Journal of Clinical Medicine

23 pages, 3195 KB

Open AccessArticle

Association Between Progranulin (PGRN) Levels in Serum and Cerebrospinal Fluid with Integrated Clinical Indices in Patients with Idiopathic Normal Pressure Hydrocephalus

by Łukasz A. Poniatowski, Kristin Eske-Pogodda, Agnieszka Siwińska, Mieszko Olczak, Kristian Meinck and Michael J. Fritsch

J. Clin. Med. 2026, 15(15), 6129; https://doi.org/10.3390/jcm15156129 - 6 Aug 2026

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Abstract

Background/Objectives: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable syndrome, but biologically informative biomarkers remain limited. Progranulin (PGRN) constitutes a pleiotropic growth factor involved in neuroinflammation, lysosomal function, and tissue repair, which has not been adequately studied in iNPH. The purpose of [...] Read more.

Background/Objectives: Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable syndrome, but biologically informative biomarkers remain limited. Progranulin (PGRN) constitutes a pleiotropic growth factor involved in neuroinflammation, lysosomal function, and tissue repair, which has not been adequately studied in iNPH. The purpose of this study was to examine the serum and cerebrospinal fluid (CSF) levels of PGRN in corresponding patients with suspected iNPH and its correlation with integrated clinical, functional, and neuroradiological parameters. Methods: Thirteen patients with probable iNPH underwent an evaluation protocol, including clinical assessment, neuroradiological evaluation, Tap-test with concomitant gait analysis, and paired serum/CSF sampling. PGRN concentrations in biofluids were measured by ELISA. Correlation analyses were performed. Composite Tap-test response variable derived from quantitative gait-improvement indices was modeled using ridge-logistic regression with leave-one-out cross-validation. Results: In the between-group analyses, serum and CSF concentrations of PGRN were not correlated (r = −0.10, p = 0.74), suggesting that peripheral and intrathecal PGRN behave as non-redundant, compartment-specific readouts rather than as interchangeable measures of the same biological process. Higher CSF concentration of PGRN was nominally associated with older age (r = 0.69, p = 0.009) and with poorer turning-time improvement after the Tap-test (r = −0.62, p = 0.025), while serum concentration of PGRN showed no meaningful associations with clinical or neuroradiological variables. In the model of logistic regression, inclusion of CSF concentration of PGRN substantially improved discrimination of Tap-test response. The full ridge-logistic regression model, including serum and CSF concentration of PGRN, symptom duration, and Kiefer score, achieved an accuracy of 0.923 and an AUC of 0.881. The CSF concentration of PGRN coefficient remained consistently negative across bootstrap resamples (penalized OR 0.434; 95% CI: 0.354–0.697), indicating that higher baseline CSF concentration of PGRN was associated with a lower probability of significant short-term Tap-test response, whereas serum PGRN contributed negligibly to the model. Conclusions: The observed changes in PGRN in CSF may reflect compartment-specific intrathecal inflammatory or tissue-stress processes and may help identify patients with lower short-term responsiveness to CSF drainage. These findings support further longitudinal evaluation of CSF concentration of PGRN for biological stratification and prognostic refinement in iNPH. Full article

(This article belongs to the Special Issue Neuroinflammation and Neuroimmunology in Neurological Disorders)

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13 pages, 1853 KB

Open AccessFeature PaperArticle

Patient-Reported Visual Function and Vision-Related Quality of Life Across Ophthalmic Diseases: An Exploratory Cross-Sectional Study

by Kenji Kashiwagi, Syowta Fukuba, Hiroshi Kasai, Yoshiko Fukuda, Shuhei Hosoda and Naohiko Tanabe

J. Clin. Med. 2026, 15(15), 6128; https://doi.org/10.3390/jcm15156128 - 6 Aug 2026

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Abstract

Background/Objectives: Patient-reported outcomes (PROs) provide information on subjective visual function that is not fully captured by conventional clinical measures. This exploratory cross-sectional study evaluated item-level responses to an original 11-item questionnaire and their association with vision-related quality of life across ophthalmic diseases. Methods: [...] Read more.

Background/Objectives: Patient-reported outcomes (PROs) provide information on subjective visual function that is not fully captured by conventional clinical measures. This exploratory cross-sectional study evaluated item-level responses to an original 11-item questionnaire and their association with vision-related quality of life across ophthalmic diseases. Methods: A total of 262 participants, including patients with glaucoma, age-related macular degeneration, diabetic retinopathy, retinitis pigmentosa, cataract, and individuals with long-standing severe visual impairment, completed the questionnaire and the National Eye Institute Visual Function Questionnaire-25 (VFQ-25). Associations with age, disease category, and better-eye visual acuity were examined using correlation analyses, multivariable regression, and ordinal logistic models. Results: Perceived change in vision after treatment or disease management (A6) showed the most consistent item-level associations. A6 remained associated with age after adjustment for disease category and visual acuity (β = −0.030, p < 0.001), whereas visual acuity was not associated with questionnaire domains. A6 was negatively correlated with the VFQ-25 composite score (r = −0.693, p < 0.001) and remained associated with this score in multivariable analysis (β = −0.230, p < 0.001). Conclusions: Item-level PRO responses varied across clinical backgrounds and were not adequately explained by visual acuity alone. These findings suggest that patient-perceived visual change after treatment or disease management may provide complementary information on vision-related quality of life. Further studies using validated instruments and disease-specific severity measures are needed. Full article

(This article belongs to the Section Ophthalmology)

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19 pages, 2731 KB

Open AccessArticle

Prediction of Prolonged Length of Hospital Stay in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: An Interpretable Machine Learning Tool

by Jingjing Xiong, Lian Liu, Zhenni Chen, Weiling Cai, Jianjun Luo, Suli Liu, Jiangyue Qin, Fangying Chen, Xiaohua Li, Zhixin Qiu and Yongchun Shen

J. Clin. Med. 2026, 15(15), 6127; https://doi.org/10.3390/jcm15156127 - 6 Aug 2026

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Abstract

Objective: Reducing the length of hospital stay (LOS) is a core objective in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop an interpretable and clinically applicable machine learning tool for predicting prolonged LOS in this [...] Read more.

Objective: Reducing the length of hospital stay (LOS) is a core objective in the management of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study aimed to develop an interpretable and clinically applicable machine learning tool for predicting prolonged LOS in this population. Methods: This retrospective three-center study enrolled 1342 patients, who were randomly allocated to a training set (70%) and a test set (30%). Candidate predictors were screened using least absolute shrinkage and selection operator (LASSO) regression, and six machine learning models were developed and compared: logistic regression, random forest, gradient boosting machine, CatBoost, support vector machine, and neural network. Model discrimination was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis. Model interpretability was achieved through SHapley Additive exPlanations (SHAP) and subgroup analyses. Results: Prolonged LOS, defined as >10 days (the median LOS in the training set), occurred in 42.0% of patients. Nine predictors were identified, including daily inhaled medication use, sputum microbiological examination, antibiotic administration, corticosteroid therapy, diuretic use, ICU admission, oxygenation index, platelet count, and neutrophil count. The random forest model demonstrated superior and consistent discriminative performance, achieving an AUC of 0.778 (95% CI: 0.748–0.807) in the training set and 0.721 (95% CI: 0.672–0.771) in the test set. SHAP analysis ranked diuretic use, daily inhaled medication use, corticosteroid therapy, sputum microbiological examination, and antibiotic administration as the five most influential features, revealing treatment-related variables associated with prolonged LOS. Subgroup analyses indicated better predictive performance in lower-risk patients (age ≤ 65 years with eGFR 1–2 stage). Conclusions: Random Forest may enable to promptly identify prolonged LOS high-risk patients, enhancing clinical vigilance and optimizing healthcare resource allocation in AECOPD patients. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition)

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Graphical abstract

10 pages, 10531 KB

Open AccessCase Report

Bronchoscopy-Guided Intratracheal Suture Repair of Recurrent Tracheoesophageal Fistula in an Adolescent

by Lu Qin, Xiao-Fen Tao, Jia Liu, Ting Huang, Hu-Jun Wu, Guo-Ping Jin, Lan-Fang Tang and Lei Wu

J. Clin. Med. 2026, 15(15), 6126; https://doi.org/10.3390/jcm15156126 - 6 Aug 2026

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Abstract

Introduction: Managing recurrent congenital tracheoesophageal fistula (rTEF) is clinically challenging. Repeat thoracotomy is technically demanding due to dense adhesions and carries high morbidity, whereas outcomes of conventional endoscopic interventions vary, and sustained closure may be difficult to achieve in complex recurrent fistulas. We [...] Read more.

Introduction: Managing recurrent congenital tracheoesophageal fistula (rTEF) is clinically challenging. Repeat thoracotomy is technically demanding due to dense adhesions and carries high morbidity, whereas outcomes of conventional endoscopic interventions vary, and sustained closure may be difficult to achieve in complex recurrent fistulas. We report the use of bronchoscopy-guided intratracheal suturing in a refractory case. Case Presentation: A 17-year-old male with a history of congenital TEF experienced multiple recurrences despite two thoracotomies and one endoscopic clipping attempt. The procedure was performed under general anesthesia without endotracheal intubation, and superimposed high-frequency jet ventilation was used for airway management. Following electrocautery treatment of the visible tracheal-side margins, four interrupted absorbable sutures were placed through tissues adjacent to the fistula opening under bronchoscopic guidance. Tightening of the sutures approximated the visible fistula margins. The procedure lasted 62 min with no complications. Follow-up bronchoscopy, methylene blue testing, and esophagography at 2 weeks showed no evidence of fistula leakage, indicating early technical closure. At the 3-month telephone follow-up, the patient remained asymptomatic and reported normal oral intake and physical activity. These findings suggest early technical success; longer objective follow-up is required to assess durability. Conclusions: In this highly selected adolescent, bronchoscopy-guided intratracheal suturing was technically feasible and achieved early fistula closure without a perioperative complication. Longer objective follow-up after loss of suture tensile strength is required to determine whether closure can be maintained without mechanical suture support. Full article

(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions—2nd Edition)

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16 pages, 678 KB

Open AccessArticle

Exploring Multidimensional Diabetes Self-Management and Health-Related Functioning in Relation to Vascular Complications

by Claudiu Cobuz, Mădălina Ungureanu-Iuga, Iuliana Costescu, Alina Cornea and Maricela Cobuz

J. Clin. Med. 2026, 15(15), 6125; https://doi.org/10.3390/jcm15156125 - 6 Aug 2026

Viewed by 439

Abstract

Background/Objectives: Diabetes mellitus is associated with complex behavioral, psychosocial, and functional challenges that may influence disease burden and complication profiles. This study aimed to identify latent dimensions of diabetes self-management and health-related functioning and to evaluate their association with the type of [...] Read more.

Background/Objectives: Diabetes mellitus is associated with complex behavioral, psychosocial, and functional challenges that may influence disease burden and complication profiles. This study aimed to identify latent dimensions of diabetes self-management and health-related functioning and to evaluate their association with the type of diabetes-related complications. Methods: A cross-sectional study was conducted in 300 patients with type 2 diabetes, classified into microvascular and macrovascular complication groups. A questionnaire comprising DSMQ (diabetes self-management questionnaire) derived items, SF-36-derived items, and other questions was administered to all participants. Exploratory factor analysis was performed to identify latent dimensions related to self-management, emotional burden, dietary behavior, glycemic control challenges, glucose monitoring, and functional status. Composite scores were calculated for factors with acceptable internal consistency. Between-group comparisons, Spearman correlation analysis, and binary logistic regression models adjusted for age, sex, residence area, marital status, education, diabetes duration, and treatment type were applied. Results: Six latent factors were identified: Emotional Burden, Dietary Self-Management, Functional Limitations, Glycemic Control Challenges, Glucose Monitoring, and General Health Perception. However, only the factors demonstrating acceptable internal consistency were retained for subsequent analyses: Emotional Burden, Functional Limitations, and Glycemic Control Challenges. Functional Limitations showed the strongest association with complication type, with patients with macrovascular complications reporting greater functional impairment. After adjustment for potential confounders and correction for multiple comparisons, higher adherence to the recommended meal plan (DSMQ2) and greater functional limitations remained the principal differences between the complication groups. Functional Limitations Score remained independently associated with complication type in both unadjusted and adjusted logistic regression models. Conclusions: These cross-sectional findings support the integration of functional, psychosocial, and behavioral assessment into comprehensive diabetes care and highlight differences in patient-reported outcomes across complication groups. Full article

(This article belongs to the Special Issue Clinical Advances in Diabetes, Obesity, and Hypertension)

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13 pages, 2728 KB

Open AccessArticle

The Diagnostic and Prognostic Value of Immunohistochemical Markers in Bladder Cancer: A Real-World Study of 477 Patients

by Xingxing Tang, Jia Liu, Qiang Zhao, Xiao Yang, Yong Yang and Peng Du

J. Clin. Med. 2026, 15(15), 6124; https://doi.org/10.3390/jcm15156124 - 6 Aug 2026

Viewed by 462

Abstract

Introduction: To investigate the diagnostic and prognostic value of commonly used immunohistochemical markers regarding high-grade disease, muscle-invasion bladder cancer (MIBC) and survival in bladder cancer. Methods: A total of 477 patients diagnosed with bladder cancer at Peking University Cancer Hospital between [...] Read more.

Introduction: To investigate the diagnostic and prognostic value of commonly used immunohistochemical markers regarding high-grade disease, muscle-invasion bladder cancer (MIBC) and survival in bladder cancer. Methods: A total of 477 patients diagnosed with bladder cancer at Peking University Cancer Hospital between 2009 and 2024 were included. The immunohistochemical markers included CK7, CK20, GATA3, Uroplakin 3, CK5/6, P40, P63, Syn, CD56, CGA, Vimentin, S100, LCA, Ki67, P53, Her2, EGFR, PD-L1, PD-1 tumor, PD-1 stroma, and Pan-TRK. Logistic analyses were used to determine the diagnostic value of the markers for high-grade disease and MIBC. Cox regression analyses were used to determine the prognostic value of the markers for survival. Results: We found Ki67 positivity (p < 0.001) and Her2 positivity (p = 0.001) might have an association with high-grade disease, while no marker demonstrated diagnostic value for MIBC. Patients with CK7 positivity (p = 0.012), Uroplakin 3 positivity (p = 0.004), and PD-1 (stroma) positivity (p = 0.037) had better overall survival (OS) than those with negative expression, while Cox regression analyses showed only CK7 positivity (p = 0.025) and Uroplakin 3 positivity (p = 0.008) had prognostic value for better OS. However, considering there were only 2 CK7-negative patients, the sample size might be insufficient to demonstrate its prognostic value. Conclusions: These results suggest that Ki67 positivity and Her2 positivity might have association with high-grade disease, and Uroplakin 3 positivity might have prognostic value for better OS. However, these conclusions require further clarification through larger-scale studies in the future. Full article

(This article belongs to the Topic Biomarkers of Disease: Discovery and Clinical Applications)

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17 pages, 307 KB

Open AccessReview

Regulation and Use of Cannabidiol in Croatia Compared with Selected European and International Models: From Consumer Products to Clinical Practice

by Ana Batinic, Antonia Zecic, Zeljko Dujic and Davorka Sutlovic

J. Clin. Med. 2026, 15(15), 6123; https://doi.org/10.3390/jcm15156123 - 6 Aug 2026

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Abstract

Cannabidiol (CBD) has attracted growing scientific and clinical interest due to its potential therapeutic applications and increasing availability across Europe. This narrative review examined the regulatory status, market availability, and clinical use of CBD in Croatia in relation to selected European Union countries [...] Read more.

Cannabidiol (CBD) has attracted growing scientific and clinical interest due to its potential therapeutic applications and increasing availability across Europe. This narrative review examined the regulatory status, market availability, and clinical use of CBD in Croatia in relation to selected European Union countries and international reference models (Canada and Australia). A literature search was conducted using PubMed, Scopus, and Web of Science, complemented by official regulatory and governmental sources. The analysis included Croatia, Germany, the Netherlands, Slovenia, Italy, France, and Finland, while Canada and Australia were discussed as international reference models. Considerable differences were identified regarding the regulation of CBD-containing products, access to medical cannabis, reimbursement policies, clinical implementation, and the role of pharmacists. Germany and the Netherlands have established well-developed systems for medical cannabis use, whereas Finland represents a more restrictive regulatory model. In Croatia, CBD-containing products are widely available, but their integration into routine clinical practice remains limited. Regulatory uncertainty, insufficient professional training, and the lack of standardised clinical guidance were identified as important barriers. The findings suggest that the expansion of the consumer CBD market has generally outpaced the integration of cannabinoid-based therapies into healthcare practice across the countries included in this review. Improved professional training and clearer clinical guidance may facilitate their evidence-based implementation in clinical practice. Full article

(This article belongs to the Section Clinical Nutrition & Dietetics)

15 pages, 1706 KB

Open AccessArticle

Early Childhood Caries and Immunonutritional Status in Preschool Children: A Retrospective Comparative Study of the HALP Score and Hematological Biomarkers

by Peris Celikel, Yesim Yaptırmıs, Elif Bilici, Hacer Umay Ugurlu, Erol Emir Ceylan, Fuat Cetinkaya and Fatih Sengul

J. Clin. Med. 2026, 15(15), 6122; https://doi.org/10.3390/jcm15156122 - 6 Aug 2026

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Abstract

Background: Early childhood caries (ECC) is a common chronic disease in children and has been associated with systemic inflammatory and nutritional alterations. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score reflects immunonutritional status. This study investigated the associations of the HALP score [...] Read more.

Background: Early childhood caries (ECC) is a common chronic disease in children and has been associated with systemic inflammatory and nutritional alterations. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score reflects immunonutritional status. This study investigated the associations of the HALP score and hematological parameters with ECC, caries burden, and periapical disease severity. Methods: This retrospective comparative study included 126 preschool children: 97 with ECC and 29 caries-free controls. Participants were further classified into low (Periapical Index (PAI) 1–3) and high (PAI 4–5) periapical disease severity groups according to the highest Periapical Index score. The HALP score was calculated using the standard formula. Statistical significance was set at p < 0.05. Results: No statistically significant association was detected between the HALP score and ECC, dmft, or periapical disease severity (p > 0.05). Albumin levels were higher in the ECC group than in controls (p < 0.001). Neither the HALP score nor its individual hematological components were associated with caries burden in negative binomial regression analyses (p > 0.05). Greater caries burden was independently associated with severe periapical disease (Odds Ratio (OR) = 1.19, 95% Confidence Interval (CI): 1.09–1.30, p < 0.001), whereas hemoglobin was not (p = 0.052). Conclusions: No statistically significant association was detected between the HALP score and ECC status, caries burden, or periapical disease severity. Although albumin levels differed between children with ECC and caries-free controls, neither the HALP score nor its individual hematological components were independently associated with caries burden. Larger prospective multicenter studies are needed to validate these findings. Full article

(This article belongs to the Special Issue Dental Care and Oral Health in Adolescents and Children)

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15 pages, 851 KB

Open AccessArticle

Hydroxychloroquine Exposure Intensity During Early Pregnancy and Composite Fetal Adverse Pregnancy Outcomes in Systemic Lupus Erythematosus: A Retrospective Cohort Study

by Meng Jiang, Yanling Chang and Jiayue Wu

J. Clin. Med. 2026, 15(15), 6121; https://doi.org/10.3390/jcm15156121 - 6 Aug 2026

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Abstract

Background: Hydroxychloroquine (HCQ) is commonly recommended during pregnancy in women with systemic lupus erythematosus (SLE), but real-world patterns of early-pregnancy HCQ continuation, reduction, or interruption remain clinically relevant. This study aimed to evaluate the association between HCQ exposure intensity during early pregnancy [...] Read more.

Background: Hydroxychloroquine (HCQ) is commonly recommended during pregnancy in women with systemic lupus erythematosus (SLE), but real-world patterns of early-pregnancy HCQ continuation, reduction, or interruption remain clinically relevant. This study aimed to evaluate the association between HCQ exposure intensity during early pregnancy and composite fetal adverse pregnancy outcomes in pregnancies complicated by SLE. Methods: This retrospective cohort study included 513 pregnancies complicated by SLE. HCQ exposure intensity during early pregnancy, defined as conception to 13 weeks and 6 days of gestation, was classified into three groups: no HCQ exposure, reduced/interrupted HCQ exposure, and full HCQ exposure. The primary outcome was composite fetal adverse pregnancy outcome, defined as fetal loss, preterm birth, or fetal growth restriction. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with full HCQ exposure as the reference group. Results: Among 513 pregnancies, 96 (18.7%) had no HCQ exposure, 68 (13.3%) had reduced/interrupted HCQ exposure, and 349 (68.0%) had full HCQ exposure during early pregnancy. Composite fetal adverse pregnancy outcomes occurred in 47/96 (49.0%), 48/68 (70.6%), and 136/349 (39.0%) pregnancies, respectively (p < 0.001). After adjustment for maternal age, primiparity, lupus nephritis history, antiphospholipid antibody positivity, chronic hypertension, prednisone dose > 15 mg/day, and baseline immunosuppressant use, reduced/interrupted HCQ exposure was associated with higher odds of composite fetal adverse pregnancy outcome compared with full HCQ exposure (adjusted OR 4.17, 95% CI 2.25–7.75, p < 0.001). No independent association was observed for no HCQ exposure after adjustment (adjusted OR 1.30, 95% CI 0.78–2.16, p = 0.309). Conclusions: In pregnancies complicated by SLE, reduced or interrupted HCQ exposure during early pregnancy was independently associated with an increased risk of composite fetal adverse pregnancy outcomes, while no independent association was observed for no HCQ exposure after adjustment for baseline risk factors. These findings highlight the potential clinical importance of maintaining HCQ treatment continuity during early pregnancy. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 583 KB

Open AccessArticle

Exploratory Evaluation of Combined Hormonal Indices in Non-Obstructive Azoospermia: Diagnostic Performance and Prediction of TESE Success

by Sakine Merve Aydın, Neset Gumusburun, Naziye Gurkan, Nazan Yurtcu, Canan Soyer Calıskan, Zehra Yılmaz and Muhammet Sahin Yılmaz

J. Clin. Med. 2026, 15(15), 6120; https://doi.org/10.3390/jcm15156120 - 6 Aug 2026

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Abstract

Background: The aim of this study was to evaluate the diagnostic performance of combined testicular function indices in patients with non-obstructive azoospermia and to investigate the clinical value of these indices in predicting the diagnosis of non-obstructive azoospermia and the success of testicular [...] Read more.

Background: The aim of this study was to evaluate the diagnostic performance of combined testicular function indices in patients with non-obstructive azoospermia and to investigate the clinical value of these indices in predicting the diagnosis of non-obstructive azoospermia and the success of testicular sperm extraction. Methods: This retrospective observational study included 224 male patients who underwent infertility assessment. The patients were classified into a normospermic group (n = 165) and a non-obstructive azoospermia group (n = 59). Serum anti-Müllerian hormone, follicle-stimulating hormone, luteinising hormone and total testosterone levels were assessed. The Testicular Function Index, the modified Testicular Function Index and the logarithmically transformed index were calculated. Patients in the non-obstructive azoospermia group underwent micro-TESE and were classified according to sperm retrieval status. Diagnostic performance was assessed using ROC analysis. Results: Among the 59 patients with non-obstructive azoospermia who underwent micro-TESE, sperm retrieval was successful in 26 patients and unsuccessful in 33 patients. In the non-obstructive azoospermia group, anti-Müllerian hormone and testosterone levels were lower, whilst follicle-stimulating hormone and luteinising hormone levels were higher (all p < 0.001). All combined indices were found to be significantly lower in the non-obstructive azoospermia group (all p < 0.001). In the ROC analysis, follicle-stimulating hormone demonstrated the highest discriminatory performance (AUC = 0.978). In the testicular sperm extraction analysis, anti-Müllerian hormone was found to be the marker with the highest performance (AUC = 0.930). Conclusions: (Follicle-stimulating hormone demonstrated the highest diagnostic performance for distinguishing non-obstructive azoospermia, whereas anti-Müllerian hormone was the strongest predictor of TESE success. Although the combined testicular function indices showed good diagnostic performance, they did not outperform these established hormonal markers and should therefore be regarded as complementary tools for the integrated assessment of testicular function. These findings should be considered exploratory and require further validation. Full article

(This article belongs to the Special Issue Clinical Aspects of Male Infertility and Azoospermia)

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14 pages, 1420 KB

Open AccessArticle

An Evidence-Informed Clinical Pathway for COPD Exacerbations in Emergency Departments: Diagnostic Assessment, Severity Stratification, and Individualized Management

by Rafael Suarez del Villar Carrero, Santiago Toranzo-Nieto and Laura Álvarez Santin

J. Clin. Med. 2026, 15(15), 6119; https://doi.org/10.3390/jcm15156119 - 6 Aug 2026

Viewed by 615

Abstract

Background/Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are a common reason for emergency department (ED) attendance and hospital admission. Acute respiratory worsening is non-specific, and previous spirometric confirmation may be unavailable at presentation. We aimed to translate current recommendations into an ED-specific [...] Read more.

Background/Objectives: Exacerbations of chronic obstructive pulmonary disease (COPD) are a common reason for emergency department (ED) attendance and hospital admission. Acute respiratory worsening is non-specific, and previous spirometric confirmation may be unavailable at presentation. We aimed to translate current recommendations into an ED-specific clinical pathway that standardizes safety-critical steps without replacing individualized clinical judgment. Methods: We performed a targeted synthesis of international and Spanish guidance and key studies relevant to ED diagnosis, severity assessment, pharmacological treatment, respiratory support, antimicrobial stewardship, and disposition. The evidence base was updated in June 2026, and the pathway was reviewed by a multidisciplinary clinical group. Results: The revised pathway comprises four stages: (1) verify previous COPD confirmation, identify an acute exacerbation-like syndrome, and assess alternative or concomitant diagnoses; (2) grade acute severity using point-of-care variables and separately assess patient vulnerability; (3) provide severity-adjusted treatment with early reassessment; and (4) determine disposition and follow-up. It incorporates controlled oxygen, individualized bronchodilator delivery, explicit criteria for systemic corticosteroids and antibiotics, assessment of risk for Pseudomonas aeruginosa, non-invasive ventilation (NIV), and a defined adjunctive role for high-flow nasal cannula (HFNC). Patients without previous post-bronchodilator spirometry are classified as having suspected COPD and require confirmation after recovery. Conclusions: This evidence-informed pathway is a preliminary clinical framework, not a diagnostic rule or validated decision instrument. It is intended to support, rather than replace, professional judgment. Feasibility, acceptability, diagnostic safety, and clinical impact require prospective evaluation, beginning with a pilot implementation study. Full article

(This article belongs to the Special Issue Chronic Obstructive Pulmonary Disease (COPD): Treatment and Management—Second Edition)

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12 pages, 1270 KB

Open AccessArticle

MELD 3.0 Score and Time to Discharge After Pericardiectomy: A Competing Risks Analysis in Tuberculous Constrictive Pericarditis

by Xiaoqiang Gao, Shuzhen Wang, Xin Zhang, Jing Guo, Kunyue Tan, Hong Liu, Wenqian Wu and Feng Xiong

J. Clin. Med. 2026, 15(15), 6118; https://doi.org/10.3390/jcm15156118 - 6 Aug 2026

Viewed by 373

Abstract

Background/Objectives: Tuberculous constrictive pericarditis (TCP) is characterized by “backward failure” and systemic venous congestion, leading to secondary multi-organ dysfunction. The Model for End-Stage Liver Disease (MELD) 3.0 score assesses liver, renal, and nutritional status, yet its prognostic utility in TCP remains undefined. [...] Read more.

Background/Objectives: Tuberculous constrictive pericarditis (TCP) is characterized by “backward failure” and systemic venous congestion, leading to secondary multi-organ dysfunction. The Model for End-Stage Liver Disease (MELD) 3.0 score assesses liver, renal, and nutritional status, yet its prognostic utility in TCP remains undefined. This study aimed to evaluate the preoperative MELD 3.0 score as a predictor of time to discharge in patients undergoing pericardiectomy for TCP. Methods: We analyzed 190 patients undergoing pericardiectomy for TCP between 2018 and 2024. The association between preoperative MELD 3.0 scores and time to discharge (ICU, postoperative, and total) was assessed using Fine–Gray competing risks regression to account for in-hospital mortality. Models were adjusted for age, albumin, and anti-tuberculosis therapy. Results: Each unit increase in MELD 3.0 was associated with higher operative mortality (OR 1.21, p = 0.013). In multivariable analysis, a high MELD 3.0 score (>median 9.6) was independently associated with a lower probability of discharge (i.e., delayed discharge) for total hospital stay (subdistribution hazard ratio [sHR] 0.606, 95% CI 0.453–0.811), postoperative stay (sHR 0.665), and ICU stay (sHR 0.658). Preoperative albumin was also a strong predictor of faster discharge. Conclusions: The preoperative MELD 3.0 score independently predicts delayed hospital discharge after pericardiectomy for TCP, even when accounting for mortality risk. It serves as a pragmatic tool for quantifying the systemic burden of congestion and stratifying perioperative risk. Full article

(This article belongs to the Section Cardiology)

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14 pages, 1085 KB

Open AccessArticle

Quantitative HRCT-Derived Fibrosis Burden as an Independent Predictor of Mortality in Patients with Idiopathic Pulmonary Fibrosis: A Retrospective Observational Study

by Burcu Akkok, Hatice Sahin and Betul Kizildag

J. Clin. Med. 2026, 15(15), 6117; https://doi.org/10.3390/jcm15156117 - 6 Aug 2026

Viewed by 396

Abstract

Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with increasing prevalence and mortality. High-resolution computed tomography (HRCT) is routinely performed in IPF assessment and can provide additional quantitative information. However, the prognostic utility of these HRCT-based parameters in IPF remains [...] Read more.

Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with increasing prevalence and mortality. High-resolution computed tomography (HRCT) is routinely performed in IPF assessment and can provide additional quantitative information. However, the prognostic utility of these HRCT-based parameters in IPF remains uncertain. This study aimed to investigate the prognostic value of quantitative HRCT findings in predicting mortality among patients with IPF. Methods: In this retrospective cohort study, 48 patients diagnosed with IPF between 2014 and 2024 were analyzed. Demographics, pulmonary function tests, HRCT findings, and quantitative measurements, including coronary artery calcium (CAC) score; densities of hepatic, paraspinal muscle, and lumbar vertebral bone mineral; and HRCT-derived fibrosis scores, were collected at baseline and after at least two years. The primary outcome was all-cause mortality. Results: The mean age was 66.8 ± 8.5 years; 77.1% were male. During a median follow-up of 63.3 months, 22 patients (45.8%) died, mainly from IPF-related causes (71.4%). Non-survivors had significantly higher HRCT fibrosis scores both at diagnosis (p = 0.006) and at two years (p = 0.002). Fibrosis scores increased significantly over time in non-survivors (p = 0.019). CAC scores rose in both groups, with a greater increase in non-survivors, but their independent prognostic value was limited after adjustment. Multivariable analysis identified male sex (hazard ratio [HR]: 5.46, p = 0.031) and second-year fibrosis score (HR: 1.10, p < 0.001) as independent predictors of mortality. Conclusions: HRCT-derived fibrosis burden is an independent predictor of mortality in IPF, alongside male sex. While other HRCT-based measures showed limited prognostic significance, longitudinal increases in CAC scores suggested potential cardiovascular implications. Full article

(This article belongs to the Section Respiratory Medicine)

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17 pages, 6173 KB

Open AccessArticle

Equivalent Clinical Outcomes but Divergent Biological Adaptation After Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Longitudinal MRI Cohort Study

by Evren Sönmez, Lokman Ayhan, Said Onar, Ergin Anlı, Abdurrahim Tekin, Engin Can, Selçuk Yapar, Akın Öztürk, Suna Dilbaz, Nuri Serdar Baş and Serdar Çevik

J. Clin. Med. 2026, 15(15), 6116; https://doi.org/10.3390/jcm15156116 - 6 Aug 2026

Viewed by 388

Abstract

Background/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after [...] Read more.

Background/Objectives: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) can produce comparable short-term clinical outcomes, but their regional effects on cervical muscle morphology are incompletely characterized. This study compared 12-month clinical outcomes and quantitative magnetic resonance imaging (MRI) changes after single-level C6–7 ACDF and CDA. Methods: This retrospective longitudinal cohort included 100 age-, sex-, and body mass index-matched patients (50 ACDF and 50 CDA). Neck and arm pain were assessed on 0–10 scales, and the Neck Disability Index (NDI) was analyzed as a 0–50-point score. Regional muscle cross-sectional area (CSA) and fatty infiltration (FI) were quantified on standardized preoperative and 12-month axial T2-weighted turbo spin-echo images at C6–7. The primary analysis included four posterior muscles. CSA change was expressed relative to baseline, whereas FI change was expressed in percentage points. Results: Clinical outcomes were statistically indistinguishable at 12 months (neck-pain score, 0.50 vs. 0.36, p = 0.318; NDI, 2.6 vs. 2.2 points, p = 0.479; perfect-outcome rate, 68.0% in both groups). Both groups showed significant regional posterior muscle CSA reduction and FI increase; however, the magnitude was greater after ACDF than after CDA (CSA reduction, −15% to −19% vs. −5% to −9%; absolute FI increase, +5.1 to +8.2 vs. +1.1 to +2.3 percentage points; all between-group q < 0.001). Surgical technique was independently associated with both MRI change metrics. Greater regional CSA reduction was modestly associated with higher concurrent 12-month neck-pain scores (β = −0.26, p = 0.022). This concurrent association does not establish causation or predict outcomes beyond 12 months. Conclusions: ACDF and CDA produced equivalent measured clinical outcomes at 12 months, while CDA showed a more favorable regional posterior muscle MRI profile. Differential device-related artifact was not quantitatively assessed and cannot be completely excluded, although concordant findings across four implant-remote posterior muscles make artifact unlikely to be the sole explanation. The functional and longer-term clinical significance of this imaging difference is not established and requires prospective longitudinal study. Full article

(This article belongs to the Special Issue Advances in Cervical Spine Surgery: Techniques, Outcomes, and Complications)

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22 pages, 1427 KB

Open AccessArticle

Longitudinal Clinical and Microscopic Findings After Dequalinium Chloride Treatment in Vulvovaginal Infections: A Retrospective Real-World Study from Mexican Gynecological Practice

by Gerardo Casanova-Román, Carolina Navarro-Venegas, Verónica Ávalos-López, Cinthya Verver-Moreno, Henry Velazquez-Soto, Nataly Arellano-Contreras, Isabel Garza Ramos Raya, Israel Casanova-Méndez and on behalf of the AMEGINE Clinical Research Group

J. Clin. Med. 2026, 15(15), 6115; https://doi.org/10.3390/jcm15156115 - 6 Aug 2026

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Abstract

Background: Vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection are among the most common infectious conditions encountered in gynecological practice. Although intravaginal dequalinium chloride exhibits broad antimicrobial activity, real-world longitudinal data describing treatment-associated clinical and microscopic changes remain limited, particularly in Latin [...] Read more.

Background: Vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection are among the most common infectious conditions encountered in gynecological practice. Although intravaginal dequalinium chloride exhibits broad antimicrobial activity, real-world longitudinal data describing treatment-associated clinical and microscopic changes remain limited, particularly in Latin American populations. Objective: We aimed to characterize the short-term longitudinal evolution of clinical manifestations, vaginal pH, and fresh wet-mount microscopic findings in women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection treated with intravaginal dequalinium chloride during routine outpatient gynecological care. Methods: This retrospective longitudinal study included non-pregnant women with vulvovaginal candidiasis, bacterial vaginosis, or mixed vaginal infection who received intravaginal dequalinium chloride as the sole anti-infective therapy. Patients were evaluated at baseline, treatment completion (Day 7), and post-treatment follow-up (Day 14). Longitudinal assessment included patient-reported symptoms, physician-assessed clinical findings, vaginal pH, and fresh wet-mount microscopic examination. To ensure consistent evaluation across study visits, predefined protocol-based standardized assessment criteria were applied uniformly to all patients. Repeated-measures non-parametric analyses were performed to compare longitudinal changes over time. Results: Sixty-nine women were included, comprising those with vulvovaginal candidiasis (n = 24), bacterial vaginosis (n = 31), and mixed vaginal infection (n = 14). Significant longitudinal improvement was observed in clinical manifestations, vaginal pH, and fresh microscopic findings across all diagnostic groups (all p < 0.0001). Median composite assessment scores decreased from 8 (IQR 6–10) at baseline to 3 (IQR 1–5) at treatment completion and to 1 (IQR 0–3) at post-treatment follow-up. Improvements in vaginal pH were accompanied by reductions in inflammatory and infection-associated microscopic findings and by increased predominance of Döderlein bacilli during follow-up. Intravaginal dequalinium chloride was generally well tolerated, with only mild transient adverse events documented. Conclusions: In this retrospective longitudinal study, intravaginal dequalinium chloride treatment was associated with short-term changes in clinical manifestations, vaginal pH, and fresh microscopic findings among women with vulvovaginal candidiasis, bacterial vaginosis, and mixed vaginal infection. These findings describe short-term treatment-associated changes observed in routine clinical practice but do not establish comparative efficacy, causality, or microbiological cure. Prospective controlled studies incorporating standardized microbiological endpoints and longer follow-up are warranted to confirm these observations. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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16 pages, 1340 KB

Open AccessArticle

The Gemini Eye in Microsurgery: Video-Based Capillary Refill and Chromatic Assessment for Free Flap Monitoring

by Ebru Aşiret, Burak Yaşar, Büşra Taş Efe, Süleyman Ege Tozan, Hasan Murat Ergani and Ramazan Erkin Ünlü

J. Clin. Med. 2026, 15(15), 6114; https://doi.org/10.3390/jcm15156114 - 6 Aug 2026

Viewed by 471

Abstract

Background/Objectives: Postoperative free flap monitoring relies on clinical assessment of colour, turgor, and capillary refill time (CRT). The high frequency of required assessments renders this process labour-intensive and inherently subjective, with sensitivity dependent on observer experience and fatigue. This study evaluated the [...] Read more.

Background/Objectives: Postoperative free flap monitoring relies on clinical assessment of colour, turgor, and capillary refill time (CRT). The high frequency of required assessments renders this process labour-intensive and inherently subjective, with sensitivity dependent on observer experience and fatigue. This study evaluated the feasibility of a large multimodal AI (Artificial Intelligence) model (Gemini 3 Flash, Google AI Studio) applied without any task-specific training or fine-tuning, with each video analysed in an independent session, to establish whether meaningful diagnostic agreement is achievable before any domain-specific training is introduced, with the ultimate goal of supporting the development of a machine-based secondary safety net that augments, rather than replaces, the primary clinical assessment of the responsible surgeon in postoperative free flap surveillance. Methods: One hundred and forty-three postoperative video recordings from 143 different patients who underwent fasciocutaneous free flap reconstruction for extraoral defects were analysed. The cohort was deliberately enriched for pathological cases to ensure adequate representation of each vascular compromise category. Assessment was based on intrapatient comparison between flap and adjacent native tissue, without task-specific training or prior clinical information. AI outputs were compared against consensus assessments of three senior plastic surgeons (two associate professors, one full professor) for four parameters: flap colour, turgor, CRT interpretation, and clinical diagnosis. Agreement was evaluated using Cohen’s kappa (κ). Receiver operating characteristic (ROC) analysis assessed the discriminative performance of the AI confidence score. Results: Statistically significant agreement was demonstrated across all four parameters (p < 0.001 for all): flap colour (κ = 0.613, 95% CI: 0.489–0.737, 80.4%), turgor (κ = 0.676, 95% CI: 0.558–0.794, 83.9%; assessed from visual surrogates rather than direct palpation), CRT interpretation (κ = 0.487, 95% CI: 0.360–0.614, 74.1%), and clinical diagnosis (κ = 0.524, 95% CI: 0.399–0.649, 74.1%). Normal flaps were correctly identified in 81.0% of cases and venous compromise in 69.4%. ROC analysis identified a confidence score percentile cutoff of 89 as the optimal threshold for discriminating compromised from normal flaps, with scores below 89 indicating a compromised (pathological) result (AUC = 0.667, 95% CI: 0.579–0.755; sensitivity 77.0%, specificity 52.4%; overall accuracy 62.9%). Conclusions: A structured-prompted multimodal LLM (Large Language Model) demonstrated statistically significant agreement with the consensus judgement of senior plastic surgeons in postoperative free flap assessment without task-specific training, relying solely on intrapatient visual comparison. These findings constitute a proof-of-concept for AI-based video analysis as a potential adjunctive approach in free flap surveillance, warranting prospective validation with independent clinical outcome data before any claim of clinical utility, with possible broader applicability across clinical domains pending such validation. Key limitations include the absence of independent clinical outcome or confirmation of diagnostic categories, deliberately enriched sampling, a small arterial insufficiency subgroup, and the current absence of a formal data processing agreement for the cloud-based AI platform used. Full article

(This article belongs to the Special Issue Integrating Artificial Intelligence into Plastic, Reconstructive, and Aesthetic Surgery: Innovations, Challenges, and Clinical Application)

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18 pages, 13700 KB

Open AccessSystematic Review

The Efficacy and Safety of Neoadjuvant Immunotherapy in Pan-Squamous Cell Carcinomas: A Meta-Analysis of Esophageal, Head and Neck, Cervical, Lung, Cutaneous, and Oral Squamous Cell Carcinomas

by Xiaotong Fu, Shuiqing Xu and Ming Wang

J. Clin. Med. 2026, 15(15), 6113; https://doi.org/10.3390/jcm15156113 - 6 Aug 2026

Viewed by 508

Abstract

Background: Squamous cell carcinomas (SCCs) share squamous differentiation and may engage the programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) pathway, although their causes, biology, and treatment differ by anatomical site. We evaluated tumor response, short-term survival, and grade 3–4 adverse events [...] Read more.

Background: Squamous cell carcinomas (SCCs) share squamous differentiation and may engage the programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) pathway, although their causes, biology, and treatment differ by anatomical site. We evaluated tumor response, short-term survival, and grade 3–4 adverse events after neoadjuvant immune-checkpoint blockade, with or without chemotherapy, followed by surgery. Methods: A comprehensive search of PubMed, Embase, the Cochrane Library, and clinical trial registries was conducted from inception to October 2024. Prospective and retrospective studies evaluating neoadjuvant immunotherapy, with or without chemotherapy, before surgery in patients with SCC were included. In mixed-histology studies, data were eligible only when SCC outcomes could be extracted separately. Pooled proportions and 95% confidence intervals (CIs) were estimated with random-effects models. Results: A total of 44 studies involving 2586 patients with six anatomical SCC groups were included. The pooled objective response rate (ORR) was 0.70 (95% CI, 0.59–0.80), clinical complete response (cCR) rate was 0.17 (95% CI, 0.10–0.28), and pathological complete response (pCR) rate was 0.30 (95% CI, 0.27–0.34). The pooled 1-year progression-free survival (PFS), disease-free survival (DFS), and overall survival (OS) rates were 0.82 (95% CI, 0.79–0.86), 0.86 (95% CI, 0.75–0.92), and 0.92 (95% CI, 0.90–0.93), respectively. The pooled incidence of grade 3–4 adverse events was 0.18 (95% CI, 0.14–0.23). Because the PD-L1 subgroup contained only one study for most outcomes, checkpoint-target subgroup findings were considered exploratory. Conclusions: Existing predominantly single-arm evidence suggests antitumor activity of neoadjuvant immune-checkpoint blockade, with or without chemotherapy, in selected patients with resectable SCC. Because esophageal SCC accounted for most studies and clinical heterogeneity was substantial, these pooled proportions should not be interpreted as comparative effects or as evidence of uniform benefit across SCC sites. Full article

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

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10 pages, 493 KB

Open AccessArticle

Association of the Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) Score with Diabetic Retinopathy Severity: A Case–Control Comparison with Non-Diabetic Ophthalmology Patients

by Nurcan Gürsoy and Ersan Gürsoy

J. Clin. Med. 2026, 15(15), 6112; https://doi.org/10.3390/jcm15156112 - 6 Aug 2026

Viewed by 305

Abstract

Background/Objectives: The hemoglobin–albumin–lymphocyte–platelet (HALP) score combines routine laboratory measures into an index of systemic immune–nutritional status. Its relationship with graded diabetic retinopathy (DR) severity is not fully established. We compared HALP between patients with DR and ophthalmology controls without documented diabetes and examined [...] Read more.

Background/Objectives: The hemoglobin–albumin–lymphocyte–platelet (HALP) score combines routine laboratory measures into an index of systemic immune–nutritional status. Its relationship with graded diabetic retinopathy (DR) severity is not fully established. We compared HALP between patients with DR and ophthalmology controls without documented diabetes and examined its association with retinopathy stage and proliferative disease. Methods: This prospective single-center case–control study enrolled 209 consecutive adults: 105 patients with DR and 104 controls. DR was recorded across eight ordered stages and additionally classified as non-proliferative DR (NPDR) or proliferative DR (PDR). Between-group tests, Spearman correlation, logistic regression, and receiver operating characteristic analysis were used. Results: HALP was lower in the DR group than in controls (47.47 [26.44] vs. 52.67 [31.83], p = 0.048) and in PDR than in NPDR (45.98 [17.62] vs. 52.90 [42.49], p = 0.008). HALP declined modestly with increasing stage (rho = −0.260, p = 0.007). In an exploratory age- and sex-adjusted model, each 10-unit increase in HALP was associated with lower odds of case-group membership (OR = 0.850, 95% CI: 0.750–0.963; p = 0.011). Within the DR cohort, HALP was not significantly associated with PDR after adjustment for age, sex, and HbA1c (OR = 0.809, 95% CI: 0.640–1.023; p = 0.077). Discrimination between cases and controls was limited (AUC = 0.579); a threshold of ≤52.09 provided 62.9% sensitivity and 53.8% specificity. Conclusions: Lower HALP values accompanied DR case status and greater retinopathy severity, but the adjusted association with PDR was not significant. Because diabetes status differed between groups, the case–control finding may reflect systemic effects of diabetes as well as retinal involvement. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Diabetic Retinopathy)

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15 pages, 4488 KB

Open AccessReview

The Role of Wearable Devices in the Management of Congenital Heart Disease

by Inés Martínez-Saludes, Cristina Ruiz-Herguido, Joan Sanchez de Toledo, David Ferri-Rufete, Silvia Montserrat, David Viñas Fernandez, Eduardo Flores-Umanzor and Raquel Luna-López

J. Clin. Med. 2026, 15(15), 6111; https://doi.org/10.3390/jcm15156111 - 6 Aug 2026

Viewed by 457

Abstract

Patients with congenital heart disease (CHD) represent a special healthcare challenge due to their high complexity, which accompanies them throughout all life stages. Consequently, this population faces increased morbidity and mortality rates, often linked to hemodynamic shifts in pulmonary flow or cardiac output. [...] Read more.

Patients with congenital heart disease (CHD) represent a special healthcare challenge due to their high complexity, which accompanies them throughout all life stages. Consequently, this population faces increased morbidity and mortality rates, often linked to hemodynamic shifts in pulmonary flow or cardiac output. These risks are further compounded by potential arrhythmias and heart failure decompensation, which may lead to the progressive progression toward advanced stages of the disease. Unfortunately, standard outpatient follow-up is often not capable of responding to the continuous monitoring needs presented by these patients and their families. This selective review frames information on the wearable devices that have emerged as a key solution for continuous and remote monitoring. Beyond clinical tracking, research is increasingly focusing on their role in assessing physical activity—a critical determinant of health outcomes in the CHD population. This review examines the existing literature on wearable technology in both pediatric and adult patients while also addressing the current limitations that hinder their integration into routine clinical practice. Full article

(This article belongs to the Special Issue Congenital Heart Diseases: Epidemiology, Treatment and Lifelong Support)

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19 pages, 1089 KB

Open AccessArticle

Clinical Impact of Multidrug-Resistant Bacterial Infections in Critically Ill Patients: A Retrospective Cohort Study

by Mateusz Bartoszewicz, Ewa Płonowska, Marta Krysik, Jerzy Robert Ładny and Sławomir Lech Czaban

J. Clin. Med. 2026, 15(15), 6110; https://doi.org/10.3390/jcm15156110 - 6 Aug 2026

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Abstract

Background/Objectives: Antimicrobial-resistant bacterial infections are frequent in intensive care units (ICUs), but the independent effect of multidrug resistance relative to infection with susceptible organisms remains uncertain. We compared clinical characteristics, microbiology, treatment intensity, and in-hospital mortality among patients with no documented bacterial infection, [...] Read more.

Background/Objectives: Antimicrobial-resistant bacterial infections are frequent in intensive care units (ICUs), but the independent effect of multidrug resistance relative to infection with susceptible organisms remains uncertain. We compared clinical characteristics, microbiology, treatment intensity, and in-hospital mortality among patients with no documented bacterial infection, antimicrobial-susceptible infection, or multidrug-resistant (MDR) infection. Methods: We conducted a single-center retrospective cohort study of the first eligible ICU hospitalization for each patient at the University Clinical Hospital in Bialystok, Poland, from 1 January 2017 to 1 June 2023. Infection groups were assigned using clinical documentation, microbiological results, and local laboratory resistance-phenotype coding; patients with multiple isolates were classified according to the most resistant clinically relevant isolate. Multivariable logistic regression evaluated associations with in-hospital mortality. Results: Among 3326 patients, 1413 (42.5%) had a documented bacterial infection: 481 (34.0% of infected patients) had susceptible infection and 932 (66.0%) had MDR infection. Crude mortality was 45.5%, 46.8%, and 48.4% in the no-infection, susceptible-infection, and MDR-infection groups, respectively (p = 0.354), whereas mean ICU length of stay was 10.0, 15.5, and 25.2 days (p < 0.001). In the complete-case whole-cohort model (n = 678), MDR infection (adjusted OR 2.70, 95% CI 1.84–3.96) and susceptible infection (adjusted OR 2.16, 95% CI 1.26–3.69) were associated with in-hospital death versus no infection. Within the infected cohort (n = 352), MDR status was not independently associated with mortality versus susceptible infection (adjusted OR 1.09, 95% CI 0.61–1.93). Conclusions: MDR infection identified patients with prolonged ICU exposure and greater organ-support requirements but did not independently increase mortality relative to susceptible infection. Interpretation is limited by the retrospective single-center design, complete-case analysis, and absence of time-resolved MDR acquisition data. Full article

(This article belongs to the Section Infectious Diseases)

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10 pages, 392 KB

Open AccessArticle

Is Total Hip Arthroplasty Feasible in Patients with Severe Preoperative Thrombocytopenia Managed by a Structured Perioperative Protocol? A Propensity Score-Matched Cohort Study

by Jong Min Park, Jae Hak Lim, Ji Hoon Bahk, Woo Lam Jo, Saad Mohammed AlShammari and Young Wook Lim

J. Clin. Med. 2026, 15(15), 6109; https://doi.org/10.3390/jcm15156109 - 6 Aug 2026

Viewed by 255

Abstract

Background/Objectives: Total hip arthroplasty (THA) routinely produces perioperative blood loss of 800–1200 mL, which raises concern that patients with thrombocytopenia may be at substantially higher surgical risk. Evidence on THA safety in this population, however, remains scarce. We compared perioperative and functional [...] Read more.

Background/Objectives: Total hip arthroplasty (THA) routinely produces perioperative blood loss of 800–1200 mL, which raises concern that patients with thrombocytopenia may be at substantially higher surgical risk. Evidence on THA safety in this population, however, remains scarce. We compared perioperative and functional outcomes of THA between patients with preoperative platelet counts below 80 × 10⁹ cells/L and propensity score-matched controls with normal counts. Methods: In this retrospective matched cohort study, we reviewed 972 consecutive primary THAs. From this cohort, 30 patients with baseline platelet counts below 80 × 10⁹ cells/L were identified and matched 1:2 with 60 control patients who had normal platelet counts (≥150 × 10⁹ cells/L) using 1:2 nearest-neighbor matching. For all patients in the thrombocytopenic group, platelet counts were corrected to above 80 × 10⁹ cells/L prior to surgery; thus, the study evaluates outcomes after preoperative hematologic optimization rather than surgery performed at uncorrected thrombocytopenic levels. All patients were closely monitored for at least one week postoperatively to evaluate complications and clinical outcomes. Results: Operative time (78.2 vs. 78.8 min, p = 0.898), estimated blood loss (492 vs. 505 mL, p = 0.821), hematoma rate (6.7% vs. 1.7%, p = 0.257), surgical site infection (6.7% vs. 1.7%, p = 0.257), and Harris Hip Scores (86.1 vs. 85.7, p = 0.615) did not differ significantly between groups, although the absolute wound-complication rates were numerically about four-fold higher in the thrombocytopenic group and the small sample limited statistical power. The study group did require more packed red blood cell transfusions (7.43 vs. 1.4 units, p < 0.001) and had longer hospital stays (9.8 vs. 6.0 days, p = 0.017). Conclusions: When severe preoperative thrombocytopenia is corrected to above 80 × 10⁹ cells/L and managed with a structured perioperative protocol—meticulous intraoperative hemostasis and close postoperative surveillance for re-bleeding—THA can be performed with acceptable wound complication rates and functional outcomes and without catastrophic hemorrhage. Transfusion requirements and hospital stay remain higher, and the small sample size precludes concluding that the risk of infrequent complications is equivalent to that of patients with normal platelet counts. THA is therefore feasible, rather than unequivocally safe, under careful hematologic optimization. Full article

(This article belongs to the Special Issue Total Hip Arthroplasty Today: Trends, Challenges, and Future Directions)

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16 pages, 6598 KB

Open AccessArticle

Artificial Intelligence Reading of Postoperative Cochlear Implant X-Rays

by Mariam Aljehani, Faris Albassam, Ebtesam Aljohani, Fida AlMuhawas, Farid Alzhrani and Abdulrahman Hagr

J. Clin. Med. 2026, 15(15), 6108; https://doi.org/10.3390/jcm15156108 - 6 Aug 2026

Viewed by 326

Abstract

Background/Objectives: Postoperative X-ray is the standard method for confirming cochlear implant (CI) electrode position, but interpretation varies between readers and subtle abnormalities can be missed. We evaluated a proof-of-concept deep learning framework for automated classification of CI electrode position on postoperative X-rays [...] Read more.

Background/Objectives: Postoperative X-ray is the standard method for confirming cochlear implant (CI) electrode position, but interpretation varies between readers and subtle abnormalities can be missed. We evaluated a proof-of-concept deep learning framework for automated classification of CI electrode position on postoperative X-rays across four CNN architectures, each trained with and without class weighting, as an initial step toward determining whether such models warrant further clinical development. Methods: We analyzed 1033 radiographic regions of interest from 673 patients at a tertiary referral center. ResNet18, EfficientNet-B0, DenseNet121, and EfficientNet-B3 were evaluated using patient-level data splitting, transfer learning, and consensus ground truth from two independent specialists, assessed on an independent test set and through five-fold patient-level cross-validation, with Grad-CAM used to evaluate model attention. Results: DenseNet121 (non-weighted) achieved the highest AUC (0.932; 95% CI 0.836–1.000) and specificity of 98.6% (95% CI 95.3–99.6%), while EfficientNet-B3 (weighted) reached the highest sensitivity (69.2%; 95% CI 42.4–87.3%). Under cross-validation, ResNet18 (weighted) was the most consistent model (AUC 0.861 ± 0.030); single-split AUC values were optimistic by a mean of 0.069 across models. Grad-CAM confirmed electrode-focused attention in ResNet18 and DenseNet121. Conclusions: Multi-architecture CNNs showed potential to classify CI electrode position with high specificity and clinically interpretable attention, supporting further investigation as screening-support tools rather than autonomous diagnostic systems. Full article

(This article belongs to the Section Otolaryngology)

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17 pages, 743 KB

Open AccessSystematic Review

Imaging-Based Markers of Sarcopenia in Lower Limb Ischemia: A Systematic Review

by Oliwia Grzelak, Ignacy Bobrowski, Joanna Halman, Michał Gniedziejko, Mariusz Siemiński and Jacek Wojciechowski

J. Clin. Med. 2026, 15(15), 6107; https://doi.org/10.3390/jcm15156107 - 6 Aug 2026

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Abstract

Background/Objectives: Imaging-based markers of sarcopenia have emerged as potential indicators of frailty and predictors of clinical outcomes in patients with lower limb ischemia undergoing revascularization. However, the available evidence remains inconclusive. This systematic review aims to provide a comprehensive overview of current [...] Read more.

Background/Objectives: Imaging-based markers of sarcopenia have emerged as potential indicators of frailty and predictors of clinical outcomes in patients with lower limb ischemia undergoing revascularization. However, the available evidence remains inconclusive. This systematic review aims to provide a comprehensive overview of current imaging-based approaches to sarcopenia assessment and to evaluate their relationship with clinical outcomes in this population. Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) database: ID CRD420251229527. A literature search was performed in PubMed and Scopus to identify studies published between 1 January 2020 and 1 August 2025. Studies assessing imaging-derived markers of sarcopenia in adults undergoing revascularization for lower limb ischemia were included. Due to heterogeneity in imaging methods, sarcopenia definitions and reported outcomes, a narrative synthesis was performed. Results: Nine studies involving 2563 patients were included in this review. Computed tomography (CT) was the predominant imaging modality used for sarcopenia assessment, with muscle measurements most frequently obtained at the level of the third lumbar vertebra (L3). Commonly reported imaging-derived markers included the skeletal muscle index, psoas muscle-based parameters and muscle radiodensity. Assessment strategies varied across studies, particularly with respect to measurement techniques, anatomical landmarks and the thresholds used to define sarcopenia. Most studies reported an association between imaging-derived low muscle mass and increased long-term mortality; however, independent associations after multivariable adjustment were less consistent. Findings regarding postoperative complications and limb-related outcomes were limited and inconsistent. Conclusions: Current evidence suggests that imaging-derived muscle markers may provide additional prognostic information regarding long-term mortality in patients undergoing revascularization for lower limb ischemia, while associations with postoperative complications and limb-related outcomes remain inconsistent. However, the small number of retrospective studies and substantial methodological heterogeneity limit their comparability, highlighting the need for standardization in future research. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

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14 pages, 3300 KB

Open AccessArticle

Diabetic Retinopathy Grading and Concurrent Cardiorenal Biomarker Abnormalities in Type 2 Diabetes: Albuminuria and Elevated NT-proBNP—A Retrospective Cross-Sectional Study

by İrfan Alisan, Ahmet Gazi Mustan, Bektas Isik, Fatih Necip Arıcı, Cahit Dinçer, Çisem Yılmaz, Mehmet Erdevir, Ahmet Altıntaş, Çiğdem Erhan, Merve Saracoglu Sumbul, Huseyin Ali Ozturk, Erdinc Gülümsek, Begüm Seyda Avcı and Hilmi Erdem Sumbul

J. Clin. Med. 2026, 15(15), 6106; https://doi.org/10.3390/jcm15156106 - 6 Aug 2026

Viewed by 329

Abstract

Background: Diabetic retinopathy (DR) is the most prevalent microvascular complication of type 2 diabetes mellitus (T2DM) and a recognised marker of systemic vascular injury. Whether DR—graded independently by two experienced ophthalmologists as part of routine institutional care—is independently associated with concurrent nephropathy (urine [...] Read more.

Background: Diabetic retinopathy (DR) is the most prevalent microvascular complication of type 2 diabetes mellitus (T2DM) and a recognised marker of systemic vascular injury. Whether DR—graded independently by two experienced ophthalmologists as part of routine institutional care—is independently associated with concurrent nephropathy (urine albumin-to-creatinine ratio [UACR] ≥ 30 mg/g) and subclinical cardiac stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥ 125 pg/mL) remains insufficiently examined. Methods: Retrospective cross-sectional study of 401 T2DM adults who underwent dilated fundus examination independently graded by two board-certified ophthalmologists (each ≥ 10 years’ experience in diabetic eye disease) using ETDRS-based classification. Inter-physician agreement was quantified by Cohen’s weighted kappa. The primary composite outcome was concurrent nephropathy and subclinical cardiac stress. Multivariable logistic regression adjusted for age, sex, HbA1c, diabetes duration, eGFR, hypertension, and pharmacological treatments. Results: The composite outcome was present in 120 (64.2%) DR-positive vs. 14 (6.5%) DR-negative patients (crude OR: 25.59 (13.78–47.51); p < 0.001; fully adjusted OR: 21.49 (11.02–41.81); p < 0.001). Inter-physician agreement was high (Cohen’s weighted κ = 0.88; 95% CI: 0.83–0.93). Nephropathy alone was found in 164 (87.7%) vs. 76 (35.5%) patients (OR: 12.95 (7.71–21.75); p < 0.001), and elevated NT-proBNP in 137 (73.3%) vs. 39 (18.2%) patients (OR: 12.29 (7.65–19.76); p < 0.001). A significant trend across DR severity grades was observed (p for trend < 0.001), although the gradient was not strictly monotonic. ROC AUC = 0.837 (95% CI: 0.784–0.860). Conclusions: Ophthalmologist-graded DR was independently associated with the concurrent presence of albuminuria and elevated NT-proBNP in T2DM. Because the design is cross-sectional, these findings describe association rather than prediction or causation. They generate the hypothesis that retinal grading may help flag patients in whom cardiorenal biomarker assessment is worth considering, but prospective validation is required before any screening application. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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19 pages, 1486 KB

Open AccessArticle

Low CT-Derived Thoracic Muscle Area and Composite Weaning Failure in Mechanically Ventilated ICU Patients with Pneumonia: An Exploratory Analysis by Age Group

by Seonghye Jung, Kwonhyung Hyung, Heemoon Park, Hyun Woo Lee, Jung-Kyu Lee, Tae Yun Park, Eun Young Heo, Deog Kyeom Kim and Hyo Jin Lee

J. Clin. Med. 2026, 15(15), 6105; https://doi.org/10.3390/jcm15156105 - 5 Aug 2026

Viewed by 346

Abstract

Background/Objectives: Whether the prognostic contribution of low skeletal muscle mass varies with age in ventilated patients is untested. We assessed whether the association between low computed tomography (CT)-derived thoracic muscle area and ventilator-liberation outcomes differs by age. Methods: This single-center retrospective cohort included [...] Read more.

Background/Objectives: Whether the prognostic contribution of low skeletal muscle mass varies with age in ventilated patients is untested. We assessed whether the association between low computed tomography (CT)-derived thoracic muscle area and ventilator-liberation outcomes differs by age. Methods: This single-center retrospective cohort included 607 adults with pneumonia requiring invasive ventilation in the intensive care unit (ICU) between 2016 and 2021. Thoracic muscle area was quantified by deep-learning segmentation of the whole thoracic musculature (first to twelfth thoracic vertebra) on the chest CT obtained closest to ICU admission and normalized to the length of the thoracic spine (median offset 0 days; 86% within ±7 days, before or after); low thoracic muscle area was the sex-specific lowest quartile. The primary outcome was composite weaning failure (extubation failure, tracheostomy, or ventilation >21 days). Multivariable logistic regression stratified at 75 years tested a muscle-area-by-age interaction. Results: Composite weaning failure occurred in 290 patients (47.8%). In fully adjusted complete-case models (n = 539), low thoracic muscle area was associated with composite weaning failure in younger patients (adjusted odds ratio 3.63; 95% CI 1.67–7.87) but not significantly in older patients (1.68; 0.91–3.13); the age interaction was not significant (p = 0.061) and was removed by height-normalization and by correction for multiple comparisons. A graded association across muscle-area quartiles was present in both strata (lowest vs. highest quartile: younger 4.79, older 2.53). Low thoracic muscle area was not associated with ICU mortality in either stratum, although an exploratory landmark analysis showed higher 7-day mortality in younger patients with low muscle area (20.6% vs. 10.8%). Conclusions: Low CT-derived thoracic muscle area was associated with composite weaning failure in both age strata, with a larger point estimate in patients younger than 75 years, although the age interaction was not significant in the fully adjusted model and was removed by height-normalization and by correction for multiple comparisons. The graded association in both age strata is hypothesis-generating and requires prospective validation. Full article

(This article belongs to the Section Intensive Care)

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24 pages, 2242 KB

Open AccessArticle

Wearable Assessment of Dynamic Trunk Sway Reveals Directional Balance Adaptations During Sling-Assisted Walking After Stroke

by Begum Yalcin, Yiğit Can Gökhan, Hülya Şirzai, Güneş Yavuzer and Hande Argunsah

J. Clin. Med. 2026, 15(15), 6104; https://doi.org/10.3390/jcm15156104 - 5 Aug 2026

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Abstract

Background: Quantitative assessment of dynamic balance remains challenging in clinical practice. Wearable inertial measurement unit (IMU)-based technologies offer an objective and accessible approach for monitoring postural control. This study aimed to develop and preliminarily validate a wearable IMU-based trunk sway monitoring system (SwayTracker) [...] Read more.

Background: Quantitative assessment of dynamic balance remains challenging in clinical practice. Wearable inertial measurement unit (IMU)-based technologies offer an objective and accessible approach for monitoring postural control. This study aimed to develop and preliminarily validate a wearable IMU-based trunk sway monitoring system (SwayTracker) and investigate trunk sway characteristics in stroke patients walking with and without arm sling support. Methods: A sternum-mounted IMU system was developed to quantify dynamic trunk sway during walking. Fifteen healthy adults and fourteen stroke patients participated. The healthy participants established normative reference values, whereas the stroke patients completed walking trials with and without arm sling support. Trunk sway was quantified using anteroposterior (AP) and mediolateral (ML) deviations and a polar-coordinate-based sway model. Results: The healthy reference cohort exhibited a mean trunk sway magnitude (radius) of 8.20 ± 3.16°. The stroke patients demonstrated greater sway during unsupported (15.36 ± 5.83°) and sling-assisted walking (15.35 ± 4.59°). Although overall sway magnitude remained unchanged, the mean sway direction shifted from 69.49° to 110.20°, indicating a redistribution of trunk sway from the anterior-right toward the anterior-left quadrant. Forward sway remained the dominant AP component, whereas ML sway shifted from predominantly rightward to leftward with sling use. Conclusions: SwayTracker provides a feasible method for objective assessment of dynamic trunk sway during walking. The stroke patients exhibited increased sway magnitude and altered directional organization compared with healthy individuals. Arm sling use primarily modified ML postural compensation patterns rather than reducing overall trunk sway, highlighting the potential of wearable trunk sway monitoring for gait and balance assessment in neurological rehabilitation. Full article

(This article belongs to the Special Issue New Technological Treatments and Methods in Neurorehabilitation)

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15 pages, 21981 KB

Open AccessArticle

Absorbable Plate-Assisted Columellar Strut Graft Using Auricular Cartilage: A Large-Scale Clinical Study of 1710 Cases in Rhinoplasty

by Hyo Heon Kim and Jae Hoon Kim

J. Clin. Med. 2026, 15(15), 6103; https://doi.org/10.3390/jcm15156103 - 5 Aug 2026

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Abstract

Background: Columellar strut grafting is a widely adopted technique for nasal tip support in rhinoplasty; however, autologous cartilage grafts are associated with well-recognized limitations, including resorption, warping, and donor-site morbidity. Absorbable plates composed of poly-L-lactic acid (PLA) or poly-lactic-co-glycolic acid (PLGA), which [...] Read more.

Background: Columellar strut grafting is a widely adopted technique for nasal tip support in rhinoplasty; however, autologous cartilage grafts are associated with well-recognized limitations, including resorption, warping, and donor-site morbidity. Absorbable plates composed of poly-L-lactic acid (PLA) or poly-lactic-co-glycolic acid (PLGA), which have an established role in craniofacial fracture fixation, were investigated as a structural adjunct to auricular cartilage columellar strut grafts. The present study evaluates the safety and clinical outcomes of this technique in a large patient cohort. Methods: A retrospective review was conducted of 1710 consecutive patients who underwent primary rhinoplasty with absorbable plate-assisted columellar strut grafting between November 2012 and June 2022. A PLA plate (n = 792) or PLGA plate (n = 918) was used in combination with auricular conchal cartilage. Nasal tip projection was assessed using standardized clinical photographs and Ricketts’ E-line analysis at a minimum follow-up of 1 month (range, 1 month to 6 years). Results: Satisfactory nasal tip projection was achieved and sustained throughout the follow-up period in the majority of patients. Transient mild overprojection, attributable to intentional overcorrection, resolved consistently by 6 months postoperatively. Among patients with recorded follow-up, the overall complication rate was 0.35% (6 of 1710 patients): 1 case of minor skin exposure and 1 case requiring revision for the aesthetic desire of further tip elevation (rather than structural projection loss) in the PLA group and 4 cases of mucosal penetration in the PLGA group, all of which occurred during the initial learning phase and resolved without sequelae. No delayed infections were recorded. Conclusions: Absorbable plate-assisted columellar strut grafting using auricular conchal cartilage is a safe, reproducible, and effective technique for achieving stable nasal tip projection. By providing temporary structural support during the critical early healing phase and subsequently undergoing biologic resorption, this approach mitigates the long-term risks associated with permanent implants while avoiding the morbidity of costal cartilage harvest. Despite the limitations of a retrospective design lacking a cartilage-only control group and objective three-dimensional volumetric assessments, it represents a viable and practical alternative for nasal tip support, particularly in East Asian patients with thick skin envelopes and weak cartilaginous frameworks. Full article

(This article belongs to the Special Issue Advances in Plastic and Reconstructive Surgery: Bridging Function, Aesthetics, and Innovation)

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14 pages, 509 KB

Open AccessArticle

Bempedoic Acid in Patients with Chronic Coronary Syndrome Not Achieving LDL Targets Despite Intensive Therapy: A Real-World Study from Spain

by José Javier Gómez-Barrado, Paula Gómez-Turégano, Miguel Turégano-Yedro, Elena Jiménez-Baena, Ana Isabel Fernández-Chamorro and Marta Gómez-Turégano

J. Clin. Med. 2026, 15(15), 6102; https://doi.org/10.3390/jcm15156102 - 5 Aug 2026

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Abstract

Background/Objectives: Achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets in patients with chronic coronary syndrome (CCS) remains challenging despite intensive lipid-lowering therapy. Bempedoic acid (BA) offers an oral therapeutic option, although data on its clinical performance and patient-level determinants of response in real-world Spanish [...] Read more.

Background/Objectives: Achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets in patients with chronic coronary syndrome (CCS) remains challenging despite intensive lipid-lowering therapy. Bempedoic acid (BA) offers an oral therapeutic option, although data on its clinical performance and patient-level determinants of response in real-world Spanish settings are limited. Methods: We conducted a prospective multicentre study across the four healthcare areas of Cáceres province, Spain, including consecutive CCS patients with LDL-C ≥ 55 mg/dL despite stable intensive lipid-lowering therapy. BA 180 mg/day was added to background treatment. Lipid parameters, metabolic profile, and safety outcomes were assessed after a median follow-up of 28 weeks (IQR 23–47). Multivariable analyses were performed to identify factors associated with of LDL-C reduction and target attainment. A total of 118 patients were analyzed for outcomes. Results: A total of 118 patients (mean age 62.4 ± 10.0 years; 79.2% male) were included. BA reduced LDL-C by 22.8% (−16.36 mg/dL; p < 0.001), enabling 48.3% of patients to achieve LDL-C < 55 mg/dL. Higher baseline LDL-C (β = −0.515; p = 0.001) and the presence of diabetes mellitus (B = 13.8 mg/dL; p = 0.024) were independently associated with greater LDL-C reduction. Notably, 56.3% of patients presented with elevated baseline lipoprotein(a) levels (>50 mg/dL), describing a high underlying burden of residual risk. BA was well tolerated, with a modest increase in uric acid levels but no gout events and a high treatment persistence rate (94.4%). Conclusions: In a real-world CCS population receiving intensive lipid-lowering therapy, BA provides clinically meaningful LDL-C reduction with a favorable safety profile in this multicentre cohort from Cáceres province. Patients with higher baseline LDL-C and diabetes derive greater benefit, supporting a more personalized approach to therapy. These findings reinforce the role of BA in Spanish patients as an intermediate step in lipid-lowering strategies before escalation to more costly therapies, addressing the scarcity of local real-world data. Full article

(This article belongs to the Section Cardiology)

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26 pages, 2825 KB

Open AccessReview

The Benefits of Non-Pharmaceutic Interventions on Intrinsic Capacity in Insulin-Resistant Adult and Geriatric Populations—A Narrative Review

by Iulia-Daniela Lungu, Adina Carmen Ilie, Ramona Ștefăniu, Sabinne-Marie Albișteanu, Ana-Maria Turcu, Gabriela Grigoraș, Diana-Gabriela Constantinescu, Anca-Iuliana Pîslaru and Ioana Dana Alexa

J. Clin. Med. 2026, 15(15), 6101; https://doi.org/10.3390/jcm15156101 - 5 Aug 2026

Viewed by 384

Abstract

Insulin resistance (IR) is a well-established metabolic disorder characterized by reduced responsiveness of peripheral tissues to insulin, leading to hyperglycemia and compensatory hyperinsulinemia. Background: In older adults, IR tends to develop gradually and may remain undiagnosed for years due to the insidious [...] Read more.

Insulin resistance (IR) is a well-established metabolic disorder characterized by reduced responsiveness of peripheral tissues to insulin, leading to hyperglycemia and compensatory hyperinsulinemia. Background: In older adults, IR tends to develop gradually and may remain undiagnosed for years due to the insidious nature of the condition, which often lacks overt symptoms. Non-pharmacological interventions refer to the sum of all measures taken in order to improve a certain biological determination or physical parameter and they consist of lifestyle and dietary modifications. Although insulin resistance is recognized as a central mechanism involved in the development of numerous chronic diseases associated with aging, its impact on intrinsic capacity and the mechanisms underlying this relationship are insufficiently synthesized in the literature. In this context, the present narrative review aims to integrate the current evidence on the interaction between insulin resistance and intrinsic capacity, highlighting common biological mechanisms and potential therapeutic and preventive strategies to promote healthy aging. Methods: We conducted a literature search in PubMed, Scopus and Web of Science databases, screening the literature published between 2010 and January 2026. The search strategy included keywords and Boolean operators in order to refine the suggestions. Relevant articles, reviews, studies and guidelines were selected based on their relevance to the objective of this review. Results and Conclusions: The results of the review highlight that insulin resistance represents a central mechanism contributing to the decline in intrinsic capacity through chronic inflammation, oxidative stress, mitochondrial dysfunction and alteration of the gut microbiota. Current evidence suggests that nutritional interventions, in particular the Mediterranean diet and the DASH diet, can improve insulin sensitivity by modulating the microbiota and reducing systemic inflammation, with the potential to contribute to maintaining functional capacity and promoting healthy aging. Full article

(This article belongs to the Special Issue Diabetes Mellitus and Emerging Health Challenges: A Multidisciplinary Perspective)

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14 pages, 273 KB

Open AccessArticle

Association of Systemic and Ocular Comorbidities with Visual Recovery in Patients with Postoperative Corneal Oedema: A Real-World Study of Cataract Surgery Outcomes

by Mirna Džaja Lozo, Miro Vuković, Petra Rizvan, Ana Marušić and Ljubo Znaor

J. Clin. Med. 2026, 15(15), 6100; https://doi.org/10.3390/jcm15156100 - 5 Aug 2026

Viewed by 303

Abstract

Background/Objectives: To evaluate the combined effect of systemic and ocular comorbidities on postoperative recovery after phacoemulsification by assessing corneal status, visual acuity outcomes, and visual recovery dynamics using a real-world data study approach. Methods: This retrospective analysis was conducted on patients undergoing small-incision [...] Read more.

Background/Objectives: To evaluate the combined effect of systemic and ocular comorbidities on postoperative recovery after phacoemulsification by assessing corneal status, visual acuity outcomes, and visual recovery dynamics using a real-world data study approach. Methods: This retrospective analysis was conducted on patients undergoing small-incision phacoemulsification. Patients were categorised based on the presence of ocular and systemic comorbidities into four groups: those with only ocular diseases, those with only systemic diseases, those with neither ocular nor systemic diseases, and those with both ocular and systemic comorbidities. For evaluation of postoperative recovery and the impact of comorbidities, we analysed postoperative visual acuity and the recovery of visual acuity after the surgery. Results: Our results indicate that ocular comorbidities are associated with slower early postoperative visual recovery, while systemic comorbidities alone did not have a significant impact on visual acuity values and recovery. However, the differences between comorbidity groups decreased over time following surgery and postoperative visual acuity outcomes became comparable across groups. This suggests that regardless of the initial disease burden, the long-term effectiveness of cataract surgery has benefit and leads to improvement in visual function. Conclusions: Patients with ocular comorbidities, because of the slower postoperative recovery based on visual acuity, should receive closer monitoring in the early postoperative period. These findings can help in the optimisation of the postoperative follow-up protocols and reduce the healthcare burden associated with cataract management. Full article

(This article belongs to the Section Ophthalmology)

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J. Clin. Med., Volume 15, Issue 15 (August-1 2026) – 374 articles

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