Journal of Clinical Medicine

13 pages, 935 KB

Open AccessArticle

Expert Perspectives on Managing Iron Deficiency in People with CKD and/or HF

by Sunil Bhandari, John G. F. Cleland, Fozia Z. Ahmed, Fraser J. Graham, Matt Hall, Paul R. Kalra, Philip A. Kalra, Kate I. Stevens, David C. Wheeler, Simon G. Williams, Dora. I. A. Pereira, Marco Soscia, Harry Lewis and Imogen Taylor

J. Clin. Med. 2026, 15(4), 1676; https://doi.org/10.3390/jcm15041676 - 23 Feb 2026

Cited by 1 | Viewed by 852

Abstract

Background: Iron deficiency (ID) is common among people with chronic kidney disease (CKD) and/or heart failure (HF). Despite the additional burden ID causes among people with CKD and HF, there is considerable uncertainty surrounding the best way to diagnose it and, subsequently, identify [...] Read more.

Background: Iron deficiency (ID) is common among people with chronic kidney disease (CKD) and/or heart failure (HF). Despite the additional burden ID causes among people with CKD and HF, there is considerable uncertainty surrounding the best way to diagnose it and, subsequently, identify who is most likely to benefit from receiving iron therapy. Methods: This manuscript reports the markers and thresholds used in ID diagnosis, treatment, and management in the UK by nephrologists and cardiologists who manage people with chronic kidney disease or heart failure, as well as investigating future challenges and questions that remain unanswered. The research involved three stages: an online questionnaire, individual interviews, and a panel meeting, which discussed the findings from the first two stages. Results: The panel concluded that there is no robust definition of iron deficiency that can be applied to chronic kidney disease and heart failure. Existing methods of diagnosing iron deficiency come with various problems; a transferrin saturation of <20% is the most popular, but it is not regarded as a perfect solution. Transferrin saturation is also the most popular way of assessing the success of iron deficiency treatment. Clinicians generally do not vary treatment regimens based on severity or subgroups. There are large variations in monitoring and the ability to administer iron therapy in secondary care. Conclusions: There is a clear need to consolidate current approaches to diagnosing and treating iron deficiency in people with chronic kidney disease and/or heart failure. Simple markers and thresholds, and simple strategies to implement them are required. Full article

(This article belongs to the Section Nephrology & Urology)

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31 pages, 1680 KB

Open AccessSystematic Review

The Current State of Intraoperative Imaging in Maxillofacial Surgery: A Systematic Review

by Charlotte Thomas, Gary Dong, Dorien I. Schonebaum, Sanjana Challa, Alynah J. Adams, Emily Song, Fatima Arif, Jose A. Foppiani, Warren Schubert, Umar Choudry and Samuel J. Lin

J. Clin. Med. 2026, 15(4), 1675; https://doi.org/10.3390/jcm15041675 - 23 Feb 2026

Viewed by 860

Abstract

Background: In maxillofacial reconstruction, even small inaccuracies can compromise aesthetics, function, and safety. Surgeons currently rely on preoperative imaging; however, recent advances in intraoperative imaging now provide three-dimensional, real-time guidance, possibly enhancing surgical outcomes. This review evaluates the current application of intraoperative [...] Read more.

Background: In maxillofacial reconstruction, even small inaccuracies can compromise aesthetics, function, and safety. Surgeons currently rely on preoperative imaging; however, recent advances in intraoperative imaging now provide three-dimensional, real-time guidance, possibly enhancing surgical outcomes. This review evaluates the current application of intraoperative imaging in maxillary and mandibular surgery including its impact on accuracy, efficiency, and outcomes. Methods: Two separate systematic reviews (PROSPERO CRD420251125497, CRD420251124600), analyzing maxillary and mandibular repair were conducted through Cochrane, Medline, Embase, and Web of Science. Both reviews adhered to the PRISMA guidelines. Inclusion criteria encompassed intraoperative digital imaging or navigation in maxillary or mandibular surgery. Studies without human subjects, intraoperative imaging, or the surgery of interest were excluded. Bias was assessed with NIH Quality Assessment. Results: A combined total of 795 publications were screened, with 35 studies ultimately included in this review, encompassing 1643 patients. Techniques included intraoperative computed tomography (CT) (n = 12, 34.3%), stereotactic navigation (n = 16, 45.7%), augmented reality (n = 2, 5.7%), ultrasound, fluoroscopy, infrared stereoscopic and electromagnetic (n = 1, 2.9%, each). The most common indication for surgery was fracture repair. Reporting was heterogeneous, with variable metrics and reporting for accuracy, complications, and revisions. Overall, cone-beam CT (CBCT) and stereotactic navigation both demonstrated significant restoration of normal symmetry, and stereotactic navigation enabled accuracy of <2 mm. CBCT added the shortest amount of time intraoperatively, ranging from 1 to 20 min. Reporting on long-term outcomes was heterogeneous. Conclusions: A variety of intraoperative imaging and navigation techniques are being applied in maxillofacial surgery. However, inconsistent reporting metrics, small study size, and study feasibility-focused study design limit meaningful comparison across technologies. Rigorous prospective studies with standardized outcome measures are needed to further define their clinical value and guide adoption. Full article

(This article belongs to the Special Issue New Insights in Maxillofacial Surgery)

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16 pages, 687 KB

Open AccessArticle

Cardio-Reno-Microvascular Phenotypes and Multifactorial Cardiometabolic Target Achievement in Type 2 Diabetes

by Silvia Ana Luca, Raluca Malina Bungau, Andreea Herascu, Alin Albai, Sandra Lazar and Bogdan Timar

J. Clin. Med. 2026, 15(4), 1674; https://doi.org/10.3390/jcm15041674 - 23 Feb 2026

Viewed by 723

Abstract

Background: Patients with type 2 diabetes (T2D) have high morbidity and mortality rates, mainly due to cardiovascular diseases (CVDs). Given the heterogeneity of this population, in whom atherosclerotic CVD may coexist with varying degrees of microvascular and renal involvement, preventive and therapeutic needs [...] Read more.

Background: Patients with type 2 diabetes (T2D) have high morbidity and mortality rates, mainly due to cardiovascular diseases (CVDs). Given the heterogeneity of this population, in whom atherosclerotic CVD may coexist with varying degrees of microvascular and renal involvement, preventive and therapeutic needs differ among these patients. Multifactorial CV risk factor control has proven beneficial in T2D; however, it remains suboptimal, particularly for lipid and weight targets. Aims: The aims were to evaluate, in a real-world cohort of patients with T2D, whether different cardio-reno-microvascular phenotypes are associated with differences in multifactorial cardiometabolic control and to assess individual target attainment along with the use of cardioprotective therapies across phenotypes. Methods: In a single-center, cross-sectional study, 174 patients with T2D were enrolled and clustered into four phenotypes based on the presence of atherosclerotic CVD (ASCVD), chronic kidney disease, retinopathy and neuropathy. Achievement of individual and multifactorial cardiometabolic risk factor control was examined across phenotypes. Results: More than three quarters of the cohort had ASCVD, microvascular/renal disease, or both. While approximately half of the patients had optimal glycemic control, achievement of LDLC and normal BMI was modest. Target attainment did not differ significantly across phenotypes, with most patients achieving one or two targets and less than one third achieving three or more. Statin use was significantly higher in phenotypes with ASCVD, whereas use of other lipid-lowering therapies remained low. Use of SGLT2is and GLP-1 RAs was also limited. Higher BMI was independently associated with lower odds of multifactorial control. Conclusions: In this real-world cohort of patients with T2D, individual and multifactorial cardiometabolic risk factor control was suboptimal, particularly for LDLC and body weight. A phenotype-based approach may help clinicians identify vulnerable subgroups requiring more intensive, risk-based preventive strategies. Full article

(This article belongs to the Section Cardiovascular Medicine)

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16 pages, 3452 KB

Open AccessArticle

Impact of Large Language Model Assistance on Radiologists’ Diagnostic Performance for Brain Tumors by Experience Level

by Chae Won Song, Byung Hyun Baek, Seul Kee Kim, Woong Yoon, Yun Young Lee, Ilwoo Park, Jae Hyun Park, Seol Bin Park and In Woo Choi

J. Clin. Med. 2026, 15(4), 1673; https://doi.org/10.3390/jcm15041673 - 23 Feb 2026

Viewed by 855

Abstract

Background: Large language models (LLMs) may assist radiologists in interpreting brain tumor MRI. We compared the diagnostic accuracy of ChatGPT-4o and Claude 3.5 Sonnet with that of board-certified radiologists and trainees, and evaluated whether LLM assistance could enhance diagnostic performance. Methods: [...] Read more.

Background: Large language models (LLMs) may assist radiologists in interpreting brain tumor MRI. We compared the diagnostic accuracy of ChatGPT-4o and Claude 3.5 Sonnet with that of board-certified radiologists and trainees, and evaluated whether LLM assistance could enhance diagnostic performance. Methods: A total of 127 histologically confirmed brain tumor cases were included. Two LLMs analyzed representative MRI images together with structured radiologic reports, whereas two board-certified radiologists and three trainees reviewed representative images with basic demographic information only. All participants generated up to three differential diagnoses per case. The accuracy of the primary diagnosis and the accuracy of the top-three differential diagnoses were calculated and compared. Following the initial readings, LLM-generated differential diagnoses were provided to the readers, and their post-assistance diagnostic performance was re-evaluated. Results: Claude 3.5 Sonnet achieved a primary diagnostic accuracy of 50.4% and a top-three differential accuracy of 85.0%, comparable to ChatGPT-4o (44.9% and 82.7%, respectively). Radiologists demonstrated a higher primary diagnostic accuracy (69.3%, p < 0.001) compared to LLMs, but a similar top-three differential accuracy (80.7%). In contrast, trainees showed a primary diagnostic accuracy (48.0%) comparable to LLMs, but a lower top-three differential accuracy (62.5%) than LLMs. With LLM assistance, radiologists exhibited a significant improvement in the top-three differential accuracy (from 80.7% to 90.2%, p < 0.001), and trainees showed significant improvements in both the primary and top-three differential accuracy (from 48.0% to 58.8%, p < 0.001, and from 62.5% to 81.1%, p < 0.001, respectively). Conclusion: LLMs demonstrated the ability to expand differential diagnostic considerations when operating on structured imaging inputs. LLM assistance was associated with improved trainee performance in this constrained experimental setting. These findings should be interpreted cautiously and require validation under balanced input conditions and clinically realistic workflows. Full article

(This article belongs to the Section Clinical Research Methods)

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10 pages, 2234 KB

Open AccessArticle

Mid-Term Results of Ceramic Monoblock Acetabular Cups in Primary Total Hip Arthroplasty: A Minimum 5-Year Follow-Up

by Chan Young Lee, Gong-Yeong Kim, Taek-Rim Yoon and Kyung-Soon Park

J. Clin. Med. 2026, 15(4), 1672; https://doi.org/10.3390/jcm15041672 - 23 Feb 2026

Viewed by 754

Abstract

Introduction: Ceramic-on-ceramic (CoC) articulation in total hip arthroplasty (THA) offers excellent wear characteristics but carries risks such as liner malseating and ceramic fracture. To solve these problems, monoblock acetabular cups with preassembled ceramic liners were developed to minimize technical errors and allow the [...] Read more.

Introduction: Ceramic-on-ceramic (CoC) articulation in total hip arthroplasty (THA) offers excellent wear characteristics but carries risks such as liner malseating and ceramic fracture. To solve these problems, monoblock acetabular cups with preassembled ceramic liners were developed to minimize technical errors and allow the use of larger femoral heads. This study aimed to evaluate the mid-term clinical and radiological outcomes of a ceramic monoblock acetabular cup system. Methods: A retrospective analysis was performed on 106 primary THAs in South Korean patients using the Maxera monoblock cup (Zimmer Biomet) between 2015 and 2018, with a minimum follow-up of 5 years. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS). Radiologic evaluation included osteolysis and radiolucent lines. Normality of clinical variables was confirmed, and pre-to-postoperative comparisons were performed using paired t-tests. Results: The mean follow-up was 6.8 ± 1.4 years. The most common preoperative diagnosis was avascular necrosis (66.0%). Cups sized ≤52 mm were used in 80.2% of hips, allowing the frequent use of large femoral heads (32–40 mm). Clinical scores improved significantly: HHS from 37.0 ± 13.4 to 90.8 ± 6.2, WOMAC from 66.6 ± 11.5 to 7.6 ± 6.7, and VAS from 6.45 ± 1.1 to 1.1 ± 0.8 (p < 0.001). No osteolysis was observed. Radiolucent lines was appeared in four hips (3.7%) without evidence of migration or loosening. One cup fixation failure (0.9%) required revision. No cases of ceramic fracture, squeaking, or dislocation occurred. Conclusions: The ceramic monoblock acetabular cup demonstrated excellent mid-term clinical and radiological outcomes with a very low complication rate. The ability to reliably use large femoral heads likely contributed to enhanced joint stability. However, the absence of screw fixation and inability to directly visualize cup insertion require careful attention during cup impaction. Long-term studies with comparative cohorts are warranted. Full article

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

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18 pages, 1968 KB

Open AccessArticle

Association Between Body Mass Index and Clinical Outcomes of CDK4/6 Inhibitors in HR+/HER2− Metastatic Breast Cancer: A Real-World Cohort Study

by Seval Orman, Miray Aydoğan, Nisanur Sarıyar Busery, Sedat Yıldırım, Hacer Şahika Yıldız, Hamit Bal, Utku Dönem Gündoğdu, Seval Ay Ersoy, Deniz Işık, Hatice Odabaş and Nedim Turan

J. Clin. Med. 2026, 15(4), 1671; https://doi.org/10.3390/jcm15041671 - 23 Feb 2026

Viewed by 731

Abstract

Background: Body mass index (BMI) has been widely investigated as a potential prognostic factor in breast cancer; however, its clinical relevance in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) metastatic breast cancer treated with CDK4/6 inhibitors remains controversial, particularly in [...] Read more.

Background: Body mass index (BMI) has been widely investigated as a potential prognostic factor in breast cancer; however, its clinical relevance in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) metastatic breast cancer treated with CDK4/6 inhibitors remains controversial, particularly in contemporary real-world settings. This study aimed to evaluate the association between baseline BMI and clinical outcomes, including survival and treatment-related toxicity, in a real-world cohort. Methods: This single-centre retrospective observational cohort study included patients with HR+/HER2− metastatic breast cancer treated with endocrine therapy and a CDK4/6 inhibitor (palbociclib or ribociclib) in the metastatic setting between January 2018 and May 2025. Patients were categorised by baseline BMI (<25 vs. ≥25 kg/m²). Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan–Meier method and Cox proportional hazards models. To minimise confounding, propensity score matching (PSM) with a 1:3 nearest-neighbour algorithm was performed. Non-linear associations between continuous BMI and survival outcomes were explored using restricted cubic spline analyses. Treatment-related adverse events were evaluated according to CTCAE v5.0. Results: A total of 456 patients were included; 321 (70.4%) had a BMI ≥ 25 kg/m², and 135 (29.6%) had a BMI < 25 kg/m². Propensity score matching produced a balanced cohort of 220 patients. The reduction in sample size after matching reflects the need to achieve close baseline comparability between groups. In the matched cohort, no statistically significant differences in PFS (log-rank p = 0.55) or OS (log-rank p = 0.31) were observed across BMI categories. BMI was not an independent predictor of PFS or OS in multivariable analyses. However, restricted cubic spline modelling revealed a non-linear relationship between continuous BMI and survival outcomes, with increased risk at extreme BMI values, underscoring the limitations of dichotomous BMI categorisation. Conclusions: In this real-world cohort of patients with HR+/HER2− metastatic breast cancer treated with CDK4/6 inhibitors, dichotomised BMI categories were not independently associated with survival outcomes. However, modelling BMI as a continuous variable revealed a non-linear (U-shaped) relationship, with increased risk at both the low and high ends of the BMI distribution. These findings suggest that the prognostic impact of BMI is non-linear and may be obscured by simple dichotomous categorisation. Full article

(This article belongs to the Section Oncology)

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12 pages, 624 KB

Open AccessReview

Clinical Therapeutic and Management Strategies for Epilepsy: Psychological Aspects in Children with Epilepsy and Their Parents

by Hideaki Kanemura

J. Clin. Med. 2026, 15(4), 1670; https://doi.org/10.3390/jcm15041670 - 23 Feb 2026

Viewed by 754

Abstract

Epileptic activities can affect various aspects including neuropsychological and social functions, which lead to reductions in quality of life (QOL) for epileptic children. Social function in epileptic children can be negatively impacted due to emotional instability, including stigma associated with having epilepsy. The [...] Read more.

Epileptic activities can affect various aspects including neuropsychological and social functions, which lead to reductions in quality of life (QOL) for epileptic children. Social function in epileptic children can be negatively impacted due to emotional instability, including stigma associated with having epilepsy. The parents of children with refractory epilepsy could experience severe anxiety regarding clinical seizures in their children, and this severe parental anxiety state could lead to adaptable dysfunction in their children. Moreover, associations between epilepsy and fatigue or headache are well known to clinicians but insufficiently understood. A deeper understanding of these issues in epilepsy could be important for managing the clinical course and treatment regimen. Seizure activities could be associated with impaired neuropsychological/social functions as represented by stigma, fatigue, and headache. Seizure severities are thus important QOL-related factors in terms of neuropsychological and social issues in epileptic children. A relationship between current seizure activity and perception of stigma could be evident in epileptic children. Seizure activity represented as frequent seizures could also be related to fatigue and seizure-associated headache, which can lead to reduced QOL in children with epilepsy. In addition, seizure-related factors in epileptic children including frequent seizures could lead to a greater perception of stigma among their parents. Meanwhile, educational interventions about epilepsy for parents could reduce negative emotional influences when caring for children presenting with seizure attacks. Therapeutic management thus appears desirable to achieve better seizure control and establish educational support for parents, aiming to improve QOL in children with epilepsy. Full article

(This article belongs to the Special Issue Clinical Therapeutic and Management Strategies of Epilepsy—Social and Neuropsychological Aspects)

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17 pages, 1482 KB

Open AccessArticle

Avoiding False-Positive Glaucoma Diagnosis in Myopic Eyes: Clinical Importance of OCT Scan Diameter

by Saadet Gültekin Irgat, Ramazan Demirel, Ecem Ulutürk, Alpaslan Koç, Fatih Özcura and Özlem Arık

J. Clin. Med. 2026, 15(4), 1669; https://doi.org/10.3390/jcm15041669 - 23 Feb 2026

Viewed by 835

Abstract

Background/Objectives: Diagnosing glaucoma in myopic eyes remains challenging because myopia-related structural changes can mimic glaucomatous damage on optical coherence tomography (OCT). This study aimed to identify the optimal circular scan diameter for differentiating physiological myopic thinning from glaucomatous loss by analyzing retinal nerve [...] Read more.

Background/Objectives: Diagnosing glaucoma in myopic eyes remains challenging because myopia-related structural changes can mimic glaucomatous damage on optical coherence tomography (OCT). This study aimed to identify the optimal circular scan diameter for differentiating physiological myopic thinning from glaucomatous loss by analyzing retinal nerve fibre layer thickness (RNFLT) and colour-code distribution across three scan diameters. Methods: In this prospective cross-sectional study, 204 eyes (41 controls, 44 mild myopia, 66 moderate myopia, and 53 high myopia) were examined using spectral-domain OCT (Spectralis, Heidelberg). Three concentric circumpapillary scans centred on the Bruch’s membrane opening were obtained: C1 = 3.5 mm, C2 = 4.1 mm, and C3 = 4.7 mm. Global and sectoral RNFLT were evaluated in seven anatomical regions (TS, NS, N, NI, TI, T, and G). Statistical analyses included one-way ANOVA, repeated-measures ANOVA, and receiver operating characteristic (ROC) analysis. Results: RNFLT decreased significantly with increasing scan diameter (p< 0.001). Thinning was most pronounced in the nasal-superior (NS) and nasal-inferior (NI) quadrants. Across all diameters, C2 (4.1 mm) showed the highest and most consistent discriminatory performance between myopic and control eyes (NI: AUC = 0.674, p = 0.001; NS: AUC = 0.625, p = 0.014). A progressive shift in OCT colour-code distribution was observed from green to yellow/red with both increasing myopia and larger scan diameters, reflecting anatomical stretching in the nasal and inferior regions. This change was most prominent at the outer ring (C3), where the temporal-inferior (TI) quadrant showed a significant rise in yellow codes (p = 0.020). Repeated-measures ANOVA revealed significant between-group effects in NS and NI (p < 0.01) and notable group × diameter interactions in NS and TS (p< 0.05). Conclusions: RNFLT thinning in non-glaucomatous myopic eyes predominantly affects nasal quadrants, whereas temporal segments remain relatively preserved. The 4.1 mm (C2) scan provides the most balanced diagnostic performance and minimizes false-positive “red disease” results. Recognition of the ring-dependent colour-code shift and segment-specific thinning is crucial for accurate interpretation of OCT findings in myopic eyes. Full article

(This article belongs to the Section Ophthalmology)

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Graphical abstract

13 pages, 1443 KB

Open AccessArticle

Early Prediction of 90-Day Periprosthetic Joint Infection After Hip Arthroplasty for Proximal Femur Fracture Using Machine Learning: Development and Temporal Validation of a Predictive Model

by Nicolò Giuseppe Biavardi, Francesco Pezone, Federico Morlini, Mattia Alessio-Mazzola, Valerio Pace, Pierluigi Antinolfi, Giacomo Placella and Vincenzo Salini

J. Clin. Med. 2026, 15(4), 1668; https://doi.org/10.3390/jcm15041668 - 23 Feb 2026

Viewed by 765

Abstract

Background: Periprosthetic joint infection (PJI) after hip arthroplasty for proximal femur fracture is a severe complication, and early postoperative identification remains challenging. This study developed and validated machine learning (ML) models for the early prediction of 90-day EBJIS 2021 “confirmed” PJI using routinely [...] Read more.

Background: Periprosthetic joint infection (PJI) after hip arthroplasty for proximal femur fracture is a severe complication, and early postoperative identification remains challenging. This study developed and validated machine learning (ML) models for the early prediction of 90-day EBJIS 2021 “confirmed” PJI using routinely available perioperative data. Methods: We performed a single-center retrospective study including 1182 consecutive adults undergoing primary hip arthroplasty for proximal femur fracture (2015–2022). Forty-seven perioperative candidate predictors were extracted, including early postoperative laboratory values (postoperative day 1–2 and maxima within 72 h). Six algorithms were trained and compared (logistic regression, random forest, support vector machine, multilayer perceptron, XGBoost, and stacking ensemble) using a stratified 80/20 training–test split with 10-fold cross-validation, grid-search hyperparameter tuning, and class weighting. A sensitivity-prioritizing classification threshold was derived using training data only and applied unchanged to evaluation cohorts. Uncertainty was estimated via 1000 bootstrap iterations. Calibration was assessed using the Brier score and calibration intercept/slope. Temporal validation was conducted in a same-center 2023 cohort (n = 147). Model explainability used SHAP. Results: EBJIS-confirmed 90-day PJI occurred in 58/1182 (4.9%) patients. In held-out testing, the final XGBoost model demonstrated good discrimination (AUC 0.889, 95% CI 0.804–0.960) with good overall calibration (Brier score 0.043). Using a prespecified sensitivity-prioritizing threshold selected in the training set, test-set sensitivity was 100%, specificity 58.5%, PPV 11.4%, and NPV 100%. The stacking ensemble yielded the highest discrimination (AUC 0.937; 95% CI 0.89–0.98). In temporal validation (same-center 2023 cohort; n = 147), model performance remained stable (AUC 0.892; sensitivity 85.7%; NPV 99.1% at the prespecified threshold). Calibration was favorable in the development cohort (Brier 0.041; intercept −0.04; slope 0.96) and in 2023 (Brier 0.038; intercept −0.06; slope 0.94). SHAP identified postoperative C-reactive protein, operative duration, body mass index, ASA class, and serum sodium as the most influential predictors. Conclusions: ML models, particularly XGBoost, supported early postoperative risk stratification for 90-day EBJIS-confirmed PJI after fracture-related hip arthroplasty, with a consistently high NPV and stable calibration in a temporally independent same-center cohort. Prospective multi-center validation and impact evaluation are needed before clinical implementation. Full article

(This article belongs to the Special Issue Clinical Advances in Trauma and Orthopaedic Surgery)

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12 pages, 2540 KB

Open AccessArticle

Real-Time Perfusion Assessment with Hyperspectral Imaging After Revascularization in Peripheral Artery Disease

by Michaela Kluckner, Wolfgang Hitzl, Florian K. Enzmann, David Wippel, Maximilian Lutz and Sabine Wipper

J. Clin. Med. 2026, 15(4), 1667; https://doi.org/10.3390/jcm15041667 - 23 Feb 2026

Cited by 2 | Viewed by 733

Abstract

Background/Objectives: Hyperspectral imaging (HSI) facilitates noninvasive assessment of tissue perfusion in patients with peripheral arterial disease. However, available studies are either based on small cohorts and provide no comparison to standard methods or only one-time measurements. Methods: In this prospective cohort [...] Read more.

Background/Objectives: Hyperspectral imaging (HSI) facilitates noninvasive assessment of tissue perfusion in patients with peripheral arterial disease. However, available studies are either based on small cohorts and provide no comparison to standard methods or only one-time measurements. Methods: In this prospective cohort study, assessment of tissue perfusion with transcutaneous oxygen pressure (TcPO2) measurement and HSI before (1 day) and after revascularization (1–3 days) in patients with Rutherford category 3–6 was performed. The primary endpoint was change in tissue perfusion evaluated with the different methods. HSI and TcPO2 were correlated with clinical improvement after revascularization. Results: Significant improvement in the perfusion was detected by tissue oxygenation in the microcirculation (StO2; improvement +12%, mean difference 5 ± 15.9, p < 0.001) and near-infrared spectroscopy (NIR; improvement +9%, mean difference 3.7 ± 7.1, p < 0.001), but not with the tissue hemoglobin index (THI; mean difference +0.8 ± 10.3, p = 0.428). A high number of worse or unchanged HSI measurements despite successful revascularization was detected. A significant improvement of TcPO2 after revascularization (mean difference +16.2 ± 27.7 mmHg, p < 0.001), consistent with clinical improvement, was detected. No correlation of the HSI parameters with TcPO2 or clinical symptoms could be seen. Conclusions: Significant improvement of StO2, NIR and TcPO2 values was detected after successful revascularization; however, no correlation of HSI parameters with TcPO2 or clinical results could be observed. Furthermore, the substantial rate of lower or unchanged HSI parameters despite clinical improvement and higher TcPO2 values calls the validity and clinical relevance of TIVITA^®-based HSI measurements for postoperative tissue perfusion improvement into question. Full article

(This article belongs to the Special Issue Advances in Vascular and Endovascular Surgery: Second Edition)

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12 pages, 7312 KB

Open AccessArticle

Symptom-Oriented, Connectome-Informed Deep Brain Stimulation for Asymmetric Dystonic Tremor: Unilateral Ventral Intermediate Nucleus (VIM) DBS Targeting a Tremor-Dominant Network

by Olga Mateo-Sierra, Javier Ricardo Pérez-Sánchez, Beatriz De la Casa-Fages, María Teresa Del Castillo, Pilar Fernández, Pascual Elvira, José Paz and Francisco Grandas

J. Clin. Med. 2026, 15(4), 1666; https://doi.org/10.3390/jcm15041666 - 23 Feb 2026

Viewed by 727

Abstract

Background: Deep brain stimulation (DBS) has traditionally followed diagnosis-driven, nucleus-centered targeting paradigms. Increasing evidence supports a circuit-based framework in which clinical outcomes depend on modulation of symptom-relevant networks rather than diagnostic labels alone. This approach is particularly relevant in mixed movement disorder phenotypes [...] Read more.

Background: Deep brain stimulation (DBS) has traditionally followed diagnosis-driven, nucleus-centered targeting paradigms. Increasing evidence supports a circuit-based framework in which clinical outcomes depend on modulation of symptom-relevant networks rather than diagnostic labels alone. This approach is particularly relevant in mixed movement disorder phenotypes such as dystonic tremor, where the most disabling symptom may not align with the conventional surgical target. Methods: We report a clinically illustrative single case treated using a symptom-oriented, connectome-informed DBS strategy. Clinical phenotype, tremor severity, functional impairment, prior medical and botulinum toxin treatments, and longitudinal outcomes were systematically reviewed. DBS target selection prioritized the dominant, treatment-refractory symptom rather than the underlying dystonia diagnosis. Surgical planning incorporated high-resolution MRI with patient-specific thalamic segmentation using Brainlab Brain Elements^®, followed by postoperative lead localization and volume of tissue activated visualization with the SureTune™ platform. Results: A 54-year-old left-handed woman with long-standing cervical dystonia developed a severe, markedly asymmetric dystonic tremor predominantly affecting the left upper limb, resulting in profound functional disability. Instead of conventional bilateral globus pallidus internus DBS, unilateral right ventral intermediate nucleus (VIM) DBS was selected to engage tremor-related cerebellothalamic circuits. Rapid and marked improvement was observed, with tremor severity reduced to mild levels within 15 days after stimulation onset. At 6-month follow-up, overall tremor severity improved from 49 to 13 points on the Fahn–Tolosa–Marin Tremor Rating Scale, corresponding to a 73.5% reduction. This improvement was associated with restoration of legible handwriting, independent feeding and drinking, and recovery of bimanual fine motor function. Clinical benefit remained stable throughout follow-up, without stimulation-related adverse effects. Conclusions: This case illustrates the feasibility of a symptom-oriented, connectome-informed DBS strategy in selected patients with dystonic tremor. When symptom expression and network involvement are markedly asymmetric, selective unilateral modulation of the tremor-dominant circuit may achieve meaningful and durable functional improvement. Further studies are needed to assess the generalizability of this approach. Full article

(This article belongs to the Special Issue Neurological Rehabilitation: Repair Mechanisms, Plasticity, and Connectomes)

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12 pages, 1562 KB

Open AccessArticle

Surgical Complications in Hirschsprung Disease and the Impact of Botulinum Toxin Injection on Hirschsprung-Associated Enterocolitis

by Fatma Özcan Siki, Mehmet Sarikaya, İlhan Çiftci, Gamze Kaygisiz Bayindir, Metin Gündüz and Tamer Sekmenli

J. Clin. Med. 2026, 15(4), 1665; https://doi.org/10.3390/jcm15041665 - 23 Feb 2026

Viewed by 634

Abstract

Background: Hirschsprung disease (HD) is associated with substantial postoperative morbidity, particularly due to Hirschsprung-associated enterocolitis (HAEC), despite definitive surgical treatment. Postoperative outcomes may vary according to the length of the aganglionic segment and the surgical technique used, and optimal management of recurrent HAEC [...] Read more.

Background: Hirschsprung disease (HD) is associated with substantial postoperative morbidity, particularly due to Hirschsprung-associated enterocolitis (HAEC), despite definitive surgical treatment. Postoperative outcomes may vary according to the length of the aganglionic segment and the surgical technique used, and optimal management of recurrent HAEC remains a significant clinical challenge. Methods: The medical records of patients who underwent corrective surgery for HD between 2011 and 2023 were retrospectively reviewed. Demographic characteristics, disease segment length, surgical technique, postoperative complications, and HAEC episodes were recorded. HAEC diagnosis and follow-up assessments were conducted in accordance with the Delphi criteria. Patients with recurrent HAEC and obstructive symptoms refractory to standard conservative management were evaluated for botulinum toxin injection (BTI). Results: A total of 72 patients were included in the study. The majority of the patients were male (83.3%), with a mean age at diagnosis of 11 months. The Duhamel procedure was the most frequently performed surgical technique. Although the rate of anastomotic leakage was greater in patients who underwent the Swenson procedure compared with the Duhamel group, this difference did not reach statistical significance when the appropriate statistical methods were used because the small sample size. No significant difference in the incidence of HAEC was observed among the different surgical techniques. BTI was administered to 13 patients, and regression of enterocolitis episodes according to the Delphi criteria was observed in 11 patients (84.6%). Most postoperative complications are observed in patients with long-segment Hirschsprung disease. Conclusions: Postoperative complications and HAEC remain major clinical challenges in the management of Hirschsprung disease, particularly in patients with long-segment involvement. Although the surgical technique may influence certain complication rates, HAEC appears to be a multifactorial condition. Botulinum toxin injection may serve as a supportive treatment option in selected patients with refractory HAEC; however, prospective controlled studies are needed to further clarify its role. Full article

(This article belongs to the Special Issue Advances in Gastroenterological Surgery)

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7 pages, 1061 KB

Open AccessCase Report

Deep-Infiltrating Endometriosis Causing Acute Mechanical Intestinal Obstruction Without Intestinal Invasion: A Case Report with Diagnostic and Surgical Insights

by Jung Hyun Park, Jeonghyeon Shin and Mee-Ran Kim

J. Clin. Med. 2026, 15(4), 1664; https://doi.org/10.3390/jcm15041664 - 23 Feb 2026

Viewed by 707

Abstract

Background: Endometriosis is a chronic, estrogen-dependent disorder that may extend beyond the pelvis to involve the gastrointestinal tract, most commonly the rectosigmoid and, less frequently, the small bowel. Although often asymptomatic, such lesions may rarely manifest as acute bowel obstruction. Case: We report [...] Read more.

Background: Endometriosis is a chronic, estrogen-dependent disorder that may extend beyond the pelvis to involve the gastrointestinal tract, most commonly the rectosigmoid and, less frequently, the small bowel. Although often asymptomatic, such lesions may rarely manifest as acute bowel obstruction. Case: We report a 42-year-old woman who presented with small bowel ileus caused by deep-infiltrating endometriosis (DIE). Imaging revealed a right ovarian endometrioma with severe adhesions resulting in a distal ileal transition point. After partial decompression with conservative treatment, laparoscopic adhesiolysis with right salpingo-oophorectomy and left salpingectomy was undertaken. Intraoperative findings revealed dense adnexal–ileal adhesions without transmural involvement. Postoperative hormonal suppression was instituted. Conclusions: This rare case demonstrates small bowel obstruction caused by DIE adhesions without intestinal invasion. Preoperative imaging facilitated a minimally invasive approach, while combined surgical and hormonal therapy was associated with reduced recurrence risk. These findings expand the recognized spectrum of endometriosis-related intestinal complications and support tailored management strategies. Full article

(This article belongs to the Section General Surgery)

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13 pages, 1648 KB

Open AccessArticle

Mixed-Reality-Assisted Physician-Modified Stent Grafts: An Experimental Pre-Clinical Feasibility Study Using the Valiant Captivia and Endurant II Stent Graft Systems

by Johannes Hatzl, Jana Ebner, Christian Uhl, Andreas Sebastian Peters, Alexandru Barb, Jonathan Fiering, Alexandra Marquardt and Dittmar Böckler

J. Clin. Med. 2026, 15(4), 1663; https://doi.org/10.3390/jcm15041663 - 23 Feb 2026

Cited by 1 | Viewed by 713

Abstract

Objectives: Physician-modified endografts (PMEGs) expand endovascular treatment options in urgent or cost-sensitive settings where industry-provided custom-made devices (CMDs) are not available. Current PMEG manufacturing techniques are time-consuming, lack standardization, and often require repeated adjustments to achieve strut-free fenestration positioning. Mixed reality (MxR) may [...] Read more.

Objectives: Physician-modified endografts (PMEGs) expand endovascular treatment options in urgent or cost-sensitive settings where industry-provided custom-made devices (CMDs) are not available. Current PMEG manufacturing techniques are time-consuming, lack standardization, and often require repeated adjustments to achieve strut-free fenestration positioning. Mixed reality (MxR) may streamline this process by overlaying virtual templates directly onto the physical stent graft guiding fenestration positioning. Methods: We developed a standardized MxR-assisted workflow for four-fenestrated PMEG preparations and compared it to a conventional marking technique. In this experimental set-up, between May 2025 and July 2025, three stent grafts were evaluated (Endurant II^® 28 mm, Valiant Captivia^® 30 mm, and Valiant Captivia^® 32 mm). Five observers performed fenestration marking on 20 grafts per device type (10 per method), resulting in 60 PMEGs and 240 fenestrations. Outcomes included absolute positional error, relative positional error, number of strut-free fenestrations, number of re-attempts to achieve strut-free configuration, time required, and usability assessed via the System Usability Scale (SUS). Results: Across 240 fenestrations, both methods achieved high accuracy. Median absolute errors ranged from 0 to 1.25 mm for the conventional method and 0 to 1.75 mm for MxR. Relative positional errors were similarly small, with no significant differences between methods. MxR achieved higher rates of strut-free fenestration in the 28 mm Endurant II^® device. Re-attempts were fewer with MxR. Median procedure time was significantly reduced for the MxR-assisted workflow in Valiant Captivia 30 mm (5.0 vs. 9.8 min, p = 0.049) and 32 mm (5.6 vs. 8.2 min, p = 0.049) while a trend was observed for Endurant II (7.5 vs. 15.6 min, p = 0.066). SUS scores favored MxR (76.2 vs. 62.6), though not significantly. Conclusions: The MxR-assisted PMEG production workflow seems promising in this pre-clinical, experimental study and warrants continued development and investigation. Full article

(This article belongs to the Special Issue Aortic Diseases: Modern Strategies in Diagnosis, Management, and Prevention of Complications)

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14 pages, 1500 KB

Open AccessArticle

Range of Motion and Muscle Activity During the Front Kick in Karate Kyokushin

by Jacek Kaczmarski, Monika Błaszczyszyn and Zbigniew Borysiuk

J. Clin. Med. 2026, 15(4), 1662; https://doi.org/10.3390/jcm15041662 - 23 Feb 2026

Viewed by 849

Abstract

Background/Objectives: The front kick is among the most commonly used techniques in martial arts. This study aimed to analyze the range of motion during the mae-geri kick in advanced-level Kyokushin karate practitioners compared to an intermediate-level control group under three conditions: before [...] Read more.

Background/Objectives: The front kick is among the most commonly used techniques in martial arts. This study aimed to analyze the range of motion during the mae-geri kick in advanced-level Kyokushin karate practitioners compared to an intermediate-level control group under three conditions: before warm-up, after warm-up, and after a shadow fight. Methods: The study group [N = 28, M: 27.6 years, body mass 81.9 kg, height 1.8 m] consisted of advanced-level Kyokushin karate practitioners (3rd kyu and higher), and the control group consisted of intermediate-level practitioners (6th to 4th kyu). A wireless surface electromyography (EMG) system was used to record muscle activity and an inertial measurement unit (IMU) was used to measure joint angles. Before the study began, the maximum voluntary contraction was determined for each muscle tested. Each participant performed three consecutive kicks in three conditions: before warm-up, after warm-up, and after a shadow fight. Results: The intermediate-level practitioners used the soleus muscle more than advanced practitioners during the front kick (48.92% vs. 35.94% before the warm-up kick, p = 0.042, η²_p = 0.27). After the warm-up, both groups began to use the soleus muscle more intensively (intermediate: 48.92% vs. 61.72% MVC, p = 0.046; advanced: 35.94% vs. 48.69% MVC, p = 0.045), and the advanced group’s activity in the medial gastrocnemius muscle increased compared to before the warm-up (58.23% vs. 39.20% MVC, p = 0.016). Conclusions: Advanced vs. intermediate Kyokushin karate practitioners display distinct neuro-muscular activation strategies in the mae-geri kick, particularly in soleus and gastrocnemius recruitment. Combined EMG and IMU systems can identify trends and in-form training feedback in Kyokushin karate training and effectively prepare the musculoskeletal system for rapid activity, which is important during sports competitions. Full article

(This article belongs to the Special Issue Advances in the Prevention, Diagnosis, and Rehabilitation of Sports Injuries)

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19 pages, 915 KB

Open AccessReview

Metabolic Dysfunction-Associated Steatotic Liver Disease and Sarcopenia: Review of Literature

by Hiroki Nishikawa, Soo Ki Kim, Sachiyo Yoshio and Akira Asai

J. Clin. Med. 2026, 15(4), 1661; https://doi.org/10.3390/jcm15041661 - 23 Feb 2026

Viewed by 1415

Abstract

In 2023, the terminology of metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed. MASLD uses metabolic abnormalities as an inclusion criterion. On the other hand, sarcopenia is defined by decrease in muscle mass and muscle strength. Skeletal muscle can be affected by insulin [...] Read more.

In 2023, the terminology of metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed. MASLD uses metabolic abnormalities as an inclusion criterion. On the other hand, sarcopenia is defined by decrease in muscle mass and muscle strength. Skeletal muscle can be affected by insulin resistance (IR), and it is the largest site of insulin-stimulated glucose disposal. In recent years, advances in treatment have extended the life expectancy of patients with chronic liver disease (CLD). Due to the aging population, aging-related primary sarcopenia is expected to increase. On the other hand, liver fibrosis is an important treatment target associated with the onset of serious adverse events and poor prognosis in MASLD. The liver is the central organ for nutrition and metabolism, and patients with CLD may develop secondary sarcopenia due to various nutritional and metabolic disorders unrelated to aging. There is a strong correlation between sarcopenia, muscle fatty degeneration, liver fibrosis and IR in MASLD. MASLD and sarcopenia have a bidirectional relationship, forming a vicious cycle. In this review, we will summarize the relationship between MASLD and sarcopenia based on the current knowledge. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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18 pages, 705 KB

Open AccessArticle

Pan-Immune-Inflammatory Value (PIV) and HALP Score as Independent Prognostic Indicators in Acute Coronary Syndrome Patients

by Azmi Eyiol, Hatice Eyiol, Ahmet Yilmaz and Hasan Sari

J. Clin. Med. 2026, 15(4), 1660; https://doi.org/10.3390/jcm15041660 - 22 Feb 2026

Cited by 1 | Viewed by 796

Abstract

Introduction: Acute coronary syndrome (ACS), encompassing unstable angina, NSTEMI, and STEMI, is a major cause of morbidity and mortality worldwide. Novel inflammatory and nutritional biomarkers may provide incremental value for risk stratification beyond conventional predictors. This work sought to determine whether the Pan-Immune-Inflammatory [...] Read more.

Introduction: Acute coronary syndrome (ACS), encompassing unstable angina, NSTEMI, and STEMI, is a major cause of morbidity and mortality worldwide. Novel inflammatory and nutritional biomarkers may provide incremental value for risk stratification beyond conventional predictors. This work sought to determine whether the Pan-Immune-Inflammatory Value (PIV) and the Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score could serve as independent prognostic indicators in individuals presenting with acute coronary syndrome. Methods: A retrospective multicenter study included ACS patients hospitalized between January 2020 and May 2024. Demographics, clinical data, and laboratory results were collected. PIV was calculated as follows: neutrophils × platelets × monocytes/lymphocytes. HALP score was calculated as follows: hemoglobin × albumin × lymphocytes/platelets. Correlations with clinical parameters and mortality prediction were analyzed. Results: A total of 1134 patients (mean age 62 ± 12 years) were included. PIV showed positive correlations with WBC (Rho = 0.574), troponin (Rho = 0.381), and CRP (Rho = 0.295), and negative correlations with HDL (Rho = –0.101) and ejection fraction (Rho = –0.316) (all p < 0.01). PIV independently predicted mortality with a cut-off ≥1074.2 (AUC = 0.619, sensitivity 45%, specificity 79.9%). HALP score negatively correlated with age, troponin, CRP, and ICU stay, and predicted mortality with a cut-off ≤3.58 (AUC = 0.722, sensitivity 53.8%, specificity 82%). Comparative ROC analysis showed that HALP demonstrated superior discriminative ability for mortality prediction compared with PIV. Conclusions: PIV and HALP score are independent prognostic markers in ACS, reflecting inflammatory burden and nutritional status. Their integration into clinical workflows may enhance risk stratification and support individualized management strategies. Given their simplicity and universal availability, PIV and HALP may serve as practical adjunctive tools to established risk scores, enabling early identification of high-risk ACS patients at the time of admission. Full article

(This article belongs to the Special Issue Acute Coronary Syndromes: Clinical Advances in Diagnosis and Treatment)

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13 pages, 225 KB

Open AccessArticle

Associations Between Nasal Receptors and Olfactory Dysfunction and Dysgeusia in Coronavirus Disease 2019 (COVID-19)

by Ana María Piqueras-Sánchez, José Francisco López-Gil, Diego Hellín-Meseguer, Juan Cabezas-Herrera, Ginés Francisco Blesa-Llaona, José Meseguer-Cabezas, Enrique Bernal-Morell, Alfredo Minguela-Puras and José Antonio Díaz-Manzano

J. Clin. Med. 2026, 15(4), 1659; https://doi.org/10.3390/jcm15041659 - 22 Feb 2026

Viewed by 689

Abstract

Background/Objectives: Olfactory dysfunction and dysgeusia are common neurosensory manifestations of Coronavirus Disease 2019 (COVID-19), affecting approximately 60% of patients. These symptoms have been mechanistically linked to receptors involved in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) cell entry, including angiotensin-converting enzyme 2 (ACE2), [...] Read more.

Background/Objectives: Olfactory dysfunction and dysgeusia are common neurosensory manifestations of Coronavirus Disease 2019 (COVID-19), affecting approximately 60% of patients. These symptoms have been mechanistically linked to receptors involved in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) cell entry, including angiotensin-converting enzyme 2 (ACE2), transmembrane protease serine 2 (TMPRSS2), furin, and neuropilin-1 (NRP1), which are highly expressed in the olfactory epithelium. Nevertheless, clinical evidence supporting a direct association between receptor expression and sensory impairment remains inconsistent. Methods: We conducted a multicenter, observational, cross-sectional study including 104 adults with polymerase chain reaction–confirmed SARS-CoV-2 infection during the first and second pandemic waves. Approximately 75 days after diagnosis, nasal and/or pharyngeal samples were obtained to quantify gene expression levels of ACE2, TMPRSS2, furin, and NRP1 using quantitative polymerase chain reaction. Olfactory dysfunction and dysgeusia were recorded as dichotomous variables. Logistic regression analyses were performed with adjustment for age, sex, and race, considering receptor expression as continuous variables and as tertiles. Missing data were addressed using multiple imputation methods. Results: Olfactory dysfunction was reported by 37.5% of participants, and dysgeusia by 36.5%. No statistically significant associations were observed between baseline expression levels of ACE2, TMPRSS2, furin, or NRP1 and the presence of olfactory dysfunction or dysgeusia in either adjusted continuous or categorical models. Although these associations did not reach statistical significance, higher ACE2 and furin expression showed a nonsignificant trend toward an increased probability of sensory alterations, whereas intermediate NRP1 levels were associated with lower disease severity. Conclusions: COVID-19-related olfactory dysfunction and dysgeusia do not appear to be directly determined by isolated baseline expression of SARS-CoV-2 entry receptors. These findings support a multifactorial and dynamic pathophysiological model involving temporal receptor regulation, inflammatory processes, and host-related factors, highlighting the need for longitudinal and interventional studies. Full article

(This article belongs to the Special Issue Update on Acute Severe Respiratory Infections: 2nd Edition)

11 pages, 4109 KB

Open AccessCase Report

Sustained Intraocular Pressure Control After iStent Infinite^® Implantation for Steroid-Induced Glaucoma: A Case Report

by Kyunghee Lee, Je Hyun Seo, Leslie Jay Katz, Alex S. Huang and Su-Ho Lim

J. Clin. Med. 2026, 15(4), 1658; https://doi.org/10.3390/jcm15041658 - 22 Feb 2026

Viewed by 844

Abstract

Background/Objectives: Steroid-induced glaucoma (SIG) or ocular hypertension is a well-known complication after corticosteroid exposure to the eye, particularly intravitreal dexamethasone implantation. The main mechanism of elevated intraocular pressure (IOP) is trabecular meshwork dysfunction, leading to increased aqueous outflow resistance. Although most SIG cases [...] Read more.

Background/Objectives: Steroid-induced glaucoma (SIG) or ocular hypertension is a well-known complication after corticosteroid exposure to the eye, particularly intravitreal dexamethasone implantation. The main mechanism of elevated intraocular pressure (IOP) is trabecular meshwork dysfunction, leading to increased aqueous outflow resistance. Although most SIG cases respond to medical treatment, some patients develop persistent IOP elevation, requiring surgical intervention. Minimally invasive glaucoma surgery (MIGS) has recently emerged as a safer surgical option, but there are a limited number of reports using MIGS for SIG. Methods: A 73-year-old man, who had branch retinal vein occlusion with refractory macular edema despite multiple anti-VEGF injections, received an intravitreal Ozurdex^® (Allergan, Irvine, CA, USA) implant. He developed marked IOP elevation from 17 to 34 mmHg despite maximal topical therapy. Visual field progression and progressive retinal nerve fiber layer thinning were also observed. Given the need for continued ocular steroid use and only having one arm due to trauma making drops difficult, three trabecular micro-bypass stent devices (iStent infinite^®, Glaukos Corp., Aliso Viejo, CA, USA) were implanted for IOP control. Postoperatively, IOP decreased to 13 mmHg and remained stable at 15 mmHg for 12 months. Additionally, macular edema was well-controlled with ongoing Ozurdex treatment and no observed IOP spikes. Conclusions: This is the first reported case of SIG-associated Ozurdex successfully managed with triple trabecular micro-bypass stents. The iStent infinite implantation provided safe and sustained IOP control for SIG, highlighting its potential role in patients requiring continuous intravitreal steroids. Full article

(This article belongs to the Special Issue Advances in the Treatment of Glaucoma and Ocular Hypertension)

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14 pages, 240 KB

Open AccessArticle

Outcomes of First-Line PARP Inhibitor Therapy in Ovarian Cancer: A Multicenter Retrospective Analysis

by Baris Koksal, Hasan Cagri Yildirim, Deniz Can Guven, Fatih Kose, Gorkem Koymen, Ozlem Ozdemir, Ugur Ozberk, Efnan Algin, Murad Guliyev, Nebi Serkan Demirci, Ozkan Alan, Ahmet Baklaci, Bilgin Demir, Ozlem Topkaya, Necdet Uskent, Kadriye Bir Yucel, Orhun Akdogan, Bahadir Koylu, Fatih Selcukbiricik, Irem Bilgetekin, Kaan Helvaci, Ahmet Unal, Huseyin Salih Semiz, Teoman Sakalar, Nadiye Sever, Ceren Mordag Cicek, Gamze Gokoz Dogu, Sedat Biter, Ertugrul Bayram, Canan Yildiz, Hacer Demir, Ismail Bayrakci, Bulent Erdogan, Mehmet Emin Kalender, Halil Goksel Guzel, Banu Ozturk, Berkan Karabuga, Ozturk Ates, Emine Bihter Cetin, Mustafa Sahbazlar, Ali Inal, Veli Sunar, Fatma Bugdayci Basal, Esra Asik, Atila Yildirim, Nejat Emre Oksuz, Yuksel Urun, Erdinc Nayir, Sema Turker, Sercan On, Ali Aytac, Serkan Menekse, Yasemin Bakkal Temi, Kazim Uygun, Elif Sahin, Merve Keskinkilic and Zafer Arik Show full author list Hide full author list

J. Clin. Med. 2026, 15(4), 1657; https://doi.org/10.3390/jcm15041657 - 22 Feb 2026

Cited by 1 | Viewed by 1321

Abstract

Background: Poly(ADP-ribose) polymerase (PARP) inhibitors have been established as a first-line maintenance therapy in advanced epithelial ovarian cancer (EOC) following platinum-based chemotherapy. While phase III trials have demonstrated significant progression-free survival (PFS) benefits with olaparib and niraparib, real-world data remain limited. Methods: This [...] Read more.

Background: Poly(ADP-ribose) polymerase (PARP) inhibitors have been established as a first-line maintenance therapy in advanced epithelial ovarian cancer (EOC) following platinum-based chemotherapy. While phase III trials have demonstrated significant progression-free survival (PFS) benefits with olaparib and niraparib, real-world data remain limited. Methods: This retrospective, multicenter real-world study included 179 patients with newly diagnosed epithelial ovarian treated with first-line maintenance olaparib or niraparib across 33 centers in Türkiye between January 2014 and March 2025. Clinical, pathological, and molecular data—including BRCA (Breast Cancer Susceptibility Gene) mutation status, origin, and variant classification—was collected. The primary endpoint was PFS, and secondary endpoints included overall survival (OS) and safety. Survival outcomes were analyzed using Kaplan–Meier methods. Results: Of 179 patients, 110 received olaparib and 69 received niraparib. BRCA mutations were present in 88.3% of patients, while 11.7% had unknown HRD status. Median follow-up was 16.5 months, and median PFS was not reached. Estimated PFS rates for the overall cohort were 91.0% at 6 months, 83.0% at 12 months, and 64.0% at 24 months. In the olaparib cohort, BRCA-mutant patients demonstrated PFS rates of 89%, 78%, 73%, and 64% at 6, 12, 18, and 24 months, respectively. In the niraparib cohort, corresponding PFS rates among BRCA-mutant patients were 87% at 6 months and 75% at 12 months. Patients harboring pathogenic BRCA variants experienced longer PFS compared with those with likely pathogenic variants. Any-grade adverse events occurred in 73.7% of patients, and grade 3–4 events in 29.6%, with hematologic toxicities predominating. Dose interruptions were more frequent with niraparib, while treatment discontinuation rates were low in both groups. No cases of myelodysplastic syndrome or acute myeloid leukemia were observed. Conclusions: In this large multicenter real-world cohort, first-line maintenance therapy with olaparib and niraparib provided durable PFS benefit in patients with advanced EOC, particularly among those with pathogenic BRCA mutations, confirming their effectiveness and manageable safety profiles in routine clinical practice. Full article

(This article belongs to the Section Oncology)

32 pages, 7975 KB

Open AccessReview

Exercise Stress Testing in Clinical Cardiology: A Practical Guide to Performance and Interpretation

by Chiara Carluccio, Francesco Bressan, Matteo Pizzolato, Amedeo De Antoni, Simone Ungaro, Dorottya Balla, Alberto Cipriani, Manuel De Lazzari, Martina Perazzolo Marra, Hajnalka Vago, Domenico Corrado, Alessandro Zorzi and Francesca Graziano

J. Clin. Med. 2026, 15(4), 1656; https://doi.org/10.3390/jcm15041656 - 22 Feb 2026

Viewed by 4815

Abstract

Exercise stress testing remains one of the most widely used and cost-effective diagnostic tools in clinical cardiology. Beyond the traditional evaluation of induced ischemia, it provides valuable information on functional capacity, blood pressure response and arrhythmic behavior during exercise. In particular, the test [...] Read more.

Exercise stress testing remains one of the most widely used and cost-effective diagnostic tools in clinical cardiology. Beyond the traditional evaluation of induced ischemia, it provides valuable information on functional capacity, blood pressure response and arrhythmic behavior during exercise. In particular, the test plays a crucial role in assessing and interpreting exercise-induced arrhythmias, including tachyarrhythmias, such as premature ventricular beats (PVBs) and bradyarrhythmias, as well as corroborating the suspicion of some ion channel diseases. The usefulness of exercise testing is also highlighted in patients with devices, where it can help evaluate their function and exercise adaptation, as well as in specific conduction disorders, such as Wolff–Parkinson–White syndrome. This practical guide summarizes the key aspects of performing and interpreting the exercise stress test, focusing on hemodynamic and arrhythmic findings and their clinical implications, and includes several illustrative clinical cases. Full article

(This article belongs to the Section Cardiovascular Medicine)

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25 pages, 7391 KB

Open AccessReview

Pelvic Congestion Syndrome: The Gynecological Perspective

by Christian Krambeck, Karolin Tesch, Rafał Watrowski, Nicolai Maass and Ibrahim Alkatout

J. Clin. Med. 2026, 15(4), 1655; https://doi.org/10.3390/jcm15041655 - 22 Feb 2026

Cited by 5 | Viewed by 2931

Abstract

Background/Objectives: Chronic pelvic pain (CPP) is defined as pelvic pain lasting longer than six months and is a common yet often overlooked condition, affecting over 40% of women worldwide and accounting for about 10% of gynecological consultations. Despite extensive investigation, including laparoscopy, no [...] Read more.

Background/Objectives: Chronic pelvic pain (CPP) is defined as pelvic pain lasting longer than six months and is a common yet often overlooked condition, affecting over 40% of women worldwide and accounting for about 10% of gynecological consultations. Despite extensive investigation, including laparoscopy, no cause is identified in up to half of cases. Pelvic congestion syndrome (PCS), also referred to as pelvic venous insufficiency (PVI), has been estimated to account for up to 30% of CPP cases, although it remains underdiagnosed. PCS is caused by venous reflux or obstruction in pelvic veins and is characterized by dull, aching pain worsened by standing, intercourse, post-orgasm, and the premenstrual period. It occurs predominantly in premenopausal women, often after pregnancy. This narrative review aims to improve understanding of PCS and provide practical guidance to support diagnosis and treatment in routine gynecologic practice. Methods: We performed a comprehensive review of the current literature focusing on the clinical presentation, pathophysiology and diagnostic and treatment performance of various modalities. Special emphasis was placed on identifying accessible, non-interventional tools suitable for primary gynecological care. Results: PCS, CPP and endometriosis exhibit significant clinical overlap, including dysmenorrhea, dyspareunia and chronic pain. However, pathognomonic features like post-coital pain and pain-exacerbation by prolonged standing, combined with specific ultrasound markers, allow for early differentiation. While laparoscopy is often used to investigate CPP, it has limited sensitivity for PCS due to CO₂-pneumoperitoneum-induced venous compression, and Trendelenburg position, compared to venography, the diagnostic gold standard. In contrast, transvaginal ultrasound (TVUS) serves as a potent first-line tool. Key diagnostic criteria include ovarian vein diameter (>7–8 mm), low flow velocity (<3 cm/s), and myometrial vein dilatation (>5 mm). Furthermore, the frequent co-occurrence of endometriosis and PCS requires a multimodal diagnostic approach to avoid “diagnostic bias.” Conclusions: To improve patient outcomes and reduce diagnostic delay, office-based gynecologists should integrate specific vascular TVUS into the routine workup of CPP, not only to diagnose endometriosis but also to identify PCS. Future efforts should focus on standardized TVUS protocols and interdisciplinary care pathways involving gynecologists and interventional radiologists to enable integrated diagnostic and therapeutic approaches for patients with coexisting endometriosis and PCS, addressing both surgical and non-surgical options, as well as the bidirectional relationship and mutual pathophysiological influence between these entities. Full article

(This article belongs to the Special Issue New Advances in Minimally Invasive Surgery for Gynecologic Cancer)

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18 pages, 808 KB

Open AccessReview

Sex and Gender Differences in Chronic Kidney Disease—Explained by the Brenner–Luyckx Concept of Hyperfiltration

by Sylvia Stracke, Jonas Wille, Angelina Smolka, Ron Henkel, Kirubel Biruk Shiferaw, Dagmar Waltemath, Frieder Keller, Tilman Schmidt, Robert Wolf, Thomas Dabers, Till Ittermann and Philipp Töpfer

J. Clin. Med. 2026, 15(4), 1654; https://doi.org/10.3390/jcm15041654 - 22 Feb 2026

Cited by 2 | Viewed by 1285

Abstract

At the beginning of life, there are no sex differences in fetal kidney growth, nephron endowment nor in the prevalence of low birth weight. In chronic kidney disease (CKD) in adults, however, significant sex- and gender-specific differences exist in diagnosis, progression, and management [...] Read more.

At the beginning of life, there are no sex differences in fetal kidney growth, nephron endowment nor in the prevalence of low birth weight. In chronic kidney disease (CKD) in adults, however, significant sex- and gender-specific differences exist in diagnosis, progression, and management of CKD. In adult individuals, CKD is more prevalent in women, but CKD progression is faster in men; nevertheless, women have a higher life expectancy than men. A possible explanation for the enigmatic higher CKD prevalence in women may derive from the Brenner–Luyckx concept of hyperfiltration. Diseases that lead to hyperfiltration will lead to premature nephron loss and to a faster decline in glomerular filtration rate (GFR). This condition is predominantly seen in middle-aged men with a higher GFR, larger hypertrophied kidneys, and a higher prevalence of arterial hypertension, diabetes mellitus, smoking, and hypercholesterolemia compared to women. Thus, a high GFR may not be a good sign if it reflects hyperfiltration. Any GFR must be interpreted against the comorbidities of an individual. An individual may end up with a realistic GFR far below normal once hyperfiltration is stopped, for example, by a Sodium Glucose-Linked Transporter 2 (SGLT2) inhibitor. With regard to the management of CKD, women with CKD receive poorer healthcare compared to men with CKD. Women less frequently receive a CKD diagnosis, are less frequently referred to nephrology for co-management, less frequently undergo eGFR and albuminuria assessments, and are less likely to receive guideline-recommended treatments for CKD, such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and statins. Cardiovascular risk factors are less rigorously controlled in women with CKD compared to men with CKD. The causes for the poorer CKD care among women are to be found in gender rather than in sex. It is crucial to integrate assessments of sex and gender into both clinical routines and scientific reports. All studies should incorporate sex- and gender-specific analyses, and the evaluation of pre- and postmenopausal women should be conducted separately. The utilization of Gender Scores can help identify the impact of cultural, societal, and psychological factors on observed gender differences in ambulatory healthcare for those with CKD. Guidelines need to be sensitive to gender and emphasize the existing knowledge gaps regarding sex and gender differences in CKD healthcare. Urgent attention is required to substantially improve and ensure equitable healthcare for CKD across sexes and genders. Full article

(This article belongs to the Special Issue Chronic Kidney Disease Management: Integrating Pharmacotherapy, Biomarkers, and Lifestyle Interventions for Improved Outcomes)

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16 pages, 2007 KB

Open AccessArticle

Minimally Invasive Stabilization Versus Open Surgery for Spinal Metastases: A Retrospective Study Utilizing Propensity Score Matching and Weighting Sensitivity Analyses

by Kamil Krystkiewicz, Aleksander Kowal, Agata Krajniak, Łukasz Kuncman and Marcin Tosik

J. Clin. Med. 2026, 15(4), 1653; https://doi.org/10.3390/jcm15041653 - 22 Feb 2026

Cited by 1 | Viewed by 741

Abstract

Background: Minimally invasive spinal stabilization (MISS) is increasingly used in metastatic spine surgery, but comparative evidence vs. open posterior stabilization (OPEN) remains limited. We compared perioperative outcomes, focusing on wound-related morbidity. Methods: This retrospective single-center cohort included 71 patients undergoing posterior [...] Read more.

Background: Minimally invasive spinal stabilization (MISS) is increasingly used in metastatic spine surgery, but comparative evidence vs. open posterior stabilization (OPEN) remains limited. We compared perioperative outcomes, focusing on wound-related morbidity. Methods: This retrospective single-center cohort included 71 patients undergoing posterior stabilization for spinal metastases (MISS n = 45; OPEN n = 26). Wound-healing disorder was the primary endpoint. Groups were compared using nonparametric exact tests; adjusted and propensity score analyses were performed to assess robustness. Results: Baseline SINS, operated segment, and instrumented levels were comparable. BMI was higher in MISS (25.8 [24.0–29.7] vs. 22.1 [20.0–24.9] kg/m²; p = 0.001), and urgent admissions were more frequent in OPEN (42.3% vs. 11.1%; p = 0.006). Wound-healing disorders occurred in 6.7% (3/45) of the MISS group vs. 30.8% (8/26) of the OPEN group. (p = 0.014; crude RR 4.62, 95% CI 1.34–15.88). After adjustment for admission type, BMI, and ECOG (n = 65), the association was attenuated (adjusted RR 1.80, 95% CI 0.24–13.68; p = 0.572). SSI occurred in 1/45 (2.2%) MISS vs. 5/26 (19.2%) OPEN (p = 0.022). Estimated blood loss was similar between groups (MISS: 500 [350–800] vs. OPEN: 600 [500–700] mL; p = 0.357). The median length of stay was shorter in the MISS group, though this did not reach statistical significance. In trimmed IPTW (64 complete cases), OPEN remained associated with higher weighted risk (RR 1.91, 95% CI 0.42–8.65; p = 0.403). Conclusions: OPEN surgery was associated with higher unadjusted wound-related morbidity than MISS, while blood loss did not differ between approaches. Length of stay tended to be shorter after MISS, but analyses were underpowered. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 781 KB

Open AccessArticle

Relationship Between Perivascular Fat Inflammation and Coronary Atherosclerotic Plaque Composition

by Leif-Christopher Engel, Rafael Adolf, Salvatore Cassese, Erion Xhepa, Adnan Kastrati, Michael Joner, Heribert Schunkert, Martin Hadamitzky and Philipp Nicol

J. Clin. Med. 2026, 15(4), 1652; https://doi.org/10.3390/jcm15041652 - 22 Feb 2026

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Abstract

Background: Perivascular fat attenuation index (FAI) derived from coronary CT angiography (CCTA) has emerged as a quantitative biomarker of vascular inflammation, with potential to improve risk stratification in coronary artery disease (CAD) patients. This study aimed to evaluate plaque characteristics of coronary atherosclerotic [...] Read more.

Background: Perivascular fat attenuation index (FAI) derived from coronary CT angiography (CCTA) has emerged as a quantitative biomarker of vascular inflammation, with potential to improve risk stratification in coronary artery disease (CAD) patients. This study aimed to evaluate plaque characteristics of coronary atherosclerotic lesions in patients with high (≥−70.1 HU) or low FAI of pericoronary adipose tissue. Methods: In a retrospective analysis, patients with suspected or confirmed CAD who underwent coronary CTA were included. Coronary lesions were classified into two groups based on their perivascular inflammation as assessed by CCTA: high perivascular FAI phenotype (≥−70.1 HU) versus low FAI phenotype (<−70.1 HU). Both groups were compared with respect to various patient- and lesion-specific characteristics. Results: A total of 247 coronary lesions were analyzed in this study. Of these, 36 (14.6%) lesions were associated with high perivascular inflammation (high FAI phenotpye) and 211 (85.4%) were associated with low perivascular inflammation (low FAI phenotype). Lesions with a high FAI phenotype demonstrated a significantly higher amount of non-calcified plaque volume (NCPV) compared to lesions with a low FAI phenotype [(111.8 mm³ (69.4–184.2) versus 87.7 mm³ (44.6–143.0), p < 0.003]. NCPV emerged as a consistent and significant predictor of fat attenuation positive plaque in both univariate (OR 1.030 [95% CI, 1.010–1.050], p = 0.003); and multivariate logistic regression analyses (OR 1.028 [95% CI, 1.008–1.050]. p = 0.007). Additionally, lesions with a high FAI phenotype less frequently exhibited homogeneous calcification than their low FAI phenotype counterparts (25% versus 46.9%, p = 0.014). Conclusions: Coronary lesions associated with a high FAI phenotype on coronary CCTA consist predominantly of non-calcified plaques. Conversely, lesions characterized by a low perivascular FAI phenotype are primarily calcified and seem to be more homogeneous by visual assessment. Further prospective studies are warranted to validate these associations and explore the underlying pathophysiological mechanisms. Full article

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

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12 pages, 879 KB

Open AccessReview

by Stefano Bighetti, Luca Bettolini, Carlo Alberto Maronese, Federica Macchi, Zeno Fratton, Vincenzo Maione, Mario Valenti, Giovanni Paolino, Andrea Carugno, Marco Ferrari, Piergiacomo Calzavara-Pinton, Marina Venturini, Nicola Zerbinati and Mariateresa Rossi

J. Clin. Med. 2026, 15(4), 1651; https://doi.org/10.3390/jcm15041651 - 22 Feb 2026

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Abstract

Background/Objectives: Dupilumab-related ocular surface disease (DROSD) is a significant safety challenge in atopic dermatitis (AD) management, potentially leading to treatment interruption despite cutaneous efficacy. This narrative review evaluates risk stratification and management strategies to standardize monitoring and preserve long-term drug persistence. Methods [...] Read more.

Background/Objectives: Dupilumab-related ocular surface disease (DROSD) is a significant safety challenge in atopic dermatitis (AD) management, potentially leading to treatment interruption despite cutaneous efficacy. This narrative review evaluates risk stratification and management strategies to standardize monitoring and preserve long-term drug persistence. Methods: A search of PubMed/MEDLINE was conducted from inception to 31 December 2025. Evidence was synthesized from clinical trials, pooled safety analyses, and real-world registries, focusing on risk factors, monitoring tools, and interdisciplinary management algorithms for DROSD in AD populations. Results: Clinical trials identify conjunctivitis as a reproducible, context-dependent signal enriched in AD populations. Real-world data highlight that ocular symptoms disproportionately drive treatment dissatisfaction and discontinuation. Clinical vigilance must extend throughout the treatment course; while many cases appear early, a significant proportion develops between 8–16 weeks, with late-onset manifestations reported up to 12 months after initiation. Effective management relies on baseline risk documentation—including prior ocular history and AD phenotype—and the implementation of stepwise, severity-based “treat-through” protocols. Conclusions: Managing DROSD is a critical strategy for maintaining treatment persistence. Integration of routine baseline risk capture, continuous symptom surveillance, and structured multidisciplinary escalation pathways is essential to maximize ocular safety and long-term therapeutic outcomes in AD. Full article

(This article belongs to the Special Issue Disease Modifying Activity in Psoriasis and Atopic Dermatitis)

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10 pages, 230 KB

Open AccessArticle

Reducing the Length of Hospitalization for Premature Infants Using a Quality Improvement Project

by Ilan Segal, Hanna Shaferman, Evgenia Gurevich and Shmuel Zangen

J. Clin. Med. 2026, 15(4), 1650; https://doi.org/10.3390/jcm15041650 - 22 Feb 2026

Cited by 1 | Viewed by 590

Abstract

Background/Objectives: Preterms often experience unnecessary delays in discharge. This quality improvement (QI) project aimed to reduce length of stay (LOS) in the neonatal intensive care unit (NICU). Methods: In this before-and-after intervention study on preterms (28 + 0–33 + 6 weeks gestation), we [...] Read more.

Background/Objectives: Preterms often experience unnecessary delays in discharge. This quality improvement (QI) project aimed to reduce length of stay (LOS) in the neonatal intensive care unit (NICU). Methods: In this before-and-after intervention study on preterms (28 + 0–33 + 6 weeks gestation), we compared NICU outcomes (LOS, postmenstrual age (PMA) and weight at discharge, and readmission within 7 days) from pre-intervention (2013–2015) and post-intervention (2016–2017) periods. The intervention included discharge planning, standardized checklists, parental education, and team-based coordination. Results: We analyzed 377 infants. In post-interventional group, there was a reduction in LOS and PMA at discharge (31.45 ± 19.05 vs. 26.8 ± 15.8 days, p = 0.01 and 35.93 ± 1.84 vs. 35.43 ± 1.27 weeks, p < 0.01, respectively) without significant differences in discharge weight and readmission rates. Conclusions: QI interventions were significantly associated with shorter LOS for preterms. Standardized discharge procedures may improve outcomes and resource utilization in NICUs. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management of Neonatal Diseases)

32 pages, 2039 KB

Open AccessReview

Artificial Intelligence for Opioid Safety Surveillance from Clinical Text: A Clinically Focused Review

by Md Muntasir Zitu, Dwight Owen, Ashish Manne, Yuxi Zhu, Samar Binkheder and Lang Li

J. Clin. Med. 2026, 15(4), 1649; https://doi.org/10.3390/jcm15041649 - 22 Feb 2026

Cited by 2 | Viewed by 1703

Abstract

Opioid-related iatrogenic harms, including opioid use disorder, overdose, and opioid-induced respiratory depression, constitute a major patient safety challenge. Although clinicians document key safety signals in unstructured clinical narratives, many of these indicators are not readily captured by conventional surveillance approaches that rely on [...] Read more.

Opioid-related iatrogenic harms, including opioid use disorder, overdose, and opioid-induced respiratory depression, constitute a major patient safety challenge. Although clinicians document key safety signals in unstructured clinical narratives, many of these indicators are not readily captured by conventional surveillance approaches that rely on structured administrative data. This clinically focused narrative review synthesizes 47 empirical studies published between 2009 and 2025 that applied artificial intelligence (AI) methods to identify opioid-related harms from clinical text and to address the resulting ascertainment gap. Across studies, administrative coding systems, including ICD-10, often under-ascertain opioid-related events, whereas text-based AI can identify additional cases and contextual details often documented primarily in narrative records, such as fluctuating mental status, suspected drug causality, and responses to naloxone. Methodologically, the literature has progressed from interpretable rule-based lexicons to machine learning and deep learning models and, more recently, to transformer-based approaches, including large language models (LLMs) for classification and schema-driven extraction. Rule-based systems established the feasibility of transparent surveillance and frequently recovered clinically documented cases missed by billing codes. Subsequent supervised and deep learning approaches expanded scalability and, in a smaller subset of studies, were integrated into electronic health record workflows with operational metrics reported. More recent transformer- and LLM-based studies emphasize richer extraction schemas and benchmark development, including characterization of overdose context and intentionality and identification of potential prodromal neurocognitive signals, although external validation, calibration, and prospective outcome evaluation remain inconsistently reported. Given that the evidence base is predominantly retrospective and that clinical workflow studies remain comparatively few, a pragmatic near-term clinical role is to provide detection-to-triage decision support rather than autonomous diagnosis, in which systems surface candidate cases with reviewable evidence for clinician adjudication. Future progress will require greater standardization of phenotype definitions, routine equity auditing and subgroup reporting, stronger external validation and calibration at operational thresholds, and a shift from retrospective discrimination metrics toward prospective assessments of the clinical workflow impact, clinical utility, and patient-centered outcomes. Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Clinical Medicine)

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10 pages, 727 KB

Open AccessArticle

A Single Preoperative Dose of Pregabalin and Chronic Postsurgical Pain Following Elective Coronary Artery Bypass Graft Surgery: A Secondary Analysis from a Randomized, Double-Blind, Placebo-Controlled Trial

by Aikaterini Bouzia, Konstantinos Tassoudis, Vasilis Tassoudis, Maria P. Ntalouka, Anastasia Michou, Metaxia Bareka and Eleni Arnaoutoglou

J. Clin. Med. 2026, 15(4), 1648; https://doi.org/10.3390/jcm15041648 - 22 Feb 2026

Viewed by 730

Abstract

Background/Objectives: Chronic persistent postoperative pain after cardiac surgery, first described as Post CABG Pain Syndrome (PCPS), has been a well-recognized problem since 1989. This study investigated the effect of a single preoperatively administrated pregabalin dose on chronic persistent postoperative pain, in terms [...] Read more.

Background/Objectives: Chronic persistent postoperative pain after cardiac surgery, first described as Post CABG Pain Syndrome (PCPS), has been a well-recognized problem since 1989. This study investigated the effect of a single preoperatively administrated pregabalin dose on chronic persistent postoperative pain, in terms of pain intensity, rescue analgesia, and sleep disturbances, after elective cardiac surgery. Methods: This is a secondary analysis of a prospective double-blind single center study that took place in a tertiary/referral center (NCT01701921). Consecutive adult patients who underwent elective cardiac surgery with median sternotomy and extracorporeal circulation under general anesthesia were included. Patients were randomly assigned into three groups {placebo (group 1), oral pregabalin 75 mg (group 2), oral pregabalin 150 mg (group 3)}. Placebo or either dose of pregabalin were administered 1 h preoperatively. Postoperatively at 12 and 24 months, the presence of persistent chronic pain (Numeric Rating Scale, NRS), the need of daily intake of analgesics, and any potential sleep disturbances were assessed. Results: In total, 93 out of 108 patients completed this secondary analysis (86,1%). Patients from all three groups reported persistent postoperative pain at 12 and 24 months, respectively. The mean NRS scores at 12 months were 1.71 (0.588) group 1, 1.23 (0.560) group 2, and 1.19 (0.402) group 3. At 24 months, the mean NRS scores were 1.19 (0.543) Group 1, 0.84 (0.454) Group 2, and 0.84 (0.374) Group 3. No statistically important difference was detected between the two different pregabalin groups. Regarding the use of analgesics, Pearson Chi-Square showed p-values p = 0.027 in 12 months and p = 0.01 in 24 months and lower scores were detected in the high pregabalin dose group. As far as the sleep disturbances are concerned, there was no significant difference between groups. The number of patients who reported persistent postoperative pain at 12 and 24 months was significantly lower in the pregabalin groups (75 mg and 150 mg) than in the placebo group. Regarding the NRS score, Kruskal–Wallis showed a value of p = 0.001 and p = 0.005 in 12 and 24 months respectively. Regarding the use of analgesics, Pearson Chi-Square showed p-values p = 0.027 in 12 months and p = 0.01 in 24 months. Referring to sleep disturbances, there was no significant difference between groups. Conclusions: Based on the results of this study, it seems that oral administration of a single preoperative dose of pregabalin may exhibit a significant preventive effect on chronic persistent postoperative pain after elective cardiac surgery. Full article

(This article belongs to the Special Issue Advances in Anesthesia for Cardiac Surgery)

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14 pages, 3102 KB

Open AccessReview

Pulsed Field Ablation for Atrial Fibrillation: Contemporary Clinical Evidence and Real-World Experience in Redo Ablation

by Ioanna Koniari, Eleni Artopoulou, Scott Gall, Gavin S. Chu, Rafail Koros, Maria Bozika, Kassiani-Maria Nastouli, Georgios Leventopoulos, Shajil Chalil and Aruna Arujuna

J. Clin. Med. 2026, 15(4), 1647; https://doi.org/10.3390/jcm15041647 - 22 Feb 2026

Cited by 1 | Viewed by 2194

Abstract

Atrial fibrillation (AF) is the most common prevalent sustained arrhythmia and is associated with stroke, heart failure, and impaired health-related quality of life. Due to the complexity of the initiation and the persistence of AF, the pulmonary vein isolation (PVI) using thermal or [...] Read more.

Atrial fibrillation (AF) is the most common prevalent sustained arrhythmia and is associated with stroke, heart failure, and impaired health-related quality of life. Due to the complexity of the initiation and the persistence of AF, the pulmonary vein isolation (PVI) using thermal or laser energy is the most commonly applied ablation strategy. However, these thermal ablation modalities have several limitations, including a substantial risk of AF recurrence and collateral damage to tissues adjacent to the heart. Pulsed field ablation (PFA) is a novel non-thermal ablation technique in which high-voltage electric fields deliver short pulses, selectively affecting cardiomyocyte cell membranes. PFA has the potential to create myocardial lesions with minimal harm to non-cardiac tissues. Clinical studies have evaluated the safety and efficacy of PFA, examining its ability to prevent AF recurrence and its impact on surrounding structures, often in comparison with conventional PVI approaches. In this review, PFA clinical studies are discussed as well as our experience with the PFA use for redo atrial fibrillation ablation cases. Full article

(This article belongs to the Special Issue Catheter Ablation of Atrial Fibrillation: Advances and Challenges)

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J. Clin. Med., Volume 15, Issue 4 (February-2 2026) – 361 articles

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