Journal of Clinical Medicine

9 pages, 362 KiB

Open AccessArticle

Breast Cancer Treatment Disparities in a Rural Setting: Conserving Surgery Versus Mastectomy

by Benjamin C. Kensing, Lutfi A. Barghuthi, Marvin Heck, Carly R. Wadle, Rebecca J. Swindall, Alan D. Cook and Hishaam N. Ismael

J. Clin. Med. 2025, 14(9), 3264; https://doi.org/10.3390/jcm14093264 - 7 May 2025

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Abstract

Background/Objectives: Randomized controlled trials demonstrate comparable survival among early-stage breast cancer patients undergoing breast-conserving therapy or patient preference mastectomy. Many factors affect the choice of treatment like the availability of radiation centers, socioeconomic status, and insurance status. This study aimed to identify the [...] Read more.

Background/Objectives: Randomized controlled trials demonstrate comparable survival among early-stage breast cancer patients undergoing breast-conserving therapy or patient preference mastectomy. Many factors affect the choice of treatment like the availability of radiation centers, socioeconomic status, and insurance status. This study aimed to identify the determinants of surgical breast cancer treatments in a rural community. Methods: Retrospective data were obtained from the medical records of breast cancer patients between 2015 and 2022 at a single rural healthcare system. Demographics, barriers to care, support services offered, pre-treatment services, and the type and stage of cancer were analyzed to identify trends among patients who received breast-conserving therapy and mastectomy. Results: Among the 162 patients who underwent a mastectomy, 16.1% chose this procedure based on patient preference. The patient preference mastectomy group was younger with a median age of 58 years compared to 65 years in the breast conservation group. Additionally, they were 2.7 times more likely to choose a mastectomy when reporting no financial support. When receiving lymphedema management or psychosocial services, they were also more likely to be in the patient preference mastectomy group, 58.3% versus 5.2% and 100% versus 83.5%, respectively. Genetic screening, however, was more common among the breast conservation therapy group (61.9% vs. 26.9%). Conclusions: Our findings indicate an increase in the utilization of breast conservation therapy in a rural healthcare system. These patients were generally older, had financial support, and received genetic screening. Having a multidisciplinary approach to treating breast cancer contributes to our ability to pursue breast-conserving therapy measures in rural communities. Full article

(This article belongs to the Section Oncology)

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13 pages, 1422 KiB

Open AccessReview

Modern Biomarkers in IgA Nephropathy and Their Potential in Paediatric Research

by Agnieszka Such-Gruchot, Małgorzata Mizerska-Wasiak, Emilia Płatos and Małgorzata Pańczyk-Tomaszewska

J. Clin. Med. 2025, 14(9), 3263; https://doi.org/10.3390/jcm14093263 - 7 May 2025

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Abstract

Immunoglobulin A nephropathy (IgAN) is one of the most common forms of glomerulonephritis and one of the main causes of end-stage renal disease (ESRD), affecting up to 40% of patients after 20 years of the disease. Over the past few years, several studies [...] Read more.

Immunoglobulin A nephropathy (IgAN) is one of the most common forms of glomerulonephritis and one of the main causes of end-stage renal disease (ESRD), affecting up to 40% of patients after 20 years of the disease. Over the past few years, several studies have been conducted to search for biomarkers that can diagnose IgAN in a non-invasive way, select patients in the asymptomatic phase, assess the progression of the disease process and monitor its efficacy, and assess the risk of IgA nephropathy progression. Non-invasive investigations using molecules as an alternative to renal biopsy have potential relevance for diagnosis, the determination of treatment efficacy and the assessment of disease activity. For the early screening of IgAN with isolated haematuria, these factors may be useful for early intervention and result in a reduction in the risk of impaired renal function. The clinical studies discussed in this review underline that featured molecules show potential as biomarkers for the diagnosis and assessment of disease progress in IgAN. Full article

(This article belongs to the Special Issue State of the Art in Pediatric Nephrology (Second Edition))

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17 pages, 233 KiB

Open AccessSystematic Review

Artificial Intelligence Methods in the Detection of Oral Diseases on Pantomographic Images—A Systematic Narrative Review

by Katarzyna Zaborowicz, Maciej Zaborowicz, Katarzyna Cieślińska, Agata Daktera-Micker, Marcel Firlej and Barbara Biedziak

J. Clin. Med. 2025, 14(9), 3262; https://doi.org/10.3390/jcm14093262 - 7 May 2025

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Abstract

Background: Artificial intelligence (AI) is playing an increasingly important role in everyday dental practice and diagnosis, especially in the area of analysing digital pantomographic images. Through the use of innovative and modern algorithms, clinicians can more quickly and accurately identify pathological changes contained [...] Read more.

Background: Artificial intelligence (AI) is playing an increasingly important role in everyday dental practice and diagnosis, especially in the area of analysing digital pantomographic images. Through the use of innovative and modern algorithms, clinicians can more quickly and accurately identify pathological changes contained in digital pantomographic images, such as caries, periapical lesions, cysts, and tumours. It should be noted that pantomographic images are one of the most commonly used imaging modalities in dentistry, and their digital analysis enables the construction of AI models to support diagnosis. Objectives: This paper presents a systematic narrative review of studies included in scientific articles from 2020 to 2025, focusing on three main diagnostic areas: detection of caries, periapical lesions, and cysts and tumours. The results show that neural network models, such as U-Net, Swin Transformer, and CNN, are most commonly used in caries diagnosis and have achieved high performance in lesion identification. In the case of periapical lesions, AI models such as U-Net and Decision Tree also showed high performance, surpassing the performance of young dentists in assessing radiographs in some cases. Results: The studies cited in this review show that the diagnosis of cysts and tumours, on the other hand, relies on more advanced models such as YOLO v8, DCNN, and EfficientDet, which in many cases achieved more than 95% accuracy in the detection of this pathology. The cited studies were conducted at various universities and institutions around the world, and the databases (case databases) analysed in this work ranged from tens to thousands of images. Conclusions: The main conclusion of the literature analysis is that, thanks to its accessibility, speed, and accuracy, AI can significantly assist the work of physicians by reducing the time needed to analyse images. However, despite the promising results, AI should only be considered as an enabling tool and not as a replacement for the knowledge of doctors and their long experience. There is still a need for further improvement of algorithms and further training of the network, especially in identifying more complex clinical cases. Full article

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

10 pages, 898 KiB

Open AccessArticle

A Novel Prophylactic Device Against Head Deformity to Prevent Severe Positional Plagiocephaly

by Yukari Tanaka, Hiroshi Miyabayashi, Takanori Noto, Risa Kato, Nobuhiko Nagano and Ichiro Morioka

J. Clin. Med. 2025, 14(9), 3261; https://doi.org/10.3390/jcm14093261 - 7 May 2025

Viewed by 191

Abstract

Background/Objectives: Preventing head deformity in the early postnatal period could avert positional plagiocephaly (PP). Accordingly, we developed a novel prophylactic device to prevent head deformity and examined its impact on the incidence of PP and prevention of severe PP at 3 months [...] Read more.

Background/Objectives: Preventing head deformity in the early postnatal period could avert positional plagiocephaly (PP). Accordingly, we developed a novel prophylactic device to prevent head deformity and examined its impact on the incidence of PP and prevention of severe PP at 3 months of age. Methods: The newly developed prophylactic device was used immediately after birth or at the 1-month checkup, and cranial shape was measured before device application and at 3 months of age. The diagnostic threshold for PP was >5% for cranial vault asymmetry index (CVAI); cranial asymmetry (CA) of ≥13 mm was deemed severe. A database comprising cranial geometry of 3-month-old healthy Japanese infants (n = 110) served as the control. Results: This study included 42 infants who started using the novel prophylactic device immediately after birth or at the 1-month checkup. Measurements at 3 months of age revealed that the prophylactic device group had significantly lower CA and CVAI than the control group (CA [median]: 5.5 vs. 8.0, respectively, p = 0.007; CVAI: 4.3 vs. 5.8, respectively, p = 0.048). However, the PP prevalence did not differ significantly between the two groups (41% vs. 57%, respectively, p = 0.094). The number of infants with severe PP was significantly lower in the prophylactic device group than in the control group (0% vs. 14%, respectively; p = 0.012). At 3 months of age, no significant differences in CA or CVAI were observed between the immediate postnatal and 1-month groups. Conclusions: The novel prophylactic device against head deformity could prevent severe PP. Full article

(This article belongs to the Topic The Use of New Technologies for Health and Clinical Practice)

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11 pages, 479 KiB

Open AccessArticle

Functional Status Enhances the FRAX^® Prediction of Fractures in Myasthenia Gravis: A 10-Year Cohort Study

by Shingo Konno, Takafumi Uchi, Hideo Kihara and Hideki Sugimoto

J. Clin. Med. 2025, 14(9), 3260; https://doi.org/10.3390/jcm14093260 - 7 May 2025

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Abstract

Background: Patients with myasthenia gravis (MG) are susceptible to fractures due to glucocorticoid (GC) use and disease-related functional impairment affecting activities of daily living (ADL). The Fracture Risk Assessment Tool (FRAX^®) estimates fracture probability but does not incorporate disease-specific functional [...] Read more.

Background: Patients with myasthenia gravis (MG) are susceptible to fractures due to glucocorticoid (GC) use and disease-related functional impairment affecting activities of daily living (ADL). The Fracture Risk Assessment Tool (FRAX^®) estimates fracture probability but does not incorporate disease-specific functional status. We investigated whether combining FRAX^® with the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale improves fracture risk stratification in MG patients. Methods: This single-center prospective cohort study followed 53 MG patients for 10 years (2012–2022) at Toho University Ohashi Medical Center, Japan. Patients were categorized into four groups based on baseline FRAX^® probability (calculated with bone mineral density [BMD]) and MG-ADL scores using median splits: high FRAX^®/high MG-ADL (HH), high FRAX^®/low MG-ADL (HL), low FRAX^®/high MG-ADL (LH), and low FRAX^®/low MG-ADL (LL). The primary outcome was incident major osteoporotic fracture (MOF). Results: Over 10 years, nine MOFs occurred: seven in the HH group (43.8%), two in the HL group (16.7%), and none in the LH or LL groups. Fracture-free survival differed significantly among the groups (log-rank p < 0.001), with the HH group exhibiting the lowest survival rate. Baseline characteristics, including age, disease duration, MG severity scores, BMD, and FRAX^® scores, differed significantly among groups. Specific MG-ADL items reflecting greater impairment (impairment of ability to arise from a chair, double vision, and ptosis) were significantly more pronounced in the HH group at baseline. Conclusions: Combining baseline FRAX^® scores with the MG-ADL assessment effectively stratifies long-term MOF risk in patients with MG. Individuals with both high FRAX^® and high MG-ADL represent a particularly high-risk subgroup. This dual-assessment approach may improve the identification of patients requiring targeted preventive interventions. Full article

(This article belongs to the Special Issue New Advances in Myasthenia Gravis)

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16 pages, 466 KiB

Open AccessReview

Intraoperative Nerve Monitoring in Thyroid Surgery: A Comprehensive Review of Technical Principles, Anesthetic Considerations, and Clinical Applications

by Ji-Yoon Jung

J. Clin. Med. 2025, 14(9), 3259; https://doi.org/10.3390/jcm14093259 - 7 May 2025

Viewed by 233

Abstract

Background: Intraoperative nerve monitoring (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability [...] Read more.

Background: Intraoperative nerve monitoring (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability and interpretation of electromyographic (EMG) signals. Methods: This narrative review summarizes the principles and methodologies of IONM in thyroid surgery, focusing on the mechanisms of RLN injury, the clinical benefits of IONM, and its limitations. Particular emphasis is placed on the anesthesiologic considerations, including the effects of neuromuscular blocking agents and anesthetic maintenance methods for EMG signal quality. Recent advances in alternative IONM techniques are also discussed. Results: IONM facilitates early detection of RLN injury and improves surgical outcomes. However, signal loss and technical errors occur in up to 23% of cases. Appropriate anesthetic management, such as the judicious use of neuromuscular blocking agents and the use of reversal agents like sugammadex, can significantly improve IONM accuracy. Alternative approaches, such as transcutaneous or thyroid cartilage electrode-based monitoring, show promise in overcoming current limitations. Conclusions: IONM is a valuable tool in modern thyroid surgery, aiding in the prevention of RLN injury. Anesthesiologists play a crucial role in optimizing IONM quality by managing factors that affect EMG signals. Ongoing research into novel monitoring techniques is expected to further enhance patient safety and surgical precision. Full article

(This article belongs to the Section Anesthesiology)

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Graphical abstract

13 pages, 1811 KiB

Open AccessArticle

Characteristics and Outcomes of New-Onset Cardiomyopathy in Hospitalized COVID-19 Patients

by Sachin Kumar, Gautam Shah, Raunak Nair, Sarah Rikabi, Mohannad Seif, Bindesh Ghimire, Brian Griffin and Umesh N. Khot

J. Clin. Med. 2025, 14(9), 3258; https://doi.org/10.3390/jcm14093258 - 7 May 2025

Viewed by 240

Abstract

Background: The association between Coronavirus Disease-2019 (COVID-19) and new-onset cardiomyopathy (NOC) is unclear. Objectives: We aim to assess the incidence of NOC in hospitalized COVID-19 patients and its impact on short- and long-term survival. Methods: We retrospectively studied 2219 COVID-19 patients hospitalized between [...] Read more.

Background: The association between Coronavirus Disease-2019 (COVID-19) and new-onset cardiomyopathy (NOC) is unclear. Objectives: We aim to assess the incidence of NOC in hospitalized COVID-19 patients and its impact on short- and long-term survival. Methods: We retrospectively studied 2219 COVID-19 patients hospitalized between March 2020 and February 2022 who underwent an in-hospital echocardiogram. NOC was defined as a left-ventricular ejection fraction (LVEF) reduction of >10%, resulting in an LVEF of <54% for females and <52% for males. The 30-day and 1-year survival outcomes in patients without and with NOC were studied. Results: Among 25,943 hospitalized COVID-19 patients, 2219 met our inclusion criteria, with 209 (9.4%) having NOC. NOC patients were more likely to be male (56.1% vs. 68.4%, p = 0.001) and have chronic kidney disease (51.4% vs. 60.3%, p = 0.018). They had a higher 30-day mortality rate (29.1% vs. 32%, p = 0.033), but the 1-year survival rate was similar between the patients without and with NOC (36.9% vs. 41.6%, p = 0.12). Multivariable regression revealed that advanced age, admission to intensive care unit, mechanical ventilation, treatment with glucocorticoids, and treatment with vasopressors were associated with higher odds of 30-day mortality in NOC patients. Only 74 (35.4%) NOC patients had follow-up echocardiograms after discharge, of which 47 showed persistent cardiomyopathy. Conclusions: NOC can affect around 1 out of 10 hospitalized COVID-19 patients undergoing echocardiography. While NOC was associated with worse short-term survival, it did not impact the long-term mortality of these patients. Persistent LVEF deficits in some patients emphasize the need for improved outpatient follow-up to identify at-risk individuals and optimize treatment. Full article

(This article belongs to the Special Issue Cardiovascular Issues in Critical Care)

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20 pages, 781 KiB

Open AccessArticle

Cardio-Oncology Challenges in Elderly Patients

by Ester Topa, Eliana De Rosa, Alessandra Cuomo, Francesco Curcio, Marika Rizza, Francesco Elia, Veronica Flocco, Umberto Attanasio, Martina Iengo, Francesco Fiore, Maria Cristina Luise, Grazia Arpino, Roberto Bianco, Chiara Carlomagno, Mario Giuliano, Luigi Formisano, Marco Picardi, Carminia Maria Della Corte, Floriana Morgillo, Giulia Martini, Erika Martinelli, Stefania Napolitano, Teresa Troiani, Giovanni Esposito, Antonio Cittadini, Guido Iaccarino, Giuseppe Rengo, Pasquale Abete, Valentina Mercurio and Carlo Gabriele Tocchetti Show full author list Hide full author list

J. Clin. Med. 2025, 14(9), 3257; https://doi.org/10.3390/jcm14093257 - 7 May 2025

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Abstract

Background and Objectives: Along with the ageing of the population, cancer and cardiovascular (CV) diseases more frequently coexist, complicating patients’ management. Here, we focus on elderly oncologic patients, describing clinical features and comorbidities, discussing therapeutic management CV risk factors and CV complications risen [...] Read more.

Background and Objectives: Along with the ageing of the population, cancer and cardiovascular (CV) diseases more frequently coexist, complicating patients’ management. Here, we focus on elderly oncologic patients, describing clinical features and comorbidities, discussing therapeutic management CV risk factors and CV complications risen during our CV follow-up, and exploring the different items of the comprehensive geriatric assessment (CGA) and the correlation between cardiac function by means of standard 2D echocardiography and each of the CGA items. Methods: A total of 108 consecutive patients (mean age 73.55 ± 5.43 years old; 40.7% females) referred to our cardio-oncology unit were enrolled, and three different groups were identified: Group 1, patients naïve for oncologic treatments (mean age 73.32 ± 5.40; 33% females); Group 2, patients already on antineoplastic protocols (mean age 73.46 ± 5.09; 44.1% females); and Group 3, patients who had already completed cancer treatments (mean age 74.34 ± 6.23; 55% female). The correlation between CGA, performed in a subgroup of 62 patients (57.4%), and echocardiographic parameters was assessed. Results: Group 2 patients had the highest incidence of CV events (CVEs) (61.8% vs. 14.8% in Group 1, 15% in Group 3; p ≤ 0.001) and withdrawals from oncologic treatments (8.8% vs. none in Group 1; p = 0.035). Group 2 had worse 48-month survival (47.1% vs. 22.2% in Group 1, 20% in Group 3; p = 0.05), which was even more evident when focusing on patients who died during follow-up. When assessing echocardiographic parameters, physical activity showed an inverse correlation with the left ventricular mass index (p = 0.034), while the Frailty index showed a direct correlation with the E/e’ ratio (p = 0.005). Conclusions: A thorough baseline CV assessment is important in elderly oncologic patients eligible for anticancer treatment. In this population, CGA can be a simple, feasible screening tool that might help identify patients at a greater risk of developing CVEs correlating to several pivotal cardiovascular parameters. Full article

(This article belongs to the Special Issue Clinical Updates on Cardiac and Vascular Toxicities from Antineoplastic Drugs and Beyond)

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12 pages, 2115 KiB

Open AccessArticle

The Role of the Abdominal Perforator Exchange (APEX) Technique in the Perforator Selection Algorithm for Delayed Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction

by Dmitry V. Melnikov, Elina I. Abdeeva, Semyon I. Ivanov and Victor A. Gombolevskiy

J. Clin. Med. 2025, 14(9), 3256; https://doi.org/10.3390/jcm14093256 - 7 May 2025

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Abstract

Background: The deep inferior epigastric artery perforator (DIEP) flap is currently the most widely used method for autologous breast reconstruction. Its primary advantage over the transverse rectus abdominis muscle (TRAM) flap is the reduction in donor-site morbidity, as it preserves the integrity [...] Read more.

Background: The deep inferior epigastric artery perforator (DIEP) flap is currently the most widely used method for autologous breast reconstruction. Its primary advantage over the transverse rectus abdominis muscle (TRAM) flap is the reduction in donor-site morbidity, as it preserves the integrity of the abdominal muscles and motor nerves. Importantly, each patient’s unique vascular anatomy requires an individualized approach to perforator selection and the surgical technique. Objective: We aimed to minimize donor-site morbidity and refine the perforator selection strategy in delayed DIEP flap breast reconstruction using the abdominal perforator exchange (APEX) technique. Materials and Methods: In this study, we prospectively and retrospectively analyzed the use of the APEX technique in patients undergoing delayed DIEP flap breast reconstruction between April 2020 and October 2024. All patients underwent preoperative non-contrast magnetic resonance angiography of the donor area. A total of 106 patients were enrolled and divided into two groups: 34 patients underwent reconstruction using the APEX technique, and 72 patients received standard DIEP flap breast reconstruction. Results: Our study demonstrated a statistically significant increase in operative time, averaging 30.5 min in the APEX group (p < 0.05). There was also a significant difference in the incidence of marginal flap necrosis between the two groups. No cases of myotomy were observed, and motor nerve transection was required in one case. Conclusions: The APEX technique has been shown to be reliable when standard dissection would compromise the neuromuscular anatomy of the abdominal wall without compromising perfusion in the flap. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

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13 pages, 526 KiB

Open AccessReview

The Role of Bronchoscopy in the Diagnosis of Interstitial Lung Disease: A State-of-the-Art Review

by A. Rolando Peralta and Al Muthanna Shadid

J. Clin. Med. 2025, 14(9), 3255; https://doi.org/10.3390/jcm14093255 - 7 May 2025

Viewed by 270

Abstract

The diagnostic evaluation of interstitial lung diseases (ILDs) remains challenging due to their heterogeneous etiologies and overlapping clinical and radiographic patterns. A confident diagnosis often necessitates histopathological sampling, particularly when high-resolution computed tomography and serologic assessments are inconclusive. While surgical lung biopsy (SLB) [...] Read more.

The diagnostic evaluation of interstitial lung diseases (ILDs) remains challenging due to their heterogeneous etiologies and overlapping clinical and radiographic patterns. A confident diagnosis often necessitates histopathological sampling, particularly when high-resolution computed tomography and serologic assessments are inconclusive. While surgical lung biopsy (SLB) has long been considered the diagnostic gold standard, its invasiveness, associated morbidity, and limited feasibility in high-risk patients have driven the pursuit of less invasive alternatives. Here, we review the current applications, diagnostic yield, procedural techniques, and complications of several bronchoscopic modalities. Bronchoalveolar lavage (BAL) aids in characterizing inflammatory profiles and differentiating among conditions such as hypersensitivity pneumonitis, sarcoidosis, and eosinophilic pneumonia. Endobronchial biopsies (EBBs) and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) are valuable in diagnosing granulomatous diseases with lymphadenopathy. Transbronchial lung biopsy (TBLB) is effective for peribronchial and centrilobular diseases but is limited by small sample size and tissue distortion. Transbronchial lung cryobiopsy (TBC) enables acquisition of larger, well-preserved parenchymal tissue samples from the peripheral lung. Over recent years, studies have demonstrated that TBC, when interpreted within a multidisciplinary discussion (MDD), achieves diagnostic concordance rates with SLB exceeding 75%, and up to 95% in cases where high diagnostic confidence is reached. When performed in experienced centers using standardized protocols, TBC is considered a viable first-line histopathologic tool in the diagnostic evaluation of ILD. Adequate training and standardization of the TBC procedure are needed to ensure low complication rates and a high yield. Full article

(This article belongs to the Section Respiratory Medicine)

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17 pages, 2609 KiB

Open AccessFeature PaperArticle

Tranilast Reduces Intestinal Ischemia Reperfusion Injury in Rats Through the Upregulation of Heme-Oxygenase (HO)-1

by Emilio Canovai, Ricard Farré, Gert De Hertogh, Antoine Dubois, Tim Vanuytsel, Jacques Pirenne and Laurens J. Ceulemans

J. Clin. Med. 2025, 14(9), 3254; https://doi.org/10.3390/jcm14093254 - 7 May 2025

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Abstract

Background: Intestinal ischemia reperfusion injury (IRI) is a harmful process that occurs during intestinal infarction and intestinal transplantation (ITx). It is characterized by severe inflammation which disrupts the mucosal barrier, causing bacterial translocation and sepsis. Tranilast (N-[3,4-dimethoxycinnamoyl]-anthranilic acid) (TL) is a synthetic compound [...] Read more.

Background: Intestinal ischemia reperfusion injury (IRI) is a harmful process that occurs during intestinal infarction and intestinal transplantation (ITx). It is characterized by severe inflammation which disrupts the mucosal barrier, causing bacterial translocation and sepsis. Tranilast (N-[3,4-dimethoxycinnamoyl]-anthranilic acid) (TL) is a synthetic compound with powerful anti-inflammatory properties. Objective: To investigate the effect of pretreatment with TL in a validated rat model of intestinal IRI (60 min of ischemia). Methods: TL (650 mg/kg) was administered by oral gavage 24 and 2 h before the onset of ischemia. Experiment 1 examined 7-day survival in 3 study groups (sham, vehicle+IRI and TL+IRI, n = 10/group). In Experiment 2, the effects on the intestinal wall integrity and inflammation were studied after 60 min of reperfusion using 3 groups (sham, IRI and TL+IRI, n = 6/group). The following end-points were studied: L-lactate, intestinal fatty acid-binding protein (I-FABP), histology, intestinal permeability, endotoxin translocation, pro- and anti-inflammatory cytokines and heme oxygenase-1 (HO-1) levels. Experiment 3 examined the role of HO-1 upregulation in TL pretreatment, by blocking its expression using Zinc protoporphyrin (ZnPP) at 20 mg/kg vs. placebo (n = 6/group). Results: Intestinal IRI resulted in severe damage of the intestinal wall and a 10% 7-day survival. These alterations led to endotoxin translocation and upregulation of pro-inflammatory cytokines. TL pretreatment improved survival up to 50%, significantly reduced inflammation and protected the intestinal barrier. The HO-1 inhibitor ZnPP, abolished the protective effect of TL. Conclusions: TL pretreatment improves survival by protecting the intestinal barrier function, decreasing inflammation and endotoxin translocation, through upregulation of HO-1.This rat study of severe intestinal ischemia reperfusion injury demonstrates a novel role for Tranilast as a potential therapy. Administration of Tranilast led to a marked reduction in mortality, inflammation and intestinal permeability and damage. The study proved that Tranilast functions through upregulation of heme oxygenase-1. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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10 pages, 776 KiB

Open AccessArticle

Guideline-Directed Medical Therapy in Sepsis Survivors with Left Ventricular Systolic Dysfunction: An Observational Study

by Thomas Oswald, Samuel Malomo, Thomas Alway, Stanislav Hadjivassilev, Steven Coombs, Susan Ellery, Joon Lee, Claire Phillips, Barbara Philips, Rachael James, David Hildick-Smith, Victoria Parish and Alexander Liu

J. Clin. Med. 2025, 14(9), 3253; https://doi.org/10.3390/jcm14093253 - 7 May 2025

Viewed by 187

Abstract

Background: Sepsis survivors can develop left ventricular systolic dysfunction (LVSD) and heart failure. These patients are often treated with guideline-directed medical therapy (GDMT) known to be effective in patients with non-sepsis-related heart failure. This study sought to assess the use of GDMT on [...] Read more.

Background: Sepsis survivors can develop left ventricular systolic dysfunction (LVSD) and heart failure. These patients are often treated with guideline-directed medical therapy (GDMT) known to be effective in patients with non-sepsis-related heart failure. This study sought to assess the use of GDMT on sepsis survivors with LVSD. Methods: Sepsis survivors with suspected myocardial injury and/or heart failure diagnosed with LVSD in a UK cardiac centre were retrospectively studied. Clinical and transthoracic echocardiography (TTE) data were recorded and analysed. Results: Of the 25 sepsis survivors (age 56 ± 11 years; 52% males), 11 (44%) had LVSD (LVEF < 50%). LV end-diastolic internal diameter (LVIDd) was similar between patients with vs. without LVSD (5.2 ± 0.8 cm vs. 4.7 ± 0.8 cm; p = 0.214). Patients with LVSD had significantly greater LV end-systolic internal diameter (LVIDs) than those without LVSD (4.0 ± 1.2 cm vs. 2.8 ± 0.6 cm; p = 0.027). Tricuspid annular plane systolic excursion (TAPSE) was similar between the two groups (2.1 ± 0.5 cm vs. 2.2 ± 0.6 cm; p = 0.910). Of the 11 patients with LVSD, nine patients underwent repeat TTE scans after 6 months [IQR 3–9], most of whom were taking GDMT. The majority (8/9) of these patients demonstrated LV systolic functional recovery (>5% LVEF increase; mean LVEF improvement 16 ± 11%) after GDMT. Reductions were seen in LVIDd (5.3 ± 0.8 cm to 5.0 ± 0.7 cm) and LVIDs (4.1 ± 1.2 cm to 3.7 ± 0.8 cm) after GDMT, though these changes did not reach statistical significance (both p > 0.05). Conclusions: GDMT appears beneficial in sepsis survivors with LV dysfunction. This finding should be validated on a larger and multi-centre basis to further affirm the value of medical therapy in post-sepsis heart failure. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure—2nd Edition)

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26 pages, 1083 KiB

Open AccessArticle

Demographic and Socio-Economic Disparities in the Outcomes Among Patients with NVAF Treated with Oral Anticoagulants: A Real-World Evaluation of Medicare Beneficiaries

by Nipun Atreja, Anandkumar Dubey, Monal Kohli, Jenny Jiang, Melissa Hagan, Gideon Aweh, Shayna Adams and Dong Cheng

J. Clin. Med. 2025, 14(9), 3252; https://doi.org/10.3390/jcm14093252 - 7 May 2025

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Abstract

Objectives: To assess the association between apixaban use and the risk of stroke/systemic embolism (SE) and major bleeding (MB) compared with other anticoagulants (OACs) across demographic and socio-economic subgroups in the treatment of nonvalvular atrial fibrillation (NVAF). Methods: The study included [...] Read more.

Objectives: To assess the association between apixaban use and the risk of stroke/systemic embolism (SE) and major bleeding (MB) compared with other anticoagulants (OACs) across demographic and socio-economic subgroups in the treatment of nonvalvular atrial fibrillation (NVAF). Methods: The study included adult NVAF patients initiating OAC treatment between 2013 and 2019 in the Medicare database. Inverse probability treatment weighted Cox proportional hazard models were used to assess stroke/SE and MB outcomes across various subgroups. Results: Overall, the adjusted risks of stroke/SE and MB were lower for apixaban compared with warfarin (stroke/SE: HR, 0.69, [95% confidence interval (CI): 0.65–0.74], MB: 0.59 [95% CI: 0.57–0.60]), rivaroxaban (stroke/SE: 0.88 [95% CI: 0.84–0.92], MB: 0.60 [95% CI: 0.58–0.61]) and dabigatran (stroke/SE: 0.88 [95% CI: 0.80–0.95], MB: 0.76 [95% CI: 0.72–0.80]). Among the low socio-economic status (SES) group, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.73 [95% CI: 0.69–0.77], MB: 0.60 [95% CI: 0.57–0.62]) and rivaroxaban (stroke/SE: 0.88 [95% CI: 0.83–0.94], MB: 0.61 [95% CI: 0.59–0.63]). Among medium SES patients, apixaban was associated with lower risk vs. warfarin (stroke/SE: 0.67 [95% CI: 0.63–0.71] MB: 0.60 [95% CI: 0.58–0.63]), rivaroxaban (stroke/SE: 0.85 [95% CI: 0.79–0.91], MB: 0.59 [95% CI: 0.56–0.61]) and dabigatran (stroke/SE: 0.85 [95% CI: 0.73–0.99], MB: 0.77 [95% CI: 0.70–0.84]). Apixaban was also associated with lower risks of stroke/SE and MB compared with other OACs among most other demographic, socio-economic subgroups. Conclusions: Apixaban was associated with lower risk of stroke/SE and MB than warfarin, rivaroxaban, dabigatran across most demographic, socio-economic subgroups. Full article

(This article belongs to the Section Cardiovascular Medicine)

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15 pages, 924 KiB

Open AccessArticle

The Role of Periarticular Knee Muscle Torques in Ensuring the Body Balance of Older Adults with Balance Disturbances

by Piotr Prochor, Łukasz Magnuszewski, Paulina Zalewska, Michał Świętek, Zyta Beata Wojszel and Szczepan Piszczatowski

J. Clin. Med. 2025, 14(9), 3251; https://doi.org/10.3390/jcm14093251 - 7 May 2025

Viewed by 176

Abstract

Background: The role of the periarticular muscles of the knee joint in ensuring body balance is still ambiguous. Therefore, we conducted clinical and biomechanical assessments on 52 older adults (36 women and 16 men, age of 67.58 ± 7.30 years, body weight [...] Read more.

Background: The role of the periarticular muscles of the knee joint in ensuring body balance is still ambiguous. Therefore, we conducted clinical and biomechanical assessments on 52 older adults (36 women and 16 men, age of 67.58 ± 7.30 years, body weight of 75.10 ± 13.42 kg, and height of 163.92 ± 8.80 cm) to determine the role of the knee muscles in balance maintenance. Methods: The clinical examination included the Dizziness Handicap Inventory (DHI), the Geriatric Depression Scale (GDS), the Performance-Oriented Mobility Assessment (POMA), the Functional Reach Test (FRT), the Falls Efficacy Scale—International (FES-I), and bioimpedance parameters (skeletal muscle mass—SMM—and its derived parameter—Diff SMM). The biomechanical assessment involved parameters that characterize muscle torques of knee joint extensors and flexors in isokinetic and isometric conditions, as well as changes in the centre of pressure (COP) position while standing with eyes open and closed. Results: Based on treatment history and DHI results (>10 points), 26 participants were identified as having balance disorders, while the remaining participants formed the control group. Statistical analysis was performed to determine differences between the groups. The groups significantly differed in terms of the results obtained from the DHI (p < 0.001) and GDS (p = 0.04) questionnaires as well as FES-I (p < 0.001) and POMA (p = 0.002) tests. While SMM (p = 0.012) was similar in the groups, Diff SMM (p = 0.04) significantly differed. The multiple regression analysis confirmed the knee joint extensor parameters’ significant role in predicting the COP path (p = 0.03 and p = 0.04 for two assumed models). Conclusions: The obtained results proved that the muscle torques of knee extensors can be used in the diagnostic process of older patients with balance disorders, indicating possible rehabilitation directions. Full article

(This article belongs to the Special Issue Challenges and Advances in Geriatrics and Gerontology)

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32 pages, 1271 KiB

Open AccessReview

Atrial Cardiomyopathy in Atrial Fibrillation: Mechanistic Pathways and Emerging Treatment Concepts

by Paschalis Karakasis, Panagiotis Theofilis, Panayotis K. Vlachakis, Nikolaos Ktenopoulos, Dimitrios Patoulias, Antonios P. Antoniadis and Nikolaos Fragakis

J. Clin. Med. 2025, 14(9), 3250; https://doi.org/10.3390/jcm14093250 - 7 May 2025

Viewed by 260

Abstract

Atrial fibrillation (AF) is increasingly recognized not merely as an arrhythmia, but as a clinical manifestation of atrial cardiomyopathy (AtCM)—a progressive, multifaceted disease of the atrial myocardium involving structural, electrical, mechanical, and molecular remodeling. AtCM often precedes AF onset, sustains its perpetuation, and [...] Read more.

Atrial fibrillation (AF) is increasingly recognized not merely as an arrhythmia, but as a clinical manifestation of atrial cardiomyopathy (AtCM)—a progressive, multifaceted disease of the atrial myocardium involving structural, electrical, mechanical, and molecular remodeling. AtCM often precedes AF onset, sustains its perpetuation, and contributes to thromboembolic risk independently of rhythm status. Emerging evidence implicates diverse pathophysiological drivers of AtCM, including inflammation, epicardial adipose tissue, metabolic dysfunction, oxidative stress, ageing, and sex-specific remodeling. The NLRP3 inflammasome has emerged as a central effector in atrial inflammation and remodeling. Gut microbial dysbiosis, lipid dicarbonyl stress, and fibro-fatty infiltration are also increasingly recognized as contributors to arrhythmogenesis. AtCM is further linked to atrial functional valve regurgitation and adverse outcomes in AF. Therapeutically, substrate-directed strategies—ranging from metabolic modulation and immunomodulation to early rhythm control—offer promise for altering the disease trajectory. This review synthesizes mechanistic insights into AtCM and discusses emerging therapeutic paradigms that aim not merely to suppress arrhythmia but to modify the underlying substrate. Recognizing AF as a syndrome of atrial disease reframes management strategies and highlights the urgent need for precision medicine approaches targeting the atrial substrate. Full article

(This article belongs to the Section Cardiology)

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27 pages, 5331 KiB

Open AccessSystematic Review

Comparative Efficacy and Precision of Robot-Assisted vs. Conventional Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Ümit Mert, Moh’d Yazan Khasawneh, Maher Ghandour, Ahmad Al Zuabi, Klemens Horst, Frank Hildebrand, Bertil Bouillon, Mohamad Agha Mahmoud and Koroush Kabir

J. Clin. Med. 2025, 14(9), 3249; https://doi.org/10.3390/jcm14093249 - 7 May 2025

Viewed by 215

Abstract

Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis [...] Read more.

Background/Objectives: Total knee arthroplasty (TKA) is a common procedure for knee osteoarthritis. While conventional TKA (C-TKA) remains standard, robot-assisted TKA (RA-TKA) has been introduced to enhance implant positioning and clinical outcomes. However, its comparative benefits remain unclear. This systematic review and meta-analysis compared RA-TKA with C-TKA, examining the influence of robotic system, surgeon experience, and follow-up duration. Methods: A systematic search was conducted across the PubMed, Scopus, Web of Science, and Cochrane Library databases. Randomized controlled trials (RCTs) comparing RA-TKA with C-TKA were included. Outcomes were categorized into clinical, radiographic, and safety endpoints. Subgroup and meta-regression analyses explored factors influencing outcome variability, including robotic system, number of surgeons, and follow-up duration. Results: Twenty-five RCTs (5614 patients) were analyzed. RA-TKA showed modest improvements in clinical outcomes, such as KSS and VAS pain scores, but results varied across subgroups. RA-TKA demonstrated a significantly better flexion range of motion (ROM) in certain countries (e.g., Russia, MD = 10; 95%CI: 5.44, 14.56) and with specific robotic systems (e.g., NAVIO). No significant differences were found in OKS and HSS scores. Radiographic outcomes, including the HKA Angle, varied by robotic system, with NAVIO and YUANHUA showing better alignment than C-TKA. Complication rates were comparable, though RA-TKA had a higher risk of conversion to open surgery (10% vs. 2%). Meta-regression identified robotic system and surgeon experience as key predictors of outcome variability. Conclusions: RA-TKA offers advantages in implant alignment and postoperative pain reduction. However, benefits are inconsistent across settings, and some robotic systems may not provide improvements over C-TKA. Full article

(This article belongs to the Section Orthopedics)

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19 pages, 1616 KiB

Open AccessSystematic Review

Risk Factors for Prenatal Anxiety in European Women: A Review

by Alba Val, Cristina M. Posse and M. Carmen Míguez

J. Clin. Med. 2025, 14(9), 3248; https://doi.org/10.3390/jcm14093248 - 7 May 2025

Viewed by 127

Abstract

Background: Prenatal anxiety is a common problem affecting a large number of women. The presence of anxiety during pregnancy is associated with adverse consequences for both the mother and the baby. The main objective of this review was to determine the risk factors [...] Read more.

Background: Prenatal anxiety is a common problem affecting a large number of women. The presence of anxiety during pregnancy is associated with adverse consequences for both the mother and the baby. The main objective of this review was to determine the risk factors associated with anxiety during pregnancy in European women. Specifically, we wanted to know if these factors are the same as those found in other continents and if they are similar to those associated with depression during this stage. Methods: A literature review was carried out on studies that were published in the last 10 years in the PsycInfo, Medline, and SCOPUS databases. Thirteen studies were selected for the purposes of this review. Results: Sociodemographic risk factors associated with a higher level of anxiety during pregnancy included having a lower educational level and socioeconomic status. Obstetric and pregnancy-related risk factors included having had complications during pregnancy. Having a history of mental health problems, low social support, high levels of stress, and being exposed to adverse life events were the most relevant psychological factors for presenting prenatal anxiety. Furthermore, these factors are largely common to those associated with prenatal anxiety in other continents of the world and to those associated with prenatal depression. Conclusions: This review shows that there are multiple factors that contribute to women experiencing prenatal anxiety. Most can be identified at the beginning of pregnancy, and some factors, such as psychological ones, are potentially modifiable. This underlines the importance of carrying out a proper screening for anxiety during pregnancy in order to prevent its onset or treat it appropriately. Furthermore, the fact that risk factors are common for both prenatal anxiety and depression implies that the same intervention could reduce the probability of the onset of both pathologies and the possible consequences associated with them. Full article

(This article belongs to the Special Issue Mood Disorders: Diagnosis, Management and Future Opportunities)

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13 pages, 789 KiB

Open AccessArticle

Impact of Frailty and Other Factors as Estimated by HU to Predict Response to Anabolic Bone Medications

by Abdelrahman M. Hamouda, Zach Pennington, Rahul Kumar, Michael L. Martini, Derrick Obiri-Yeboah, Maria Astudillo Potes, Nicholas Kendall, Anthony L. Mikula, Michelle J. Clarke, William E. Krauss, Ahmad N. Nassr, Brett A. Freedman, Arjun S. Sebastian, Melvin D. Helgeson, Kurt A. Kennel, Jeremy L. Fogelson and Benjamin D. Elder

J. Clin. Med. 2025, 14(9), 3247; https://doi.org/10.3390/jcm14093247 - 7 May 2025

Viewed by 222

Abstract

Introduction: Bone health optimization is a key component of the preoperative management of spine surgery patients, as poor bone quality increases the odds of mechanical complications. The present study aimed to achieve the following: (1) compare the relative efficacy of current osteoporosis medications [...] Read more.

Introduction: Bone health optimization is a key component of the preoperative management of spine surgery patients, as poor bone quality increases the odds of mechanical complications. The present study aimed to achieve the following: (1) compare the relative efficacy of current osteoporosis medications in improving bone quality; (2) identify factors influencing treatment response in preoperative spine surgery patients. Methods: Patients treated at a single, multisite institution who received osteoporosis treatment were identified. Data were gathered on pre- and post-treatment lumbar spine Hounsfield Unit (HU) measurements, patient demographics, frailty scores (modified Frailty Index/mFI, risk analysis index/RAI), and pharmacologic treatment details. The primary outcome was a ≥7 point improvement in lumbar HU, and baseline and logistic regression models were utilized to identify factors associated with this improvement. Medications were grouped as anabolic (teriparatide, romosozumab) and antiresorptive (denosumab, alendronate) therapies. Results: A total of 267 patients were included (median age: 74 years; IQR [66–81]; 67.3% female), with 127 (47.6%) improving by ≥7 HU. The treatment agents used were alendronate (95), denosumab (113), romosozumab (31), and teriparatide (28). Univariable comparisons revealed significant differences across medication groups in age (p < 0.001), sex (p < 0.001), mFI (p < 0.001), RAI (p = 0.004), BMI (p < 0.001), pre-treatment HU (p = 0.022), and treatment duration (p < 0.001). The highest HU improvement rates (ΔHU ≥ 7) were observed in patients receiving the anabolic medications romosozumab (67.7%) and teriparatide (60.7%). Univariable logistic regression identified male sex (OR 0.54, p = 0.019), higher pre-treatment HU (OR 0.99, p = 0.006), and longer treatment duration (OR 0.97, p = 0.003) as factors associated with lower odds of HU improvement. Only romosozumab was associated with significantly higher odds of HU improvement relative to alendronate (OR 3.02, p = 0.012). In our multivariable analysis, male sex (OR 0.53, p = 0.028) and higher pre-treatment HU (OR 0.99, p = 0.002) remained significant predictors of HU improvement. However, medication type was not significant in the multivariable analysis. Conclusions: Our study highlights that male sex and higher pre-treatment HU were independently associated with lower odds of HU improvement, while medication type was not a significant predictor. Additionally, anabolic agents offered superior improvement relative to antiresorptive therapies. Full article

(This article belongs to the Special Issue Latest Developments in Minimally Invasive Spinal Treatment—2nd Edition)

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7 pages, 1179 KiB

Open AccessCase Report

Perioperative Stroke in MCA Aneurysm Surgery: The Hidden Risks of Amphetamine Use

by Firat Taskaya, Vanessa Magdalena Swiatek, Sifian Al-Hamid, Julius Reiser, Roland Schwab, Klaus-Peter Stein, Daniel Behme, Ali Rashidi, I. Erol Sandalcioglu and Belal Neyazi

J. Clin. Med. 2025, 14(9), 3246; https://doi.org/10.3390/jcm14093246 - 7 May 2025

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Abstract

Background/Objectives: Perioperative strokes are a rare but recognized complication of cerebral aneurysm surgeries, often influenced by patient-specific factors. Amphetamine abuse, known for its vasospastic effects, is an underexplored risk factor in the neurosurgical setting. This report highlights the clinical and perioperative challenges associated [...] Read more.

Background/Objectives: Perioperative strokes are a rare but recognized complication of cerebral aneurysm surgeries, often influenced by patient-specific factors. Amphetamine abuse, known for its vasospastic effects, is an underexplored risk factor in the neurosurgical setting. This report highlights the clinical and perioperative challenges associated with acute undisclosed amphetamine abuse in a patient undergoing elective clipping of an unruptured middle cerebral artery (MCA) aneurysm. Methods: A 46-year-old male presented with a 3 mm broad-based unruptured aneurysm in the proximal M1 segment of the right MCA. The patient reported a history of illicit drug use, including intravenous consumption. Upon further questioning, he admitted to intermittent use of amphetamines, although he denied any recent use. Elective aneurysm clipping via a transsylvian approach was performed after multidisciplinary consensus. Postoperatively, the patient developed anisocoria, prompting an emergency CT with perfusion and angiography, showing significant findings. Further imaging revealed a bilateral superior cerebellar artery territory infarction. Given the patient’s medical history, a toxicology screening later confirmed recent amphetamine use. Conclusions: This case highlights the need for preoperative evaluation, including routine toxicology screening, in patients with a history of substance abuse. Amphetamine use may present perioperative challenges and increase the risk of complications like vasospasm and stroke. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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11 pages, 2002 KiB

Open AccessArticle

Inter-Relationships Between the Deep Learning-Based Pachychoroid Index and Clinical Features Associated with Neovascular Age-Related Macular Degeneration

by Michiyuki Saito, Mizuho Mitamura, Yuki Ito, Hiroaki Endo, Satoshi Katsuta and Susumu Ishida

J. Clin. Med. 2025, 14(9), 3245; https://doi.org/10.3390/jcm14093245 - 7 May 2025

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Abstract

Background/Objectives: To investigate the impact of pachychoroid on the clinical features of neovascular age-related macular degeneration (nAMD) in Japan using the deep learning-based Hokkaido University pachychoroid index (HUPI), which has a high discriminative ability for pachychoroid. Methods: This retrospective observational study [...] Read more.

Background/Objectives: To investigate the impact of pachychoroid on the clinical features of neovascular age-related macular degeneration (nAMD) in Japan using the deep learning-based Hokkaido University pachychoroid index (HUPI), which has a high discriminative ability for pachychoroid. Methods: This retrospective observational study examined 124 eyes of 111 treatment-naïve nAMD patients, including 44 eyes with type 1 macular neovascularization (MNV), 26 eyes with type 2 MNV, and 54 eyes with polypoidal choroidal vasculopathy (PCV). HUPI was calculated for each eye from EDI-OCT choroidal images using our modified LeNet that had learned the image patterns of pachychoroid. Differences in HUPI between nAMD types and inter-relationships between nAMD parameters, including HUPI, were evaluated. Results: The mean HUPI was 0.53 ± 0.30 for type 1 MNV, 0.33 ± 0.23 for type 2 MNV, and 0.61 ± 0.3 for PCV, with significant differences between any two of the three groups (p < 0.05, for each). Round-robin multiple regression analysis for nAMD parameters showed the close associations of the HUPI with choroidal vascular hyperpermeability (CVH) and subretinal fluid (SRF) (p = 0.017 and p < 0.001 for each) and the clear division of nAMD parameters into the following two groups: one including intraretinal fluid and type 1 and type 2 MNV and the other including SRF, CVH, polypoidal lesions, and HUPI. Conclusions: HUPI revealed that eyes with type 1 MNV and PCV had more pachychoroid-like features than eyes with type 2 MNV. HUPI was tightly associated with CVH and SRF but not MNV per se in nAMD parameters, reinforcing the pathoetiological concept of differentiating pachychoroid from typical nAMD. Full article

(This article belongs to the Special Issue Artificial Intelligence and Eye Disease)

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21 pages, 20581 KiB

Open AccessReview

Postoperative Infection After Esophageal Injury in Anterior Cervical Spine Surgery: A Comprehensive Review of Diagnosis, Management, and Outcomes

by Chae-Gwan Kong and Jong-Beom Park

J. Clin. Med. 2025, 14(9), 3244; https://doi.org/10.3390/jcm14093244 - 7 May 2025

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Abstract

Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 [...] Read more.

Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 to 2025 using PubMed, Scopus, and Web of Science, focusing on infection, esophageal injury, surgical outcomes, and management strategies, with emphasis on recent advances in diagnostics, surgical techniques, and postoperative care. Our findings highlight the multifactorial nature of these complications and the critical role of early recognition, accurate diagnosis, and timely management. Imaging modalities such as CT, MRI, and contrast esophagography, along with flexible esophagoscopy, are indispensable in assessing injury and infection extent. Effective management requires a multidisciplinary approach integrating broad-spectrum antibiotics, surgical debridement, vascularized flap reinforcement, negative pressure wound therapy, and antibiotic-loaded cement beads. Meticulous postoperative care with prolonged antibiotics, nutritional support, and imaging follow-up is vital for optimizing outcomes. Innovative approaches, including vascularized muscle flaps and hyperbaric oxygen therapy, show promise in enhancing healing and reducing infections. Our review underscores the need for future meta-analyses to strengthen evidence and refine protocols. As surgical techniques evolve, so too must our diagnostic, surgical, and postoperative strategies to minimize complications and improve patient outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Spine Disorders)

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9 pages, 631 KiB

Open AccessArticle

Extended Hematological Parameters and Short-Term Mortality in Sepsis Patients: A Retrospective Study

by Piotr F. Czempik and Agnieszka Wiórek

J. Clin. Med. 2025, 14(9), 3243; https://doi.org/10.3390/jcm14093243 - 7 May 2025

Viewed by 194

Abstract

Background/Objectives: Sepsis has a high mortality rate, with septic shock exceeding 50%. The most common score for diagnosis and prognosis in sepsis is the Sepsis-related Organ Failure Assessment (SOFA). This study aimed to identify hematological parameters for the prediction of intensive care [...] Read more.

Background/Objectives: Sepsis has a high mortality rate, with septic shock exceeding 50%. The most common score for diagnosis and prognosis in sepsis is the Sepsis-related Organ Failure Assessment (SOFA). This study aimed to identify hematological parameters for the prediction of intensive care unit (ICU) mortality. Methods: This study collected demographic and clinical data from sepsis patients, including age, sex, infection site, length of stay, the SOFA, and ICU mortality. The standard laboratory panel included, among others, complete blood count with differential and reticulocyte panel. Intergroup differences were analyzed using Student’s t-test, Mann–Whitney U test, Pearson’s χ², and Fisher’s test where applicable. The AUROC was used for evaluating the predictive value of hematological parameters. Multiple logistic regression was performed to exclude the impact of potential confounding factors. Results: This study analyzed data from 190 sepsis patients hospitalized in the ICU, excluding patients with other conditions significantly affecting mortality. The median age was 65.0 (IQR 51.0–71.0) years. The sexes were almost perfectly balanced. The sites of infection were mostly the abdominal cavity, lungs, and urinary tract. The short-term mortality rate was 30%, with higher SOFA scores and significant differences in leukocyte, platelet, and erythrocyte parameters between survivors and non-survivors. The percentage of nucleated red blood cells (NRBCs) showed the highest AUROC. Conclusions: The only reliable hematological parameter for predicting ICU mortality in sepsis patients may be the percentage of NRBCs. The presence of NRBCs in a blood smear is linked to a worse prognosis. Full article

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

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13 pages, 443 KiB

Open AccessArticle

A Multicenter Study by the DENO Research Group on the Use of Denosumab in Giant-Cell Tumors of the Bone

by DENO Research Group, Carolina de la Calva, Manuel Angulo, Paula González-Rojo, Ana Peiró, Pau Machado, Juan Luis Cebrián, Roberto García-Maroto, Antonio Valcárcel, Pablo Puertas, Gregorio Valero-Cifuentes, Óscar Pablos, Miriam Maireles, María Luisa Fontalva, Iván Chaves, Aida Orce, Luis Coll-Mesa, Israel Pérez, Fausto González, María del Carmen Sanz and Isidro Gracia Show full author list Hide full author list

J. Clin. Med. 2025, 14(9), 3242; https://doi.org/10.3390/jcm14093242 - 7 May 2025

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Abstract

Background/Objectives: Despite the therapeutic potential of denosumab for the treatment of giant-cell tumors of the bone (GCTBs), there is a lack of standardization in treatment protocols. Methods: We present a multicenter, retrospective, descriptive study conducted across the seven hospitals in Spain [...] Read more.

Background/Objectives: Despite the therapeutic potential of denosumab for the treatment of giant-cell tumors of the bone (GCTBs), there is a lack of standardization in treatment protocols. Methods: We present a multicenter, retrospective, descriptive study conducted across the seven hospitals in Spain affiliated with the DENO Research Group. Seventy-three patients diagnosed with GCTB and treated with denosumab were included and stratified according to treatment strategy—neoadjuvant (n = 38), adjuvant (n = 8), and single treatment (n = 27). Results: Patients in the neoadjuvant group received denosumab for a median of 6.1 months, with reintroduction after surgery in 25.8% of all cases. Among the neoadjuvant patients treated with curettage, recurrence was 35.5%, with no association with denosumab treatment duration (p = 0.274) nor with denosumab reintroduction after surgery (p = 0.405). In the adjuvant group, those who completed treatment received denosumab for 15.3 months, while those still undergoing therapy received it for a median of 12.8 months; only one case (12.5%) recurred. Recurrence rates in neoadjuvant and adjuvant treatment strategies were not different (p = 0.394). Patients treated only with denosumab and no longer on treatment had received it for 34.2 months, with 31.3% recurrence; those still on treatment had received it for 51.8 months, with 25.0% recurrence. Across all strategies, more than 85% of patients reported favorable clinical outcomes, and only 43.8% presented adverse events. No deaths occurred during this study. Conclusions: Although patients who experienced recurrence during neoadjuvant treatment had longer durations of denosumab administration, the difference was not statistically significant. Similarly, recurrence rates did not differ significantly, whether denosumab was reintroduced after surgery or not. Among the patients treated with curettage, recurrence rates were comparable between neoadjuvant and adjuvant strategies. Discontinuation of the single treatment did not necessarily result in disease progression. Full article

(This article belongs to the Special Issue Clinical Management and Treatment of Orthopedic Oncology: 2nd Edition)

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9 pages, 1209 KiB

Open AccessArticle

Radiological Evaluation of Retained Primary Molars in Adolescents with Mandibular Second Premolar Agenesis

by Dita Meistere, Aleksandra Karkle, Sindija Mengele, Liga Kronina and Laura Neimane

J. Clin. Med. 2025, 14(9), 3241; https://doi.org/10.3390/jcm14093241 - 7 May 2025

Viewed by 120

Abstract

Objectives: We aimed to evaluate the condition of retained primary molars in case of mandibular second premolar agenesis. Materials and Methods: In total, 2692 panoramic radiographs of adolescent patients were analyzed to determine the prevalence of tooth agenesis. Patients (N = [...] Read more.

Objectives: We aimed to evaluate the condition of retained primary molars in case of mandibular second premolar agenesis. Materials and Methods: In total, 2692 panoramic radiographs of adolescent patients were analyzed to determine the prevalence of tooth agenesis. Patients (N = 156) with at least one mandibular second premolar agenesis were further explored to determine the presence and condition of retained primary teeth. Teeth were classified as good or poor based on root resorption, infraocclusion, caries, and restorations. Results: The prevalence of mandibular second premolar agenesis was 5.8% (N = 156). For the set period for this study, 138 (58.5%) primary molars were present. Out of these retained teeth, N = 83 were in good condition. There was a statistically significant positive weak correlation between age and the level of root resorption (rs = 0.348, n = 138, p < 0.001). There was no association between infraocclusion and the level of root resorption (p = 0.747). Signs of infraocclusion were noted in 32 out of 138 teeth. There was no association between gender and the presence of infraocclusion (p = 0.067) and the presence or lack of infraocclusion and the therapeutic status of a tooth (p = 0.450). Only 28 out of 138 (20.3%) were intact. There was a significant difference in the level of root resorption between restored and/or carious (median = 3, IQR 2–4) and intact teeth (median = 2, IQR 1.75–3), U = 1168, p = 0.044, r = 0.242. Conclusions: Overall, 35.2% of corresponding primary molars were present in oral cavity, and were in good condition, and could potentially be preserved in the long term. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Radiology: Clinical Progress and New Directions)

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22 pages, 5842 KiB

Open AccessArticle

Comparison of Dimensional Accuracy of Diagnostic Trial Restoration Transfer with Four Different Methods: A Randomized Clinical Trial

by Lucas Queiroz Caponi, Pilar Fenoy-Illacer, Oscar Figueras-Álvarez, Eduardo de Lima Flor, Carla Vidal-Ponsoda and Miguel Roig

J. Clin. Med. 2025, 14(9), 3240; https://doi.org/10.3390/jcm14093240 - 7 May 2025

Viewed by 131

Abstract

Background/Objective: Diagnostic trial restorations play a crucial role in restorative dentistry by allowing clinicians to evaluate aesthetics, function, and phonetics before finalizing definitive restorations. These restorations facilitate communication between patients, clinicians, and dental technicians, ensuring treatment alignment and predictable outcomes. The accuracy of [...] Read more.

Background/Objective: Diagnostic trial restorations play a crucial role in restorative dentistry by allowing clinicians to evaluate aesthetics, function, and phonetics before finalizing definitive restorations. These restorations facilitate communication between patients, clinicians, and dental technicians, ensuring treatment alignment and predictable outcomes. The accuracy of transferring diagnostic trial restorations to the oral cavity is essential to maintain the integrity of the planned design. Various fabrication techniques, including conventional silicone matrices and computer-aided design/computer-aided manufacturing (CAD-CAM)-based methods, have been developed to improve transfer precision. However, there is limited evidence directly comparing their dimensional accuracy. This randomized in vivo study aimed to evaluate and compare the accuracy of four commonly used techniques—condensation silicone, addition PVS silicone, transparent PVS silicone, and CAD-CAM combination matrices—by assessing their linear and volumetric discrepancies. Methods: Twenty patients requiring aesthetic rehabilitation of their anterior maxillary teeth participated. The sequence of matrix usage was determined through randomization. Four techniques for transferring diagnostic trial restorations were evaluated: (1) condensation silicone matrix, (2) addition polyvinyl siloxane (PVS) silicone matrix, (3) transparent PVS silicone matrix, and (4) CAD-CAM combination matrix. Dimensional accuracy was assessed by comparing intraoral scans (IOSs) of the transferred restorations to the original diagnostic wax-up. Linear discrepancies were measured at four buccal landmarks (cervical, medial, lower medial, and incisal), and volumetric deviation was evaluated using reverse engineering alignment software. Results: Significant differences were observed among the groups in both linear and volumetric discrepancies (p < 0.05). The CAD-CAM combination matrix showed superior volumetric accuracy, with minimal deviations from the diagnostic wax-up. The addition PVS silicone matrix demonstrated consistent linear accuracy, particularly at the cervical and medial landmarks. The condensation silicone matrix exhibited moderate performance across both linear and volumetric accuracy. The transparent PVS silicone matrix showed the highest variability, with greater volumetric deviations. Conclusions: The study highlights that the choice of matrix material and technique significantly impacts the dimensional accuracy of diagnostic trial restoration transfers. The CAD-CAM combination matrix and the addition PVS silicone matrix demonstrated superior advantages compared to the other techniques. Clinicians should consider the specific requirements of each case, including accuracy and ease of use, when selecting a transfer technique for aesthetic rehabilitations. Full article

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

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10 pages, 390 KiB

Open AccessArticle

Prevalence and Risk Factors of Metabolic-Associated Fatty Liver Disease in Children with Down Syndrome at a Tertiary Care Center

by Maria D. Karaceper, Maria-Jose Villegas, Sanathan Sadh, Sierra Kawesa, Jamie Strain, Asha Nair, Alissa Dupuis, Mary Pothos, Ming-Hua Zheng and Mohit Kehar

J. Clin. Med. 2025, 14(9), 3239; https://doi.org/10.3390/jcm14093239 - 7 May 2025

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Abstract

Background: The global rise of metabolic-associated fatty liver disease (MAFLD) in children is particularly concerning in high-risk groups such as those with Down Syndrome (DS), who have an elevated risk of obesity and insulin resistance. Despite increasing recognition of MAFLD in pediatric populations, [...] Read more.

Background: The global rise of metabolic-associated fatty liver disease (MAFLD) in children is particularly concerning in high-risk groups such as those with Down Syndrome (DS), who have an elevated risk of obesity and insulin resistance. Despite increasing recognition of MAFLD in pediatric populations, data on its prevalence and risk factors among children with DS in Canada remain limited. Method: This retrospective study reviewed medical records of children with DS at the CHEO Down Syndrome Clinic (2013–2023). A diagnosis of MAFLD required evidence of hepatic steatosis on imaging, lab markers, or biopsy, along with the presence of metabolic risk features. Demographic, laboratory, and diagnostic data were analyzed. Results: Among 503 children with DS (231 females, 271 males; median age: 172 months), 54 (10.7%) had MAFLD. The MAFLD group was older (median age: 205 vs. 163 months, p = 0.0002) and had higher BMI (31.39 vs. 20.5, p < 0.0001). Most cases (47/54) were diagnosed via ultrasound, and 49/54 met MAFLD criteria due to excessive adiposity. Lab results showed a median ALT of 35 U/L, triglycerides of 4.4 mmol/L, and LDL cholesterol of 2.59 mmol/L. FibroScan in 13 children revealed a median transient elastography of 5.3 kPa. BMI was the strongest predictor of MAFLD (OR: 1.2, 95% CI: 1.1–1.2). Conclusions: The DS clinic-based prevalence of MAFLD underscores the need for proactive screening and early intervention. BMI was the strongest predictor, emphasizing targeted management strategies. Further research is needed to refine diagnostic approaches and improve outcomes. Full article

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

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22 pages, 3237 KiB

Open AccessSystematic Review

Oral Dydrogesterone Versus Vaginal Progesterone for Luteal Phase Support in Frozen–Thawed Embryo Transfer Cycles: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Konstantinos Stavridis, Dimitrios Balafoutas, Theodoros Kalampokas, Vassiliki Benetou, Evangelia Samoli, Nikolaos Vlahos and Maria-Iosifina Kasdagli

J. Clin. Med. 2025, 14(9), 3238; https://doi.org/10.3390/jcm14093238 - 7 May 2025

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Abstract

Background/Objectives: Until recently, oral dydrogesterone has only been established in fresh in vitro fertilization (IVF) cycles, whereas its role in luteal phase support (LPS) for frozen embryo transfer (FET) cycles remains unclear. The aim of this study is to determine whether oral [...] Read more.

Background/Objectives: Until recently, oral dydrogesterone has only been established in fresh in vitro fertilization (IVF) cycles, whereas its role in luteal phase support (LPS) for frozen embryo transfer (FET) cycles remains unclear. The aim of this study is to determine whether oral dydrogesterone as LPS in FET cycles results in pregnancy rates comparable to vaginal progesterone, focusing primarily on ongoing pregnancy rates, but also on clinical pregnancy, miscarriage, and live birth rates. Methods: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five databases (Embase, MEDLINE^®, APA PsycInfo, Global Health, and HMIC) and two additional sources were searched from inception to November 28, 2024. Only randomized controlled trials (RCTs) were included. A common effects model combined risk estimates, and heterogeneity was assessed using I². Study quality was evaluated with Risk of Bias 2 (RoB2), and evidence certainty was graded using GRADE. Results: Overall, five RCTs with a total of 636 women were included in the meta-analysis. The comparison between oral dydrogesterone and vaginal progesterone for LPS did not yield significant differences for any of the outcomes studied. For ongoing pregnancies, the pooled odds ratio (OR) was 0.90 (95% CI: 0.59–1.35), with no heterogeneity (I² = 8.7%). For miscarriage events, the OR was 1.41 (95% CI: 0.63–3.13, I² = 0). For clinical pregnancies, the OR was 0.94 (95% CI: 0.62–1.42, I² = 49.2%), with heterogeneity attributed to dosage. For live births, the pooled OR was 1.08 (95% CI: 0.67–1.75, I² = 0%). Two studies were assessed as high risk of bias, two as low risk, and one as moderate. The GRADE assessment indicated low to moderate certainty of evidence. Conclusions: Oral dydrogesterone and vaginal progesterone yield comparable reproductive outcomes for LPS in FET cycles. Given its ease of administration, dydrogesterone may serve as a viable alternative in future FET protocols. However, further RCTs are needed to assess its efficacy against other progesterone administration routes. Full article

(This article belongs to the Special Issue Assisted Reproductive Technology: Recent Developments and Future Perspectives)

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13 pages, 1788 KiB

Open AccessSystematic Review

Reducing Infections and Improving Healing in Complex Wounds: A Systematic Review and Meta-Analysis

by María Juana Millán-Reyes, Diego Fernando Afanador-Restrepo, María del Carmen Carcelén-Fraile, Agustín Aibar-Almazán, Marcelina Sánchez-Alcalá, Javier Cano-Sánchez, María Aurora Mesas-Aróstegui and Yolanda Castellote-Caballero

J. Clin. Med. 2025, 14(9), 3237; https://doi.org/10.3390/jcm14093237 - 7 May 2025

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Abstract

Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative [...] Read more.

Background and Objectives: Wound management in complex and traumatic injuries remains a significant clinical challenge, with a high risk of surgical site infections (SSIs) and associated complications. This systematic review and meta-analysis aim to evaluate the effectiveness of diverse interventions, including Negative Pressure Wound Therapy (NPWT), advanced dressings, irrigation techniques, antibiotic regimens, and innovative therapies, in improving wound healing outcomes and reducing infection rates. Materials and Methods: An exhaustive literature search focused on the use of NPWT, dressings, and antibiotics in the care of chronic wounds was conducted following PRISMA guidelines in the PubMed, Scopus, Web of Science, and CINAHL databases. Eligible studies included randomized controlled trials and prospective cohorts assessing interventions for wound care in trauma, surgical, and chronic wound settings. The risk of bias was assessed using the ROB2 tool. Subgroup analyses were performed to evaluate the relative risk (RR) of infections based on the intervention type. Results: The analysis included 17 studies spanning diverse geographical and clinical settings. NPWT demonstrated significant benefits in reducing infection rates compared to control groups (RR: 0.590, 95% CI: 0.458–0.760, and p < 0.001). Although advanced dressings demonstrated clinically relevant benefits as reported across the included studies, the meta-analysis did not reveal statistically significant differences (RR: 0.516, 95% CI: 0.242–1.100, and p = 0.087). Antibiotic therapies significantly reduced infections when administered within 24 h of injury, while low-pressure irrigation techniques effectively minimized bacterial contamination without causing tissue damage. Growth factors and honey-based treatments exhibited promising results in accelerating wound healing and reducing infection risks in chronic wounds. Conclusions: NPWT emerges as a highly effective intervention for infection prevention and wound healing, supported by robust evidence. Advanced dressings and innovative therapies show potential but require further research for conclusive evidence. These findings underscore the importance of tailoring wound care strategies to the clinical context and patient needs. Future research should focus on long-term outcomes and cost-effectiveness analyses to enhance the integration of these therapies into clinical practice. Full article

(This article belongs to the Special Issue Clinical Management and Outcomes in Wound Healing)

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10 pages, 979 KiB

Open AccessArticle

Good Mid-Term Clinical Outcomes and Low Arthroplasty Conversion Rates After Hip Arthroscopy with Labral Debridement Without Refixation or Reconstruction

by Manuel Gahleitner, Daniel Hofer, Rainer Hochgatterer, Tobias Gotterbarm and Antonio Klasan

J. Clin. Med. 2025, 14(9), 3236; https://doi.org/10.3390/jcm14093236 - 7 May 2025

Viewed by 161

Abstract

Introduction: The present study investigates the five-year outcomes of hip arthroscopy for cam or pincer-type femoroacetabular impingement (FAI) and associated labral tears in a defined patient population. Methods: Patients who underwent hip arthroscopy for cam or pincer-type arthroscopy femoroacetabular impingement (FAI) [...] Read more.

Introduction: The present study investigates the five-year outcomes of hip arthroscopy for cam or pincer-type femoroacetabular impingement (FAI) and associated labral tears in a defined patient population. Methods: Patients who underwent hip arthroscopy for cam or pincer-type arthroscopy femoroacetabular impingement (FAI) and labral tears at our hospital in the past five years were included. All patients who underwent revision—like a total hip arthroplasty (THA), a subsequent hip arthroscopy at another hospital, or had primary osseous diseases—were excluded. Patients were contacted via mail and asked to answer a clinical questionnaire called the “Hip Osteoarthritis Outcome Score” (HOOS) and to indicate whether there was a second surgery like a subsequent arthroscopy or THA. Results: There were 77 hip arthroscopies in 75 patients the last 5 years. A total of 29 patients responded. Those who did not respond were contacted via phone. All in all, we obtained the results of 49 patients (50 hips—29 right, 19 left, and 1 bilateral) who underwent hip arthroscopy over the past five years. The mean age at the time of operation was 41 years. Our results were as follows: 24 hips had an isolated labral tear, 49 hips a combined FAI pathology with cam and/or pincer-type impingement and labral tears, 3 patients had a posttraumatic FAI, and 1 patient suffered from hip chondromatosis, who was subsequently excluded; further, 22 patients (23 procedures) were lost to follow-up. HOOS contains various subscales; only the postoperative result of subscale 1 (symptoms) did not show a statistically significant improvement compared with the preoperative value. All other subscales showed a statistically significant improvement in comparison with the preoperative condition. Five patients (10.2%) still experienced symptoms, so we performed a total hip arthroplasty (THA) as a second surgical procedure. One patient was revised due to chondromatosis. One patient was revised at another center, and another was excluded because of chondromatosis. Conclusions: The five-year follow-up results of hip arthroscopy proved successful outcomes. Hip arthroscopy is an effective treatment for FAI in order to delay primary THA, regaining mobility and range of motion and reducing pain. Longer-term studies with a larger cohort are necessary. Full article

(This article belongs to the Special Issue Hip Diseases: From Joint Preservation to Hip Arthroplasty Revision)

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11 pages, 1527 KiB

Open AccessSystematic Review

Matrix Metalloproteinase-9 and Postoperative Outcomes in Carotid Endarterectomy: A Systematic Review

by João Gonçalves-Silva, Mariana Fragão-Marques, Hugo Ribeiro, Susana I. Sá and João Rocha-Neves

J. Clin. Med. 2025, 14(9), 3235; https://doi.org/10.3390/jcm14093235 - 7 May 2025

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Abstract

Background/Objectives: Carotid endarterectomy (CEA) is the treatment of choice for severe symptomatic and asymptomatic carotid artery stenosis. Nonetheless, it carries risks and several complications, including stroke and death. Previous studies have indicated that elevated matrix metalloproteinase-9 (MMP-9) levels may serve as biomarkers for [...] Read more.

Background/Objectives: Carotid endarterectomy (CEA) is the treatment of choice for severe symptomatic and asymptomatic carotid artery stenosis. Nonetheless, it carries risks and several complications, including stroke and death. Previous studies have indicated that elevated matrix metalloproteinase-9 (MMP-9) levels may serve as biomarkers for adverse outcomes after CEA. This systematic review investigates the association between plasma MMP-9 levels and adverse cardiovascular outcomes following CEA. Methods: PubMed/MedLine, Scopus and Web of Science were searched for studies assessing the relationship between plasma MMP-9 levels and postoperative outcomes after CEA. Assessment of studies’ quality was performed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tool for observational cohorts and cross-sectional studies. Results: Five studies were included (n = 891 participants). All five were retrospective cohort studies. MMP-9 was significantly higher in patients who presented with a combination of amaurosis fugax, central retinal artery occlusion, TIA and minor/major stroke at follow-up. However, individual outcomes like TIA or stroke did not consistently correlate with MMP-9 levels. Additionally, increased MMP-9 levels were also associated with cognitive dysfunction post CEA. Conclusions: Despite the potential of MMP-9 levels to serve as a biomarker for predicting postoperative cerebrovascular complications, this review presents limitations, including a high risk of bias in included studies and variability in methodologies. There is a need for further research with larger cohorts to validate these findings and improve risk stratification and management strategies for patients undergoing CEA. Full article

(This article belongs to the Section Vascular Medicine)

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J. Clin. Med., Volume 14, Issue 9 (May-1 2025) – 406 articles

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