Journal of Clinical Medicine

17 pages, 1407 KB

Open AccessArticle

Superficial Retinal Vascular Network Morphology and Sectoral RNFL Thickness in Children with a History of Bilateral Congenital Cataract Surgery: An Exploratory OCT/OCTA Study

by Mehmet Omer Kiristioglu, Ahmet Tuncer Ozmen, Meral Yildiz, Ahmet Akcan, Esin Sogutlu Sari and Mehmet Baykara

J. Clin. Med. 2026, 15(13), 5320; https://doi.org/10.3390/jcm15135320 - 7 Jul 2026

Viewed by 417

Abstract

Background: Whether congenital cataract-related visual deprivation and subsequent rehabilitation are associated with retinal structural and vascular network differences remains unclear. This study evaluated superficial retinal vascular network descriptors and retinal nerve fiber layer (RNFL) thickness in children after bilateral congenital cataract extraction [...] Read more.

Background: Whether congenital cataract-related visual deprivation and subsequent rehabilitation are associated with retinal structural and vascular network differences remains unclear. This study evaluated superficial retinal vascular network descriptors and retinal nerve fiber layer (RNFL) thickness in children after bilateral congenital cataract extraction and secondary intraocular lens implantation. Methods: Age-matched children served as controls. Participants underwent spectral-domain optical coherence tomography (OCT) and 6 × 6 mm optical coherence tomography angiography (OCTA). Metrics were magnification-corrected, and comparisons used generalized estimating equation models adjusted for age, eye side, axial length, and spherical equivalent. Results: Eighteen pseudophakic children (36 eyes; median age, 8 years) and 17 controls (34 eyes; median age, 9 years) were included. In adjusted models, macular mean vessel diameter was higher in pseudophakic eyes (β = 11.16 µm; p = 0.003), as was macular mean tortuosity (β = 0.032; p = 0.001). Branchpoint density was lower in direction but not independently significant (p = 0.125). Choroidal thickness, choroidal vascularity index, and foveal avascular zone area did not differ significantly. Temporal RNFL thickness was greater in pseudophakic eyes (β = 13.37 µm; p = 0.007); other RNFL parameters were not significant. Conclusions: These findings suggest exploratory differences in superficial vascular network morphology and temporal RNFL thickness. However, because the groups differed clinically in best-corrected visual acuity, refractive status, and axial length, residual confounding cannot be excluded despite magnification correction and adjusted modeling. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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28 pages, 27136 KB

Open AccessArticle

Automated Adaptive Approach for Specular Highlight Removal in Digital Dentistry: A Proof-of-Concept Study for Preserving Tooth Surface Texture

by Ji Su Han, Sung-Ae Son, Il-Ho Park, Eun-Ha Jung, Jeong-woo Lee, Seok-Woo Park and Jae-Seung Jeong

J. Clin. Med. 2026, 15(13), 5319; https://doi.org/10.3390/jcm15135319 - 7 Jul 2026

Viewed by 376

Abstract

Background/Objectives: Digital intraoral photography is widely used for clinical documentation, longitudinal monitoring, and AI-assisted dental image analysis. However, specular highlights caused by saliva and intense illumination can obscure tooth texture and compromise image fidelity. This study aimed to develop an automated method for [...] Read more.

Background/Objectives: Digital intraoral photography is widely used for clinical documentation, longitudinal monitoring, and AI-assisted dental image analysis. However, specular highlights caused by saliva and intense illumination can obscure tooth texture and compromise image fidelity. This study aimed to develop an automated method for removing specular highlights from intraoral images while preserving tooth surface texture. Methods: A three-stage pipeline consisting of adaptive threshold prediction, mask generation, and image inpainting was proposed. Initially, the Hue, Saturation, Value (HSV) statistical features were extracted from each image and used to train a regression model that predicts an image-specific threshold. Subsequently, the predicted threshold was applied in the CIE LAB color space, followed by a condition-based dynamic adjustment algorithm to refine the mask area and distribution. Finally, an Aggregated Contextual Transformation (AOT)-based generator network was used to restore the masked regions. Results: The proposed dynamic adjustment reduced over-masking compared with regression-only processing and better preserved tooth surface texture. Pixel distribution analysis demonstrated a lower distributional discrepancy, with the Wasserstein distance reduced from 2.9601 to 1.3505 and the Kullback–Leibler divergence reduced from 0.3451 to 0.0618. In the clinical expert evaluation, the proposed method was preferred in 69.5% of the 200 evaluation responses, and the preference difference was statistically significant (p < 0.001). Conclusions: As a proof-of-concept study conducted under controlled conditions using synthetic images, the proposed pipeline reduced specular highlights while better preserving tooth surface texture than the baseline approaches. These findings suggest that the pipeline may support standardized preprocessing of dental image datasets, although broader applications such as long-term monitoring and AI-assisted diagnostic workflows require validation on real clinical photographs. Full article

(This article belongs to the Topic Machine Learning and Deep Learning in Medical Imaging)

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18 pages, 273 KB

Open AccessArticle

Prevalence and Correlates of Disposable E-Cigarette Use Among Adolescents and Young Adults in Southern Poland

by Józefa Dąbek, Julia Żerdka, Patryk Brasse and Grzegorz Smolka

J. Clin. Med. 2026, 15(13), 5318; https://doi.org/10.3390/jcm15135318 - 7 Jul 2026

Viewed by 305

Abstract

Introduction: In recent years, electronic cigarettes, including disposable e-cigarettes and tobacco heating devices, have grown in popularity, especially among young people and young adults. Although e-cigarettes are touted as a “safer” alternative to traditional cigarettes, a growing body of evidence indicates that vaping [...] Read more.

Introduction: In recent years, electronic cigarettes, including disposable e-cigarettes and tobacco heating devices, have grown in popularity, especially among young people and young adults. Although e-cigarettes are touted as a “safer” alternative to traditional cigarettes, a growing body of evidence indicates that vaping can cause serious health problems, especially in the respiratory and cardiovascular systems. Aim of the Study: The aim of the study was to assess the prevalence of disposable e-cigarettes and other nicotine products among adolescents and young adults, as well as to examine the factors associated with regular smoking and nicotine dependence across individual nicotine-containing products. Material and Methods: The survey was conducted among residents of southern Poland. A total of 625 (100%) people were examined. Among them were: 350 women and 275 men. The subjects were aged between 14 and 29 years (Median and 25th–75th percentile: 19; 16–23). The study used an original questionnaire, the completion of which was anonymous and voluntary. The questions included in the survey concerned the smoking status of the respondents, the main sources of nicotine intake and general information such as age, gender, place of residence, employment or education, and financial stability of the family. The survey used the Fagerström test to examine the degree of nicotine dependence among the subjects. Results: A total of 34% (212; 33.92%) of the surveyed group of adolescents and young adults were smokers, most of whom used disposable e-cigarettes (69; 32.55%). In addition, 60% (368; 58.88%) of respondents reported having tried disposable e-cigarettes. Smokers, of both traditional cigarettes and e-cigarettes, accounted for 14% (88; 14.08%) of the study group. The results of the study showed a statistically significant effect of the age of the participants on the method of nicotine intake (p = 0.013). In the younger group, e-cigarettes were more often used, while in the older group, the use of heated tobacco products and traditional cigarettes dominated. Respondents’ median age at the first use of nicotine products was 16 years. Factors such as living in the city, lower financial stability, and having a parent who smoked during childhood were significantly associated with a higher likelihood of regular nicotine product use. Among the regular users, a high level of nicotine dependence was observed in 28.64% (n = 61) of individuals, with the largest proportion occurring among those using electronic cigarettes (39.37%; n = 50). Conclusions: 1. In the study group of adolescents and young adults, disposable e-cigarettes were the most used nicotine-containing product. 2. Parental smoking and male gender were positively associated with the likelihood of smoking, whereas primary education and financial stability were inversely associated with tobacco use. 3. Electronic cigarette users exhibited the highest average nicotine dependence scores. Multivariate analysis confirmed that male gender, the type of nicotine product used, and place of residence were independently associated with higher Fagerström test scores. Full article

(This article belongs to the Section Epidemiology & Public Health)

14 pages, 238 KB

Open AccessArticle

Association of Perineural and Lymphovascular Invasion with Clinical and Pathological T Staging in Head and Neck Squamous Cell Carcinoma

by Aldona Chloupek, Paweł Grab, Dominika Zawadka-Modras and Dariusz Jurkiewicz

J. Clin. Med. 2026, 15(13), 5317; https://doi.org/10.3390/jcm15135317 - 7 Jul 2026

Viewed by 349

Abstract

Background/Objectives: Perineural invasion (PNI) and lymphovascular invasion (LVI) are adverse histopathological features in head and neck squamous cell carcinoma (HNSCC). Their relationship with clinical and pathological T categories remains clinically relevant, particularly in surgically treated cohorts. This exploratory retrospective study evaluated the [...] Read more.

Background/Objectives: Perineural invasion (PNI) and lymphovascular invasion (LVI) are adverse histopathological features in head and neck squamous cell carcinoma (HNSCC). Their relationship with clinical and pathological T categories remains clinically relevant, particularly in surgically treated cohorts. This exploratory retrospective study evaluated the frequency of PNI and LVI according to clinical and pathological T stage in primary HNSCC staged according to the AJCC/UICC 8th edition. Methods: We analyzed 170 consecutive surgically treated patients with primary HNSCC. PNI and LVI were recorded from histopathology reports of resection specimens. Results: PNI status was available in 124 cases and was positive in 61 (49.2%); LVI status was available in 126 cases and was positive in 62 (49.2%). PNI frequency increased with advancing clinical T stage (12.5% in cT1, 54.3% in cT2, 70.0% in cT3, and 69.2% in cT4) and pathological T stage (14.3% in pT1, 51.5% in pT2, 71.9% in pT3, and 66.7% in pT4). LVI also increased with higher clinical T stage (28.1%, 53.2%, 57.1%, and 61.5%) and pathological T stage (25.7%, 50.0%, 54.6%, and 75.0%). Tongue tumors showed descriptively high crude proportions of PNI and LVI, but these subgroup findings were based on small numbers and were not adjusted for T stage, depth of invasion, or other confounders. Conclusions: In this single-center cohort, PNI and LVI were more frequent in higher T categories. These findings should be interpreted as descriptive and hypothesis-generating, because no recurrence, survival, or treatment-outcome analyses were available and the adjusted models were exploratory. Full article

(This article belongs to the Section Otolaryngology)

21 pages, 820 KB

Open AccessArticle

Long-Term Cognitive and Functional Outcomes Following Postoperative Delirium and Liberal Fluid Fasting in Elderly Trauma Patients: A Prospective Single-Centre Study

by Patricia Knabe, Janine Allmendinger, Tobias Haas, Max Knabe, Lina Lenninger, Anne-Marie Just, Boris Holzapfel, Carl Neuerburg, Roland Tomasi and Thomas Saller

J. Clin. Med. 2026, 15(13), 5316; https://doi.org/10.3390/jcm15135316 - 7 Jul 2026

Viewed by 434

Abstract

Background: Postoperative delirium (POD) is a frequent and serious complication in elderly surgical patients. Liberalising preoperative fluid fasting has been shown to reduce its incidence. However, evidence on long-term cognitive and functional outcomes following POD or liberal fluid fasting remains limited. Objectives [...] Read more.

Background: Postoperative delirium (POD) is a frequent and serious complication in elderly surgical patients. Liberalising preoperative fluid fasting has been shown to reduce its incidence. However, evidence on long-term cognitive and functional outcomes following POD or liberal fluid fasting remains limited. Objectives: This study investigates whether POD and different fluid fasting regimens are associated with changes in cognitive performance and activities of daily living twelve months after surgery. Methods: As a follow-up to the prospective ‘LFFgertrud’ trial, 89 geriatric patients were contacted by phone twelve months after elective trauma or orthopaedic surgery (March 2023–February 2024). Participants completed four validated questionnaires assessing cognition and everyday functioning: the Short Blessed Test (SBT), EQ-5D-5L, Barthel index (BI), and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Results: The hypotheses regarding the effects of POD and fluid fasting on cognitive and functional outcomes were not statistically supported. In contrast, neurodegenerative disease was strongly associated with poorer outcomes in three of the four follow-up measures (SBT: β = 1.27, p = 0.01; EQ-5D-5L: β = 1.43, p < 0.001; BI: β = −1.63, p < 0.001), and polymedication also emerged as a relevant predictor. Although not statistically significant, descriptive trends indicated that patients who developed POD showed lower cognitive performance and reduced quality of life at twelve months. Conclusions: POD and fluid fasting duration were not significantly associated with long-term cognitive or functional outcomes one year after hospitalisation. The findings highlight the importance of considering pre-existing neurocognitive disease and polypharmacy when assessing the risk of adverse long-term outcomes in older patients. Due to the multifactorial nature of recovery in this population, further research involving larger sample sizes is required in order to gain a better understanding of the factors that influence long-term outcomes. Full article

(This article belongs to the Section Anesthesiology)

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16 pages, 840 KB

Open AccessArticle

Prognostic Value of Skeletal Muscle Loss in Unresectable Hepatocellular Carcinoma Treated with TACE-Based Combination Therapy

by Ningjing Yang, Kaiyu Chen, Chongming Zheng, Puchuang Xu, Junhao Pan, Yuepeng Jin, Gang Chen and Wenhao Hu

J. Clin. Med. 2026, 15(13), 5315; https://doi.org/10.3390/jcm15135315 - 7 Jul 2026

Viewed by 333

Abstract

Background/Objectives: Decreases in skeletal muscle mass affect the efficacy of and tumor response to various therapies for hepatocellular carcinoma (HCC). This study aimed to investigate the relationship between changes in skeletal muscle mass during TACE-based combination therapy and tumor response and prognosis. Methods: [...] Read more.

Background/Objectives: Decreases in skeletal muscle mass affect the efficacy of and tumor response to various therapies for hepatocellular carcinoma (HCC). This study aimed to investigate the relationship between changes in skeletal muscle mass during TACE-based combination therapy and tumor response and prognosis. Methods: This retrospective study analyzed 306 patients with unresectable HCC, divided into four groups according to the treatment received: TACE alone (n = 133), TACE plus targeted and immunotherapy combination (TACE + T + I, n = 68), TACE plus immunotherapy (TACE + I, n = 52), and TACE plus targeted therapy (TACE + T, n = 53). Skeletal muscle mass was assessed at the third lumbar vertebral level (L3) before treatment and at six months post-treatment using computed tomography (CT) scans. Patients were stratified based on changes in skeletal muscle index (SMI) values. Kaplan–Meier and Cox proportional hazards models were used to compare overall survival (OS) among groups classified by changes in SMI, while tumor response was assessed with univariate and multivariate analyses, using logistic regression analysis. Result: A total of 306 patients with unresectable HCC were included in this study. The median OS was 17.0 (0.9–83.0) months in the decreased-SMI group compared with 35.0 (2.0–113.0) months in the non-decreased-SMI group. The overall response rate (CR + PR) was 34.7% in the decreased-SMI group and 53.8% in the non-decreased group. Among different treatment regimens, significant differences in Kaplan–Meier survival curves were observed between the TACE and TACE + T + I groups. In multivariate analysis, decreased SMI remained an independent predictor of poor OS and tumor non-response, whereas a low-SMI pre-treatment was not an independent prognostic factor. Additionally, inadequate nutritional status and compromised liver function were associated with a greater decrease in SMI during comprehensive treatment. Conclusions: A decline in skeletal muscle index (SMI) among patients with unresectable hepatocellular carcinoma (HCC) undergoing TACE-based comprehensive treatment is associated with poor prognosis and unfavorable tumor response and is further linked to deteriorating nutritional status and impaired liver function. Monitoring SMI provides an effective approach for assessing overall patient condition and predicting clinical outcomes. Full article

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

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27 pages, 12101 KB

Open AccessReview

A Prototype-Guided 3D Deep Learning Framework for Myocardial Perfusion Scintigraphy Segmentation

by Madallah Alruwaili and Mahmood A. Mahmood

J. Clin. Med. 2026, 15(13), 5314; https://doi.org/10.3390/jcm15135314 - 7 Jul 2026

Viewed by 362

Abstract

Background: Myocardial perfusion scintigraphy (MPS) is widely used for noninvasive assessment of coronary artery disease, but publicly available datasets suitable for reproducible deep learning segmentation studies remain limited. This paper proposes CardioProto-SegNet, an image-only 3D anatomy-directed segmentation framework for myocardial region delineation [...] Read more.

Background: Myocardial perfusion scintigraphy (MPS) is widely used for noninvasive assessment of coronary artery disease, but publicly available datasets suitable for reproducible deep learning segmentation studies remain limited. This paper proposes CardioProto-SegNet, an image-only 3D anatomy-directed segmentation framework for myocardial region delineation using the public Myocardial Perfusion Scintigraphy Image Database v1.0.0 from PhysioNet, which contains 83 patient studies. Methods: The model is implemented as a 3D U-Net-like residual encoder–decoder network enhanced with squeeze-and-excitation channel recalibration and compact prototype-memory refinement at the bottleneck. Because the public dataset does not provide structured clinical variables, all reported results correspond to image-only myocardium segmentation. Results: Experimental evaluation demonstrated reliable segmentation performance on the available public dataset. CardioProto-SegNet achieved a Dice score of 0.7402 on the holdout test split. In five-fold cross-validation, the model obtained a mean Dice of 0.8239, mean IoU of 0.6870, mean accuracy of 0.9943, mean ROC-AUC of 0.9867, and mean PR-AUC of 0.8561. Since confirmed ischemia or infarction labels were not available, an exploratory image-derived subgroup analysis was additionally performed based on myocardial ROI uptake heterogeneity to examine model behavior in lower- and higher-heterogeneity cases. The ablation study showed that residual connections were important for stable segmentation performance, while the deeper variant achieved the highest tested performance, with a Dice score of 0.8290, IoU of 0.7096, and PR-AUC of 0.8831. Conclusions: Overall, the findings suggest that CardioProto-SegNet provides a reproducible public dataset benchmark for myocardium segmentation in MPS and may serve as a foundation for future downstream quantitative and CAD-oriented analysis when larger datasets with clinical labels become available. Full article

(This article belongs to the Special Issue Cardiac Imaging in Cardiovascular Disorders)

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22 pages, 3533 KB

Open AccessReview

Cardiac CT in the Era of Precision Cardiology: From Calcium Scoring to Comprehensive Risk Profiling

by Gianluigi Napoli, Donatella Tansella, Maria Teresa Savo, Abdulrahman Alsergani, Laura Fusini, Saima Mushtaq, Andrea Baggiano, Fabio Fazzari, Gianluca Pontone, Michele Davide Latorre, Eduardo Urgesi, Maria Cristina Carella, Raffaella Motta, Andrea Igoren Guaricci and Valeria Pergola

J. Clin. Med. 2026, 15(13), 5313; https://doi.org/10.3390/jcm15135313 - 7 Jul 2026

Viewed by 534

Abstract

Cardiac computed tomography (CT) has evolved into a pivotal tool in precision cardiology, enabling comprehensive, non-invasive evaluation of coronary anatomy, plaque composition, vascular function, and inflammation. From calcium scoring to advanced physiological imaging, CT now integrates multiple layers of cardiovascular information within a [...] Read more.

Cardiac computed tomography (CT) has evolved into a pivotal tool in precision cardiology, enabling comprehensive, non-invasive evaluation of coronary anatomy, plaque composition, vascular function, and inflammation. From calcium scoring to advanced physiological imaging, CT now integrates multiple layers of cardiovascular information within a unified diagnostic framework. Coronary artery calcium (CAC) quantification provides a robust, reproducible measure of atherosclerotic burden and refines risk estimation beyond traditional algorithms, particularly in asymptomatic individuals with an intermediate likelihood. Building upon this anatomical foundation, coronary CT angiography (CCTA) extends evaluation to the anatomical and morphological characterization of coronary artery disease (CAD), identifying both obstructive and non-obstructive plaques with high prognostic accuracy. The addition of CT-derived fractional flow reserve (FFR-CT) and stress perfusion CT (CTP) bridges anatomy and physiology, improving identification of flow-limiting stenoses and guiding revascularization decisions while reducing unnecessary invasive procedures. Beyond luminal assessment, CT-derived biomarkers such as the perivascular fat attenuation index (pFAI) have introduced a new dimension of vascular inflammation imaging, revealing residual risk even in patients without significant stenosis and suggesting novel pathways for individualized therapeutic targeting. Driven by advances in artificial intelligence and photon-counting detector technology, cardiac CT is transitioning from a purely diagnostic modality to an integrative platform for cardiovascular phenotyping. Taken as a whole, this integration of structural, functional, and biological data provides a genuinely holistic view of coronary health. In practical terms, it shifts clinical decision-making from population-based risk models toward precision-guided patient-specific strategies. Full article

(This article belongs to the Special Issue Cardiac Imaging in Cardiovascular Disorders)

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19 pages, 283 KB

Open AccessArticle

The Effect of COVID-19 Vaccines on Chronic Inflammatory Remodeling in NSTEMI Patients: A Galectin-3-Based Single-Center Study

by Adem Koksal, Mesut Tomakin, Mehmet Seyfettin Saribaş, Fatih Akkaya, Fatmanur Cavdaroglu Ustabas, Ibrahim Caltekin, Diler Us Altay, Tevfik Noyan and Ali Aygun

J. Clin. Med. 2026, 15(13), 5312; https://doi.org/10.3390/jcm15135312 - 7 Jul 2026

Viewed by 454

Abstract

Background: This study evaluated the potential effects of different COVID-19 vaccine platforms (mRNA and inactivated) on acute coronary syndrome (ACS) through Galectin-3, a biomarker of chronic inflammation and fibrosis. It aimed to compare serum Galectin-3 levels among NSTEMI patients according to COVID-19 vaccination [...] Read more.

Background: This study evaluated the potential effects of different COVID-19 vaccine platforms (mRNA and inactivated) on acute coronary syndrome (ACS) through Galectin-3, a biomarker of chronic inflammation and fibrosis. It aimed to compare serum Galectin-3 levels among NSTEMI patients according to COVID-19 vaccination status and vaccine type. Methods: A total of 75 patients with NSTEMI were prospectively enrolled and categorized into three groups: inactivated vaccine recipients (n = 25), mRNA vaccine recipients (n = 25), and unvaccinated controls (n = 25). Serum Galectin-3 levels were measured to assess chronic inflammatory status. Additionally, markers of acute myocardial injury and inflammatory response were analyzed. Results: Galectin-3 levels were similar across the inactivated vaccine, mRNA vaccine, and unvaccinated NSTEMI group, with no statistically significant difference observed (p = 0.481). Although troponin I levels and acute inflammatory cell burden were higher in vaccinated patients compared with the unvaccinated NSTEMI group, Galectin-3 levels remained comparable among all groups. No significant differences in Galectin-3 levels were observed according to vaccination status or vaccine type. Conclusions: In this exploratory cohort of NSTEMI patients, serum Galectin-3 levels did not differ significantly according to COVID-19 vaccination status or vaccine type. These findings suggest no detectable association between vaccination history and Galectin-3 levels in the study population. Larger prospective studies with longitudinal follow-up are needed to confirm these observations. Full article

(This article belongs to the Section Cardiology)

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25 pages, 1220 KB

Open AccessReview

Topical Pain Management: An Updated Review of Current Evidence and Emerging Strategies

by Urszula Adamiak-Giera, Patryk Rzeczycki, Magdalena Sawczuk, Oliwia Pęciak and Monika Białecka

J. Clin. Med. 2026, 15(13), 5311; https://doi.org/10.3390/jcm15135311 - 7 Jul 2026

Viewed by 2317

Abstract

Introduction: Pain is one of the most common reasons why patients seek medical care, and chronic pain is now recognized as a major health problem worldwide. Better understanding of pain mechanisms has shown the importance of distinguishing nociceptive, neuropathic, and nociplastic pain [...] Read more.

Introduction: Pain is one of the most common reasons why patients seek medical care, and chronic pain is now recognized as a major health problem worldwide. Better understanding of pain mechanisms has shown the importance of distinguishing nociceptive, neuropathic, and nociplastic pain in order to choose the most effective treatment. In recent years, topical analgesics have gained increasing attention because they can provide pain relief directly at the site of application while reducing systemic exposure and the risk of adverse effects. This is especially important in older adults, patients with multiple diseases, and those exposed to polypharmacy. Methods: This narrative review presents the current knowledge on the pharmacology, efficacy, and safety of topical drugs used in pain treatment. Particular attention is given to topical non-steroidal anti-inflammatory drugs (NSAIDs), lidocaine, capsaicin, menthol, and camphor. The review also discusses newer and less established therapies used mainly in neuropathic pain, including topical ketamine, amitriptyline, phenytoin, gabapentin, and clonidine. A structured, non-systematic literature search was conducted using the PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases to identify studies evaluating the efficacy and safety of topical analgesic therapies. Results: Current evidence supports topical NSAIDs as first-line therapy for localized musculoskeletal pain and osteoarthritis, while lidocaine and high-concentration capsaicin patches are effective options in focal neuropathic pain. Although several newer topical therapies show promising results, more high-quality clinical studies are still needed. Overall, topical analgesia is an important part of multimodal pain management because it combines analgesic efficacy with a better safety profile compared with many systemic therapies. Conclusions: Taking the aspects discussed in this paper into account, it seems justified to search for new drug combinations that would contribute to effective pain therapy with topical agents. It is recognized that a multimodal approach to pain management, which utilizes drugs with different mechanisms of action, can increase efficacy and reduce the systemic adverse events of the drugs used. The effective and safe treatment of patients with pain, especially neuropathic pain, despite emerging new clinical trials, remains a challenge for clinicians. Full article

(This article belongs to the Section Pharmacology)

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12 pages, 737 KB

Open AccessArticle

Real-World Safety and Herpes Zoster Outcomes After Recombinant Zoster Vaccination in Inflammatory Bowel Disease

by Gian Mario Morrone, Sara Sandri, Marta Vernero, Angelo Armandi, Gian Paolo Caviglia and Davide Giuseppe Ribaldone

J. Clin. Med. 2026, 15(13), 5310; https://doi.org/10.3390/jcm15135310 - 7 Jul 2026

Viewed by 998

Abstract

Background/Objectives: Patients with inflammatory bowel disease (IBD) are at an increased risk of herpes zoster (HZ), particularly during immunosuppressive treatment. To assess the safety of the recombinant zoster vaccine (RZV, Shingrix^®) and describe HZ occurrence in a real-world IBD cohort, including [...] Read more.

Background/Objectives: Patients with inflammatory bowel disease (IBD) are at an increased risk of herpes zoster (HZ), particularly during immunosuppressive treatment. To assess the safety of the recombinant zoster vaccine (RZV, Shingrix^®) and describe HZ occurrence in a real-world IBD cohort, including patients receiving advanced therapies. Methods: This prospective, single-centre observational study included 114 adults with IBD who were offered RZV; 69 received at least one dose, and 45 declined or postponed vaccination. Follow-up began at the vaccine proposal. For time-to-event analyses, vaccination was modelled as a time-varying exposure beginning 14 days after a documented second dose. IBD clinical relapse was defined by worsening disease-activity indices and/or treatment escalation. Results: During a median follow-up of 17 months (IQR 9–29), 11 patient-reported HZ episodes occurred: 8/69 (11.6%) among patients who received vaccination and 3/45 (6.7%) among those who did not. The time-dependent association between complete vaccination and HZ was not statistically significant (HR 2.51; 95% CI 0.66–9.51; p = 0.18), and adjustment for advanced therapy did not materially change the estimate. Prior HZ was associated with a higher risk of a subsequent reported episode (adjusted HR 6.26; 95% CI 1.80–21.76; p = 0.004). IBD clinical relapse occurred in 4/69 (5.8%) vaccinated and 2/45 (4.4%) unvaccinated patients (p = 1.00). Among 72 patients receiving advanced therapy, HZ occurred in 4/42 vaccinated and 2/30 unvaccinated patients (p = 1.00), while IBD relapse occurred in 3/42 and 1/30, respectively (p = 0.64). No serious vaccine-related adverse events or significant pre-/post-vaccination changes in disease activity were observed. Conclusions: RZV showed a favourable short-term safety profile in patients with IBD, including those receiving advanced therapies. The small number of self-reported HZ events and the non-randomised design preclude conclusions regarding vaccine effectiveness. Full article

(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice, 2nd Edition)

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15 pages, 1897 KB

Open AccessArticle

Pediatric Acute Poisoning: The Bipolar Evolution of the Poisoning Spectrum from 2019 to 2024 in Southwest China

by Shunli Liu, Yan Wang and Lan Huang

J. Clin. Med. 2026, 15(13), 5309; https://doi.org/10.3390/jcm15135309 - 7 Jul 2026

Viewed by 311

Abstract

Objective: To analyze the evolving epidemiological characteristics of pediatric poisoning from 2019 to 2024 in Southwest China, explore the changing patterns of pediatric poisoning in the post-pandemic era, and provide a reference for poisoning prevention and the development of effective prevention and [...] Read more.

Objective: To analyze the evolving epidemiological characteristics of pediatric poisoning from 2019 to 2024 in Southwest China, explore the changing patterns of pediatric poisoning in the post-pandemic era, and provide a reference for poisoning prevention and the development of effective prevention and treatment strategies. Methods: This study included 3923 cases of pediatric poisoning treated at the Emergency Department of West China Second University Hospital, Sichuan University. Clinical data such as gender, age, poisonous substance, and cause of poisoning were described. The chi-square trend test was used to analyze annual changes, and multivariate Poisson regression was employed to identify risk factors for hospitalization and for intentional poisoning in children. Results: The total number of cases increased significantly from 544 in 2019 to 1006 in 2024. A marked “polarization” pattern was observed: among children aged 1–3 years, unintentional ingestion of household chemicals predominated (n = 2332), whereas among adolescents aged 12–14 years, intentional self-poisoning cases surged by 580%, with the toxic agents shifting mainly to psychotropic prescription drugs. From 2019 to 2024, the proportions of intentional poisoning, psychotropic drug poisoning, psychiatric comorbidity, and delayed presentation all increased significantly. Poisson regression indicated that the post-pandemic period, psychiatric comorbidity, and exposure to psychotropic drugs were risk factors for intentional poisoning. Conclusions: Following the COVID-19 pandemic, mental health problems among adolescents have become increasingly prominent, and pediatric poisoning has exhibited a bipolarization pattern. Clinical prevention and control strategies should shift from simple emergency treatment to early intervention, psychological screening, and comprehensive prevention, so as to reduce health damage to children and the societal disease burden. Full article

(This article belongs to the Section Epidemiology & Public Health)

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13 pages, 1890 KB

Open AccessArticle

A New Severity Index for Placental Abruption Predicts Recurrence Risk in Future Pregnancies

by Lior Kerber, Shai Rippel, Ori Cohen, Lior Rokach, Efrat Spiegel, Taeer Avnon and Offer Erez

J. Clin. Med. 2026, 15(13), 5308; https://doi.org/10.3390/jcm15135308 - 7 Jul 2026

Viewed by 369

Abstract

Background: Placental abruption (PA) is an unpredictable obstetric complication associated with substantial maternal and fetal/neonatal morbidity and mortality in the index and subsequent pregnancies. The previous PA severity classification categorizes more than two-thirds of cases as severe, which limits its clinical utility despite [...] Read more.

Background: Placental abruption (PA) is an unpredictable obstetric complication associated with substantial maternal and fetal/neonatal morbidity and mortality in the index and subsequent pregnancies. The previous PA severity classification categorizes more than two-thirds of cases as severe, which limits its clinical utility despite its association with adverse maternal outcomes. Objective: We aimed to develop a novel, clinically applicable PA severity classification and to determine its ability to predict its recurrence in subsequent pregnancies. Study design: This retrospective, population-based cohort study included medical records of all women who delivered at our medical center from 2001 to 2021. Pregnancies complicated by chromosomal abnormalities or major congenital anomalies were excluded. The novel PA severity classification included maternal (transfusion of ≥4 units of red blood cells, admission to an intensive care unit, DIC, hysterectomy, or maternal death) and neonatal (birth asphyxia, hypoxic–ischemic encephalopathy, umbilical cord blood acidosis defined as pH < 7.0, neonatal intensive care unit admission at ≥35 weeks gestation, or perinatal death) complications. Maternal characteristics, clinical features, and perinatal outcomes were compared between the novel and the existing PA severity classifications. A multivariate regression model was used to determine the association between PA severity and the risk of its recurrent in subsequent pregnancies. Results: Our cohort included 298,281 deliveries; of them, 1567 (0.5%) had PA. The rate of severe PA was lower in the novel vs. the existing classification (p < 0.001). Within the novel classification, severe PA was associated with higher rates of mild and severe preeclampsia and lower mean fibrinogen concentrations and platelet counts compared with mild abruption (all p < 0.001). Severe PA was independently associated with an increased risk of recurrence in subsequent pregnancies (OR 1.82, 95% CI 1.05–3.14). Conclusions: We propose a novel, clinically relevant PA severity classification that accurately identifies severe disease providing prognostic information regarding the risk of PA recurrence in future pregnancies. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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15 pages, 545 KB

Open AccessArticle

Factors Associated with the Early Ambulation After Elective Lumbar Spinal Surgery: A Retrospective Cohort Study

by Busakorn Ruksouy, Tanyong Pipanmekaporn, Pathomporn Pin-on, Pichitchai Atthakomol and Piyada Boonsong

J. Clin. Med. 2026, 15(13), 5307; https://doi.org/10.3390/jcm15135307 - 7 Jul 2026

Viewed by 373

Abstract

Background: Early ambulation (EA), mobilizing within 24 h, is a cornerstone of recovery after lumbar spine surgery. Clinical evidence suggests that EA is strongly associated with superior postoperative outcomes, including accelerated functional recovery, reduced complications, and a significantly shorter length of hospital [...] Read more.

Background: Early ambulation (EA), mobilizing within 24 h, is a cornerstone of recovery after lumbar spine surgery. Clinical evidence suggests that EA is strongly associated with superior postoperative outcomes, including accelerated functional recovery, reduced complications, and a significantly shorter length of hospital stay. Despite these benefits, there remains a critical gap in the literature regarding the specific patient and surgical factors that influence a patient’s ability to achieve early mobilization. Objective: To identify factors associated with EA and assess its relationship with postoperative recovery after elective lumbar spinal fusion. Methods: A retrospective cohort study was conducted at Phichit Provincial Hospital between 2017 and 2024. Demographic, anesthesia, and surgical data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent factors associated with EA. Results: Of 581 patients, 332 were in the EA group (57.2%), and 249 (42.8%) were in the delayed ambulation (DA) group. Independent factors associated with EA included American Society of Anesthesiologists (ASA) class I–II (OR 1.60, 95% CI 1.05–2.43, p = 0.027), anesthetic time < 200 min (OR 2.04, 95% CI 1.25–3.35, p = 0.005), and intravenous parecoxib administration (OR 3.45, 95% CI 2.34–5.18, p < 0.001). The EA group demonstrated significantly lower complication rates (3.9% vs. 20.4%, p < 0.001), shorter hospital stays (7 [IQR 6–9] vs. 9 [IQR 8–12] days, p < 0.001), and reduced total hospitalization costs ($1958 [IQR $933–$2966] vs. $2815 [IQR $1019–$3555], <0.001). No significant difference in 30-day readmission rates was observed. Conclusions: EA after elective lumbar spinal fusion was associated with better postoperative recovery. Factors independently associated with EA included lower ASA class, shorter anesthetic duration, and postoperative intravenous parecoxib use. Full article

(This article belongs to the Section Anesthesiology)

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23 pages, 2205 KB

Open AccessReview

Dynamic Changes in Peripheral Nerve Stiffness After Regional Anesthesia: Implications of Shear Wave Elastography in Adductor Canal Block

by Hyeonsook Jee, Sung-woo Hyung, Yuseung Oh and Hye Joo Yun

J. Clin. Med. 2026, 15(13), 5306; https://doi.org/10.3390/jcm15135306 - 7 Jul 2026

Viewed by 377

Abstract

Adductor canal block (ACB) is widely used for perioperative analgesia in knee surgery because it provides effective pain control while preserving quadriceps muscle strength. With the increasing use of ultrasound-guided regional anesthesia, interest has expanded beyond conventional morphologic imaging toward quantitative assessment of [...] Read more.

Adductor canal block (ACB) is widely used for perioperative analgesia in knee surgery because it provides effective pain control while preserving quadriceps muscle strength. With the increasing use of ultrasound-guided regional anesthesia, interest has expanded beyond conventional morphologic imaging toward quantitative assessment of peripheral nerve function and biomechanics. Shear wave elastography (SWE) is an emerging ultrasound-based technique that enables real-time quantification of tissue stiffness and has recently gained attention in peripheral nerve evaluation. Previous SWE studies have primarily focused on chronic neuropathic conditions, including entrapment neuropathy and diabetic neuropathy, in which increased nerve stiffness is commonly observed. However, emerging observations suggest that peripheral nerve stiffness may dynamically decrease following regional anesthesia procedures such as ACB. This finding raises the possibility that nerve stiffness reflects not only chronic structural pathology but also transient physiologic and biomechanical modulation. Potential mechanisms underlying reduced stiffness after ACB include perineural hydrodissection, decreased fascial compression, sympathetic blockade-induced vasodilation, altered intraneural pressure, and changes in surrounding muscle tension. Because the saphenous nerve within the adductor canal is superficial and consistently visualized under ultrasound guidance, ACB represents an attractive model for investigating dynamic changes in peripheral nerve biomechanics. This narrative review summarizes current evidence regarding SWE assessment of peripheral nerves and discusses the potential implications of dynamic stiffness changes after regional anesthesia. We review the biomechanical principles of SWE, factors affecting nerve stiffness, current evidence in neuropathic and perioperative settings, technical limitations, and future clinical applications. Understanding the dynamic behavior of peripheral nerve stiffness may expand the role of SWE from a diagnostic tool for neuropathy to a quantitative biomarker for regional anesthesia and perioperative nerve physiology. Full article

(This article belongs to the Special Issue Regional Anesthesia and Pain Management: Mastering Clinical Art for Optimal Patient Satisfaction)

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36 pages, 3326 KB

Open AccessReview

From Continuous-Flow Mechanical Circulatory Support to Heart Transplantation: Hemodynamic, Immunometabolic, and Body Composition Determinants of Rehabilitation Outcomes

by Przemysław Lutomski, Krzysztof J. Filipiak, Hanna Wachowiak-Baszyńska, Ewa Straburzyńska-Migaj, Zbigniew Krasiński, Marek Jemielity, Jacek Zieliński and Tomasz Urbanowicz

J. Clin. Med. 2026, 15(13), 5305; https://doi.org/10.3390/jcm15135305 - 7 Jul 2026

Cited by 1 | Viewed by 974

Abstract

Background: Continuous-flow left ventricular assist devices (LVADs) and heart transplantation (HTX) improve survival and quality of life in advanced heart failure. However, restoration of central hemodynamics does not consistently normalize exercise capacity, physical performance, or body composition. Persistent skeletal muscle dysfunction, endothelial [...] Read more.

Background: Continuous-flow left ventricular assist devices (LVADs) and heart transplantation (HTX) improve survival and quality of life in advanced heart failure. However, restoration of central hemodynamics does not consistently normalize exercise capacity, physical performance, or body composition. Persistent skeletal muscle dysfunction, endothelial abnormalities, metabolic disturbances, and adverse body composition changes frequently limit functional recovery. Methods: This narrative review examines determinants of rehabilitation outcomes across the transition from advanced heart failure to LVAD support and subsequent HTX. Particular emphasis is placed on restoration of pulsatile circulation, vascular and microcirculatory adaptation, immunosuppressive therapy, body composition remodeling, and emerging immunometabolic mechanisms. Results: Rehabilitation outcomes appear to be increasingly determined by peripheral rather than central cardiovascular factors. Continuous-flow LVAD support induces vascular, endothelial, autonomic, and microcirculatory adaptations that may persist after transplantation. Although HTX restores physiological pulsatile circulation and cardiac output, recovery is often limited by skeletal muscle dysfunction, impaired mitochondrial capacity, chronotropic abnormalities, and adverse body composition changes. Immunosuppressive therapies further influence muscle plasticity, adipose tissue distribution, insulin sensitivity, endothelial function, and exercise adaptation, contributing to phenotypes such as sarcopenia, myosteatosis, and sarcopenic obesity. Conclusions: Functional recovery after LVAD support and HTX is a multidimensional process extending beyond restoration of cardiac function. We propose a hemodynamic–immunometabolic framework in which vascular adaptation, skeletal muscle biology, body composition remodeling, and immunosuppressive therapy interact to determine rehabilitation success and may inform personalized rehabilitation strategies. Full article

(This article belongs to the Special Issue New Clinical Perception of Cardiac Rehabilitation)

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11 pages, 231 KB

Open AccessArticle

Association Between Gastroesophageal Reflux Symptoms and Temporomandibular Disorders in Healthcare Professionals: The Role of Shift Work, Oral Parafunctions, and Psychological Distress

by Mehmet Fatih Özsaray, Büşra Özsaray and Elif Pilatin Şahin

J. Clin. Med. 2026, 15(13), 5304; https://doi.org/10.3390/jcm15135304 - 7 Jul 2026

Viewed by 356

Abstract

Background/Objectives: Shift work is associated with circadian disruption, sleep disturbances, and psychological distress, all of which may influence both reflux-related symptoms and temporomandibular disorder (TMD)-related complaints. However, the relationships among reflux-related symptom burden, TMD severity, oral parafunctional behaviors, and psychological distress in healthcare [...] Read more.

Background/Objectives: Shift work is associated with circadian disruption, sleep disturbances, and psychological distress, all of which may influence both reflux-related symptoms and temporomandibular disorder (TMD)-related complaints. However, the relationships among reflux-related symptom burden, TMD severity, oral parafunctional behaviors, and psychological distress in healthcare professionals remain insufficiently understood. To evaluate the association between reflux-related symptom burden, assessed using the Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) questionnaire, and TMD severity among healthcare professionals, and to investigate the potential roles of shift work, oral parafunctional behaviors, and psychological distress in this relationship. Methods: This cross-sectional observational study included healthcare professionals working at a tertiary hospital. Data were collected using validated questionnaires, including the GERD-HRQL, Fonseca Anamnestic Index, Oral Behavior Checklist (OBC), Depression Anxiety Stress Scale-21 (DASS-21), and Epworth Sleepiness Scale (ESS). Participants were categorized as shift workers (≥4 night shifts/month) and non-shift workers. Correlation and multivariable regression analyses were performed. Results: A total of 240 participants were included. Higher GERD-HRQL scores were positively correlated with TMD severity (r = 0.31, 95% CI: 0.19 to 0.42, p < 0.001), oral parafunctional behavior scores (r = 0.28, 95% CI: 0.16 to 0.39, p < 0.001), and DASS-21 stress scores (r = 0.35, 95% CI: 0.23 to 0.46, p < 0.001). Shift workers demonstrated significantly higher GERD-HRQL scores and TMD severity scores than non-shift workers, with small-to-moderate effect sizes. In multivariable analysis, higher TMD severity, OBC score, stress score, and shift-work exposure showed adjusted associations with higher GERD-HRQL scores. The model explained 32% of the variance in reflux-related symptom burden (R² = 0.32; adjusted R² = 0.29). Conclusions: Higher GERD-HRQL scores, reflecting reflux-related symptom burden rather than objectively confirmed GERD, showed weak to small-to-moderate associations with TMD severity, oral parafunctional behaviors, psychological distress, and shift-work exposure among healthcare professionals. These findings indicate co-occurrence of gastrointestinal, temporomandibular, behavioral, and psychosocial symptom domains within this occupational population. Longitudinal studies using objective diagnostic methods are required to clarify the directionality and clinical significance of these associations. Full article

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

10 pages, 1281 KB

Open AccessArticle

Effects of SGLT2 Inhibitors on Proteinuria and Renal Function Parameters in Non-Diabetic Kidney Transplant Recipients: A Retrospective Cohort Study Based on 12-Month Follow-Up Data

by Serdar Kahvecioglu, Huseyin Celik, Asena Serap Karatutlu, Saide Elif Gullulu Boz, Pinar Ozdemir, Ozger Akarsu, Nazife Nur Ozer Sensoy and Nimet Aktas

J. Clin. Med. 2026, 15(13), 5303; https://doi.org/10.3390/jcm15135303 - 7 Jul 2026

Viewed by 360

Abstract

Background: Sodium–glucose cotransporter 2 (SGLT2) inhibitors have demonstrated significant renoprotective effects in patients with chronic kidney disease. However, kidney transplant recipients have been excluded from major randomized trials, and evidence in non-diabetic transplant patients remains limited. This study aimed to investigate the [...] Read more.

Background: Sodium–glucose cotransporter 2 (SGLT2) inhibitors have demonstrated significant renoprotective effects in patients with chronic kidney disease. However, kidney transplant recipients have been excluded from major randomized trials, and evidence in non-diabetic transplant patients remains limited. This study aimed to investigate the potential effects of SGLT2 inhibitors in non-diabetic kidney transplant recipients. Methods: Kidney transplant recipients were screened retrospectively and divided into two groups based on SGLT2 inhibitor use. A total of 18 non-diabetic patients receiving SGLT2 inhibitors (Group 1) were compared with 30 matched controls (Group 2). Patients were followed at baseline, 3, 6, and 12 months. Proteinuria, serum creatinine, eGFR, uric acid, and tacrolimus levels were analyzed. Results: Baseline demographic and biochemical characteristics were similar between groups. In Group 1, proteinuria decreased by 20% at 6 months and 26% at 12 months compared with baseline. The reduction in proteinuria from baseline to 6 months was significantly greater in Group 1 than in controls (p = 0.037). No significant changes were observed in serum creatinine, eGFR, tacrolimus levels, or infection-related adverse events between groups. Conclusions: SGLT2 inhibitors may confer an early antiproteinuric benefit in non-diabetic kidney transplant recipients without apparent adverse effects on renal function or safety. Larger prospective studies are needed to confirm long-term effects. Full article

(This article belongs to the Special Issue Clinical Advances in Kidney Transplantation)

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12 pages, 772 KB

Open AccessArticle

Prevalence, Predictors, and Clinical Outcomes of Cervical Arterial Dissection in Patients with Spontaneous Coronary Artery Dissection: A Multicenter Retrospective Cohort Study

by Hend Bcharah, Hussein Abdul Nabi, Luke Dreher, George Bcharah, Katie Mand, Vinicius De Sousa Barzon Serra, Linnea M. Baudhuin, Yuxiang Wang, Mayowa A. Osundiji and Fadi E. Shamoun

J. Clin. Med. 2026, 15(13), 5302; https://doi.org/10.3390/jcm15135302 - 7 Jul 2026

Viewed by 378

Abstract

Background: Patients with spontaneous coronary artery dissection (SCAD) are at increased risk of cardiovascular events, including dissection in other arterial territories such as cervical arteries. Those with combined coronary and cervical arterial dissection (CACAD) may have more widespread arterial abnormalities and worse [...] Read more.

Background: Patients with spontaneous coronary artery dissection (SCAD) are at increased risk of cardiovascular events, including dissection in other arterial territories such as cervical arteries. Those with combined coronary and cervical arterial dissection (CACAD) may have more widespread arterial abnormalities and worse outcomes, underscoring the need for better risk stratification and personalized care. Objective: This study examined the prevalence of cervical artery dissection (CvAD) in patients diagnosed with SCAD, evaluated potential risk factors for developing CvAD, and assessed their impact on clinical outcomes, including all-cause mortality, SCAD recurrence, and stroke. The goal was to enhance risk stratification by identifying SCAD patients at increased risk for CvAD. Design: In this retrospective cohort study, patients diagnosed with SCAD between 2018 and 2024 across Mayo Clinic sites were identified using ICD-10 codes. Manual chart review confirmed CvAD diagnoses. Patients were stratified based on the presence or absence of CvAD. Chi-square and independent t-tests were used to compare risk factors and comorbidities. Univariate screening and multivariable logistic regression were used to identify predictors of CvAD. Results: Among 1380 patients with SCAD, 131 (9.5%) had CvAD. The median follow-up was 2.02 years (IQR: 1.1–5.2 years). All CvAD diagnoses were identified after the index SCAD event through systematic post-SCAD vascular imaging. The mean age was similar between groups (51.5 ± 11.3 years in CACAD vs. 50.9 ± 10.7 years in SCAD-only, p = 0.540), and the majority were female (93.9% vs. 91.9%, p = 0.529). Multivariable regression identified extremity arterial dissection (OR: 8.13, 95% CI: 3.41–19.36, p < 0.001), fibromuscular dysplasia (FMD) (OR: 7.52, 95% CI: 4.67–12.10, p < 0.001), connective tissue disorders (CTDs) (OR: 6.85, 95% CI: 2.35–19.98, p < 0.001), and anxiety (OR: 1.69, 95% CI: 1.01–2.81, p = 0.044) as significant predictors of CvAD. CvAD was a strong independent predictor of stroke (OR: 6.37, 95% CI: 2.93–13.87, p < 0.001). Mortality and SCAD recurrence did not differ significantly between groups. Conclusions: Patients with CACAD demonstrate a systemic vascular phenotype with significantly higher rates of FMD, connective tissue disease, extremity arterial dissection, and stroke. These findings highlight the importance of comprehensive vascular screening and individualized monitoring in at-risk SCAD patients. Full article

(This article belongs to the Section Cardiovascular Medicine)

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13 pages, 248 KB

Open AccessArticle

Association of Cumulative Smoking Exposure with REM Sleep Alterations in Obstructive Sleep Apnea: A Cross-Sectional Study Supported by Exhaled Carbon Monoxide Measurement

by Kadir Burak Akgün and Derya Yavuz Demiray

J. Clin. Med. 2026, 15(13), 5301; https://doi.org/10.3390/jcm15135301 - 7 Jul 2026

Viewed by 404

Abstract

Objective: The association of smoking with sleep apnea is often based on subjective data. This study quantified the effects of smoking on sleep architecture using exhaled carbon monoxide (eCO) and polysomnography (PSG). Methods: A total of 183 patients with suspected obstructive sleep apnea [...] Read more.

Objective: The association of smoking with sleep apnea is often based on subjective data. This study quantified the effects of smoking on sleep architecture using exhaled carbon monoxide (eCO) and polysomnography (PSG). Methods: A total of 183 patients with suspected obstructive sleep apnea (OSA) were included in this prospective study. Following full-night PSG, eCO was measured within 10 min. Data were analyzed using the Generalized Linear Model (GLM). Results: Although initial unadjusted analyses showed an inverse correlation between eCO levels and central apnea count, GLM revealed that male gender was the only independent predictor for central apnea, negating the effect of eCO. GLM analyses, adjusted for age, gender, BMI, and alcohol and drug use, revealed that cumulative smoking load (pack-years) was independently associated after multivariable adjustment with reduced REM sleep duration (B = −0.345, 95% CI [−0.571; −0.119], p = 0.003) and REM sleep percentage (B = −0.099, 95% CI [−0.158; −0.040], p = 0.001). Similarly, smoking duration (years) significantly predicted decreased REM sleep duration (B = −0.426, 95% CI [−0.724; −0.128], p = 0.005) and REM percentage (B = −0.119, 95% CI [−0.197; −0.041], p = 0.003). Formal interaction analyses did not detect a statistically significant interaction with body mass index (BMI) (p > 0.05 for all interaction terms). Conclusions: In OSA, smoking is independently associated with alterations in REM sleep architecture rather than respiratory events. Cumulative smoking load and smoking duration are independently associated with alterations in REM sleep after adjusting for any other major clinical comorbidities. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: Advances in Clinical Diagnosis and Management)

21 pages, 1472 KB

Open AccessArticle

Striving for Consensus: Neuroma Prevention and Preferred Approaches in Surgical Digit Amputations—A Survey of Hand Surgeons

by Alexander Draschl, Werner Girsch, Lars-Peter Kamolz, Patrick Sadoghi, Juergen Dolderer, Marcel Hoh and Sebastian P. Nischwitz

J. Clin. Med. 2026, 15(13), 5300; https://doi.org/10.3390/jcm15135300 - 7 Jul 2026

Viewed by 329

Abstract

Background: Although surgical digit amputations are common procedures in hand surgery, substantial differences in technical approaches have been reported, with the development of symptomatic neuromas posing a major challenge. Given the absence of a universally accepted technique, especially concerning painful neuroma prevention, [...] Read more.

Background: Although surgical digit amputations are common procedures in hand surgery, substantial differences in technical approaches have been reported, with the development of symptomatic neuromas posing a major challenge. Given the absence of a universally accepted technique, especially concerning painful neuroma prevention, this survey study’s rationale was to explore the preferred surgical approach for traumatic noninfected digital amputation injuries (excluding the thumb) at the interphalangeal (IP) joint levels. Methods: A 10-point online questionnaire was sent to ÖGH, DGH and SGH members. To provide a comprehensive overview of the preferred approach, descriptive statistics were performed, while examining differences based on years of surgical experience (≤20 years versus >20) and society affiliation (ÖGH vs. DGH vs. SGH) via inferential Pearson-chi square and Fisher’s exact tests were employed. Results: Of the 1670 experts contacted, 213 (12.8%) took part in the survey. Across different societies and years of surgical experience, there is a consensus on most aspects, including smoothing bony edges after transosseous resection (99.8%), removal of articular cartilage after disarticulation (78.9%), shortening flexor tendons (81.2%), and avoiding additional extensor tendon shortening (92.3%). No consensus was found on the technique of surgical bone transection, the reduction of the phalangeal head during disarticulation and the treatment of digital nerves including neuroma prevention. Conclusions: Although there is a broad consensus on most aspects of surgical digit amputation, the treatment of digital nerves and neuroma prevention remains an area with a lack of consensus. Future studies should focus on these aspects to uncover further benefits. Full article

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

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12 pages, 2143 KB

Open AccessArticle

Early Post-Transplant Changes in Nutritional Status Predict Long-Term Graft Loss and Mortality

by Taha Enes Cetin, Omer Faruk Akcay, Veysel Baran Tomar, Serhat Haliloglu, Anil Oguzhan Soylu, Kadriye Altok and Yasemin Erten

J. Clin. Med. 2026, 15(13), 5299; https://doi.org/10.3390/jcm15135299 - 7 Jul 2026

Viewed by 298

Abstract

Background: Nutritional status is an important determinant of outcomes after kidney transplantation, yet the prognostic significance of longitudinal changes in nutritional indices remains insufficiently investigated. We evaluated whether first-year changes in the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score were [...] Read more.

Background: Nutritional status is an important determinant of outcomes after kidney transplantation, yet the prognostic significance of longitudinal changes in nutritional indices remains insufficiently investigated. We evaluated whether first-year changes in the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score were associated with long-term adverse outcomes in kidney transplant recipients (KTRs). Methods: This retrospective cohort study included 352 adult KTRs with a median follow-up of 11.4 years. PNI and CONUT were calculated before transplantation and at the first post-transplant year. Patients were categorized according to changes in nutritional status as improved/stable or worsened. The primary outcome was a composite of end-stage renal disease (ESRD) or death with a functioning graft. Two separate multivariable logistic regression models were constructed to evaluate the associations of changes in first-year PNI and CONUT with the composite outcome after adjustment for clinically relevant demographic and transplant-specific variables, including first-year rejection episodes, estimated glomerular filtration rate (eGFR), and urine protein-to-creatinine ratio (PCR). Additional analyses were performed separately for graft loss and death with a functioning graft. Results: Baseline PNI and CONUT scores were comparable between patients with and without adverse outcomes. Patients who reached the composite outcome had significantly lower first-year eGFR (p = 0.001), whereas first-year rejection episodes and urine PCR were similar between the groups. After multivariable adjustment, worsening first-year PNI (OR: 2.02, 95% CI: 1.08–3.77, p = 0.028) and worsening first-year CONUT (OR: 2.01, 95% CI: 1.11–3.65, p = 0.022) remained independently associated with the composite outcome. Higher first-year eGFR was independently associated with a lower risk of adverse outcomes. Separate analyses of graft loss and death with a functioning graft supported the primary findings, with stronger associations observed for graft-related outcomes. Conclusions: Early deterioration in nutritional status, reflected by worsening changes in PNI and CONUT during the first post-transplant year, was independently associated with adverse long-term outcomes in KTRs. Serial assessment of these simple and inexpensive nutritional indices may improve long-term risk stratification and help identify patients who could benefit from closer clinical follow-up and individualized nutritional assessment. Full article

(This article belongs to the Special Issue Chronic Kidney Disease: Treatment, Nutritional Intervention and Renal Transplantation)

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14 pages, 846 KB

Open AccessArticle

Electro-Mechanical Cardiac Remodeling in Metabolic Syndrome: Association Between Frontal QRS-T Angle and Subclinical Left Ventricular Dysfunction Assessed by Four-Dimensional Echocardiography

by Zeynep Ulutas, Yakup Yigit, Mirac Karaagac and Mehmet Cansel

J. Clin. Med. 2026, 15(13), 5298; https://doi.org/10.3390/jcm15135298 - 7 Jul 2026

Viewed by 286

Abstract

Background/Objectives: Metabolic syndrome (MS) has been demonstrated to be associated with subclinical myocardial dysfunction, which develops in the early stages. It has been hypothesised that traditional echocardiographic parameters may be insufficient in detecting these changes. The frontal QRS-T angle is an electrocardiographic [...] Read more.

Background/Objectives: Metabolic syndrome (MS) has been demonstrated to be associated with subclinical myocardial dysfunction, which develops in the early stages. It has been hypothesised that traditional echocardiographic parameters may be insufficient in detecting these changes. The frontal QRS-T angle is an electrocardiographic parameter that is easily obtained and that reflects ventricular electrical heterogeneity. This study aimed to examine the relationship between the frontal QRS–T angle and left ventricular myocardial deformation, as assessed by four-dimensional strain echocardiography (4DSE), in patients with MS. Methods: The present cross-sectional study comprised 70 patients diagnosed with MS and 61 healthy individuals matched for age and gender. All participants underwent standard transthoracic and 4DSE examination and 12-lead electrocardiography. The values of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and global area strain (GAS) were analysed. The frontal QRS-T angle was calculated as the absolute difference between the QRS and T axes. The interrelationships between the variables were assessed using correlation and multivariate linear regression analyses. Results: Despite comparable left ventricular ejection fraction (LVEF) between the groups, 4DSE-derived myocardial deformation parameters, including GLS, GCS, GAS, and GRS, were significantly impaired in the MS group. The frontal QRS-T angle was found to be significantly higher in patients diagnosed with MS in comparison to the control group (p < 0.001). A significant correlation was identified between the frontal QRS-T angle and GLS (r = 0.498, p < 0.001). In multivariable linear regression analysis, the frontal QRS–T angle was independently associated with GLS (standardized β = 0.501, p < 0.001). In exploratory receiver operating characteristic (ROC) analysis, the frontal QRS–T angle showed moderate discriminatory ability for GLS-defined impaired myocardial deformation area under the curve (AUC) = 0.720). Conclusions: An increased frontal QRS–T angle in individuals with metabolic syndrome was independently associated with subclinical LV dysfunction despite preserved ejection fraction (EF). These findings suggest that the frontal QRS–T angle may serve as a simple and readily available electrocardiographic marker associated with impaired myocardial deformation, warranting further validation in larger prospective studies. Full article

(This article belongs to the Section Cardiology)

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18 pages, 2523 KB

Open AccessArticle

Evaluation of the Effectiveness and Safety of the Use of CODUBIX^® ŻEBRA, CODUBIX^® S ŻEBRA Rib Bone Prostheses

by Tadeusz Orłowski, Marcin Zieliński, Janusz Włodarczyk, Piotr Kasprzak, Magdalena Tokarska, Kaja Jezierska and Witold Sujka

J. Clin. Med. 2026, 15(13), 5297; https://doi.org/10.3390/jcm15135297 - 7 Jul 2026

Viewed by 376

Abstract

Background: The Codubix^® ŻEBRA and Codubix^® S ŻEBRA prostheses (by Tricomed SA), made of a biocompatible polypropylene–polyester braid, were developed as tools for the treatment of bone defects resulting from cancer surgery or mechanical injuries. Methods: The retrospective analysis investigation presents [...] Read more.

Background: The Codubix^® ŻEBRA and Codubix^® S ŻEBRA prostheses (by Tricomed SA), made of a biocompatible polypropylene–polyester braid, were developed as tools for the treatment of bone defects resulting from cancer surgery or mechanical injuries. Methods: The retrospective analysis investigation presents the efficacy and safety of rib bone prostheses made of knitted polyester–polypropylene fabric used to fill defects in the ribs and sternum. Data were collected from 113 patients (68 males, 45 females) undergoing surgery at three clinical centres. Prosthesis implantation was performed to bridge bone defects in the ribs and/or sternum. The analysis included preoperative and intraoperative data, two follow-up visits and a final interview with the patients. All prostheses were implanted using two techniques for filling defects in the chest wall: the ‘hammock’ (suspension) fixation method in 87 patients, and the ‘rigid’ fixation method in 26 patients. Results: The main cause of defects was cancer surgery (95.6%) performed in cases of sarcomas, squamous cell carcinomas, and desmoid tumours. Other causes (e.g., congenital defects and mechanical trauma) were less common. The ‘rigid’ fixation method extended the surgery time by approximately 16 min compared to the suspension method. Differences were also noted in the recovery period—an average of 56 days for the ‘hammock’ method and 30 days for the ‘rigid’ method. During the second follow-up visit, the treatment outcome using these prostheses was rated as good in 90.3% of cases. The average duration of hospitalisation was 21 days, regardless of the implantation method. No prosthesis-related adverse events were reported. Complications were observed in 21 cases in the first days after surgery. The most common ones were sensory disturbances (5.3%), infections (3.5%), haematomas and blood effusions (2.7%). Conclusions: A retrospective study demonstrates that knitted prostheses are safe and effective solution for repairing extensive defects resulting from tumours, trauma or congenital malformations. The implants ensure high patient comfort and maintain normal physical functioning without interference. Full article

(This article belongs to the Section General Surgery)

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19 pages, 7970 KB

Open AccessReview

Red Complex Pathogens, Periodontal Dysbiosis and Periodontal Therapy in Alzheimer’s Disease and Dementia

by Julia Bijoch and Karol Jędrasiak

J. Clin. Med. 2026, 15(13), 5296; https://doi.org/10.3390/jcm15135296 - 7 Jul 2026

Viewed by 425

Abstract

This narrative review synthesizes evidence linking periodontal dysbiosis with Alzheimer’s disease, all-cause dementia, and dementia-relevant mechanisms, focusing on the red complex pathogens P. gingivalis, T. denticola, and T. forsythia and on the translational meaning of periodontal therapy. A PubMed-centered literature search [...] Read more.

This narrative review synthesizes evidence linking periodontal dysbiosis with Alzheimer’s disease, all-cause dementia, and dementia-relevant mechanisms, focusing on the red complex pathogens P. gingivalis, T. denticola, and T. forsythia and on the translational meaning of periodontal therapy. A PubMed-centered literature search up to May 2026 informed this synthesis (a narrative review, not a registered systematic review or meta-analysis) of 46 periodontal-scope sources, supplemented by five contextual references identified outside the periodontal search (51 references in total). P. gingivalis shows the strongest mechanistic support, including gingipains, lipopolysaccharide, outer membrane vesicles, endothelial stress, and neuroinflammatory signaling; T. denticola shows moderate biological plausibility; and T. forsythia remains mainly hypothesis-generating. Human studies associate periodontitis, tooth loss, oral-hygiene indicators, and periodontal-care exposure with dementia-relevant outcomes, but residual confounding, reverse causation, dental-care access, and heterogeneous endpoints preclude causal inference. Notably, direct targeting of a single periodontal pathogen has not shown clinical benefit, as the gingipain inhibitor atuzaginstat failed in the GAIN trial, contrasting with the modest success of amyloid-targeting therapies. Current evidence supports graded plausibility rather than causal certainty, and a registered multi-database systematic review with neurological endpoints is needed before meta-analytic clinical claims can be made. Full article

(This article belongs to the Special Issue Periodontitis and Systemic Health: Exploring the Oral-Systemic Connection)

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10 pages, 231 KB

Open AccessArticle

Use of Intravenous Lidocaine, Ketamine, and Magnesium for Acute Pain Control After Lung Resection Surgery: A Prospective Cohort Study

by Julissa Herrera, Silvia Torres, Maria Diaz, Iñaki Gascó, Alessandro Ruggiero, Nicolas Varela, Manuel Murie-Fernandez and Marc Vives

J. Clin. Med. 2026, 15(13), 5295; https://doi.org/10.3390/jcm15135295 - 7 Jul 2026

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Abstract

Background: Thoracic surgery is associated with severe postoperative pain caused by chest wall manipulation and intercostal nerve injury. Multimodal analgesia with non-opioid agents such as lidocaine, ketamine and magnesium might be beneficial for pain control and reduce opioid consumption. Methods: In [...] Read more.

Background: Thoracic surgery is associated with severe postoperative pain caused by chest wall manipulation and intercostal nerve injury. Multimodal analgesia with non-opioid agents such as lidocaine, ketamine and magnesium might be beneficial for pain control and reduce opioid consumption. Methods: In this prospective cohort study, we recruited 118 consecutive patients who underwent lung resection via thoracotomy from January 2019 to January 2021 at Hospital Universitari de Girona Doctor Josep Trueta. The primary outcome was total intravenous morphine consumption within the first 24 h postoperatively. Multivariable linear regression modeling was used to determine the adjusted association between lidocaine, ketamine and magnesium administration and morphine consumption in the first 24 h after surgery. Statistical analysis was performed using Wilcoxon’s rank-sum and Fisher’s exact tests. Results: In total, 71 patients received lidocaine, ketamine and magnesium intraoperatively (LKM group) while 47 patients did not receive this regimen (non-LKM group). The LKM group had a higher prevalence of hypertension and higher proportions of patients undergoing lobectomy and pneumonectomy. Morphine consumption within 24 h postoperatively was lower in the LKM group than in the non-LKM group (median (interquartile range), 2 (0–6) mg vs. 5 (3–8) mg; p = 0.001). No drug-related adverse events were observed. After multivariable risk adjustment, lidocaine, ketamine and magnesium use was associated with significantly decreased total intravenous morphine consumption within 24 h postoperatively (−1.76, 95% confidence interval = −3.40 to −0.12, p = 0.03). Conclusions: Lidocaine, ketamine and magnesium use was associated with lower 24 h morphine consumption in our prospective cohort. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Anesthesiology)

16 pages, 2433 KB

Open AccessArticle

Prognostic Value of the Lactate-to-Albumin and C-Reactive Protein-to-Albumin Ratios in COVID-19–Associated ARDS

by Sultan Almuntashiri, Yazeed Adel M. Alsubhi, Ziyad Khalid B. Alhelali, Abdulrahman Fraih M. Alanazi, Meshari Mohammed B. Alamri, Bader M. Alshoumr, Saleh Alghamdi, Mohammad Hajaj Said Almermesh, Talib Hussain and Sirajudheen Anwar

J. Clin. Med. 2026, 15(13), 5294; https://doi.org/10.3390/jcm15135294 - 7 Jul 2026

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Abstract

Background: Coronavirus disease 2019 (COVID-19) is frequently complicated by acute respiratory distress syndrome (ARDS), which is associated with high mortality. The lactate-to-albumin ratio (LAR) and C-reactive protein-to-albumin ratio (CAR) have been proposed as prognostic markers in critical illness, but their comparative performance [...] Read more.

Background: Coronavirus disease 2019 (COVID-19) is frequently complicated by acute respiratory distress syndrome (ARDS), which is associated with high mortality. The lactate-to-albumin ratio (LAR) and C-reactive protein-to-albumin ratio (CAR) have been proposed as prognostic markers in critical illness, but their comparative performance in COVID-19–associated ARDS is not well established. Methods: We conducted a retrospective cohort study using the MIMIC-IV database, which contains data from Beth Israel Deaconess Medical Center, United States, including COVID-19 ICU admissions from 2020 to 2022. Adult COVID-19 patients with available PaO₂/FiO₂, lactate, albumin, and C-reactive protein measurements within the first 48 h of ICU admission were included. Receiver operating characteristic analysis, Kaplan–Meier survival analysis, and Cox proportional hazards regression were performed. Results: Of the 3620 patients screened, 66 met the inclusion criteria; 36 survived and 30 died. Non-survivors had significantly higher LAR and CAR values at ICU admission. In ROC analyses, LAR demonstrated moderate discrimination for 30-day mortality (AUC 0.706) and showed higher discriminatory performance than CAR in most subgroup analyses. Among ARDS patients, LAR showed moderate predictive ability (AUC 0.693), compared with CAR (AUC 0.655). In severe ARDS, both markers demonstrated improved discrimination (0.722 AUC for LAR and 0.797 for CAR). High LAR was associated with significantly higher 30-day mortality in all ARDS patients (60.5% vs. 24.0%; p = 0.0056) and severe ARDS patients (72.0% vs. 20.0%; p = 0.0022). Elevated CAR was also associated with increased mortality, particularly in severe ARDS (73.1% vs. 14.3%; p < 0.001). In multivariable Cox regression, LAR remained independently associated with 30-day mortality. Conclusions: LAR demonstrated independent prognostic value for 30-day mortality in critically ill COVID-19 patients with ARDS. CAR showed variable performance. These readily available biomarkers, particularly LAR, may aid early risk stratification although larger studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Ventilation in Critical Care Medicine: 2nd Edition)

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16 pages, 592 KB

Open AccessArticle

Longitudinal Changes in Serum Procalcitonin After Bariatric Surgery and Their Associations with Anthropometric, Metabolic, and Inflammatory Parameters

by Gurbet Ünal Özen, Çağrı Büyükkasap, Beyza Dursun and Aslı Akyol

J. Clin. Med. 2026, 15(13), 5293; https://doi.org/10.3390/jcm15135293 - 7 Jul 2026

Viewed by 318

Abstract

Objective: Obesity is a systemic disease characterized by low-grade chronic inflammation and increased metabolic risk. Although bariatric surgery is known to improve metabolic and inflammatory status, the longitudinal behavior of emerging inflammatory biomarkers such as procalcitonin (PCT) remains insufficiently characterized. This study [...] Read more.

Objective: Obesity is a systemic disease characterized by low-grade chronic inflammation and increased metabolic risk. Although bariatric surgery is known to improve metabolic and inflammatory status, the longitudinal behavior of emerging inflammatory biomarkers such as procalcitonin (PCT) remains insufficiently characterized. This study aimed to evaluate postoperative changes in serum procalcitonin (PCT) levels in patients undergoing bariatric surgery and to investigate their associations with anthropometric measurements, liver enzymes, and novel inflammatory indices. Methods: In this retrospective longitudinal cohort study, 38 patients who underwent sleeve gastrectomy and had complete preoperative and postoperative follow-up data at months 1, 3, and 6 were included. Anthropometric and biochemical parameters were analyzed, and systemic inflammation was assessed using PCT, Systemic Immune-Inflammation Index (SII) and the Systemic Inflammation Response Index (SIRI). Repeated-measures analyses were performed according to data distribution, and correlations were evaluated using Spearman analysis. Results: PCT levels showed a significant reduction at postoperative month 1 compared with the preoperative period. However, despite continued reductions in body weight, BMI, and fat mass at postoperative months 3 and 6, PCT levels plateaued without further significant change. In the preoperative period, PCT demonstrated strong positive correlations with liver enzymes (p < 0.01). At postoperative month 1, PCT was significantly associated with glucose and HbA1c levels. Although SII and SIRI decreased after surgery, no significant correlation with PCT was observed. Conclusions: PCT decreased in the early postoperative period after sleeve gastrectomy and may reflect early metabolic and inflammatory changes associated with rapid weight loss. However, its sensitivity for monitoring long-term inflammatory changes appears limited. The observed preoperative associations with liver enzymes may suggest a potential relationship between PCT levels, liver enzyme alterations, and metabolic alterations in obesity. Full article

(This article belongs to the Special Issue Bariatric Surgery: Current Status and Emerging Clinical Trends)

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17 pages, 1108 KB

Open AccessArticle

Pulmonary Telerehabilitation and Telemonitoring for Patients with Chronic Obstructive Pulmonary Disease: A Single-Arm Pilot Feasibility Study

by Matías Otto-Yáñez, Rodrigo Torres-Castro, Lea Soliman, Onah Chiemelie, Sandra C. Webber, Renata Mancopes, Antonio Sarmento and Diana C. Sanchez-Ramirez

J. Clin. Med. 2026, 15(13), 5292; https://doi.org/10.3390/jcm15135292 - 7 Jul 2026

Viewed by 484

Abstract

Background: Pulmonary rehabilitation is effective for people with chronic obstructive pulmonary disease (COPD), but access remains limited. Telerehabilitation with telemonitoring may improve access to home-based care; however, feasibility data are currently scarce. This study assessed the feasibility, acceptability, and occurrence of adverse [...] Read more.

Background: Pulmonary rehabilitation is effective for people with chronic obstructive pulmonary disease (COPD), but access remains limited. Telerehabilitation with telemonitoring may improve access to home-based care; however, feasibility data are currently scarce. This study assessed the feasibility, acceptability, and occurrence of adverse effects in a videoconference-based pulmonary telerehabilitation program supported by wearable devices in individuals with COPD. Methods: Our one-group pre-post feasibility study evaluated an 8-week intervention comprising two supervised exercise sessions and one education session per week. Telemonitoring included wearable-device data capture (heart rate, peripheral oxygen saturation, step count) and symptom severity reporting. Feasibility outcomes included recruitment rate, study completion, dropout rate, session attendance, data-submission compliance, adverse events, and participant satisfaction. Exploratory clinical outcomes were assessed pre- and post-intervention. Results: Of 32 eligible individuals, 15 consented and attended baseline assessment (recruitment rate: 47%), and nine completed the study (completion: 60%; dropout: 40%). Among completers, median age was 67 years (interquartile range [IQR] 62–73), and seven (78%) were women. Mean session attendance was 94 ± 6.6%. Data submission rates averaged 86 ± 7.7% for the O2 ring and 97 ± 6.4% for symptom severity reporting, while smartwatch data were submitted by all participants (100%). No adverse events were reported, and participant satisfaction was high. No statistically significant pre-post changes were observed in clinical outcomes. Mean 6-min walk test distance increased by 29 m, a potentially clinically relevant but exploratory finding. Conclusions: A videoconference-based pulmonary telerehabilitation program supported by wearable devices appears to be operationally deliverable among participants who remained engaged, with no adverse events observed in this small, selected group of participants with COPD. Findings should be interpreted cautiously due to the small sample size, one-group design, and attrition. Full article

(This article belongs to the Special Issue Moving Forward to New Trends in Pulmonary Diseases: 2nd Edition)

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21 pages, 1152 KB

Open AccessArticle

Clinical Predictors and Recovery Patterns of Visual Impairment as a Post-Stroke Complication: A Retrospective Single-Center Cohort Study from a Romanian Comprehensive Stroke Unit

by Mirela Loredana Grigoraș, Sorin Lucian Bolintineanu, Livia Stanga and Laura Andreea Ghenciu

J. Clin. Med. 2026, 15(13), 5291; https://doi.org/10.3390/jcm15135291 - 7 Jul 2026

Viewed by 365

Abstract

Background/Objectives: Visual impairment is an underrecognized but functionally disabling complication of stroke that adversely affects rehabilitation potential, autonomy, and quality of life. Clinical, anatomical, and ophthalmologic determinants of post-stroke visual recovery remain incompletely defined, particularly in Eastern European tertiary stroke units where structured [...] Read more.

Background/Objectives: Visual impairment is an underrecognized but functionally disabling complication of stroke that adversely affects rehabilitation potential, autonomy, and quality of life. Clinical, anatomical, and ophthalmologic determinants of post-stroke visual recovery remain incompletely defined, particularly in Eastern European tertiary stroke units where structured visual follow-up is not standardized. This study aimed to identify clinical, imaging, and ophthalmologic predictors of favorable visual recovery and to evaluate whether integrating these domains improves early prognostic stratification beyond standard neurological assessment. Methods: We conducted a retrospective single-center cohort study of 71 consecutive adult patients admitted with acute stroke and a documented visual complication between January 2022 and September 2025 at Pius Brinzeu Emergency County Hospital and Victor Babes University of Medicine and Pharmacy Timisoara. Favorable recovery was defined as ≥50% improvement in visual field index (VFI) at 6 months. Group comparisons used Student’s t-test, Mann–Whitney U test, chi-square test, and Fisher’s exact test. Multivariable logistic regression, Cox proportional hazards modeling, and unsupervised k-means clustering were performed. Results: Twenty-nine patients (40.8%) achieved favorable recovery, while 42 (59.2%) had persistent impairment. Responders were younger (62.8 ± 10.7 vs. 70.4 ± 10.8 years, p = 0.005) and had lower admission National Institutes of Health Stroke Scale (NIHSS) (6.4 ± 2.9 vs. 10.3 ± 4.4, p < 0.001), smaller lesion volumes (18.7 ± 11.4 vs. 33.2 ± 18.7 mL, p < 0.001), thicker peripapillary retinal nerve fiber layer (89.3 ± 7.6 vs. 78.2 ± 9.4 μm, p < 0.001), and earlier rehabilitation initiation (11.4 ± 5.3 vs. 21.7 ± 9.8 days, p < 0.001). NIHSS, time to rehabilitation, and optical coherence tomography (OCT) pRNFL thickness remained independent predictors. The full integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.87. Cluster analysis identified three distinct phenotypes with favorable recovery rates of 79.2%, 34.8%, and 8.3%. Conclusions: Combined clinical, neuroimaging, and ophthalmologic profiling—particularly OCT pRNFL—meaningfully refines early prediction of post-stroke visual recovery and supports phenotype-driven rehabilitation planning. Full article

(This article belongs to the Section Clinical Neurology)

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J. Clin. Med., Volume 15, Issue 13 (July-1 2026) – 472 articles

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