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Volume 14
Issue 6
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J. Clin. Med., Volume 14, Issue 6 (March-2 2025) – 349 articles

Cover Story (view full-size image): Bone regeneration has emerged as field of critical research and clinical advancement, fueled by the growing demand for effective treatments in orthopedics and oncology. This review evaluated a range of bone regeneration strategies, examining the clinical outcomes, materials used, surgical techniques, and the effectiveness of various approaches in treating bone defects. The results indicated that while advancements in synthetic and naturally derived biomaterials show considerable potential, challenges remain in optimizing therapeutic strategies across diverse patient populations and clinical settings. Further research is required to establish standardized protocols and determine the optimal application of various materials and techniques to enhance patient outcomes and the quality of care. View this paper
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16 pages, 5739 KiB  
Review
An Atypical Presentation of Reticular Erythematous Mucinosis: A Case Report and Comprehensive Literature Review
by Beatrice Bălăceanu-Gurău, Cristina Violeta Tutunaru and Olguța Anca Orzan
J. Clin. Med. 2025, 14(6), 2131; https://doi.org/10.3390/jcm14062131 - 20 Mar 2025
Viewed by 374
Abstract
Reticular erythematous mucinosis (REM) is a rare form of primary cutaneous mucinosis, often linked to viral infections, inflammatory conditions, ultraviolet radiation, radiotherapy, malignant disorders, or an underlying immune dysfunction. It typically affects middle-aged women and manifests as symmetrical erythematous macules, papules, or plaques [...] Read more.
Reticular erythematous mucinosis (REM) is a rare form of primary cutaneous mucinosis, often linked to viral infections, inflammatory conditions, ultraviolet radiation, radiotherapy, malignant disorders, or an underlying immune dysfunction. It typically affects middle-aged women and manifests as symmetrical erythematous macules, papules, or plaques that exhibit a reticular and annular configuration, mainly on the midline of the thorax or dorsum. Although these regions represent the most prevalent sites, atypical occurrences have been noted. We report an unusual case of REM in a pediatric female patient with an ongoing history of B-cell acute lymphoblastic leukemia. The physical examination revealed an atypical distribution of REM lesions, symmetrically affecting the gluteal region and proximal thighs. Establishing a definitive diagnosis required a meticulous correlation between clinical, dermoscopic, and histopathologic findings. To our knowledge, this is the first documented case of REM in a patient with acute lymphoblastic leukemia. Our study underlines the importance of including REM in the differential diagnosis of persistent erythematous lesions, particularly in immunocompromised patients or those with a history of malignancy. Furthermore, we provide a comprehensive literature review, emphasizing the etiology, risk factors, pathogenetic mechanisms, diagnostic challenges, and different therapeutic options for REM. Full article
(This article belongs to the Section Dermatology)
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14 pages, 1382 KiB  
Article
Assessing Cardiovascular Risk Among Polish Soldiers: Insights Using the POL SCORE Tool
by Magdalena Zawadzka, Justyna Marszałkowska-Jakubik, Ewelina Ejchman-Pac, Beata Pająk-Tarnacka and Paweł Szymański
J. Clin. Med. 2025, 14(6), 2130; https://doi.org/10.3390/jcm14062130 - 20 Mar 2025
Viewed by 274
Abstract
Background/Objectives: Maintaining the health and operational readiness of military personnel is a strategic priority, particularly in the context of cardiovascular diseases (CVDs), which remain a significant public health challenge in Poland. Despite a decline in mortality rates between 2006 and 2012, Poland [...] Read more.
Background/Objectives: Maintaining the health and operational readiness of military personnel is a strategic priority, particularly in the context of cardiovascular diseases (CVDs), which remain a significant public health challenge in Poland. Despite a decline in mortality rates between 2006 and 2012, Poland continues to report higher premature mortality rates compared to the OECD average. This study highlights the importance of effective risk assessment and management strategies, employing the POL SCORE scale, an adaptation of the European Society of Cardiology’s Systematic Coronary Risk Evaluation (SCORE) project. Methods: This study included 196 participants, comprising soldiers and civilian employees of the Ministry of National Defense, to assess their 10-year cardiovascular mortality risk. Data were collected using clinical evaluations and self-reported questionnaires. Results: Findings revealed that 66.3% of participants were at moderate risk, with significant differences observed based on gender and education level. Notably, the average triglyceride level was 219.3 ± 114.31 mg/dL in the very high-risk group, compared to 97.4 ± 41.31 mg/dL in the low-risk group. Stress, reported by 88.2% of participants, emerged as the most prevalent work-related risk factor. Alarmingly, a lack of awareness regarding cardiovascular risk factors was observed, particularly among high-risk individuals. Conclusions: This study underscores the need for targeted health education, regular preventive screenings, and psychological support, particularly among military personnel. These interventions are crucial to mitigating the burden of CVDs and ensuring the operational readiness of armed forces. Full article
(This article belongs to the Section Cardiology)
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13 pages, 2462 KiB  
Article
The Efficacy and Safety of Direct Oral Anticoagulants Compared to Warfarin for Left Ventricular Thrombus Resolution
by Mariana Sousa Paiva, Francisco Gama, Samuel Azevedo, Pedro M. Lopes, Francisco Albuquerque, Carla Reis, Pedro Freitas, Sara Guerreiro, João Abecasis, Marisa Trabulo, António M. Ferreira, Regina Ribeiras, Jorge Ferreira and Pedro Pulido Adragão
J. Clin. Med. 2025, 14(6), 2129; https://doi.org/10.3390/jcm14062129 - 20 Mar 2025
Viewed by 404
Abstract
Background and Aim: Left ventricular thrombus (LVT) is a common complication of myocardial infarction (MI) and heart failure with reduced ejection fraction (HFrEF), typically managed with vitamin K antagonists (VKAs) for up to six months. However, data on direct oral anticoagulants (DOACs) for [...] Read more.
Background and Aim: Left ventricular thrombus (LVT) is a common complication of myocardial infarction (MI) and heart failure with reduced ejection fraction (HFrEF), typically managed with vitamin K antagonists (VKAs) for up to six months. However, data on direct oral anticoagulants (DOACs) for LVT treatment remain limited and conflicting. This study evaluates the effectiveness and safety of DOACs compared to warfarin for LVT resolution. Methods: We conducted a single-center retrospective cohort study of consecutive patients diagnosed with LVT from January 2010 to May 2024. The primary outcome was LVT resolution at 24 months. Safety outcomes included major bleeding and thromboembolic events. Diagnosis and follow-up were performed via echocardiography, with cardiac magnetic resonance and computed tomography as needed. Anticoagulant type, dose, duration, and concurrent antiplatelet therapy were at the treating physician’s discretion. Results: Among 171 patients (82.5% male, mean age 59.8 ± 14.7 years), 99 received DOACs and 72 received warfarin. LVT resolution was higher with DOACs (66.7% vs. 50%, HR 2.0, 95% CI 1.07–3.73, p = 0.029), with a trend toward faster thrombus resolution (185 vs. 220 days, p = 0.214) though statistically not significant. DOAC use remained an independent predictor of LVT resolution, regardless of antiplatelet use. Major bleeding (2.9%), thromboembolic events (5.3%), and mortality (5.3%) were similar between groups. Conclusions: DOAC therapy was associated with higher LVT resolution rates and a comparable safety profile to warfarin. Further randomized clinical trials are warranted to validate these findings. Full article
(This article belongs to the Section Cardiovascular Medicine)
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12 pages, 1084 KiB  
Article
Predicting the Hamstring Graft Size for ACL Reconstruction Using a 3D Tendon Model in Preoperative MRI
by Andreas Frodl, Moritz Mayr, Markus Siegel, Hans Meine, Elham Taghizadeh, Sebastian Bendak, Hagen Schmal and Kaywan Izadpanah
J. Clin. Med. 2025, 14(6), 2128; https://doi.org/10.3390/jcm14062128 - 20 Mar 2025
Viewed by 283
Abstract
Background: Rupture of the ACL is a common injury among men and women athletes. While planning the surgical ACL reconstruction procedure, the eventual graft’s diameter is extremely important. Many parameters are therefore evaluated pre-surgery to ensure access to reliable data for estimating the [...] Read more.
Background: Rupture of the ACL is a common injury among men and women athletes. While planning the surgical ACL reconstruction procedure, the eventual graft’s diameter is extremely important. Many parameters are therefore evaluated pre-surgery to ensure access to reliable data for estimating the graft diameter. Considering this, magnetic resonance imaging (MRI), particularly qualitative analyses of the hamstring tendons, offers a promising approach. Methods: In a retrospective analysis, we carried out 3D segmentation of the gracilis (GT) and semitendinosus tendon (ST) utilizing MRI with varying slice thicknesses and field strengths. The cross-sectional area (CSA) was calculated on different levels (by relying on the models we had thus created) to generate a mean of CSA with six specific segments. We then correlated the mean CSA with the diameter of the graft measured during surgery. Results: A total of 32 patients were included (12 female, 20 male) in this retrospective analysis. We observed the largest CSA in segment 10 mm–0 (16.8 ± 6.1) with differences between men and women. The graft size and tendon diameter correlated significantly in all segments throughout our study cohort. The strongest correlation was apparent in the segment 10 mm–0 (r = 0.552). Conclusions: MRI-based 3D segmentation and the STGT CSA represent a reliable method for estimating preoperatively a quadrupled hamstring graft diameter. The 10 mm–0 mm segment above the joint line showed a strong correlation, making it an ideal reference for graft planning. Full article
(This article belongs to the Section Orthopedics)
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11 pages, 3000 KiB  
Article
Temperature Dynamics of Porcine and Human Lungs During Static Ice Storage: Ice Is Not 4 °C
by Ismail Cenik, Jan Van Slambrouck, Annalisa Barbarossa, Xin Jin, An-Lies Provoost, Pratik Patel, Lucas Churchill, Ben Bulka, John Haney and Laurens J. Ceulemans
J. Clin. Med. 2025, 14(6), 2127; https://doi.org/10.3390/jcm14062127 - 20 Mar 2025
Viewed by 272
Abstract
Background: Static ice storage (SIS) has long been accepted as the conventional lung preservation method, assuming to maintain 4 °C temperature. Although never directly confirmed by temperature measurements, this assumption has been widely accepted. We aimed to measure lung and preservation temperature [...] Read more.
Background: Static ice storage (SIS) has long been accepted as the conventional lung preservation method, assuming to maintain 4 °C temperature. Although never directly confirmed by temperature measurements, this assumption has been widely accepted. We aimed to measure lung and preservation temperature with SIS in porcine experiments and clinical observations. Methods: Porcine lungs were preserved with SIS for 8 h (group I, n = 3) and 3 h followed by 10 °C storage (group II, n = 3). Tissue (tissueT°), first bag preservation solution (psT°) and second bag saline (salineT°) temperature were monitored. In clinical lungs (n = 4), psT° was monitored during SIS. Surface (surfaceT°) and core (coreT°) temperature were assessed before and after SIS (n = 62). Results: After 4 h in porcine lung group I, average tissueT° was 0.66 °C, psT° was 0.12 °C and salineT° was −0.02 °C. After 3 h in group II, average tissueT° was 1.90 °C, psT° was 0.57 °C and salineT° was 2.33 °C. In clinical observations, psT° was below 4 °C after 9–13 min and 0 °C after 78–267 min. After SIS, median surfaceT° was 1.25 °C (min-max; −3.2–9.2 °C) and coreT° was 1.45 °C (−0.4–4.8 °C). Conclusions: SIS leads to rapid temperature drops below 4 °C, approaching 0 °C within 2–4 h. The post-SIS lung temperature shows considerable variability and does not consistently remain at the commonly assumed 4 °C, posing potential freezing injury to donor lungs. Full article
(This article belongs to the Special Issue Lung Transplantation: Current Progress and Future Directions)
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15 pages, 2904 KiB  
Article
Innominate Artery Graft Cannulation for Selective Antegrade Cerebral Perfusion in Aortic Surgery: Clinical Findings and Feasibility
by Ufuk Turkmen, Kudret Atakan Tekin, Gorkem Yigit, Ayla Ece Celikten and Ertekin Utku Unal
J. Clin. Med. 2025, 14(6), 2126; https://doi.org/10.3390/jcm14062126 - 20 Mar 2025
Viewed by 358
Abstract
Background: Cerebral protection during aortic surgery is crucial for improving surgical outcomes and reducing neurological complications. Selective antegrade cerebral perfusion (SACP) is increasingly used, and innominate artery (IA) side graft cannulation presents an innovative alternative to conventional axillary artery cannulation, with the [...] Read more.
Background: Cerebral protection during aortic surgery is crucial for improving surgical outcomes and reducing neurological complications. Selective antegrade cerebral perfusion (SACP) is increasingly used, and innominate artery (IA) side graft cannulation presents an innovative alternative to conventional axillary artery cannulation, with the potential to reduce complications associated with the latter. Methods: In this retrospective study, 196 patients who underwent proximal aortic surgery with IA graft cannulation for SACP between January 2021 and June 2024 were analyzed. Demographic data, intraoperative parameters, and postoperative outcomes were evaluated. Complications such as new stroke, postoperative delirium, mortality, and acute renal failure (ARF) were assessed. Results: The median age of the patients was 63 years, and 18.37% underwent emergency surgery for Type A acute aortic dissection (TAAAD). The most frequently performed surgical procedure was ascending aorta and hemiarch replacement (36.74%). The median cardiopulmonary bypass, cross-clamp, and SACP durations were 120.5, 93, and 23 min, respectively. The postoperative mortality rate was 3.06%, stroke rate was 2.04%, delirium rate was 9.18%, and ARF rate was 3.06%. All cases of delirium resolved spontaneously within 2–3 days. The mortality rate among Marfan syndrome (MFS) patients was 4.35%, with no reported stroke cases in this group. Conclusions: IA graft cannulation is a safe and effective method for providing SACP in aortic surgery, particularly in high-risk patient groups such as those with TAAAD and MFS. This technique ensures optimal cerebral perfusion, minimizes neurological and systemic complications, and enhances surgical efficiency by reducing operative duration. However, large-scale, multicenter, and prospective studies are needed to evaluate its long-term efficacy and safety. Full article
(This article belongs to the Section Cardiovascular Medicine)
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17 pages, 3055 KiB  
Article
Lumbar Muscle Fatty Infiltration and Atrophy in Patients with Low Back Pain and Degenerative Spinal Pathologies: A CT Imaging Study
by Tess Mardulyn, Arnaud Delafontaine, Patrice Jissendi and Laurent Fabeck
J. Clin. Med. 2025, 14(6), 2125; https://doi.org/10.3390/jcm14062125 - 20 Mar 2025
Viewed by 780
Abstract
Background/Objectives: Low back pain (LBP) may be related to intramuscular fatty infiltration (FI), the topography of which has been the subject of only a few studies. Our goal is therefore to determine the importance and topography of FI at the lumbar level and [...] Read more.
Background/Objectives: Low back pain (LBP) may be related to intramuscular fatty infiltration (FI), the topography of which has been the subject of only a few studies. Our goal is therefore to determine the importance and topography of FI at the lumbar level and evaluate its correlation with LBP. Methods: We conducted a retrospective study and compared 254 LBP patients who underwent a lumbosacral CT scan with a sample of 115 healthy subjects, all classified into three age groups (≤35, 36–55, and >55 years old). In CT scan images from L2 to S1, muscle density (Hounsfield unit values ranging from −29 to +150), reflecting intramuscular FI, was measured. LBP was further divided into five subgroups of pathologies. Results: There was a significant difference in muscle density between the small and large circles at the L4/L5 and L5/S1 levels in LBP patients, which was not observed in the healthy subjects. In both LBP patients and healthy subjects, a decreasing density gradient was observed from L2 to S1, with a significant difference in density across age groups. LBP patients exhibit lower muscle densities compared to healthy subjects. Conclusions: In LBP patients, fatty infiltration (FI) of the paraspinal muscles is most pronounced in the lower lumbar region and appears to be localized at the level of muscle insertion. This localized muscle deficit differs from the age-related process of FI and may contribute to the development of LBP and discopathies. Full article
(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)
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18 pages, 2414 KiB  
Article
Impact of Hepatitis B Infection on Patient and Graft Survival After Kidney Transplantation
by Anissa Paschereit, Vivien Greese, Kayo Sakurayama, Michael Duerr, Fabian Halleck, Lutz Liefeldt, Mira Choi, Klemens Budde and Marcel G. Naik
J. Clin. Med. 2025, 14(6), 2124; https://doi.org/10.3390/jcm14062124 - 20 Mar 2025
Viewed by 454
Abstract
Objectives: Chronic Hepatitis B virus (HBV) infection is a significant global health issue, with dialysis patients at increased risk and reduced response to HBV vaccination. The effects of HBV serological status on kidney transplant outcomes, particularly for patients with resolved or inactive [...] Read more.
Objectives: Chronic Hepatitis B virus (HBV) infection is a significant global health issue, with dialysis patients at increased risk and reduced response to HBV vaccination. The effects of HBV serological status on kidney transplant outcomes, particularly for patients with resolved or inactive HBV infection, needs more data, especially from current era. This study evaluated the impact of chronic and non-active HBV infection on patient and graft survival after kidney transplantation. Methods: Retrospective analysis was conducted of kidney-only transplant recipients at our center from 1 January 1990 to 31 August 2019 (end of observation). Patients were grouped by their HBV serostatus before transplantation into three categories: HBV negative (HBsAg−/Anti-Hbc−), non-active HBV infection (HbsAg−/Anti-Hbc+) and chronic HBV infection (HbsAg+/Anti-Hbc+). Primary outcomes included patient survival, graft survival, and overall graft and patient survival, analyzed using Kaplan–Meier (KM) curves, log-rank tests, Restricted mean survival times (RMST), and Accelerated failure time (AFT) models. Results: Among 2490 patients, 2197 were HBV negative, 218 had non-active HBV, and 75 had chronic HBV. Over a mean follow-up of 8.1 years, mortality and graft failure rates were highest in chronic HBV patients (49% and 37%), followed by non-active HBV (39% and 29%) and HBV-negative patients (30% and 20%). KM analysis revealed significantly lower overall survival rates for chronic HBV and non-active HBV groups compared to HBV-negative patients (p = 0.006). RMST confirmed significant reductions in survival for the non-active group (12.57 vs. 14.17 years, p = 0.007). Cox regression and AFT models identified older recipient/donor age, Hepatitis-C-virus coinfection, and broad antigen mismatches as negative predictors, while living donors improved outcomes. Conclusions: While unadjusted Kaplan–Meier curves and RMST analysis suggested differences in patient and graft survival, further thorough multivariable AFT analysis did not show a significant association between non-active or chronic HBV infection and patient or graft survival after kidney transplantation. Full article
(This article belongs to the Special Issue Clinical Advancements in Kidney Transplantation)
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10 pages, 2192 KiB  
Article
Combined Surgically Induced Macular Detachment and Autologous Internal Limiting Membrane Transplantation for Refractory Full Thickness Macular Hole
by Rino Frisina, Laura Di Leo, Ilenia Gallo Afflitto, Andrea Vulpetti, Lorenzo Motta and Gabriella De Salvo
J. Clin. Med. 2025, 14(6), 2123; https://doi.org/10.3390/jcm14062123 - 20 Mar 2025
Viewed by 268
Abstract
Background/Objectives: To propose a combined surgery of surgically induced macular detachment (MD) and autologous internal limiting membrane (ILM) transplantation to treat refractory full thickness macular holes (FTMHs). Methods: A series of patients affected by refractory FTMHs underwent a combined surgery. The [...] Read more.
Background/Objectives: To propose a combined surgery of surgically induced macular detachment (MD) and autologous internal limiting membrane (ILM) transplantation to treat refractory full thickness macular holes (FTMHs). Methods: A series of patients affected by refractory FTMHs underwent a combined surgery. The following demographic and clinical data were collected: age, gender, eye, lens status, and best corrected visual acuity (BCVA). The tomographic pre- and post-operative parameters were the following: pre-operative FTMH diameter, refractory FTMH morphology (flat/with cuff), FTMH closure, foveal profile (regular/flat/inverted), flap displacement, and outer retinal layers restoration. Results: The study included a total of 14 pseudophakic eyes (14 patients). In all of the patients, surgical FTMH closure was reached. The mean BCVA improved after surgery from 1.1 ± 0.14 to 0.48 ± 03 logMAR (p < 0.0001). Statistical analysis demonstrated that the larger the FTMH, the poorer the post-operative gain in BCVA (p −0.5). The post-operative regular foveal profile was obtained in 50% of the eyes with a mean post-operative BCVA of 0.3 logMAR. A negative correlation between the time interval from diagnosis to surgery and post-operative BCVA gain was highlighted (p −0.8). Conclusions: The proposed combined surgical technique led to encouraging anatomical and functional results. Surgically induced MD increased the elasticity of the retina, and the free flap isolated the macular hole from the vitreous chamber favoring its closure. Full article
(This article belongs to the Special Issue Clinical Treatment of Refractory Full Thickness Macular Hole (FTMH))
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11 pages, 825 KiB  
Article
Cognitive and Psychomotor Performance of Patients After Ischemic Stroke Undergoing Early and Late Rehabilitation
by Aleksander Korchut, Danuta Sternal, Sylwia Krzemińska, Ewa Marcisz-Dyla and Ewelina Bąk
J. Clin. Med. 2025, 14(6), 2122; https://doi.org/10.3390/jcm14062122 - 20 Mar 2025
Viewed by 410
Abstract
Objectives: The aim of this study was to determine the performance of cognitive and psychomotor functions in patients after ischemic stroke, taking into account the effectiveness of early and late rehabilitation. Methods: The study included 86 patients with ischemic stroke hospitalized in the [...] Read more.
Objectives: The aim of this study was to determine the performance of cognitive and psychomotor functions in patients after ischemic stroke, taking into account the effectiveness of early and late rehabilitation. Methods: The study included 86 patients with ischemic stroke hospitalized in the Neurological Rehabilitation Unit. The patients were divided into two groups according to the timing of rehabilitation, considering early rehabilitation which started within 30 days of hospital discharge (56 patients), and late rehabilitation which started after 30 days of hospital discharge (30 patients). Cognitive and psychomotor functions were measured in all the study patients using the Integrated System for the Measurement of Psychophysiological Variables called Polypsychograph, including tests assessing memory, attention, eye–hand coordination, and reaction speed. The measurements were repeated after 21 days of post-stroke rehabilitation. Results: Early rehabilitation led to significant improvements in most of the parameters studied, including memory, attention, speed of thinking, and precision of movement. Late rehabilitation was followed by an improvement in the results of the indicators studied to a lesser extent than the early rehabilitation. Improvements in temporal and qualitative parameters were observed in both groups of patients undergoing early and late rehabilitation. Conclusions: In patients after ischemic stroke, early rehabilitation improved cognitive and psychomotor performance to a greater extent than late rehabilitation. Full article
(This article belongs to the Special Issue Clinical Perspectives in Stroke Rehabilitation)
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11 pages, 500 KiB  
Article
Evaluating Vaporized Cannabinoid Therapy in Multiple Sclerosis: Findings from a Prospective Single-Center Clinical Study
by Konstantina Stavrogianni, Dimitrios K. Kitsos, Vasileios Giannopapas, Vassiliki Smyrni, Athanasios K. Chasiotis, Alexandra Akrivaki, Evangelia-Makrina Dimitriadou, Christina Zompola, John S. Tzartos, Georgios Tsivgoulis and Sotirios Giannopoulos
J. Clin. Med. 2025, 14(6), 2121; https://doi.org/10.3390/jcm14062121 - 20 Mar 2025
Viewed by 835
Abstract
Introduction: Multiple Sclerosis (MS) is associated with a wide range of debilitating symptoms, and conventional therapies often fail to adequately address the disease’s multifaceted challenges. Cannabidiol (CBD) 13.0% + Delta9-tetrahydrocannabinol (THC) 9.0% (CBD13/THC9), a vaporized cannabis-based medicinal product, presents a novel therapeutic option [...] Read more.
Introduction: Multiple Sclerosis (MS) is associated with a wide range of debilitating symptoms, and conventional therapies often fail to adequately address the disease’s multifaceted challenges. Cannabidiol (CBD) 13.0% + Delta9-tetrahydrocannabinol (THC) 9.0% (CBD13/THC9), a vaporized cannabis-based medicinal product, presents a novel therapeutic option for managing MS symptoms. Methods: This single-center longitudinal study followed 69 MS patients over a six-month period. Participants were assessed at treatment initiation and at three- and six-month intervals. Key measures included muscle spasticity, urine bladder dysfunction, and the evaluation of disability progression rate. The evaluation included the Modified Ashworth Scale (MAS), the Post Void Residual (PVR) volume, and the Expanded Disability Status Scale (EDSS). Results: Significant improvement was observed across all outcome assessments. The EDSS score was decreased over time (p = 0.009), indicating a slight reduction in disability progression rate, while MAS scores showed substantial improvement in muscle spasticity (p < 0.001). Urine bladder function improved significantly, with PVR volume showing notable improvement between baseline and the six-month assessment (p < 0.001). Correlation analyses revealed that a gradual increase in vaporized CBD13/THC9 dose was correlated with slightly lower EDSS scores, while the adverse effects were negatively associated with the frequency of cannabinoid use. Finally, patients who were smokers used CBD13/THC9 more frequently. Conclusions: The vaporized CBD13/THC9 formulation demonstrated notable efficacy in slightly improving disability progression rate via reduction in muscle spasticity and urine bladder dysfunction in MS patients. This highlights its addon therapeutic value during rehabilitation in MS patients with debilitating disability symptoms. Full article
(This article belongs to the Special Issue Clinical Management of Multiple Sclerosis)
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17 pages, 430 KiB  
Article
Predicting Freezing of Gait in Parkinson’s Disease: A Machine-Learning-Based Approach in ON and OFF Medication States
by Georgios Bouchouras, Georgios Sofianidis and Konstantinos Kotis
J. Clin. Med. 2025, 14(6), 2120; https://doi.org/10.3390/jcm14062120 - 20 Mar 2025
Viewed by 377
Abstract
Background: Freezing of gait (FoG) is a debilitating motor symptom of Parkinson’s disease (PD), characterized by sudden episodes where patients struggle to initiate or sustain movement, often describing a sensation of their feet being “glued to the ground.” This study investigates the [...] Read more.
Background: Freezing of gait (FoG) is a debilitating motor symptom of Parkinson’s disease (PD), characterized by sudden episodes where patients struggle to initiate or sustain movement, often describing a sensation of their feet being “glued to the ground.” This study investigates the potential of machine-learning (ML) models to predict FoG severity in PD patients, focusing on the influence of dopaminergic medication by comparing gait parameters in ON and OFF medication states. Methods: Specifically, this study employed spatiotemporal gait features to develop a predictive model for FoG severity, leveraging a random forest regressor to identify the most influential gait parameters associated with this in each medication state. The results indicate that the model achieved higher predictive performance in the OFF-medication condition (R² = 0.82, MAE = 2.25, MSE = 15.23) compared to the ON-medication condition (R² = 0.52, MAE = 4.16, MSE = 42.00). Results: These findings suggest that dopaminergic treatment alters gait dynamics, potentially reducing the reliability of FoG predictions when patients are medicated. Feature importance analysis revealed distinct gait characteristics associated with FoG severity across medication states. In the OFF condition, step length parameters, particularly left step length mean, were the most dominant predictors, alongside swing time and stride width, indicating the role of spatial and temporal gait control in FoG severity without medication. In contrast, under the ON medication condition, stride width and gait speed emerged as the most influential predictors, followed by stepping frequency, reflecting how medication influences stability and movement rhythm. Conclusions: These findings highlight the need for predictive models that account for medication-induced gait variability, ensuring more reliable FoG detection. By integrating spatiotemporal gait analysis and ML-based prediction, this study contributes to the development of personalized intervention strategies for PD patients experiencing FoG episodes. Full article
(This article belongs to the Special Issue Parkinson's Disease: Diagnosis, Treatment, and Management)
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11 pages, 599 KiB  
Article
Comparison of Cryoballoon and Ablation Index-Guided Radiofrequency Ablation in Paroxysmal Atrial Fibrillation
by Botond Bocz, Dorottya Debreceni, Kristof-Ferenc Jánosi, Dalma Torma and Peter Kupo
J. Clin. Med. 2025, 14(6), 2119; https://doi.org/10.3390/jcm14062119 - 20 Mar 2025
Viewed by 331
Abstract
Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation [...] Read more.
Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. Methods: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators’ decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. Results: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; p < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; p < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; p < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; p = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; p = 0.22). No major complications were reported during this study. Conclusions: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time. Full article
(This article belongs to the Special Issue Atrial Fibrillation: Catheter Ablation Techniques and Management Strategies)
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22 pages, 4837 KiB  
Systematic Review
Safety and Efficacy of Stem Cell Therapy in Ischemic Stroke: A Comprehensive Systematic Review and Meta-Analysis
by Abdulrahim Saleh Alrasheed, Tala Abdullah Aljahdali, Israa Aqeel Alghafli, Ghadeer Aqeel Alghafli, Majd Fouad Almuslim, Noor Mohammad AlMohish and Majed Mohammad Alabdali
J. Clin. Med. 2025, 14(6), 2118; https://doi.org/10.3390/jcm14062118 - 20 Mar 2025
Viewed by 896
Abstract
Background: Although recent advancements in ischemic stroke management have reduced associated mortality rates, there remains a pressing need for more reliable, efficacious, and well-tolerated therapeutic approaches due to the narrow therapeutic window of current treatment approaches. The current meta-analysis sought to evaluate the [...] Read more.
Background: Although recent advancements in ischemic stroke management have reduced associated mortality rates, there remains a pressing need for more reliable, efficacious, and well-tolerated therapeutic approaches due to the narrow therapeutic window of current treatment approaches. The current meta-analysis sought to evaluate the safety and efficacy of stem cell-based therapeutic options for patients with ischemic stroke. Methods: PubMed, Web of Science, and Cochrane library databases were searched to retrieve randomized controlled trials (RCTs) evaluating the efficacy and safety of stem cell therapy (SCT) in ischemic stroke patients. Key outcomes included the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI), Fugl–Meyer Assessment (FMA), infarct size, and safety profile. The random effects model with the continuous method was used to calculate the pooled effect size in Review Manager 5.4.1, and subgroup analyses were performed based on demographics, stroke duration, and SCT delivery protocols. Results: A total of 18 RCTs involving 1026 patients were analyzed, with 538 in the treatment group and 488 in the control group. The mean change in NIHSS score was comparable between groups [MD = −0.80; 95% CI: −2.25, 0.65, p < 0.0001]. However, SCT showed better outcomes in mRS [MD = −0.56; 95% CI: −0.76, −0.35, p = 0.30] and BI scores [MD = 12.00; 95% CI: 4.00, 20.00, p = 0.007]. Additionally, the mean change in FMA score was significantly greater with SCT [MD = 18.16; 95% CI: 6.58, 29.75, p = 0.03]. The mean change in infarct volume also favored stem cell therapy [MD = 8.89; 95% CI: −5.34, 23.12, p = 0.08]. The safety profile was favorable, with adverse event rates comparable to or lower than controls. Conclusions: SCT offers a safe and effective approach to improving functional outcomes in stroke patients, particularly with early intervention. These findings highlight the potential of SCT in ischemic stroke rehabilitation while underscoring the need for standardized protocols and long-term safety evaluation. Full article
(This article belongs to the Special Issue Current Treatment and Future Options of Ischemic Stroke)
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10 pages, 473 KiB  
Article
Cancer Is a Major Determinant of Postoperative Atrial Fibrillation After Cardiac Surgery
by Georgios P. Georghiou, Andrew Xanthopoulos, George Kanellopoulos, Panos Georghiou, Amalia Georgiou, John Skoularigis, Grigorios Giamouzis, Konstantinos Lampropoulos, Ioannis Patrikios and Filippos Triposkiadis
J. Clin. Med. 2025, 14(6), 2117; https://doi.org/10.3390/jcm14062117 - 20 Mar 2025
Viewed by 336
Abstract
Background/Objectives: Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased morbidity and mortality. The pathogenesis of POAF in this setting is complex and not completely understood. Since cancer is a well-known risk factor for AF, the aim of [...] Read more.
Background/Objectives: Postoperative atrial fibrillation (POAF) occurs frequently after cardiac surgery and is associated with increased morbidity and mortality. The pathogenesis of POAF in this setting is complex and not completely understood. Since cancer is a well-known risk factor for AF, the aim of this study was to identify potential predictors, including cancer, of POAF after cardiac surgery. Methods: This prospective study included 400 consecutive patients in sinus rhythm who underwent elective cardiac surgery in Aretaeio Hospital (Nicosia, Cyprus) from January 2020 till January 2023. The primary outcome was the development of POAF during hospitalization, defined as any documented AF episode lasting >30 s. Predictors of the primary outcome were studied using univariable and multivariable logistic regression analysis. Results: Of the 400 patients (68 [61–73] years, 64 [16%] females) studied, 66 (16.5%) developed POAF. Among the variables examined, the only predictors of POAF were cardiopulmonary bypass time (odds ratio [OR] = 1.001, 95% confidence interval = [95% CI, 1.000–1.001], p = −0.031) and cancer (OR = 3.852, 95% CI = [1.535–9.664], p = 0.004). Cancer was present in 13 (4%) and in 10 (15%) of patients without and with POAF, respectively (p < 0.001). Conclusions: Cancer was associated with a dramatic increase in POAF risk early after elective cardiac surgery in this study. Whether patients developing POAF after cardiac surgery should be searched for cancer deserves further investigation. Full article
(This article belongs to the Section Cardiology)
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10 pages, 889 KiB  
Article
The Importance of Comorbidities at Baseline and 5-Year Follow-Up in a Lung Cancer Biomarker Screening Trial
by Nimue Lilith Romeikat, Frank Sullivan, Fergus Daly and Wenyan Kong
J. Clin. Med. 2025, 14(6), 2116; https://doi.org/10.3390/jcm14062116 - 20 Mar 2025
Viewed by 305
Abstract
Background/Objectives: Despite recent lung cancer screening (LCS) studies proving significant mortality reduction, comorbidities are a prominent issue affecting cost effectiveness, which is holding back national implementation. Incidental findings (IFs) of comorbidities make a significant contribution to delayed diagnoses and raise discussions about [...] Read more.
Background/Objectives: Despite recent lung cancer screening (LCS) studies proving significant mortality reduction, comorbidities are a prominent issue affecting cost effectiveness, which is holding back national implementation. Incidental findings (IFs) of comorbidities make a significant contribution to delayed diagnoses and raise discussions about optimal management plans. This is particularly relevant to national lung cancer screening (NLCS), as the high-risk population qualifying for the screening often have increased likelihood for comorbidities due to their smoking history. Methods: The Early Detection of Cancer of the Lung Scotland (ECLS) (ClinicalTrials.gov identifier NCT01925625) study showcases a targeted approach to NLCS by implementing the blood-based biomarker EarlyCDT-Lung test. Firstly, this paper explored the ECLS dataset for comorbidities present within the screening population at baseline A chi-square analysis was then undertaken to investigate the relationship of cohort allocation and incidence of new comorbidities over the five-year follow-up period. Results: High prevalence conditions were cardiovascular (38.5%), neurological/psychiatric (33.9%), gastrointestinal (29.8%), and respiratory (19.2%). While 20.3% of the total patient cohort showed a newly discovered comorbidity, there was no significant variation in new incidences between the intervention and control cohort. Conclusions: When considering these results alongside the all-cause mortality reduction shown in previous analyses, they indicate that this targeted approach to LCS might help improve the benefit–harm ratio through the introduction of biomarkers. Further refining selection criteria for low-dose CT screening might contribute to minimising the risk of overdiagnosis and overtreatment. Full article
(This article belongs to the Special Issue Clinical Diagnosis of Lung Cancer)
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12 pages, 2636 KiB  
Article
High Accuracy of Restoration of the Individual Hip Anatomy Using Custom-Made Prostheses in Total Hip Arthroplasty
by Maximilian F. Kasparek, Anna Jungwirth-Weinberger, Kirubakaran Pattabiraman, Marios Loucas, Devanand Hulmani, Maximilian Muellner, Tobias Scheidl, Oliver Haider and Thomas Muellner
J. Clin. Med. 2025, 14(6), 2115; https://doi.org/10.3390/jcm14062115 - 20 Mar 2025
Viewed by 335
Abstract
Background/Objectives: Femoral or acetabular deformities are important factors in development of early osteoarthritis. In particular, young patients benefit from individual anatomical restoration by decreasing the risk of early loosening and wear and achieving a good clinical outcome. Methods: This prospective study [...] Read more.
Background/Objectives: Femoral or acetabular deformities are important factors in development of early osteoarthritis. In particular, young patients benefit from individual anatomical restoration by decreasing the risk of early loosening and wear and achieving a good clinical outcome. Methods: This prospective study evaluates the use of a custom-made prosthesis in anterior approach total hip arthroplasty (THA). Pre- and postoperative imaging included conventional X-rays as well as computer tomography (CT) with a specialized protocol to analyze femoral diaphysis width, horizontal and vertical offset, caput-collum-diaphyseal (CCD) angle, leg length, femoral and acetabular anteversion angles, and the position of the center of rotation. Results: A total of 22 hips (11 female, 11 male) with a mean age of 55.8 years underwent THA with a custom-made prosthesis (Symbios®). Accurate restoration has been shown for offset, leg length, and femoral anteversion. The custom stems showed a good fit within the femoral canal. Conclusions: This custom-made prosthesis has been shown to be a valuable option for the treatment of hip osteoarthritis in young patients, with adequate restoration of the preoperative anatomy. Full article
(This article belongs to the Special Issue New Insights into Joint Arthroplasty)
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11 pages, 1017 KiB  
Article
Effectiveness of Radiation Shields to Minimize Operator Dose in the Bronchoscopy Suite: A Phantom Study and Clinical Application
by Hosang Jeon, Dong Woon Kim, Ji Hyeon Joo, Yongkan Ki, Suk-Woong Kang, Won Chul Shin, Seong Hoon Yoon, Yun Seong Kim, Seung Hyun Yong, Hyun Sung Chung, Taehoon Lee and Hee Yun Seol
J. Clin. Med. 2025, 14(6), 2114; https://doi.org/10.3390/jcm14062114 - 20 Mar 2025
Viewed by 386
Abstract
Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose [...] Read more.
Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system. Full article
(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions)
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14 pages, 547 KiB  
Case Report
Hemoperfusion Using the Oxiris Membrane in Septic Shock Patients with Preserved Kidney Function: A Case Series
by Darja Smirnova, Rihards Serzans, Mara Klibus, Valdis Liguts, Anna Lece, Andrejs Skesters, Gianluca Villa and Olegs Sabelnikovs
J. Clin. Med. 2025, 14(6), 2113; https://doi.org/10.3390/jcm14062113 - 19 Mar 2025
Viewed by 668
Abstract
Background/Objectives: Sepsis, a life-threatening condition caused by a dysregulated immune response to infection, is associated with high mortality. Endotoxin and cytokine overload play a crucial role in sepsis-induced organ dysfunction. The Oxiris® membrane, traditionally used as a hemofilter for renal replacement [...] Read more.
Background/Objectives: Sepsis, a life-threatening condition caused by a dysregulated immune response to infection, is associated with high mortality. Endotoxin and cytokine overload play a crucial role in sepsis-induced organ dysfunction. The Oxiris® membrane, traditionally used as a hemofilter for renal replacement therapy, has demonstrated the capacity to adsorb endotoxins and cytokines. This study investigates the clinical effect during hemoperfusion with the Oxiris® membrane in patients with septic shock and preserved renal function. Methods: We present three adult patients with septic shock who were admitted to the intensive care unit with high vasopressor requirements and elevated inflammatory markers. As they were refractory to standard therapy and renal function was preserved, a 12-hour hemoperfusion session with an Oxiris® membrane was initiated. Hemodynamic parameters, inflammatory biomarkers, and endotoxin concentrations were evaluated before, during, and after hemoperfusion treatment. Results: All patients demonstrated hemodynamic stabilization, with norepinephrine support reduced by 10.3% to 70.0%. Key inflammatory markers decreased significantly, including interleukin-6 (−41.6% to −94.0%), procalcitonin (−29.3% to −49.5%), and C-reactive protein (4.7% to −37.2%). Endotoxin concentrations decreased by 62.0% and 13.6% in two of the three patients. No adverse effects related to hemoperfusion were observed. Conclusions: Hemoperfusion with the Oxiris® membrane effectively reduced vasopressor support, inflammatory markers, and endotoxin concentrations in patients with refractory septic shock. This approach may offer a novel strategy for early immune modulation in sepsis before renal dysfunction occurs. Further studies with larger cohorts are required to validate these findings and determine optimal treatment protocols. Full article
(This article belongs to the Special Issue Sepsis and Organ Dysfunction: New Insights into Diagnosis and Treatment)
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12 pages, 1544 KiB  
Article
Comparison of SENSIMED Triggerfish® (TF) 24-Hour Monitoring in Open-Angle Glaucoma Patients Before and After Trabeculectomy
by Anna Beck, Michael Uhrig, Alexander Schuster, Christina Korb, Norbert Pfeiffer and Katrin Lorenz
J. Clin. Med. 2025, 14(6), 2112; https://doi.org/10.3390/jcm14062112 - 19 Mar 2025
Viewed by 300
Abstract
Background/Objectives: In glaucoma patients, the fluctuation in intraocular pressure during the day seems to have an influence on the progression of the disease. The contact lens sensor (CLS) Triggerfish® from the company SENSIMED records ocular dimensional changes for 24 h. The [...] Read more.
Background/Objectives: In glaucoma patients, the fluctuation in intraocular pressure during the day seems to have an influence on the progression of the disease. The contact lens sensor (CLS) Triggerfish® from the company SENSIMED records ocular dimensional changes for 24 h. The aim was to determine the amplitude of the measurements with a contact lens sensor before and after trabeculectomy (TE) in glaucoma patients. Methods: Twelve patients with glaucoma were included in this prospective, single-arm, single-center, interventional study. All patients received a CLS measurement for 24 h 8 ± 2 days before and 12 weeks (±1 week) after surgery. The raw data of the measurements were modeled using a double-harmonic cosine function. Fluctuation in the raw CLS data, amplitude, and the MESOR (midline estimating statistic of rhythm, rhythm-adjusted mean) of the modeled data were investigated. The safety and feasibility of the CLS measurements were evaluated. Results: Nine patients underwent the complete 24-h wearing period before and after surgery. Whereas the MESOR changed significantly before and after surgery (p = 0.04), the amplitude of the modeled data did not change significantly and the daytime fluctuation and circadian rhythm also did not vary significantly. The CLS could be safely removed from all study eyes after surgery. Conclusions: The non-significant change in amplitude suggests that diurnal fluctuations persist after TE. This contrasts with reports in the literature that show that TE reduces diurnal fluctuations. It can be assumed that the significant reduction in the MESOR represents the reduction in the average intraocular pressure over 24 h. The CLS can be used safely three months after TE. Full article
(This article belongs to the Section Ophthalmology)
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18 pages, 935 KiB  
Review
Rethinking Balanced Resuscitation in Trauma
by Tanya Anand, Hannah Shin, Asanthi Ratnasekera, MyDuyen Luong Tran, Rebekah Huckeby, Lindsey Butts, Ivy Stejskal, Louis J. Magnotti and Bellal Joseph
J. Clin. Med. 2025, 14(6), 2111; https://doi.org/10.3390/jcm14062111 - 19 Mar 2025
Viewed by 830
Abstract
Hemorrhagic shock from traumatic injury results in a massive systemic response with activation of the hypothalamic–pituitary–adrenal (HPA) axis, pro-thrombotic and clot-lysis pathways as well as development of an endotheliopathy. With ongoing hemorrhage, these responses become dysregulated and are associated with worsening coagulopathy, microvascular [...] Read more.
Hemorrhagic shock from traumatic injury results in a massive systemic response with activation of the hypothalamic–pituitary–adrenal (HPA) axis, pro-thrombotic and clot-lysis pathways as well as development of an endotheliopathy. With ongoing hemorrhage, these responses become dysregulated and are associated with worsening coagulopathy, microvascular dysfunction, and increased transfusion requirements. Our transfusion practices as well as our understanding of the molecular response to hemorrhage have undergone significant advancement during war. Currently, resuscitation practices address the benefit of the early recognition and management of acute coagulopathy and advocates for balanced resuscitation with either whole blood or a 1:1 ratio of packed red blood cells to fresh frozen plasma (respectively). However, a significant volume of evidence in the last two decades has recognized the importance of the early modulation of traumatic endotheliopathy and the HPA axis via the early administration of plasma, whole blood, and adjunctive treatments such as tranexamic acid (TXA) and calcium. This evidence compels us to rethink our understanding of ‘balanced resuscitation’ and begin creating a more structured practice to address additional competing priorities beyond coagulopathy. The following manuscript reviews the benefits of addressing the additional interrelated physiologic responses to hemorrhage and seeks to expand beyond our understanding of ‘balanced resuscitation’. Full article
(This article belongs to the Special Issue Clinical Advances in Therapy of Trauma and Surgical Critical Care)
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12 pages, 2501 KiB  
Article
Distal Intersection Tenosynovitis: Surgical Insights From Five Cases
by Julie Mercier, Agata Durdzinska Timoteo, Romain Baillot and Sébastien Durand
J. Clin. Med. 2025, 14(6), 2110; https://doi.org/10.3390/jcm14062110 - 19 Mar 2025
Viewed by 261
Abstract
Background: Distal intersection tenosynovitis (DIT) is a rare and recently described condition that affects the extensor pollicis longus (EPL), extensor carpi radialis brevis (ECRB), and longus (ECRL). Based on surgical observations, this study aimed to provide new insights into its physiopathology. Methods: This [...] Read more.
Background: Distal intersection tenosynovitis (DIT) is a rare and recently described condition that affects the extensor pollicis longus (EPL), extensor carpi radialis brevis (ECRB), and longus (ECRL). Based on surgical observations, this study aimed to provide new insights into its physiopathology. Methods: This was a retrospective study of all patients who underwent surgery for DIT at our institution from 2015 to 2024. Five patients were included in the study. Results: Wrist joint issues clearly explained the occurrence of DIT in three cases. Tendon lesions were observed either on the extensor carpi radialis brevis or extensor pollicis longus. Conclusions: These additional data complement the existing literature, which primarily focuses on the anatomical mechanisms of DIT without fully explaining its causes. Our observations suggest that wrist joint or bone disorders may play a significant role in its occurrence. Lesions in different tendons suggest the involvement of distinct pathological mechanisms. Full article
(This article belongs to the Section Orthopedics)
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14 pages, 2317 KiB  
Article
Long-Term Outcomes of Femorofemoral Crossover Bypass Versus Endovascular Revascularization in Iliac Artery Occlusions: A Retrospective Study
by Edin Ahmic, Paul Swatek, Iurii Mykoliuk, Anton Busau, Muhammed Abdallah, Wolfgang Hitzl, Klaus Linni, Ara Ugurluoglu and Jörg Lindenmann
J. Clin. Med. 2025, 14(6), 2109; https://doi.org/10.3390/jcm14062109 - 19 Mar 2025
Viewed by 248
Abstract
Objective: The objective of this study is to compare the long-term outcomes of femorofemoral crossover bypass (FCOB) and endovascular treatment (ET) in managing iliac artery occlusions. Methods: The data of 200 patients with iliac artery lesions who were treated at a [...] Read more.
Objective: The objective of this study is to compare the long-term outcomes of femorofemoral crossover bypass (FCOB) and endovascular treatment (ET) in managing iliac artery occlusions. Methods: The data of 200 patients with iliac artery lesions who were treated at a single center within 7 years were evaluated retrospectively. Of these, 82 (41%) underwent FCOB, and 118 (59%) received ET. Primary outcomes included patency, limb salvage, and survival rates, while secondary outcomes assessed complications, including wound infections and restenosis. Follow-up was conducted over a median of 4.98 years. Results: Primary patency (PP) rates after 3 years were 80% for FCOB and 88% for ET. Primary assisted patency (PAP) was 95% for FCOB and 93% for ET. Secondary patency (SP) was 97% for FCOB and 98% for ET. Both FCOB and ET achieved comparable long-term outcomes in limb salvage, 94% in both groups at 8 years. ET demonstrated advantages in shorter hospital stays (1.49 ± 2.51 vs. 8.21 ± 9.82 days, p < 0.0001) and lower perioperative complications, including transfusion rates (3.4% vs. 13.4%, p = 0.01226). However, FCOB exhibited lower restenosis rates (6.1% vs. 20.39%, p = 0.00441), despite a higher rate of reocclusion (19.5% vs. 6.8%, p = 0.00800). Survival rates at 8 years were 54% for FCOB and 67% for ET. Conclusions: ET is the preferred first-line approach due to its minimally invasive technique, shorter recovery time, and fewer complications. FCOB remains essential for patients with complex lesions or when ET is not feasible, offering durable long-term outcomes. Appropriate treatment selection should consider both the patient’s condition and clinical and anatomical factors to optimize the best possible patient outcomes. Full article
(This article belongs to the Section Vascular Medicine)
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22 pages, 681 KiB  
Article
Improving Perioperative Care in Gastric Surgery: Insights from the EUropean PErioperative MEdical Networking (EUPEMEN) Project
by Orestis Ioannidis, Elissavet Anestiadou, Jose M. Ramirez, Nicolò Fabbri, Javier Martínez Ubieto, Carlo Vittorio Feo, Antonio Pesce, Kristyna Rosetzka, Antonio Arroyo, Petr Kocián, Luis Sánchez-Guillén, Ana Pascual Bellosta, Adam Whitley, Alejandro Bona Enguita, Marta Teresa-Fernandéz, Stefanos Bitsianis and Savvas Symeonidis
J. Clin. Med. 2025, 14(6), 2108; https://doi.org/10.3390/jcm14062108 - 19 Mar 2025
Viewed by 495
Abstract
Background/Objectives: Gastric cancer remains a leading cause of cancer-related deaths worldwide and surgical resection represents the mainstay of treatment procedures. However, despite the advancements noted in the field of surgical oncology, perioperative complications and variability in the perioperative care provided persist. To address [...] Read more.
Background/Objectives: Gastric cancer remains a leading cause of cancer-related deaths worldwide and surgical resection represents the mainstay of treatment procedures. However, despite the advancements noted in the field of surgical oncology, perioperative complications and variability in the perioperative care provided persist. To address the challenges caused by non-standardized perioperative care for gastric surgery across European healthcare systems, the EUropean PErioperative MEdical Networking (EUPEMEN) protocol has been developed. The present study concisely provides the EUPEMEN protocol’s development, implementation, and impact on perioperative management in gastric resections. Methods: The EUPEMEN protocol was developed through a multidisciplinary collaboration involving five academic healthcare professionals from four European countries. The main activities of the collaborative group included a literature review, consensus development, the creation of multimodal rehabilitation manuals, and the development of an online learning platform. The EUPEMEN project aims for the uniform adoption of evidence-based practices across preoperative, intraoperative, and postoperative phases, leading in nutritional, psychological, and physiological optimization. Results: The implementation of the EUPEMEN protocol aims to optimize perioperative outcomes, including reduced postoperative complications, a shorter length of hospitalization, and improved recovery trajectories. The above have been achieved through structured guidelines that ensure consistent care delivery across diverse healthcare settings and tools such as rehabilitation manuals and a free-access online educational platform. Conclusions: The EUPEMEN protocol represents a new standard for perioperative care in the field of gastric surgery that is based on multidisciplinary collaboration and evidence-based practices. While challenges such as resource constraints and variability in adherence remain, the protocol demonstrates significant potential to improve patient outcomes and streamline perioperative management. Future research should focus on long-term effects and adaptation challenges in the setting of non-European healthcare systems. Full article
(This article belongs to the Special Issue Perioperative Management and Outcome of General and Abdominal Surgery)
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23 pages, 2414 KiB  
Review
Abatacept, Golimumab, and Sarilumab as Selected Bio-Originator Disease-Modifying Antirheumatic Drugs with Diverse Mechanisms of Action in Their Current Use in Treatment
by Piotr Kawczak, Igor Jarosław Feszak and Tomasz Bączek
J. Clin. Med. 2025, 14(6), 2107; https://doi.org/10.3390/jcm14062107 - 19 Mar 2025
Viewed by 422
Abstract
Background/Objectives: Arthritis encompasses a range of joint-related conditions, including osteoarthritis and rheumatoid arthritis, along with inflammatory diseases such as gout and lupus. This research study explores the underlying causes, challenges, and treatment options for arthritis, aiming to enhance the effectiveness of therapies. [...] Read more.
Background/Objectives: Arthritis encompasses a range of joint-related conditions, including osteoarthritis and rheumatoid arthritis, along with inflammatory diseases such as gout and lupus. This research study explores the underlying causes, challenges, and treatment options for arthritis, aiming to enhance the effectiveness of therapies. Methods: This research study evaluated current treatment strategies and examined the effectiveness of selected biological disease-modifying antirheumatic drugs (bDMARDs), i.e., abatacept, golimumab, and sarilumab, with a focus on emerging drug classes and their distinct mechanisms of action. Results: Biologic DMARDs like abatacept, golimumab, and sarilumab offer hopeful treatment alternatives for patients who fail to respond to conventional therapies. However, individual outcomes differ because of the disease’s complexity and the influence of accompanying health conditions. Conclusions: Treating arthritis continues to be challenging due to its numerous underlying causes and the varied ways in which patients respond to treatment. Although biologics and targeted therapies have brought progress, additional research is needed to identify new treatment targets and enhance patient results. Full article
(This article belongs to the Special Issue Targeted Treatment in Chronic Inflammatory Arthritis)
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39 pages, 2828 KiB  
Review
Genicular Artery Embolization: A Technical Review of Anatomy, Pathophysiology, Current Experiences, and Future Directions
by Joseph M. Brown, Zachary T. Vandeveer, Danielle Cadoret, James J. Morrison and Younes Jahangiri
J. Clin. Med. 2025, 14(6), 2106; https://doi.org/10.3390/jcm14062106 - 19 Mar 2025
Viewed by 753
Abstract
Genicular artery embolization (GAE) is an emerging minimally invasive procedure for managing knee osteoarthritis (OA), a condition affecting 365 million individuals globally. Initially developed to treat hemarthrosis, GAE selectively embolizes abnormal genicular vasculature, targeting synovial inflammation and reducing neoangiogenesis. This process alleviates pain [...] Read more.
Genicular artery embolization (GAE) is an emerging minimally invasive procedure for managing knee osteoarthritis (OA), a condition affecting 365 million individuals globally. Initially developed to treat hemarthrosis, GAE selectively embolizes abnormal genicular vasculature, targeting synovial inflammation and reducing neoangiogenesis. This process alleviates pain and improves joint function, providing an alternative for patients with mild-to-moderate OA who are not candidates for surgical interventions due to comorbidities or other factors. Current evidence supports the use of GAE for patients with mild-to-moderate OA who experience persistent symptoms despite conservative treatments such as physical therapy, weight management, or intra-articular injections. The procedure effectively reduces pain, improves functionality, and provides sustained benefits. This review highlights the anatomical principles, procedural techniques, and patient selection criteria for GAE, as well as the clinical evidence supporting its safety and efficacy. It also explores potential future directions for research, including optimizing patient selection, evaluating long-term outcomes, and integrating GAE into routine OA management pathways. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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26 pages, 1221 KiB  
Review
Reviewing Mobile Dental Apps for Children with Cognitive and Physical Impairments and Ideating an App Tailored to Special Healthcare Needs
by Massimo Pisano, Alessia Bramanti, Federica Di Spirito, Maria Pia Di Palo, Giuseppina De Benedetto, Alessandra Amato and Massimo Amato
J. Clin. Med. 2025, 14(6), 2105; https://doi.org/10.3390/jcm14062105 - 19 Mar 2025
Viewed by 431
Abstract
Background/Objectives: Children with special healthcare needs (SHCNs) face various physical, developmental, sensory, behavioral, or cognitive challenges affecting oral health and highlighting the need for specialized and more accessible oral and dental care. Mobile health (m-health) applications have emerged as a promising solution [...] Read more.
Background/Objectives: Children with special healthcare needs (SHCNs) face various physical, developmental, sensory, behavioral, or cognitive challenges affecting oral health and highlighting the need for specialized and more accessible oral and dental care. Mobile health (m-health) applications have emerged as a promising solution to bridge oral health education gaps and improve dental care access. This narrative review aimed to examine the available dental m-health applications designed for children with cognitive and physical impairments, exploring the perspectives of children, parents/caregivers, and dentists regarding their use and potential contribution to oral health. Based on these insights, a concept for a tailored dental m-health app is proposed, considering the interactions between children, caregivers, and dentists to support oral care. Methods: A literature search was conducted using MEDLINE/PubMed, Scopus, and Web of Science to identify studies on the use of m-health apps in pediatric dentistry for SHCN children. Results: Six studies were included in this review. M-health applications helped manage anxiety, behavioral issues, and compliance in children and were generally well received by parents and caregivers, thus improving oral hygiene practices and regular dental visits, and having the potential to reduce oral health disparities in children with cognitive and physical impairments and their families. However, current apps designed for children are limited and may not fully accommodate the diverse sensory needs of these SHCN children. Conclusions: The development of a tailored dental m-health app that adapts to the individual characteristics of SHCN children could enhance oral health awareness and support better compliance among children, parents/caregivers, and dentists. Full article
(This article belongs to the Special Issue Modern Patient-Centered Dental Care)
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8 pages, 427 KiB  
Article
Use of Pranoprofen After Strabismus Surgery in Children
by Wojciech Pawłowski, Beata Urban, Joanna Zawistowska and Alina Bakunowicz-Łazarczyk
J. Clin. Med. 2025, 14(6), 2104; https://doi.org/10.3390/jcm14062104 - 19 Mar 2025
Viewed by 330
Abstract
Objectives: The aim of our study is to evaluate the efficacy of pranoprofen 0.1% in preventing the occurrence of postoperative complications, including postoperative ocular inflammation after strabismus surgery in children. Methods: 90 children operated on for strabismus in the Department of Paediatric [...] Read more.
Objectives: The aim of our study is to evaluate the efficacy of pranoprofen 0.1% in preventing the occurrence of postoperative complications, including postoperative ocular inflammation after strabismus surgery in children. Methods: 90 children operated on for strabismus in the Department of Paediatric Ophthalmology and Strabismus of the Medical University of Bialystok between 2022 and 2023 were included in the study. The patients were aged from 2 to 17 years old. Patients were divided into three groups of 30 patients according to the method of topical postoperative treatment (group I: tobramycin, pranoprofen, dexpanthenol; group II: tobramycin, dexamethasone, dexpanthenol; group III: tobramycin, pranoprofen, dexamethasone, dexpanthenol). Patients were followed up the day after surgery, on postoperative day 14 and then 3 months after surgery. Results: No child showed signs of postoperative infection. There was one case of allergic reaction each in groups I and III. Most complications were present in group II (six cases: there were allergic reactions that occurred in three patients. Two patients experienced a complication in the form of delle, while one patient developed a granuloma), which was a statistically significant difference compared to groups I and III (p = 0.032). Conclusions: Pranoprofen used postoperatively is as effective as a glucocorticosteroid, and from our observations, carries fewer complications in cases requiring prolonged use of the anti-inflammatory treatment. Systematic postoperative follow-up is essential for the diagnosis and possible management of postsurgical complications. Full article
(This article belongs to the Section Ophthalmology)
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21 pages, 312 KiB  
Article
Sleep Health and Psychological Wellbeing in Adult Women: A Specific Focus on Endometriosis—A Survey Study
by Elisabetta Baldi, Debora Meneo, Silvia Cerolini, Francesca Gelfo and Chiara Baglioni
J. Clin. Med. 2025, 14(6), 2103; https://doi.org/10.3390/jcm14062103 - 19 Mar 2025
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Abstract
Background: Endometriosis is a chronic, oestrogen-sensitive inflammatory disease, which can have a significant impact on women’s wellbeing. Nevertheless, the sleep health of this population has been poorly investigated. This exploratory study aimed at describing sleep health, psychological wellbeing, and prevalence of endometriosis [...] Read more.
Background: Endometriosis is a chronic, oestrogen-sensitive inflammatory disease, which can have a significant impact on women’s wellbeing. Nevertheless, the sleep health of this population has been poorly investigated. This exploratory study aimed at describing sleep health, psychological wellbeing, and prevalence of endometriosis among a sample of female students and at evaluating the impact of endometriosis on sleep health and psychological wellbeing in women suffering from the disease. Methods: Women were recruited with a two-stage procedure in a cross-sectional study using online questionnaires: Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Difficulties in Emotion Regulation Scale—Short form. Furthermore, specific questions were used to measure the five dimensions of sleep health: satisfaction, vigilance, efficiency, duration, and timing. Results: In the first stage of the enrolment procedure, 1068 students (18–45 years old) responded to the questionnaire, and 8.7% reported a physician diagnosis of endometriosis. Additionally, in the second stage of the enrolment procedure, 75 women were recruited through social media and reported a diagnosis of endometriosis. Then, all women with endometriosis (169) were age-matched with 169 women without the disease. Multivariate regression analyses showed a bidirectional association between sleep health and psychological wellbeing in the matched sample. Independent samples t-test showed that women with endometriosis reported more severe insomnia symptoms and lower psychological wellbeing than controls. Statistically significant differences were also found in global sleep health and satisfaction, vigilance, and efficiency. Among women with endometriosis, pain and anxiety symptoms were bidirectionally associated, while sleep health was significantly associated with disease stage and psychological difficulties. Conclusions: Considering and treating sleep difficulties in this population may contribute to an improvement in psychological wellbeing and quality of life. Full article
(This article belongs to the Special Issue The Association Between Sleep Disorders and Metabolic and Mental Health)
10 pages, 2855 KiB  
Communication
Mission and One-Year Experience of a Kidney–Heart Outpatient Service: A Patient-Centered Management Model
by Caterina Carollo, Salvatore Evola, Alessandra Sorce, Emanuele Cirafici, Miriam Bennici, Giuseppe Mulè and Giulio Geraci
J. Clin. Med. 2025, 14(6), 2102; https://doi.org/10.3390/jcm14062102 - 19 Mar 2025
Viewed by 346
Abstract
Background: Cardiorenal Syndrome (CRS) represents a growing global health challenge due to the increasing prevalence of coexisting kidney and heart disease. The complex pathophysiology of CRS demands an integrated, multidisciplinary approach involving both nephrology and cardiology. However, specialized care models remain limited, [...] Read more.
Background: Cardiorenal Syndrome (CRS) represents a growing global health challenge due to the increasing prevalence of coexisting kidney and heart disease. The complex pathophysiology of CRS demands an integrated, multidisciplinary approach involving both nephrology and cardiology. However, specialized care models remain limited, leading to fragmented management and suboptimal outcomes. Methods: A Kidney–Heart Outpatient Service was established at "Paolo Giaccone" University Hospital in Palermo in May 2023 to provide coordinated, multidisciplinary care for non-hospitalized patients with CRS. The service involves structured patient assessments, including medical history, physical examinations, laboratory tests, imaging, and a collaborative therapeutic plan formulated by nephrologists and cardiologists. Preliminary patient data were collected and analysed to assess demographic characteristics, comorbidities, and clinical outcomes. Results: Among the first 115 patients evaluated, most were male and over 70 years old. Hypertension (91%) and diabetes were the leading comorbidities, with CKD stage G3b being the most prevalent. Cardiovascular conditions such as atrial fibrillation (18%), prior myocardial infarction (17%), and heart failure (15%) were frequently observed. Three patient deaths occurred, and one progressed to hemodialysis. Conclusions: The Kidney–Heart Outpatient Service represents a novel, patient-centered model for CRS management, aiming to improve clinical outcomes and reduce hospital admissions through multidisciplinary collaboration. Longitudinal follow-up and expanded data collection are essential to validate the long-term efficacy of this approach and refine management strategies for CRS patients. Ongoing research efforts will focus on tracking patient outcomes over extended periods, optimizing therapeutic strategies, and further integrating nephrology and cardiology training. The goal is to establish a sustainable and scalable framework for CRS management that enhances patient care and reduces the healthcare burden. Full article
(This article belongs to the Special Issue New Insights into Cardiorenal Metabolic Syndrome)
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