dihydrochloride, and Benzalkonium Bromide Against Intracanal Enterococcus faecalis

by Anna Siemińska, Katarzyna Kot, Ewa Marek, Agnieszka Chamarczuk, Magdalena Kaczała, Joanna Rasławska-Socha, Laurentia Schuster, Till Dammaschke, Liliana Szyszka-Sommerfeld and Mariusz Lipski

J. Clin. Med. 2025, 14(19), 7100; https://doi.org/10.3390/jcm14197100 - 8 Oct 2025

Viewed by 532

Abstract

Background/Objectives: The objective of this in vitro study was to compare and evaluate the in vitro antimicrobial effectiveness of Endosal, Octenisolv, and Endoxal against intracanal Enterococcus faecalis. Methods: The study sample consisted of 84 extracted single-rooted human teeth, which were [...] Read more.

Background/Objectives: The objective of this in vitro study was to compare and evaluate the in vitro antimicrobial effectiveness of Endosal, Octenisolv, and Endoxal against intracanal Enterococcus faecalis. Methods: The study sample consisted of 84 extracted single-rooted human teeth, which were divided into seven groups (12 roots in each group): Group 1—Endoxal, Group 2—Octenisolv, Group 3—Endosal, Group 4—15% ethylenediaminetetraacetic acid (EDTA), Group 5—2% sodium hypochlorite (NaOCl), Group 6—0.9% sterile saline solution (NaCl), and one positive control group where no irrigant was used. The roots were sterilized within an autoclave for 30 min at 121 °C and then contaminated with E. faecalis bacteria, after instrumentation and removing the smear layer from canals. The root canals were irrigated using a side-vented needle, and then ISO size 40 H-file was used to obtain fine dentine chips. Aliquots taken from the canals were plated on blood agar broth and the plates were incubated for 36 h. Results: In this study, significant differences were observed between the antimicrobial activity of Endoxal, Octenisolv, Endosal, 2% NaOCl, and sterile saline solution. Conclusions: The compound irrigants Endosal, Endoxal, and a novel irrigant containing disodium edetate and octenidine, which were evaluated in this study, exhibited relatively good antimicrobial properties against Enterococcus faecalis. The use of Endosal, Octenisolv or Endoxal appears promising, yet their clinical efficacy remains to be confirmed through further studies. Full article

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

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21 pages, 1703 KB

Open AccessArticle

The Effect of BeBo^® Training and EMG-Biofeedback-Assisted Therapy on Pelvic Floor Muscle Function in Women After Vaginal Delivery and Cesarean Section—A Randomized Controlled Trial

by Paulina Handzlik-Waszkiewicz, Iwona Sulowska-Daszyk and Agnieszka Suder

J. Clin. Med. 2025, 14(19), 7099; https://doi.org/10.3390/jcm14197099 - 8 Oct 2025

Viewed by 757

Abstract

Background/Objectives: Pelvic floor muscle (PFM) training is widely recommended during pregnancy and postpartum as both a preventive and therapeutic intervention. The addition of electromyography (EMG) biofeedback may further enhance training effectiveness. This study aimed to evaluate the effectiveness of a 6-week BeBo [...] Read more.

Background/Objectives: Pelvic floor muscle (PFM) training is widely recommended during pregnancy and postpartum as both a preventive and therapeutic intervention. The addition of electromyography (EMG) biofeedback may further enhance training effectiveness. This study aimed to evaluate the effectiveness of a 6-week BeBo^® PFM training program (BeBo^®, derived from the German Beckenboden, “pelvic floor”) and to compare it with BeBo^® training combined with EMG biofeedback in women after vaginal delivery (VD) and cesarean section (CS), relative to control groups. Methods: A total of 120 primiparous women (mean age 29.0 ± 1.9 years), 6–8 weeks postpartum after VD (n = 60) or CS (n = 60), were randomly assigned to BeBo^® training, BeBo^®+EMG-biofeedback, or control group. Neuromuscular PFM activity was assessed before and after intervention using surface electromyography (sEMG; Noraxon G2 TeleMyo 2400) with a vaginal probe. Results: Women performing BeBo^® training with EMG-biofeedback demonstrated significantly greater improvements in PFM endurance (p < 0.001, η² = 0.423) in both VD and CS groups compared with controls and BeBo^® training alone. Regarding maximal fast contraction, significant improvements (p = 0.042, η² = 0.097) were observed in both delivery groups within the EMG-biofeedback group, whereas BeBo^® training alone was effective only in the VD group. Conclusions: PFM training based on the BeBo^® concept, particularly when supported by EMG-biofeedback, effectively enhances neuromuscular function, with the greatest benefits observed in women after VD. EMG-biofeedback should be considered as an adjunct in standard postpartum preventive care, with training protocols tailored to delivery mode: relaxation-focused for CS and strengthening-focused for VD. Full article

(This article belongs to the Special Issue Rehabilitation Medicine and Clinical Research: From Diagnosis to Therapeutic Interventions)

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J. Clin. Med., Volume 14, Issue 19 (October-1 2025) – 440 articles

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