Journal of Clinical Medicine

10 pages, 228 KB

Open AccessArticle

Determination of Risk Factors, Incidence, and Mortality Rates of Acute Kidney Injury in COVID-19 Patients Hospitalized in the Intensive Care Unit

by Gizem Kahraman, Pınar Karabak Bilal and Mustafa Kemal Bayar

J. Clin. Med. 2026, 15(2), 483; https://doi.org/10.3390/jcm15020483 (registering DOI) - 7 Jan 2026

Abstract

Background: Although the main target of SARS-CoV-2 is the respiratory system, in some patients, it may affect multiple organ systems, leading to multi-organ failure. Acute kidney injury (AKI) remains one of the most frequent and clinically significant complications of severe COVID-19, with clinical [...] Read more.

Background: Although the main target of SARS-CoV-2 is the respiratory system, in some patients, it may affect multiple organ systems, leading to multi-organ failure. Acute kidney injury (AKI) remains one of the most frequent and clinically significant complications of severe COVID-19, with clinical importance extending beyond the acute phase due to its association with long-term renal outcomes and persistent morbidity. The incidence of AKI is particularly high among patients admitted to the intensive care unit (ICU), where its development has been consistently associated with prolonged hospitalization and increased mortality. The primary aim of this study was to determine the incidence of COVID-19-associated AKI, identify factors related to its development and severity, and evaluate mortality as a clinical outcome. Methods: Data from 238 COVID-19 patients monitored in the Intensive Care Unit of Ankara University Ibni Sina Hospital (ISH-ICU) between 1 January 2021 and 1 January 2022 were retrospectively reviewed. Patients were divided into two groups according to the presence of AKI. Those with AKI were staged according to KDIGO criteria (stages 1–2–3). Demographic characteristics, comorbidities, disease severity scores, laboratory parameters, and mortality outcomes were analyzed and compared between groups. Results: AKI was identified in 54.6% of patients. Of the patients with AKI, 32 (13.4%) had stage 1, 25 (10.5%) had stage 2, and 73 (30.7%) had stage 3 AKI. Thirteen patients (5.5%) had already developed AKI at ICU admission. AKI developed at a median of 11 days after symptom onset and 3 days after ICU admission. Advanced age, hypertension, cardiovascular disease, and chronic kidney disease were more frequent in patients with AKI (p < 0.001). Higher Charlson Comorbidity Index (CCI) and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores were observed in patients with stage 3 AKI. Lymphopenia and elevated levels of D-dimer, ferritin, IL-6, CRP, and procalcitonin were significantly higher in patients with stage 3 AKI than in patients with other AKI stages and the non-AKI group. Mortality rates were higher in patients with AKI and increased with advancing AKI stage (p < 0.001). ICU length of stay was significantly longer in the AKI group (p < 0.001). Conclusions: AKI is a common complication among critically ill patients with COVID-19 and is associated with prolonged ICU stay and higher mortality rates, particularly in advanced stages. Early identification of clinical and laboratory factors associated with AKI may support timely risk stratification and targeted management in this high-risk population. Full article

(This article belongs to the Section Nephrology & Urology)

14 pages, 25706 KB

Open AccessTechnical Note

A Simple and Cost-Effective Retractor for Transorbital Neurosurgery: Technical Note and Application in Lacrimal Keyhole Approaches

by Luca Ferlendis, Arianna Fava, Thibault Passeri, Rosaria Abbritti and Sebastien Froelich

J. Clin. Med. 2026, 15(2), 482; https://doi.org/10.3390/jcm15020482 (registering DOI) - 7 Jan 2026

Abstract

Background: Transorbital approaches (TOAs) provide minimally invasive access to anterior and middle cranial fossa lesions. However, orbital retraction remains a challenge, as narrow corridors limit maneuverability and excessive retraction increase complication risk. Conventional rigid or malleable retractors may obstruct the corridor or exert [...] Read more.

Background: Transorbital approaches (TOAs) provide minimally invasive access to anterior and middle cranial fossa lesions. However, orbital retraction remains a challenge, as narrow corridors limit maneuverability and excessive retraction increase complication risk. Conventional rigid or malleable retractors may obstruct the corridor or exert uneven pressure on delicate tissues. We present a handmade, semi-rigid plastic retractor as a low-cost, effective solution to optimize orbital retraction in TOAs. Methods: The retractor was fashioned from a cylindrical plastic drill bit container, cut into two semicircular pieces with rounded edges. Its application is described within the transorbital eyebrow lacrimal keyhole approach (TELKA). During the bony phase, one piece is placed on the orbital roof for periorbital retraction and protection, while a second may be positioned laterally to protect the temporalis muscle when required. Once adequate working space is achieved, the lateral retractor is removed and the medial one maintained throughout the procedure. Technical details are illustrated through representative clinical cases, supported by anatomical dissection and an operative video. Results: Across thirteen TELKA procedures, the semi-rigid retractor provided stable, low-intensity retraction with even pressure distribution, minimizing corridor obstruction and facilitating both microscopic and endoscopic maneuverability. No orbital or visual complications related to retraction were observed; periorbital structures were preserved, with no postoperative proptosis or aesthetic defects. Conclusions: This handmade, semi-rigid retractor is a safe, customizable, and reproducible tool that enhances surgical freedom while minimizing orbital morbidity in TOAs. It is particularly advantageous in keyhole procedures such as TELKA, representing a promising alternative to conventional retraction systems. Full article

(This article belongs to the Special Issue The Rebirth of Ventral Skull Base Surgery through Multiportal Approaches: Endonasal, Transorbital, Transmaxillary and Transoral Routes)

11 pages, 2465 KB

Open AccessCase Report

Intraoperative Suction-Assisted Kyphoplasty for Immediate Removal of Posterior PMMA Extravasation in Decompressed Vertebral Compression Fractures

by Yu-Chuan Tsuei, Hsin-Tzu Lu, Yung-Fu Hsu, Shih-Hao Cheng, William Chu and Woei-Chyn Chu

J. Clin. Med. 2026, 15(2), 481; https://doi.org/10.3390/jcm15020481 - 7 Jan 2026

Abstract

Background: Vertebral compression fractures are prevalent in elderly patients with osteoporosis. While the vertebral augmentation procedure is often used for symptom control and improving life quality, cement leakage is still a significant complication of vertebral augmentation procedures. This case report describes a 92-year-old [...] Read more.

Background: Vertebral compression fractures are prevalent in elderly patients with osteoporosis. While the vertebral augmentation procedure is often used for symptom control and improving life quality, cement leakage is still a significant complication of vertebral augmentation procedures. This case report describes a 92-year-old man with a T8 compression fracture who underwent kyphoplasty with low-viscosity bone cement after failed conservative treatment. Methods: A previously developed decompressed kyphoplasty technique using dual portals was employed to reduce intravertebral pressure; however, fluoroscopy revealed posterior leakage toward the spinal canal. A case-specific intraoperative modification of this established technique was then applied, converting the injection portal into a suction channel to aspirate extravasated cement before it hardened. Results: This approach averted spinal cord compromise, obviated the need for additional decompression surgery, and preserved neurological function. The patient achieved rapid pain relief and early mobilization. Conclusions: This case demonstrates how a suction-assisted intraoperative maneuver may be used to manage posterior cement leakage during decompressed kyphoplasty. Full article

(This article belongs to the Section Orthopedics)

14 pages, 991 KB

Open AccessArticle

Magnetic Resonance-Based Determination of Local Tissue Infection Involvement in Patients with Periprosthetic Joint Infection Following Total Hip Arthroplasty

by Farouk Khury, Mallory Ehlers, Mark Kurapatti, Anzar Sarfraz, Vinay K. Aggarwal and Ran Schwarzkopf

J. Clin. Med. 2026, 15(2), 480; https://doi.org/10.3390/jcm15020480 (registering DOI) - 7 Jan 2026

Abstract

Background: Surgical treatment of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains challenging, with thorough debridement seen as critical for success. While revision THA is well documented as the standard treatment for PJI, data on infection spread beyond the periprosthetic joint [...] Read more.

Background: Surgical treatment of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains challenging, with thorough debridement seen as critical for success. While revision THA is well documented as the standard treatment for PJI, data on infection spread beyond the periprosthetic joint into surrounding soft tissue remain limited—this is the focus of our study. Methods: We retrospectively reviewed 558 patients who underwent a revision THA due to PJI at a single academic institution from January 2011 to December 2023. Out of 558 patients, 46 (8.2%) underwent a Magnetic Resonance Imaging (MRI) scan of their hip joint prior to their revision THA due to suspicion of a PJI. MRI reports were manually chart-reviewed to evaluate patients for evidence of infection spread beyond the constraints of the periprosthetic joint space. Results: Out of 46 patients with hip MRI prior to rTHA, 45 (97.8%) had pathological findings, and 34 (73.9%) had reports suggestive of periprosthetic joint fluid collection. The infected joint effusion extended in 30 cases (65.2%) from the capsule into the surrounding soft tissue, including the greater trochanteric region (17.4%), iliopsoas area (15.2%), anterolateral musculature (13.0%), surrounding soft tissue (10.8%), gluteal (8.7%) and obturator muscles (8.7%), and iliotibial band (4.3%). Capsule thickening was observed in 23.9% of the cases. Conclusions: Our study found that the vast majority (97.8%) of the hip MRIs had pathological findings, with periprosthetic joint fluid collection being a predominant feature in 73.9% of the cases. The extraarticular extension of these fluid collections was observed in over two-thirds (30/34) of affected patients, suggesting that PJI is often not confined to the capsule. MRI studies can help surgeons obtain prior knowledge of these cases and develop a more comprehensive surgical approach for infection debridement, potentially helping improve surgical treatment outcomes after PJI. Full article

(This article belongs to the Special Issue Clinical Advances in Prosthetic Joint Infection)

24 pages, 1859 KB

Open AccessArticle

Analysis of Roux-en-Y Gastric Bypass and High-Fat Feeding Reveals Hepatic Transcriptome Reprogramming: Ironing Out the Details

by Matthew Stevenson, Munichandra Babu Tirumalasetty, Ankita Srivastava, Qing Miao, Collin Brathwaite and Louis Ragolia

J. Clin. Med. 2026, 15(2), 479; https://doi.org/10.3390/jcm15020479 - 7 Jan 2026

Abstract

Background/Objectives: Roux-en-Y gastric bypass (RYGB) improves obesity-related metabolic disorders, yet post-operative dietary composition critically shapes outcomes. This study explored how RYGB and high-fat diet (HFD) differentially regulate hepatic transcriptional programs. Methods: We performed RNA-seq on liver tissues from diet-induced obese C57BL/6 male mice [...] Read more.

Background/Objectives: Roux-en-Y gastric bypass (RYGB) improves obesity-related metabolic disorders, yet post-operative dietary composition critically shapes outcomes. This study explored how RYGB and high-fat diet (HFD) differentially regulate hepatic transcriptional programs. Methods: We performed RNA-seq on liver tissues from diet-induced obese C57BL/6 male mice 8 weeks post-RYGB or sham surgery, maintained on chow or HFD. Differentially expressed genes (DEGs) were identified using DESeq2. Gene sets were categorized as RYGB-induced (commonly regulated by surgery across diets), Reversal (RYGB-driven counter-regulation of obesity-induced changes), and HFD-induced (commonly regulated by diet). A subset of RYGB-specific HFD-induced genes was derived by excluding HFD-induced genes from the RYGB Chow vs. RYGB HFD contrast. Pathway enrichment was conducted using STRING. Results: RYGB induced 365 DEGs, including pathways related to extracellular remodeling and reduced mitochondrial/antioxidant activity. Among these, 119 Reversal genes countered obesity-associated transcriptional patterns and accounted for ~27% of the RYGB-induced enrichment results. HFD regulated 860 DEGs, highlighting stress responses and translational repression. Lastly, a set of 426 RYGB-specific HFD-induced genes revealed persistent hepatic inflammation, coagulation, and iron dysregulation under HFD despite surgery. Conclusions: RYGB induces robust hepatic transcriptomic changes that attenuate obesity-driven dysregulation, including a coordinated reprogramming of iron-handling pathways. However, high dietary fat partially overrides these benefits, promoting inflammatory, metabolic stress, and iron-related stress. Optimizing post-operative diets and carefully managing micronutrient intake, especially iron, may enhance RYGB’s metabolic efficacy and long-term liver health. Full article

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

10 pages, 1671 KB

Open AccessArticle

Prognostic Impact of Combinational Elastography in Patients with Heart Failure

by Takahiro Sakamoto, Seita Yamasaki, Taiji Okada, Akihiro Endo, Hiroyuki Yoshitomi, Shuichi Sato and Kazuaki Tanabe

J. Clin. Med. 2026, 15(2), 478; https://doi.org/10.3390/jcm15020478 - 7 Jan 2026

Abstract

Background: Elastography is a non-invasive technique used to assess tissue stiffness. There are two main types of elastography: shear-wave elastography and strain imaging. Both are useful for evaluating the degree of liver fibrosis (LF). Shear-wave imaging is influenced by fibrosis and hepatic congestion, [...] Read more.

Background: Elastography is a non-invasive technique used to assess tissue stiffness. There are two main types of elastography: shear-wave elastography and strain imaging. Both are useful for evaluating the degree of liver fibrosis (LF). Shear-wave imaging is influenced by fibrosis and hepatic congestion, whereas strain imaging primarily reflects fibrosis progression and is less affected by congestion. We previously reported the clinical usefulness of combinational elastography in patients with heart failure (HF). However, its prognostic significance in this population remains unclear. Accordingly, in this prospective study, we aimed to evaluate the prognostic impact of combinational elastography in patients with HF. Methods: We included 77 patients with HF (median age: 79 years). Shear-wave imaging was used to obtain shear-wave velocity (Vs), whereas the liver fibrosis index (LF index) was derived from strain imaging. The Vs/LF index (V/L) was used as a prognostic indicator based on combinational elastography. Cardiac events were defined as cardiac death or hospitalization due to HF. Results: During a median follow-up of 716 days, 17 cardiac deaths or hospitalizations for HF were observed. The V/L demonstrated a cut-off value of 1.2 for predicting cardiac death or hospitalization for HF, with an area under the curve of 0.80, sensitivity of 0.82, and specificity of 0.68. Kaplan–Meier analysis demonstrated that patients with a high V/L (≥1.2) had significantly higher rates of hospitalization for HF than those with a low V/L (<1.2; log-rank test, p < 0.001). Conclusions: Combinational elastography demonstrated prognostic utility in patients with HF and may serve as a novel, non-invasive tool for assessing hepatic congestion. Full article

(This article belongs to the Special Issue Innovations in Emergency and Critical Care Medicine)

11 pages, 1647 KB

Open AccessArticle

Proton Beam Therapy for Sinonasal Neuroendocrine Carcinoma: A Six-Case Series with Dosimetric Comparison and Literature Review

by Hazuki Nitta, Takashi Saito, Ryota Matsuoka, Shin Matsumoto, Shuho Tanaka, Masahiro Nakayama, Kotaro Osawa, Motohiro Murakami, Keiichiro Baba, Masatoshi Nakamura, Keitaro Fujii, Yoshiko Oshiro, Masashi Mizumoto, Keiji Tabuchi, Daisuke Matsubara and Hideyuki Sakurai

J. Clin. Med. 2026, 15(2), 477; https://doi.org/10.3390/jcm15020477 - 7 Jan 2026

Abstract

Background: Sinonasal neuroendocrine carcinoma (SNEC) is an extremely rare malignancy, and, to date, no clinical reports have detailed the use of proton beam therapy (PBT) for this disease. The present study describes the clinical courses of patients with SNEC treated with PBT [...] Read more.

Background: Sinonasal neuroendocrine carcinoma (SNEC) is an extremely rare malignancy, and, to date, no clinical reports have detailed the use of proton beam therapy (PBT) for this disease. The present study describes the clinical courses of patients with SNEC treated with PBT and highlights the advantages of PBT. Methods: In this retrospective study, we included patients with pathologically confirmed SNEC without distant metastasis who underwent PBT at our institution between 2006 and 2021. To evaluate the dosimetric advantages of PBT, comparative treatment plans using VMAT were created. Result: Six patients with pathologically diagnosed SNEC without distant metastasis were treated with PBT. Multimodal treatment was applied in five patients, including chemotherapy in four cases and surgery in two cases. The median follow-up period was 37.4 months (range: 6.9 to 108.9 months). At the end of the follow-up, three patients were alive without recurrence, while three had died due to the disease. Recurrence occurred in three cases: one local recurrence, one in cervical lymph nodes, and two distant metastases. A late adverse event of Grade 4 vision decrease was observed in one patient on the ipsilateral side. Compared with VMAT, PBT lowered the average brain dose (median 3.3 Gy (RBE) vs. 12.6 Gy), brainstem D2 cc (10.7 Gy (RBE) vs. 34.9 Gy) and contralateral optic nerve D0.1 cc (47.6 Gy (RBE) vs. 63.3 Gy), while doses to the ipsilateral optic pathway were comparable. Conclusions: PBT in multimodal treatment achieved feasible local control for SNEC. The dose-sparing effect of PBT was more evident in organs distant from the target, although careful consideration is required for adjacent structures. Full article

(This article belongs to the Special Issue Clinical Application of Radiotherapy in Modern Oncology)

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16 pages, 1109 KB

Open AccessArticle

Monocyte-Driven Systemic Biomarkers and Survival After Pulmonary Metastasectomy in Metachronous Lung-Limited Oligometastatic Disease: A Retrospective Single-Center Study

by Hacer Boztepe Yesilcay, Asim Armagan Aydin, Ahmet Unlu, Sencan Akdag, Kamuran Yuceer and Mustafa Yildiz

J. Clin. Med. 2026, 15(2), 476; https://doi.org/10.3390/jcm15020476 - 7 Jan 2026

Abstract

Background/Objectives: Metachronous lung-limited oligometastatic disease represents a biologically heterogeneous state in which patient selection for pulmonary metastasectomy remains challenging. While systemic inflammation–nutrition indices have shown prognostic value across malignancies, their relevance in this strictly defined surgical setting is not well established. Methods: We [...] Read more.

Background/Objectives: Metachronous lung-limited oligometastatic disease represents a biologically heterogeneous state in which patient selection for pulmonary metastasectomy remains challenging. While systemic inflammation–nutrition indices have shown prognostic value across malignancies, their relevance in this strictly defined surgical setting is not well established. Methods: We conducted a retrospective single-center cohort study including 109 patients with isolated metachronous pulmonary recurrence who underwent curative intent R0 metastasectomy between September 2015 and April 2024. Preoperative systemic biomarkers, including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), and monocyte-to-albumin ratio (MAR), were evaluated using receiver operating characteristic (ROC) analysis and multivariable Cox models to determine their association with overall survival (OS) and progression-free survival (PFS). Clinicopathological variables, such as lymph node involvement and metastatic burden, were incorporated into the adjusted models. Results: The median age of the cohort was 61 years (range, 29–82 years), and the sex distribution was balanced (48.6% female and 51.4% male), with 62.4% of patients being younger than 65 years. Among the systemic indices evaluated, monocyte-weighted biomarkers demonstrated the strongest prognostic performance. The MAR showed the highest discriminative ability for mortality (AUC, 0.749; p < 0.001), followed by the SIRI (AUC, 0.682; p = 0.007). In multivariable analyses, MAR independently predicted OS (p = 0.043) and PFS (p = 0.023), while SIRI independently predicted PFS (p = 0.043). Lymph node involvement remained the dominant adverse prognostic factor for both outcomes (p < 0.001); however, monocyte-weighted indices provided additional prognostic value beyond conventional anatomic criteria. Conclusions: Preoperative SIRI and MAR capture host immune–metabolic states that are relevant to postoperative trajectories and may refine risk stratification in candidates for pulmonary metastasectomy. These readily obtainable markers warrant prospective validation within biologically integrated selection frameworks. Full article

(This article belongs to the Special Issue Surgical Oncology: Clinical Application of Translational Medicine)

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12 pages, 752 KB

Open AccessArticle

Dermoscopy-Guided High-Frequency Ultrasound Imaging of Subcentimeter Cutaneous and Subcutaneous Neurofibromas in Patients with Neurofibromatosis Type 1

by Krisztina Kerekes, Mehdi Boostani, Zseraldin Metyovinyi, Norbert Kiss and Márta Medvecz

J. Clin. Med. 2026, 15(2), 475; https://doi.org/10.3390/jcm15020475 - 7 Jan 2026

Abstract

Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by cutaneous and subcutaneous neurofibromas, which impact quality of life. Dermoscopy-guided high-frequency ultrasound (DG-HFUS) integrates dermoscopy with 33 MHz ultrasound, enabling precise lesion localization and reproducible measurements. Objective: To characterize neurofibromas [...] Read more.

Background: Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterized by cutaneous and subcutaneous neurofibromas, which impact quality of life. Dermoscopy-guided high-frequency ultrasound (DG-HFUS) integrates dermoscopy with 33 MHz ultrasound, enabling precise lesion localization and reproducible measurements. Objective: To characterize neurofibromas in NF1 patients using DG-HFUS and identify imaging parameters for diagnosis, monitoring, and treatment planning. Methods: 14 genetically confirmed NF1 patients underwent DG-HFUS imaging (Dermus SkinScanner). 100 neurofibromas were assessed for size, location, shape, contours, surface, echogenicity, global echogenicity, and posterior acoustic features. Results: Lesions were dermal (79%) or subcutaneous (21%), round (28%), ovoid (63%), or spiked (9%). Mean vertical and lateral diameters were 5.37 ± 2.66 mm and 2.28 ± 1.39 mm. All were hypoechoic; 62% homogeneous, 38% heterogeneous. Margins were well-defined in 57% and poorly defined in 43%. Posterior enhancement occurred in 3% and shadowing in 10%. Conclusions: DG-HFUS provides a detailed, reproducible assessment of neurofibromas, supporting differential diagnosis, surgical planning, and longitudinal monitoring. The evaluated imaging parameters offer objective insights for optimizing NF1 management. Future developments, including 3D reconstruction and AI-assisted analysis, may further enhance its clinical utility. Full article

(This article belongs to the Special Issue Fresh Insights in Skin Disease)

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12 pages, 1738 KB

Open AccessArticle

Reintervention for Failed Aortic Bioprostheses: Distinct Patient Profiles for Redo Surgery and Valve-in-Valve TAVR in an All-Comers Cohort

by Daniela Geisler, Zsuzsanna Arnold, Marieluise Harrer, Rudolf Seemann, Georg Delle-Karth, Martin Grabenwöger and Markus Mach

J. Clin. Med. 2026, 15(2), 474; https://doi.org/10.3390/jcm15020474 - 7 Jan 2026

Abstract

Background/Objectives: Aortic valve therapy increasingly follows a lifetime management concept. As all bioprostheses ultimately degenerate, optimal outcomes rely on the appropriate selection and timing of treatment modality. This study evaluates outcomes of redo surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic [...] Read more.

Background/Objectives: Aortic valve therapy increasingly follows a lifetime management concept. As all bioprostheses ultimately degenerate, optimal outcomes rely on the appropriate selection and timing of treatment modality. This study evaluates outcomes of redo surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) in a consecutive, unselected real-world cohort treated for bioprosthetic valve failure (BVF). Methods: A single-center retrospective analysis of all patients undergoing redo-SAVR or ViV-TAVR for BVF between June 2019 and December 2024 was conducted. The primary endpoint was survival at 30 days and at 1, 3, and 5 years; the secondary endpoint was time to reintervention. Cox proportional hazards models were used; proportionality was tested; subgroups were defined by indication and presence of concomitant procedures. Results: Eighty-three patients were included (redo-SAVR n = 42; ViV-TAVR n = 41). All active endocarditis cases were managed surgically. In isolated procedures, 30-day survival was 95.5% after redo-SAVR (100% when excluding endocarditis) and 100% after ViV-TAVR; 5-year survival was 81.3% and 94.1%, respectively (94.4% for isolated redo-SAVR excluding endocarditis). Because hazards were non-proportional and risk sets were sparse beyond 5 years, we fitted a time-split Cox model (0–5 years). In multivariable analysis, endocarditis (HR 4.45, 95% CI 1.16–17.04) and NYHA IV (HR 4.87, 95% CI 0.98–24.17)—not treatment modality—were associated with mortality. Conclusions: In a real-world, all-comers setting, early outcomes for isolated reinterventions were favorable with both pathways. Mortality patterns were case-mix driven—especially by endocarditis and the need for concomitant surgery. Accordingly, ViV-TAVR and redo-SAVR should be viewed not as competing procedures but as complementary, scenario-specific options within a lifetime management strategy. Full article

(This article belongs to the Special Issue Recent Advances in Transcatheter Aortic Valve Replacement: Second Edition)

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14 pages, 304 KB

Open AccessArticle

Revisiting the Geriatric Depression Scale: An IRT-Based 10-Item Screen Outperforms the GDS-15 in Diagnostic Accuracy and Efficiency

by Ji Won Han, Dae Jong Oh, Tae Hui Kim, Kyung Phil Kwak, Bong Jo Kim, Shin Gyeom Kim, Jeong Lan Kim, Seok Woo Moon, Joon Hyuk Park, Seung-Ho Ryu, Jong Chul Youn, Dong Young Lee, Dong Woo Lee, Seok Bum Lee, Jung Jae Lee, Jin Hyeong Jhoo and Ki Woong Kim

J. Clin. Med. 2026, 15(2), 473; https://doi.org/10.3390/jcm15020473 - 7 Jan 2026

Abstract

Background/Objective: Existing abbreviated Geriatric Depression Scales (GDSs), derived via Classical Test Theory (CTT), often sacrifice accuracy for brevity and retain non-specific items. We aimed to develop a minimum-item GDS maintaining diagnostic performance equivalent to the full 30-item scale (GDS30) using Item Response [...] Read more.

Background/Objective: Existing abbreviated Geriatric Depression Scales (GDSs), derived via Classical Test Theory (CTT), often sacrifice accuracy for brevity and retain non-specific items. We aimed to develop a minimum-item GDS maintaining diagnostic performance equivalent to the full 30-item scale (GDS30) using Item Response Theory (IRT). Methods: This cross-sectional study employed rigorous 5:5 split-sample cross-validation. Participants included 6525 older adults (aged ≥60 years) from community-based (Korean Longitudinal Study on Cognitive Aging and Dementia) and clinical settings (geropsychiatry clinic). Depression was diagnosed through standardized clinical interviews based on DSM-IV criteria. Two-parameter logistic IRT models estimated item discrimination and difficulty parameters. Sequential item reduction with DeLong tests identified the minimum number of items required to maintain GDS30-equivalent area under the curve (AUC). Results: The 10-item IRT-optimized scale (GDS10-IRT) achieved an AUC of 0.856 (95% CI: 0.809–0.895) in the validation set, showing no significant difference from GDS30 (AUC = 0.883; p = 0.396). Conversely, the 15-item GDS (GDS15) demonstrated significantly lower AUC than GDS30 (p < 0.001) despite having more items. GDS10-IRT achieved a 234% improvement in efficiency ratio (AUC/items) over GDS30. Notably, Item 16 (“feeling downhearted and blue”), identified as the most discriminating symptom (a = 2.53), is absent from the GDS15 but included in GDS10-IRT. Conclusions: IRT-based item selection achieves GDS30-equivalent diagnostic accuracy with only 10 items, outperforming the widely used GDS15. By recovering high-discrimination items excluded by CTT, the GDS10-IRT offers a more efficient, specific screening tool for late-life depression. Full article

(This article belongs to the Section Mental Health)

22 pages, 974 KB

Open AccessReview

The Diabetic Nose: A Narrative Review of Rhinologic Involvement in Diabetes (1973–2025)

by Giulio Cesare Passali, Mariaconsiglia Santantonio, Desiderio Passali and Francesco Maria Passali

J. Clin. Med. 2026, 15(2), 472; https://doi.org/10.3390/jcm15020472 - 7 Jan 2026

Abstract

Background: Although diabetes mellitus is traditionally viewed as a systemic metabolic disorder, growing evidence indicates that it also affects the upper airways through vascular, inflammatory, and neuro-sensory mechanisms. The sinonasal mucosa, highly vascularized and immunologically active, may represent an early target of [...] Read more.

Background: Although diabetes mellitus is traditionally viewed as a systemic metabolic disorder, growing evidence indicates that it also affects the upper airways through vascular, inflammatory, and neuro-sensory mechanisms. The sinonasal mucosa, highly vascularized and immunologically active, may represent an early target of diabetic microangiopathy and immune–metabolic imbalance. Objectives: Our objectives are to synthesize current evidence on the rhinologic manifestations of DM, with a focus on chronic rhinosinusitis, olfactory dysfunction, and other nasal disorders, and to identify the main pathophysiologic and clinical patterns linking diabetes to sinonasal disease. Results: Evidence suggests that DM, particularly type 2 DM, increases susceptibility to CRSwNP and modulates the sinonasal microbiome toward Gram-negative predominance. Surgical outcomes after endoscopic sinus surgery are generally comparable between diabetics and non-diabetics when perioperative care is optimized. Olfactory dysfunction occurs more frequently and severely in diabetic patients, likely reflecting the combined effects of chronic inflammation, vascular compromise, and insulin resistance. Additional manifestations include recurrent epistaxis, delayed mucociliary clearance, and chronic cough. Allergic rhinitis appears to not be increased, and maybe even inversely related, especially among users of DPP-4 inhibitors. Conclusions: Diabetes intersects with rhinologic health through immune–metabolic, vascular, and epithelial pathways that may shape susceptibility, disease phenotype, and neurosensory decline. Future research should focus on disentangling type-specific mechanisms, metabolic biomarkers, and longitudinal outcomes, with the aim of developing precision-based approaches to rhinologic assessment and management in diabetic patients. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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34 pages, 5362 KB

Open AccessArticle

Radial Extracorporeal Shock Wave Therapy Versus Multimodal Physical Therapy in Non-Traumatic (Degenerative) Rotator Cuff Tendinopathy with Partial Supraspinatus Tear: A Randomized Controlled Trial

by Zheng Wang, Lan Tang, Ni Wang, Lihua Huang, Christoph Schmitz, Jun Zhou, Yingjie Zhao, Kang Chen and Yanhong Ma

J. Clin. Med. 2026, 15(2), 471; https://doi.org/10.3390/jcm15020471 - 7 Jan 2026

Abstract

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled [...] Read more.

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm²; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Shoulder and Elbow Disease: 2nd Edition)

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14 pages, 8065 KB

Open AccessArticle

Percutaneous Endoscopic Necrosectomy of Walled-Off Pancreatic and Peripancreatic Necrosis

by Mateusz Jagielski, Agata Chwarścianek, Damian Dudek, Jacek Piątkowski and Marek Jackowski

J. Clin. Med. 2026, 15(2), 470; https://doi.org/10.3390/jcm15020470 - 7 Jan 2026

Abstract

Background: Minimally invasive approaches for managing complications of acute necrotizing pancreatitis have advanced significantly in recent decades. When extensive walled-off pancreatic or peripancreatic necrosis is present, a single transluminal access may be insufficient. This study aimed to prospectively evaluate the effectiveness and [...] Read more.

Background: Minimally invasive approaches for managing complications of acute necrotizing pancreatitis have advanced significantly in recent decades. When extensive walled-off pancreatic or peripancreatic necrosis is present, a single transluminal access may be insufficient. This study aimed to prospectively evaluate the effectiveness and safety of a novel percutaneous endoscopic necrosectomy technique used as an adjunct to transmural drainage in patients with symptomatic walled-off necrosis. Methods: A total of 513 consecutive patients with symptomatic walled-off pancreatic or peripancreatic necrosis treated between 2018 and 2025 at a single tertiary center in Poland were included. All patients underwent minimally invasive endoscopic management. Among them, a subgroup required additional percutaneous drainage. The innovative technique involved creating retroperitoneal percutaneous access to the necrotic cavity, enlarging the tract, and placing a self-expanding metal stent to allow passage of the endoscope for percutaneous endoscopic necrosectomy. Results: Additional percutaneous drainage was necessary in 39/513 patients (7.6%). Of these, 9/39 (23.1%) patients (2 women, 7 men; mean age 46.7 years) underwent percuaneous endoscopic necrosectomy. The mean size of the necrotic collection was 25.96 cm. Active percutaneous drainage during ongoing transmural endotherapy lasted a median of 15 days. Patients underwent an average of 3.12 necrosectomy sessions. Treatment-related complications occurred in 2/9 patients (22.22%). Clinical and long-term success were each achieved in 8/9 patients (88.89%). Conclusions: Percutaneous endoscopic necrosectomy is a promising minimally invasive therapeutic option for extensive walled-off pancreatic and peripancreatic necrosis, particularly when necrosis extends into the pelvic region. However, clinical evidence remains limited and further studies are needed. Full article

(This article belongs to the Special Issue Advanced Endoscopy and Imaging in Gastrointestinal Diseases)

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16 pages, 280 KB

Open AccessReview

Submacular Hemorrhage Management: Evolving Strategies from Pharmacologic Displacement to Surgical Intervention

by Monika Sarna and Arleta Waszczykowska

J. Clin. Med. 2026, 15(2), 469; https://doi.org/10.3390/jcm15020469 - 7 Jan 2026

Abstract

Background: Submacular hemorrhage (SMH) is a vision-threatening condition most associated with neovascular age-related macular degeneration (nAMD), although it may also arise from polypoidal choroidal vasculopathy, pathological myopia, retinal vascular diseases, trauma, and systemic factors. Rapid management is essential because subretinal blood induces [...] Read more.

Background: Submacular hemorrhage (SMH) is a vision-threatening condition most associated with neovascular age-related macular degeneration (nAMD), although it may also arise from polypoidal choroidal vasculopathy, pathological myopia, retinal vascular diseases, trauma, and systemic factors. Rapid management is essential because subretinal blood induces photoreceptor toxicity, clot organization, and fibroglial scarring, leading to irreversible visual loss. The choice and urgency of treatment depend on hemorrhage size, duration, and underlying pathology, and the patient’s surgical risk category, which can influence the invasiveness of the selected procedure. This review aims to provide an updated synthesis of recent advances in the surgical and pharmacological management of SMH, focusing on evidence from the past five years and comparing outcomes across major interventional approaches. Methods: A narrative review of 27 recent clinical and multicentre studies was conducted. The included literature evaluated pneumatic displacement (PD), pars plana vitrectomy (PPV), subretinal or intravitreal recombinant tissue plasminogen activator (rtPA), anti-VEGF therapy, and hybrid techniques. Studies were analyzed about indications, surgical methods, timing of intervention, anatomical and functional outcomes, and complication and patient risk stratification. Results: Outcomes varied depending on the size and duration of hemorrhage, as well as the activity of underlying macular neovascularization. PD with intravitreal rtPA was reported as effective for small and recent SMH. PPV combined with subretinal rtPA, filtered air, and anti-VEGF therapy demonstrated favorable displacement and visual outcomes in medium to large hemorrhages or those associated with active nAMD. Hybrid techniques further improved clot mobilization in selected cases. Across studies, delayed intervention beyond 14 days correlated with reduced visual recovery due to blood organization and photoreceptor loss. Potential risks, including recurrent bleeding and rtPA-associated toxicity, were reported but varied across studies. Conclusions: Management should be individualized, considering hemorrhage characteristics and surgical risk. Laser therapy, including PDT, may serve as an adjunct in the perioperative or postoperative period, particularly in PCV patients. Early, tailored intervention typically yields the best functional outcomes. Full article

(This article belongs to the Special Issue Advancements and Challenges in Retina Surgery: Second Edition)

12 pages, 876 KB

Open AccessArticle

Association Between Septal Implantation Level and Pacing Threshold Stability in Leadless Pacemaker Implantation

by Dong-Hyeok Kim, Yeji Kim, Seung Woo Lee, Jeongmin Kang and Junbeom Park

J. Clin. Med. 2026, 15(2), 468; https://doi.org/10.3390/jcm15020468 - 7 Jan 2026

Abstract

Background/Objective: Leadless pacemakers (LPs, Micra™, Medtronic) offer a safe alternative to traditional transvenous systems. However, optimal implantation site within the right ventricular septum (RVS) and its effect on long-term pacing threshold stability remains under debate. The aim was to evaluate the relationship between [...] Read more.

Background/Objective: Leadless pacemakers (LPs, Micra™, Medtronic) offer a safe alternative to traditional transvenous systems. However, optimal implantation site within the right ventricular septum (RVS) and its effect on long-term pacing threshold stability remains under debate. The aim was to evaluate the relationship between pacing site within the RVS and pacing threshold stability following leadless pacemaker implantation. Methods: We retrospectively analyzed 36 patients who underwent LP implantation at two centers between 2022 and 2023. Patients were classified into two groups based on final device position by fluoroscopy: Group A (mid or upper RVS, n = 8) and Group B (low or apical RVS, n = 28). Pacing threshold, QRS duration, and left ventricular ejection fraction (LVEF) were assessed over 6 months. Results: At the 6-month follow-up, Group A demonstrated significantly lower and more stable pacing thresholds compared to Group B (0.57 ± 0.09 mV vs. 1.55 ± 0.97 mV, p < 0.001). No significant differences were observed in QRS duration or LVEF changes between groups. Echocardiography did not reveal new-onset tricuspid regurgitation. Conclusions: Given the small sample size, particularly in the mid/high septal group, these findings should be interpreted as hypothesis-generating and require confirmation in larger prospective studies. These findings highlight the importance of careful anatomical targeting during LP implantation. Prospective studies incorporating advanced imaging are warranted to confirm these results and evaluate long-term clinical outcomes. Full article

(This article belongs to the Section Cardiovascular Medicine)

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14 pages, 1280 KB

Open AccessArticle

Real-World Survival Outcomes Following Metastasectomy in RAS Wild-Type mCRC: Insights from a Multicentre National Cohort Study

by İlker Nihat Ökten, Tuba Baydaş, Mahmut Emre Yıldırım, Cemil Bilir, Şuayib Yalçın, Erdem Çubukçu, Eda Tanrıkulu Şimşek, Çağatay Aslan, Faysal Dane, Sinemis Çelik, Ahmet Bilici, Mehmet Ali Nahit Şendur, Bala Başak Öven, Abdurrahman Işıkdoğan, Hacı Mehmet Türk, Mustafa Karaca, Bülent Karabulut, Melike Özçelik, Mahmut Gümüş, Umut Kefeli and Nuri Karadurmuş Show full author list Hide full author list

J. Clin. Med. 2026, 15(2), 467; https://doi.org/10.3390/jcm15020467 - 7 Jan 2026

Abstract

Background: Metastasectomy is a cornerstone of multimodal management in metastatic colorectal cancer (mCRC), yet contemporary real-world data focusing specifically on RAS wild-type (RAS-WT) disease remain limited. We aimed to evaluate survival outcomes and prognostic factors associated with metastasectomy in patients with RAS-WT [...] Read more.

Background: Metastasectomy is a cornerstone of multimodal management in metastatic colorectal cancer (mCRC), yet contemporary real-world data focusing specifically on RAS wild-type (RAS-WT) disease remain limited. We aimed to evaluate survival outcomes and prognostic factors associated with metastasectomy in patients with RAS-WT mCRC using a large national multicentre registry. Methods: This retrospective cohort study utilized data from the ONKO-KOLON Türkiye registry. A total of 1079 patients with pathologically confirmed KRAS/NRAS wild-type mCRC were identified and categorized according to receipt of metastasectomy. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method and compared with log-rank tests across multiple clinically relevant time origins, including metastatic diagnosis, initial colorectal cancer diagnosis, and time of metastasectomy. Prognostic factors within the metastasectomy cohort were assessed using univariate Cox proportional hazards models. Serum CEA and CA19-9 were analyzed after log₁₀ transformation. Results: Among 1079 patients, 185 (17.1%) underwent metastasectomy. Patients receiving metastasectomy demonstrated significantly longer OS compared with those managed non-surgically when survival was calculated from the time of metastatic diagnosis (hazard ratio [HR] for death 0.36, 95% CI 0.27–0.47; p < 0.001), as well as improved PFS (HR for progression or death 0.39, 95% CI 0.30–0.52; p < 0.001). The survival advantage remained consistent when OS was measured from the time of initial colorectal cancer diagnosis (HR 0.37, 95% CI 0.25–0.50; p < 0.001). Median OS following metastasectomy was 43 months (95% CI 31.4–45.6). In univariate analyses within the metastasectomy cohort, higher baseline CA19-9 levels were significantly associated with inferior OS when analyzed both as a continuous variable (per log₁₀ increase; HR 1.81, 95% CI 1.20–2.75; p = 0.005) and as a categorical variable (above vs. below threshold; HR 0.37, 95% CI 0.16–0.86; p = 0.021). Other clinicopathologic factors, including age, CEA, tumor sidedness, grade, MSI status, and metastatic burden, were not significantly associated with survival. Conclusions: In this large, real-world national cohort of RAS-WT mCRC, metastasectomy was strongly associated with prolonged survival across multiple clinically relevant time frames. Within surgically treated patients, baseline CA19-9 emerged as the most informative prognostic marker, while traditional clinicopathologic variables showed limited discriminatory value. These findings highlight the importance of careful patient selection and support further prospective studies integrating molecular and biomarker-based strategies to refine prognostication and optimize surgical decision-making in RAS-WT mCRC. Full article

(This article belongs to the Section Oncology)

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16 pages, 779 KB

Open AccessArticle

Diagnostic Performance of a DOAC Urine Dipstick in Obese Outpatients with Atrial Fibrillation: Comparison with Plasma Concentrations

by Arianna Pannunzio, Valentina Castellani, Erminia Baldacci, Vittoria Cammisotto, Rosaria Mormile, Ilaria Maria Palumbo, Nicola Porcu, Antonio Chistolini, Graziella Bernardini, Danilo Menichelli, Daniele Pastori, Job Harenberg, Francesco Violi and Pasquale Pignatelli

J. Clin. Med. 2026, 15(2), 466; https://doi.org/10.3390/jcm15020466 - 7 Jan 2026

Abstract

Background: atrial fibrillation (AF) patients with obesity and high thromboembolic risk need oral anticoagulant therapy. Limited data are available on direct oral anticoagulants (DOACs) in this population, and a point-of-care method has been validated to support rapid clinical decisions and to identify [...] Read more.

Background: atrial fibrillation (AF) patients with obesity and high thromboembolic risk need oral anticoagulant therapy. Limited data are available on direct oral anticoagulants (DOACs) in this population, and a point-of-care method has been validated to support rapid clinical decisions and to identify on-off plasma concentration thresholds. Methods: This is a monocentric, cross-sectional diagnostic accuracy study on obese AF outpatients referred to Policlinico Umberto I of Rome. Urinary Dipsticks were assessed with separate pads for factor Xa (FXA-i) and thrombin inhibitor (THR-i) and compared to the reference standard of trough and peak plasma concentrations with chromogenic assays/dTT and prespecified plasma thresholds for each DOAC. Study endpoints were the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of DOACs Dipstick compared to plasma concentrations. Sub-analyses according to obesity severity and type of DOAC were performed. Results: 320 paired plasma and urine samples were available from 160 enrolled patients (mean age 73.2 ± 9.1 years). Compared to trough plasma concentrations, DOACs Dipstick showed a sensitivity of 99.24% (mean, 95% confidence interval, CI 95.82–99.98), specificity of 6.89% (0.85–22.76), PPV 82.80% (81.32–84.18), NPV 66.67% (15.79–95.52). On the other hand, compared to peak plasma concentrations, DOACs Dipstick showed a sensitivity of 97.8% (93.7–99.5), specificity of 0% (0.0–15.4), and PPV of 85.9% (85.6–86.2). Urinary Dipstick showed a sensitivity of 99.10% (95.4–100.0), specificity of 4.70% (0.60–16.20) and a PPV and NPV of 74.50% (73.2–75.8) and 66.70 (15.7–95.6), compared to plasma thresholds > 30 ng/mL of FXA-I and THR-I. Sub-analyses showed similar results between FXA-i and THR-i. Conclusions: The urine point-of-care has high sensitivity, acceptable PPV, but low specificity and NPV in AF obese patients and may be useful only in selected clinical scenarios. Full article

(This article belongs to the Section Cardiovascular Medicine)

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22 pages, 461 KB

Open AccessArticle

Measuring What Matters for Breast Cancer Survivors: Translation, Cross-Cultural Adaptation and Validation of the Croatian Version of Lymphedema Quality of Life Tool-Arm

by Ivana Klarić-Kukuz, Ana Ćurković, Josipa Grančić, Jure Aljinović, Blaž Barun, Dinko Pivalica and Ana Poljičanin

J. Clin. Med. 2026, 15(2), 465; https://doi.org/10.3390/jcm15020465 - 7 Jan 2026

Abstract

Background: Breast cancer-related lymphedema is a common long-term complication of breast cancer treatment that affects physical functioning, emotional well-being, and quality of life. Although the Lymphedema Quality of Life Questionnaire-Arm (LYMQoL-Arm) is widely used internationally, no Croatian version has been available. The primary [...] Read more.

Background: Breast cancer-related lymphedema is a common long-term complication of breast cancer treatment that affects physical functioning, emotional well-being, and quality of life. Although the Lymphedema Quality of Life Questionnaire-Arm (LYMQoL-Arm) is widely used internationally, no Croatian version has been available. The primary objective of this study was to translate and validate the Lymphedema Quality of Life Questionnaire-Upper Limb-Croatian (LYMQoL-UL-CRO) version and evaluate its psychometric properties. A secondary objective was to examine associations between its scores and the relative volume change (RVC) of the affected limb to assess construct validity further. Methods: A retrospective cross-sectional study was conducted in 87 women at least six months post-treatment. The questionnaire was translated using a forward-backward procedure. Participants completed the LYMQoL-UL-CRO, the Short Form-36 Health Survey (SF-36), Pain Intensity Numerical Rating Scale, and underwent clinical examination and limb-volume assessment. Test–retest reliability was assessed in 68 participants after 10 days. Psychometric analyses included internal consistency, intraclass correlation coefficients, measurement error indices, construct and discriminant validity tests, exploratory factor analysis, and evaluation of floor and ceiling effects. Results: LYMQoL-UL-CRO domains demonstrated acceptable to strong internal consistency and moderate test–retest reliability, with low measurement error. Strong negative correlations with the SF-36 Physical Component Summary supported construct validity, and participants with RVC ≥ 5% reported worse scores, supporting discriminant validity. Exploratory factor analysis confirmed the original four-factor structure, and no floor or ceiling effects were observed. Conclusions: The LYMQoL-UL-CRO is a reliable, valid, and culturally appropriate tool for assessing quality of life in Croatian breast cancer survivors with upper-limb lymphedema. Full article

(This article belongs to the Section Clinical Rehabilitation)

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12 pages, 502 KB

Open AccessArticle

Effects of Frenulotomy on Outcomes Associated with Breastfeeding Practice

by Junsujee Wakhanrittee, Jiraporn Khorana and Siriphut Kiatipunsodsai

J. Clin. Med. 2026, 15(2), 464; https://doi.org/10.3390/jcm15020464 - 7 Jan 2026

Abstract

Background/Objectives: This study aimed to evaluate the effects of frenulotomy in mother–infant pairs with problematic tongue-tie. Methods: A 2-year prospective observational cohort study was performed. Mother–infant pairs were divided into frenulotomy and non-frenulotomy groups by maternal choice. Four breastfeeding practice outcomes [...] Read more.

Background/Objectives: This study aimed to evaluate the effects of frenulotomy in mother–infant pairs with problematic tongue-tie. Methods: A 2-year prospective observational cohort study was performed. Mother–infant pairs were divided into frenulotomy and non-frenulotomy groups by maternal choice. Four breastfeeding practice outcomes were evaluated: reduced latching pain scores, improved LATCH scores, regained birth weight within 2 weeks post-partum, and successful exclusive breastfeeding (EBF) at 3 months of age. The comparison between groups was performed using multivariable risk regression with propensity score analysis. Results: A total of 350 mother–infant pairs were included. There were 226 mother–infant pairs who underwent frenulotomy and 124 pairs in the non-frenulotomy group. The median latching pain scores significantly decreased from 6 to 3 at 24 h post-operatively and from 6 to 0 at 1 week post-operatively (p < 0.001). The median LATCH scores increased significantly from 5 to 9 at 1 week post-operatively (p < 0.001). LATCH scores within 2 weeks were improved in the frenolotomy group (risk ratio = 1.31, p = 0.017). The success rate of EBF at 3 months was 72.12% in the frenulotomy group and 76.61% in the non-frenulotomy group, with no statistically significance. Conclusions: Short-term breastfeeding outcomes and LATCH scores in mother–infant pairs with tongue-tie improved faster in those who underwent the procedure, with no complications. Full article

(This article belongs to the Section Clinical Pediatrics)

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13 pages, 615 KB

Open AccessArticle

Effect of Hand Grip Strength on Perioperative Outcomes in Older Female Patients Scheduled for Total Knee Arthroplasty Under General Anesthesia—A Prospective Observational Study

by Sangho Lee, Doh Yoon Kim, Minsu Kong, Ann Hee You, Jung Eun Kim and Hee Yong Kang

J. Clin. Med. 2026, 15(2), 463; https://doi.org/10.3390/jcm15020463 - 7 Jan 2026

Abstract

Background: This study aims to evaluate the effect of hand grip strength (HGS) on perioperative outcomes—particularly postoperative delirium (POD)—in patients scheduled for total knee arthroplasty (TKA). Methods: Older female patients, aged ≥ 65 years, who were scheduled for TKA under general [...] Read more.

Background: This study aims to evaluate the effect of hand grip strength (HGS) on perioperative outcomes—particularly postoperative delirium (POD)—in patients scheduled for total knee arthroplasty (TKA). Methods: Older female patients, aged ≥ 65 years, who were scheduled for TKA under general anesthesia were enrolled in this study. We measured preoperative HGS and clinical frailty scale. The primary outcome was the incidence of POD within 30 days of surgery. Secondary outcomes included intraoperative hypotension, surgical site infection, postoperative pulmonary complications, postoperative nausea and vomiting, acute kidney injury, postoperative urinary retention, and hospital length of stay. Results: The final analysis was conducted on 78 participants. The median HGS was 17.9 kg, the patients were divided into Weak (HGS ≤ 17.9, n = 39) and Strong groups (HGS > 17.9, n = 39). POD was more prevalent in the Weak group (23.1% vs. 0.0%, p = 0.005). As secondary outcomes, there were no significant differences between the two groups, except the postoperative estimated glomerular filtration rate (101 [90; 120.5] mL/min/1.73 m² in the Weak group vs. 122 [104; 138] mL/min/1.73 m² in the Strong group; p = 0.007). In the receiver operating characteristic curve analysis of POD occurrence according to HGS, the cutoff value was 17.5 (area under curve 0.88, p < 0.001). In univariate logistic regression analysis, age and HGS were associated with the occurrence of POD. In multivariate logistic regression analysis, HGS was the only factor that affects POD. For each 1 kg increase in HGS, the risk of POD decreased by 28% (Odds ratio: 0.72). Conclusions: In this study, lower preoperative HGS was significantly associated with the occurrence of POD. Full article

(This article belongs to the Section Anesthesiology)

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14 pages, 914 KB

Open AccessArticle

Pupillary Pain Index-Guided Postoperative Pain Therapy in ENT Surgery: A Randomized Trial

by Marita Windpassinger, Michal Prusak, Lusine Yeghiazaryan, Robin Ristl, Sascha Ott, Lukas M. Müller-Wirtz and Kurt Ruetzler

J. Clin. Med. 2026, 15(2), 462; https://doi.org/10.3390/jcm15020462 - 7 Jan 2026

Abstract

Background: Postoperative pain levels and opioid requirements vary considerably, even among patients undergoing similar surgical interventions. The pupillary pain index—a pupillometry-derived measure of nociception-antinociception balance—may help individualize postoperative analgesia. We therefore tested the hypothesis that a pupillary pain index-guided opioid titration at the [...] Read more.

Background: Postoperative pain levels and opioid requirements vary considerably, even among patients undergoing similar surgical interventions. The pupillary pain index—a pupillometry-derived measure of nociception-antinociception balance—may help individualize postoperative analgesia. We therefore tested the hypothesis that a pupillary pain index-guided opioid titration at the end of surgery reduces postoperative pain and opioid consumption compared with standard care. Methods: At the end of surgery, a portable infrared pupilometer was used to measure pupillary dilation reflex during stepwise tetanic stimulation (10–60 mA), generating a pupillary pain index score. Adult patients undergoing elective ear-nose-throat surgery under general anesthesia were randomized to pupillary pain index-guided opioid therapy or standard care. Opioid administration in the pupillary pain index group followed predefined pupillary pain index cutoffs; in the control group, analgesia was managed per routine practice. Postoperative opioid consumption and pain—assessed using a numerical rating scale (NRS, 0–10)—were recorded every 30 min for 2 h in the post-anesthesia care unit. Linear models with covariates including remifentanil, weight, nose surgery, and sex were calculated to compare outcomes between groups. Results: Mean (±SD) opioid consumption during the first 2 postoperative hours was 4.9 ± 4.3 mg in the pupillary pain index-guided group and 6.5 ± 4.3 mg in the control group (adjusted p = 0.12). Mean pain scores were 2.0 ± 1.1 and 2.6 ± 1.4, respectively (adjusted p = 0.10). Conclusions: Pupillary pain index-guided analgesia resulted in a nearly 25% reduction in opioid consumption and lower pain scores, although not statistically significant. This suggests that PPI-guided analgesia is not inferior to standard care in terms of pain management. Full article

(This article belongs to the Special Issue Targeted Medicine in Postoperative Pain Management)

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12 pages, 2834 KB

Open AccessArticle

Objective Macular Asymmetry Metrics for Glaucoma Detection Using a Temporal Raphe–Based OCT Linearization Algorithm

by Takuhei Shoji, Miho Seo, Hisashi Ibuki, Hirokazu Ishii, Junji Kanno and Kei Shinoda

J. Clin. Med. 2026, 15(2), 461; https://doi.org/10.3390/jcm15020461 - 7 Jan 2026

Abstract

Background/Objectives: We aim to develop an image linearization process and a program capable of quantifying vertical and left–right asymmetries observed in macular scans. We then sought to verify its applicability in clinical settings. Methods: In this single-center cross-sectional study, we examined 37 consecutive [...] Read more.

Background/Objectives: We aim to develop an image linearization process and a program capable of quantifying vertical and left–right asymmetries observed in macular scans. We then sought to verify its applicability in clinical settings. Methods: In this single-center cross-sectional study, we examined 37 consecutive patients with unilateral open-angle glaucoma and analyzed paired data (glaucomatous eye vs. fellow normal eye). Spectral-domain OCT images were automatically processed by a custom program to align the disc–fovea axis and temporal raphe, and the following parameters were evaluated: (1) mean inner retinal thickness difference (superior–inferior), (2) Vertical Asymmetry Score, and (3) Quadrantal Asymmetry Score. Results: We analyzed 37 healthy eyes and 37 POAG eyes. After linearization, the mean inner retinal thicknesses for the normal and POAG groups were 93.4 µm (interquartile range [IQR]: 90.1–98.5) and 80.3 µm (IQR: 77.3–85.0), respectively. The Vertical Asymmetry Score was 6.80 (IQR: 6.15–7.25) for healthy eyes and 9.69 (IQR: 9.16–11.58) for POAG eyes. The Quadrantal Asymmetry Score was 6.35 (IQR: 5.94–7.19) for healthy eyes and 8.47 (IQR: 8.11–9.63) for POAG eyes. Significant differences were found between groups for all parameters (p < 0.001). The Vertical Asymmetry Score (AUC = 0.967, p < 0.001) and Quadrantal Asymmetry Score (AUC = 0.946, p < 0.001) demonstrated significantly greater accuracy in detecting glaucoma compared to the mean inner retinal thickness (AUC = 0.743). Conclusions: The developed linearization program and asymmetry scores have shown promise as parameters for objectively quantifying macular asymmetry using spectral-domain OCT. External validation in independent cohorts, including bilateral disease, is warranted. Full article

(This article belongs to the Special Issue Future Directions in Imaging-Guided Glaucoma Diagnosis and Therapy)

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15 pages, 985 KB

Open AccessArticle

Assessment of Awake and Sleep Bruxism in Fibromyalgia Patients with Temporomandibular Disorders

by Davide Alessio Fontana, Salvatore Nigliaccio, Francesca Pusateri, Emanuele Di Vita, Pietro Messina, Enzo Cumbo, Antonio Scardina, Elisabetta Raia and Giuseppe Alessandro Scardina

J. Clin. Med. 2026, 15(2), 460; https://doi.org/10.3390/jcm15020460 - 7 Jan 2026

Abstract

Background/Objectives: Fibromyalgia (FM) is a chronic pain syndrome often associated with musculoskeletal tenderness, fatigue, and sleep disturbances. Temporomandibular disorders (TMDs) and bruxism are frequently observed comorbidities in patients with FM, yet their objective assessment remains limited. This study aimed to evaluate masticatory muscle [...] Read more.

Background/Objectives: Fibromyalgia (FM) is a chronic pain syndrome often associated with musculoskeletal tenderness, fatigue, and sleep disturbances. Temporomandibular disorders (TMDs) and bruxism are frequently observed comorbidities in patients with FM, yet their objective assessment remains limited. This study aimed to evaluate masticatory muscle activity in patients with fibromyalgia and temporomandibular disorders using both static surface electromyography (sEMG) and a 24 h portable EMG device (Dia-BRUXO^®). Methods: Thirty female patients (mean age 53.6 ± 10.5 years) underwent comprehensive clinical and gnathological evaluations, followed by static EMG recordings of the masseter and temporalis muscles and continuous monitoring of the left masseter over a 24 h period. Results: Results revealed a significantly higher number of bruxism episodes during wakefulness (80.9 ± 130.8) compared to sleep (24.0 ± 26.8; p < 0.0001). The Masseter Time Index (MTI) and Masseter Work Index (MWI) were also significantly higher during wakefulness (p < 0.001), indicating a predominance of daytime masticatory muscle activity. Static sEMG analysis showed generally preserved bilateral muscle symmetry, accompanied by mild imbalances in occlusal load distribution and increased global muscle activation. Conclusions: These findings suggest that patients with fibromyalgia and temporomandibular disorders exhibit increased baseline masticatory muscle activity, particularly during wakefulness, possibly reflecting sustained neuromuscular tension. Continuous EMG monitoring appears to provide an objective tool for characterizing bruxism patterns and complements clinical assessment and self-reported data. However, the absence of a control group and the exclusive inclusion of female patients limit the generalizability of the results. Further studies including appropriate comparison groups are needed to clarify the specificity and clinical implications of these findings. Full article

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

11 pages, 241 KB

Open AccessArticle

The Role of High-Flow Nasal Cannula (HFNC) During Flexible Bronchoscopy in Adult Patients with Moderate Respiratory Dysfunctions: An Observational Study

by Francesco Coppolino, Pasquale Sansone, Gianluigi Cosenza, Simona Brunetti, Francesca Piccialli, Marco Fiore, Clelia Esposito, Maria Caterina Pace and Vincenzo Pota

J. Clin. Med. 2026, 15(2), 459; https://doi.org/10.3390/jcm15020459 - 7 Jan 2026

Abstract

Background/Objectives: Flexible bronchoscopy (FB) enables airway exploration and diagnosis of various respiratory pathologies, but the sedation and instrumentation required during the procedure raise oxygen demand while reducing ventilation, which can lead to hypoxemia. Conventional oxygen therapy (COT) may not adequately prevent desaturations [...] Read more.

Background/Objectives: Flexible bronchoscopy (FB) enables airway exploration and diagnosis of various respiratory pathologies, but the sedation and instrumentation required during the procedure raise oxygen demand while reducing ventilation, which can lead to hypoxemia. Conventional oxygen therapy (COT) may not adequately prevent desaturations in high-risk groups, as patients with moderate respiratory deficiency. High-flow nasal cannula (HFNC) can deliver heated, humidified oxygen at high flow rates, generating low-level positive airway pressure, improving oxygenation, reducing dead-space, and enhancing procedure tolerance. Prior studies have shown that HFNC can improve gas exchange and reduce desaturations during bronchoscopy. However, evidence remains limited for patients with moderate respiratory deficiency, who are particularly vulnerable. Evaluating the feasibility and safety of HFNC in this population is essential to guide safe procedural practice. Methods: A retrospective observational study including patients undergoing FB with HFNC support between January and May 2025. Inclusion criteria were BMI between 18 and 30; age > 18 years old; moderate respiratory dysfunction, defined by pulse oximetry, Pulmonary Functional Tests (PFTs) and Arterial Blood Gas (ABG) analysis. Exclusion criteria were intolerance/contraindication to HFNC. Procedures were performed under basic monitoring. Primary outcome was occurrence of severe hypoxemia (SpO2 < 90%). Secondary outcomes were needed for rescue maneuvers, interruption for conversion to other ventilatory strategies, and hemodynamic instability. Results: No severe desaturations were recorded, all procedures were completed without rescue maneuvers or other ventilatory strategies, and no hypoxemia occurred. Mean duration of the procedure was 9 min. Vital parameters were maintained within the normal ranges, with a mean SpO₂ during bronchoscopy of 98%. Conclusions: HFNC enables oxygenation and ventilation without adverse events in sedations for FB in patients with moderate respiratory deficiency. Full article

(This article belongs to the Special Issue Innovations in Perioperative Anesthesia: Advancing Non-Operating Room Anesthesia (NORA) and Regional Techniques)

11 pages, 609 KB

Open AccessArticle

Impact of the COVID-19 Pandemic on Emergency Department Practices for Cardiopulmonary Symptoms

by Ki Hong Kim, Jae Yun Jung, Hayoung Kim, Joong Wan Park and Yong Hee Lee

J. Clin. Med. 2026, 15(2), 458; https://doi.org/10.3390/jcm15020458 - 7 Jan 2026

Abstract

Objectives: The purpose of this study was to evaluate the trends and changes in the time to medical imaging in the emergency department (ED) for patients with cardiopulmonary symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The retrospective observational study was conducted [...] Read more.

Objectives: The purpose of this study was to evaluate the trends and changes in the time to medical imaging in the emergency department (ED) for patients with cardiopulmonary symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The retrospective observational study was conducted from the clinical database of a tertiary academic teaching hospital. Patients with cardiopulmonary symptoms (chest pain, dyspnea, palpitation and syncope) who visited an adult ED between January 2018 and December 2021 were included. The primary outcome was the time to medical imaging, including chest X-ray (CXR), chest computed tomography (CT), and focused cardiac ultrasound (FOCUS). The primary exposure was the date of the ED visit during the COVID-19 pandemic (from 1 March 2020 to 31 December 2021). Results: Among the 28,213 patients, 17,260 (61.2%) were in the pre-COVID-19 group, and 10,953 (38.8%) were in the COVID-19 group. The time to medical imaging was delayed in the COVID-19 group compared with the pre-COVID-19 group: the time to FOCUS was 9 min, the time to CXR was 6 min, and the time to chest CT was 115 min. Conclusions: We found that the time to medical imaging for patients with cardiopulmonary symptoms who visited the ED was significantly delayed during the COVID-19 pandemic. Full article

(This article belongs to the Section Emergency Medicine)

12 pages, 813 KB

Open AccessArticle

Ten Years of Atypical Cartilaginous Tumors—Is Curettage Really Enough?

by Sebastian Breden, Maximilian Stephan, Florian Hinterwimmer, Sarah Consalvo, Anna Curto Vilalta, Carolin Knebel, Rüdiger von Eisenhart-Rothe and Ulrich Lenze

J. Clin. Med. 2026, 15(2), 457; https://doi.org/10.3390/jcm15020457 - 7 Jan 2026

Abstract

Background: Atypical cartilaginous tumors (ACT), formerly classified as Grade 1 chondrosarcomas (CS1) of the extremities, are hyaline cartilage-producing neoplasms. The WHO classification (4th edition, 2013) redefined ACT as locally aggressive rather than malignant tumors, prompting a shift toward less aggressive surgical management. [...] Read more.

Background: Atypical cartilaginous tumors (ACT), formerly classified as Grade 1 chondrosarcomas (CS1) of the extremities, are hyaline cartilage-producing neoplasms. The WHO classification (4th edition, 2013) redefined ACT as locally aggressive rather than malignant tumors, prompting a shift toward less aggressive surgical management. This study reports data of a single, tertiary musculoskeletal tumor center and compares the long-term oncological outcomes of wide resections and intralesional curettage for primary ACT. Methods: This retrospective study included 61 patients with ACT treated at a tertiary tumor center between 2003 and 2023. Patients were divided into two cohorts: Cohort 1 was treated before 2013 with wide or radical resection, while cohort 2 was treated with an intralesional approach. Data on recurrence, revision rates, survival, and predictors of outcomes were analyzed using Kaplan–Meier survival analysis and log-rank testing. Results: Wide resections were performed in 24 patients, requiring prosthetic reconstruction in 76% of cases. Intralesional curettage was performed in 37 patients. Local recurrence occurred in 8% in wide resections versus 16% of curettage cases (p = 0.198), with no significant difference in time to recurrence between cohorts. Unplanned revision rates were higher in the wide resection group (42%) compared to curettage (35%), driven primarily by prosthesis-related complications. Overall survival was high in both groups (88% in wide resections vs. 94% in curettage; p = 0.705). Resection margins, and metastases were identified as significant predictors of both recurrence and tumor-related death. Conclusions: Intralesional curettage provides comparable oncological outcomes to wide resections with reduced morbidity, supporting its use as the preferred treatment for ACT in appropriately selected patients. Full article

(This article belongs to the Special Issue Diagnosis and Treatment for Bone Tumor)

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13 pages, 1309 KB

Open AccessCase Report

Left Atrial Thrombus and Cardioembolic Stroke in Chagas Cardiomyopathy Presenting with Atrial Flutter: A Case Report

by Mauricio Sebastián Moreno-Bejarano, Israel Silva-Patiño, Andrea Cristina Aragón-Jácome, Juan Esteban Aguilar, Ana Sofía Cepeda-Zaldumbide, Angela Velez-Reyes, Camila Salazar-Santoliva, Jorge Vasconez-Gonzalez, Juan S. Izquierdo-Condoy and Esteban Ortiz-Prado

J. Clin. Med. 2026, 15(2), 456; https://doi.org/10.3390/jcm15020456 - 7 Jan 2026

Abstract

Background: Chagas disease, caused by Trypanosoma cruzi, remains endemic throughout Latin America but is increasingly reported in urban areas due to migration and vector adaptation. The cardiac form is the most severe manifestation, associated with arrhythmia, mural thrombus formation, and a [...] Read more.

Background: Chagas disease, caused by Trypanosoma cruzi, remains endemic throughout Latin America but is increasingly reported in urban areas due to migration and vector adaptation. The cardiac form is the most severe manifestation, associated with arrhythmia, mural thrombus formation, and a high risk of cardioembolic events. Stroke secondary to Chagas cardiomyopathy is uncommon and poses diagnostic and therapeutic challenges. Case Presentation: A 58-year-old woman with serologic evidence of T. cruzi infection presented with sudden-onset dyspnea, oppressive chest pain, and left-sided weakness. Neurological examination revealed left brachiocrural hemiparesis and mild dysarthria (NIHSS = 9). Non-contrast cranial CT showed an acute infarct in the right middle cerebral artery territory (ASPECTS = 7). Electrocardiography demonstrated typical atrial flutter with variable conduction, and transthoracic echocardiography revealed a markedly dilated left atrium containing a mural thrombus and a left ventricular ejection fraction of 45%. Intravenous thrombolysis with alteplase (0.9 mg/kg) was administered within 4.5 h of symptom onset. Pharmacologic rhythm control was achieved using intravenous and oral amiodarone, followed by oral anticoagulation with warfarin (target INR 2.0–3.0) after excluding hemorrhagic transformation. The patient showed rapid neurological improvement (NIHSS reduction from 9 to 2) and was discharged on day 10 with minimal residual deficit (mRS = 1), sinus rhythm, and stable hemodynamics. Conclusions: This case highlights the rare coexistence of Chagas cardiomyopathy, atrial flutter, and cardioembolic stroke due to left atrial thrombus. Early recognition, adherence to evidence-based guidelines, and multidisciplinary management were key to achieving a favorable outcome. Timely diagnosis and intervention remain crucial to preventing severe complications in patients with Chagas disease. Full article

(This article belongs to the Section Cardiovascular Medicine)

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19 pages, 1332 KB

Open AccessArticle

Association of Hyperbilirubinemia with Lipid Profile and Lipid-Related Diseases: A Large Community-Based Cohort Study

by Borong Yu, Yuhe Liu, Wenqian Wu, Yong Zhou, Dan Han and Yuanwen Chen

J. Clin. Med. 2026, 15(2), 455; https://doi.org/10.3390/jcm15020455 - 7 Jan 2026

Abstract

Objectives: Emerging evidence suggests that bilirubin, beyond being a metabolic byproduct, may exert protective effects against metabolic and cardiovascular diseases due to its antioxidant properties. However, its relationship with hyperlipidemia remains unclear. This study investigated the relationship between hyperbilirubinemia and hyperlipidemia in a [...] Read more.

Objectives: Emerging evidence suggests that bilirubin, beyond being a metabolic byproduct, may exert protective effects against metabolic and cardiovascular diseases due to its antioxidant properties. However, its relationship with hyperlipidemia remains unclear. This study investigated the relationship between hyperbilirubinemia and hyperlipidemia in a large, community-based cohort. Methods: Data from 8464 participants in the Jidong Community Cohort were analyzed using a cross-sectional design. Hyperbilirubinemia was defined as serum total bilirubin (STB) ≥ 17.1 μmol/L, whereas hyperlipidemia was determined based on a prior diagnosis or elevated lipid profile. Results: Of all participants, 31.6% had hyperbilirubinemia and 51.8% had hyperlipidemia. Multivariable logistic regression revealed a significant inverse association between hyperbilirubinemia and hyperlipidemia [odds ratio (OR) = 0.764, 95% confidence interval (CI) = 0.686–0.851]. This association was significant in participants aged <65 years (OR = 0.762, p < 0.0001) but not in those aged ≥65 years. Stratified analysis by smoking status further revealed a 29% reduced risk of hyperlipidemia among never-smokers (OR = 0.708, p < 0.001), but not among current (OR = 0.831, p = 0.087) or former smokers (OR = 0.685, p = 0.175). Hyperbilirubinemia was also negatively associated with TC (p < 0.0001), TGs (p < 0.0001), LDL-C (p = 0.0061), very LDL-C (VLDL-C; p = 0.0043), and apolipoprotein B (ApoB; p < 0.0001) levels, as well as the ApoB/apolipoprotein A1 (ApoA1) ratio (p = 0.0003). Restricted cubic spline analysis revealed an inverse relationship of high STB levels with the TC, TG, LDL-C, VLDL-C, and ApoB levels, as well as the ApoB/ApoA1 ratio. Moreover, elevated STB levels were inversely linked to obesity (OR = 0.747, p < 0.0001), arterial stenosis (OR = 0.806, p = 0.0462), and metabolic syndrome (OR = 0.784, p = 0.0008). Conclusions: hyperbilirubinemia may be an independent factor protective against hyperlipidemia and related lipid abnormalities; these results provide insights for the prevention and management of lipid-related diseases. Full article

(This article belongs to the Section Cardiovascular Medicine)

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42 pages, 1594 KB

Open AccessArticle

A Retrospective Analysis of Hepatic Disease Burden and Progression in a Hospital-Based Romanian Cohort Using Integrated Cross-Sectional and Longitudinal Data (2019–2023)

by Alina Dumitrache (Păunescu), Nicoleta Anca Șuțan, Diana Ionela Popescu (Stegarus), Liliana Cristina Soare, Maria Cristina Ponepal, Cristina Florina Mihăescu, Maria Daniela Bondoc, Muhammed Atamanalp, Ana Cătălina Țânțu, Cătălina Gabriela Pisoschi, Ileana Monica Baniță and Monica Marilena Țânțu

J. Clin. Med. 2026, 15(2), 454; https://doi.org/10.3390/jcm15020454 - 7 Jan 2026

Abstract

Objective: To analyze demographic traits, clinical complications, and healthcare use in patients with chronic liver disease across major etiologies in a large Romanian cohort. Methods: A retrospective study (2019–2023) of 2359 patients with chronic hepatitis C (CHC), hepatitis associated with alcohol (ALH), cirrhosis [...] Read more.

Objective: To analyze demographic traits, clinical complications, and healthcare use in patients with chronic liver disease across major etiologies in a large Romanian cohort. Methods: A retrospective study (2019–2023) of 2359 patients with chronic hepatitis C (CHC), hepatitis associated with alcohol (ALH), cirrhosis associated with alcohol (ALC), or non-alcoholic cirrhosis (NALC). Data on demographics, clinical outcomes, and hospitalizations were analyzed using descriptive statistics, regression modeling, and clustering in IBM SPSS 27.0.1. Results: CHC patients were oldest (mean 67.5 ± 12.3 years), while ALH patients were youngest (56.0 ± 11.0 years). CHC prevalence increased with age (10.0% in ≤30-year-olds to 87.1% in ≥81-year-olds; γ = 0.535, p < 0.001). Females comprised 60–70% of CHC cases, males >85% of ALH and >78% of ALC. Mean hospitalization duration decreased from 13.80 days (2019) to 9.10 days (2023), yet cirrhotic patients had the longest stays (NALC: 16.37 ± 14.34; ALC: 17.66 ± 12.96) versus CHC (10.38 ± 10.14). Etiology was the strongest predictor of hospitalization length. Portal hypertension (PH) was the most common complication (54.3%), with males bearing more severe hepatic complications (ascites—38.3%; PH—66.8%). Conclusions: Hospital-based Romanian cohort analysis revealed that patient presentation and outcomes are fundamentally shaped by the interplay of etiology, sex, and age. We found a distinct female predominance in CHC, a pronounced male predominance in alcohol-related diseases, and evolving trends in non-alcoholic cirrhosis. These determinants dictate specific epidemiological patterns, hospitalization burdens, and complication risks, underscoring the critical need for a paradigm shift toward personalized, etiology-driven, and sex-tailored clinical management. Full article

(This article belongs to the Special Issue Cirrhosis and Its Complications: Prognosis and Clinical Management)

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J. Clin. Med., Volume 15, Issue 2 (January-2 2026) – 82 articles

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