Journal of Clinical Medicine

22 pages, 5806 KB

Open AccessCase Report

Time Is Kidney: A Case Study and Literature Review of Bilateral Renal Compartment Syndrome After Blunt Trauma, a Rare Complication

by Luis Fernandez, Ahmad Jalal Kanawati, Mohamed Abdelgawad, Diana Wu, Brittany Wagner, Andrew Navetta, Marc Mathews, Sarah Kamel, Andrew Armanyous and David Villareal

J. Clin. Med. 2026, 15(6), 2466; https://doi.org/10.3390/jcm15062466 - 23 Mar 2026

Viewed by 800

Abstract

Background: Acute compartment syndrome (ACS), a condition characterized by elevated pressure within an enclosed compartment, leads to ischemia and organ failure, and is hence a surgical emergency. Renal compartment syndrome (RCS) is a disease in which there is an increase in the pressure [...] Read more.

Background: Acute compartment syndrome (ACS), a condition characterized by elevated pressure within an enclosed compartment, leads to ischemia and organ failure, and is hence a surgical emergency. Renal compartment syndrome (RCS) is a disease in which there is an increase in the pressure within the native kidney’s compartment due to peri-renal or subcapsular fluid collection, causing acute kidney injury. To our knowledge, the diagnosis of bilateral traumatic renal compartment syndrome (BTRCS) due to trauma has not been previously described in the literature. Case Presentation: The patient is a 20-year-old female presenting as a case of blunt trauma due to a severe motor vehicle collision. Initially, investigations showed multiple injuries, including a femur fracture that was managed accordingly. Postoperatively, she remained stable with no signs of complications. However, after 10 days, she began complaining of abdominal pain. Further workup revealed an acute drop in hemoglobin, elevated serum creatinine, and bilateral perinephric hematomas. BTRCS was diagnosed and was surgically managed by open laparotomy and bilateral capsulotomy, with the return of robust urine production. The patient recovered successfully and was consequently discharged. Conclusions: This paper reports a case of renal compartment syndrome that was diagnosed and treated appropriately. Doppler ultrasound and CT scan, along with renal function tests, are the investigations of choice. Although there can be a role for conservative management, open surgical decompression remains the definitive treatment in patients with progressive renal dysfunction. To our knowledge, this represents the first reported case applying the term “bilateral traumatic renal compartment syndrome (BTRCS)” involving native kidneys following blunt trauma, successfully treated with bilateral surgical decompression and rapid physiological recovery. Full article

(This article belongs to the Special Issue Damage Control Surgery: New Insights into Resuscitation, Operative Strategies and Complications)

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20 pages, 1238 KB

Open AccessArticle

Perceived Usability as a Factor Associated with Clinical Outcomes in Mobile Health Diabetes Management: A Bayesian Mediation and Equity Analysis

by Oscar Eduardo Rodríguez Montes, María del Carmen Gogeascoechea-Trejo and Clara Bermúdez-Tamayo

J. Clin. Med. 2026, 15(6), 2465; https://doi.org/10.3390/jcm15062465 - 23 Mar 2026

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Abstract

Background: While mobile health (mHealth) interventions show promise for type 2 diabetes management, mechanisms linking user experience to clinical outcomes remain poorly understood. We hypothesized that perceived usability may mediate associations between patient characteristics and short-term clinical changes, with implications for health equity [...] Read more.

Background: While mobile health (mHealth) interventions show promise for type 2 diabetes management, mechanisms linking user experience to clinical outcomes remain poorly understood. We hypothesized that perceived usability may mediate associations between patient characteristics and short-term clinical changes, with implications for health equity in digital interventions. Methods: Secondary analysis of the intervention arm from a randomized controlled trial in urban Mexican primary care (ClinicalTrials.gov NCT05924516). Participants used a diabetes self-management mobile application for 90 days. We assessed usability with the validated Computer System Usability Questionnaire (CSUQ; 16 items, 7-point scale) and measured clinical changes in body mass index (BMI), systolic blood pressure (SBP), and HbA1c. Bayesian mediation analysis (literature-informed priors) examined interface quality as a mediator of age-related clinical effects. Item-level analysis identified educational disparities in specific usability dimensions using independent t-tests adjusted for multiple comparisons. Results: Mean overall usability was 5.20/7 (SD = 0.89, 74th percentile). Interface quality mediated 39% of the age–SBP association. Participants experiencing high usability (≥6) versus low usability showed BMI reduction −0.78 vs. −0.21 kg/m² (Cohen’s d = 0.56) and SBP reduction −7.3 vs. −1.2 mmHg (Cohen’s d = 0.51). No mediation effect was observed for HbA1c change. Users with ≤primary education (41% of sample) scored 1.9 points lower on error messages (3.2 vs. 5.1, p < 0.01) and 1.4 points lower on help documentation (3.6 vs. 5.0, p < 0.03). These disparities persisted after controlling for age and baseline severity. Conclusions: Perceived usability was associated with a potential mechanistic pathway linking user experience to clinical outcomes. Higher usability scores were associated with clinically meaningful improvements in cardiometabolic parameters. Educational disparities in understanding error messages and helping documentation represent modifiable design barriers. Implementing contextual error explanations with visual examples and plain-language help content may enhance both clinical effectiveness and equity in digital diabetes interventions. Full article

(This article belongs to the Special Issue Clinical Management for Metabolic Syndrome and Obesity)

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11 pages, 602 KB

Open AccessReview

A Pharmacovigilance Analysis of Ocular Adverse Events Associated with GLP-1 Receptor Agonists

by Abdullah Virk and Karen Allison

J. Clin. Med. 2026, 15(6), 2464; https://doi.org/10.3390/jcm15062464 - 23 Mar 2026

Cited by 1 | Viewed by 1710

Abstract

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes in addition to other conditions such as obesity. As their use expands, understanding potential ocular safety signals is important, particularly in populations already at risk for diabetic eye disease. [...] Read more.

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes in addition to other conditions such as obesity. As their use expands, understanding potential ocular safety signals is important, particularly in populations already at risk for diabetic eye disease. The aim of this study is to identify potential pharmacovigilance safety signals for ocular adverse events (AEs) related to GLP-1 RA medications to better inform future clinical practice. Methods: This study utilized the publicly available FDA Adverse Event Reporting System (FAERS) to obtain AE reports related to exenatide, tirzepatide, dulaglutide, liraglutide, and semaglutide from 2005 to 2024. Reports were categorized by demographic and geographic variables. Disproportionality analysis using reporting odds ratios (RORs) was performed to detect potential safety signals. Year-over-year trends in the proportional representation of each drug were also assessed through linear regression and time series plots. Results: Ocular AEs represented 3.61% of all GLP-1 RA related reports. Median age was 63 years, and 62.6% of reports involved female patients. Exenatide accounted for 33.61% of ocular AEs but showed a significant annual decline in reporting (–5.15% per year, p < 0.001). Semaglutide (31.37%) and tirzepatide (12.19%) demonstrated significant year-over-year increases in proportional reporting (2.23% and 0.79% per year, respectively; both p < 0.05), consistent with rapid uptake in clinical practice. Semaglutide demonstrated a modestly elevated ROR (1.46), while tirzepatide showed a low ROR (0.42), though this likely reflects shorter post-marketing exposure rather than lower clinical risk. The most frequently reported events were visual impairment, followed by vision blurred, cataract, and blindness. Conclusions: This pharmacovigilance analysis identifies potential ocular AE signals associated with GLP-1 RAs, particularly semaglutide. While semaglutide showed a statistically significant disproportional reporting signal for ocular AEs, the absence of exposure denominators, comparator groups, and the susceptibility of FAERS to reporting bias means these findings are hypothesis-generating rather than causal. Clinicians should remain vigilant and consider eye care referrals when indicated. Further research is needed to validate these associations and clarify underlying mechanisms. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 475 KB

Open AccessArticle

Early Recurrence Following Complete Initial Resection Predicts Adverse Oncological Outcomes in NMIBC

by Yavuz Mert Aydın and Necmettin Aydın Mungan

J. Clin. Med. 2026, 15(6), 2463; https://doi.org/10.3390/jcm15062463 - 23 Mar 2026

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Abstract

Background/Objectives: Early recurrence after complete initial transurethral resection of bladder tumor (TUR-BT) may indicate biologically aggressive non-muscle-invasive bladder cancer (NMIBC). This study aimed to identify clinicopathological predictors of ER and its independent impact on progression and survival outcomes. Methods: Clinical data of 335 [...] Read more.

Background/Objectives: Early recurrence after complete initial transurethral resection of bladder tumor (TUR-BT) may indicate biologically aggressive non-muscle-invasive bladder cancer (NMIBC). This study aimed to identify clinicopathological predictors of ER and its independent impact on progression and survival outcomes. Methods: Clinical data of 335 primary NMIBC patients who underwent TUR-BT between 2012 and 2024 were retrospectively analyzed. Patients with non-primary tumors, incomplete resection, or follow-up <6 months were excluded from the study. Patients were categorized into recurrence-free, early recurrence, and late recurrence groups. Logistic regression was used to identify predictors of early recurrence. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using the Kaplan–Meier method and Cox regression. A 36-month landmark analysis was conducted to adjust for heterogeneity in follow-up duration. Results: Early recurrence occurred in 118 patients (35.2%). Independent predictors of early recurrence were tumor size (OR = 1.012, p = 0.038), T1 stage (OR = 2.57, p = 0.004), high-grade pathology (OR = 1.933, p = 0.030), and absence of single-dose intravesical chemotherapy (IVC) (OR = 3.642, p = 0.025). Additionally, adjuvant IVC (OR = 0.279, p = 0.015) and intravesical BCG (OR = 0.427, p = 0.006) independently reduced the risk of early recurrence. Early recurrence independently predicted worse PFS (HR = 6.053), CSS (HR = 2.052), and OS (HR = 1.961) (all p < 0.001). The landmark analysis confirmed these results (all p < 0.05). Conclusions: Early recurrence after initial and complete TUR-BT is an independent predictor of adverse oncological outcomes. Identifying high-risk patients and applying early intravesical therapy may improve outcomes by preventing early recurrence. Full article

(This article belongs to the Special Issue Bladder Cancer: Diagnosis and Treatments)

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17 pages, 822 KB

Open AccessSystematic Review

Safety and Efficacy of Octyl 2-Cyanoacrylate (Dermabond) in Breast Surgery: A Systematic Review

by Maciej Rybicki, Marta Fijałkowska and Anna Kasielska-Trojan

J. Clin. Med. 2026, 15(6), 2462; https://doi.org/10.3390/jcm15062462 - 23 Mar 2026

Viewed by 764

Abstract

Background/Objectives: Effective wound closure in breast surgery achieves a compromise between safety and aesthetic outcomes. This systematic review evaluates the effect of 2-octyl cyanoacrylate (2-OCA) tissue adhesive (Dermabond) as a primary means of skin closure compared with traditional sutures. Methods: The study protocol [...] Read more.

Background/Objectives: Effective wound closure in breast surgery achieves a compromise between safety and aesthetic outcomes. This systematic review evaluates the effect of 2-octyl cyanoacrylate (2-OCA) tissue adhesive (Dermabond) as a primary means of skin closure compared with traditional sutures. Methods: The study protocol was registered in PROSPERO (CRD42023420595). A systematic search of PubMed, Embase, and Web of Science databases identified ten studies (n = 1870) comparing 2-OCA with standard suturing techniques in breast reduction, reconstruction, and oncological procedures. The methodological quality was assessed using Cochrane RoB 2.0 and the Newcastle–Ottawa Scale. Results: Using the Synthesis Without Meta-analysis (SWiM) framework, the results indicate that 2-OCA offers a safety profile comparable to sutures in terms of the incidence of infection and hematoma. Although a higher incidence of wound dehiscence was observed with glue, 2-OCA showed better operative efficacy and greater patient satisfaction, which is attributed to its immediate water resistance and elimination of the need for suture removal. Conclusions: The analysis suggests that 2-OCA is a feasible structural alternative to skin sutures in appropriately selected patients, with the proper management of deep skin layer tension. Full article

(This article belongs to the Special Issue Plastic and Reconstructive Surgery: Clinical Advances and Future Opportunities)

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32 pages, 3144 KB

Open AccessArticle

First-Trimester Gestational Diabetes Mellitus Risk Prediction with Machine Learning Techniques: Results from the BORN2020 Cohort Study

by Nikolaos Pazaras, Antonios Siargkas, Antigoni Tranidou, Aikaterini Apostolopoulou, Ioannis Tsakiridis, Panagiotis D. Bamidis, Sofoklis Stavros, Anastasios Potiris, Michail Chourdakis and Themistoklis Dagklis

J. Clin. Med. 2026, 15(6), 2461; https://doi.org/10.3390/jcm15062461 - 23 Mar 2026

Viewed by 774

Abstract

Background: Gestational diabetes mellitus (GDM) affects many pregnancies worldwide and is associated with adverse maternal and fetal outcomes. Current screening at 24–28 weeks limits opportunities for early intervention. We evaluated whether machine learning (ML) models using first-trimester clinical and dietary data can [...] Read more.

Background: Gestational diabetes mellitus (GDM) affects many pregnancies worldwide and is associated with adverse maternal and fetal outcomes. Current screening at 24–28 weeks limits opportunities for early intervention. We evaluated whether machine learning (ML) models using first-trimester clinical and dietary data can predict GDM risk before the standard oral glucose tolerance test. Methods: We analyzed data from 797 pregnant women enrolled in the BORN2020 prospective cohort study (Thessaloniki, Greece). Ten ML algorithms were evaluated across five class-imbalance handling strategies using stratified 5-fold cross-validation, with final evaluation on an independent 20% held-out test set. Features included maternal demographics, obstetric history, lifestyle factors, and 22 dietary micronutrient intakes from the pre-pregnancy period assessed by Food Frequency Questionnaire. Results: The best-performing model (Logistic Regression without resampling) achieved an AUC-ROC of 0.664 (95% CI: 0.542–0.777), with sensitivity of 0.783 and NPV of 0.932 at the pre-specified threshold. The high NPV should be interpreted in the context of the low GDM prevalence (14.7%), as NPV is mathematically dependent on disease prevalence. A reduced nine-feature model using only routine clinical and demographic variables achieved a numerically higher AUC of 0.712 (95% CI: 0.589–0.825), with overlapping confidence intervals, indicating that detailed FFQ-derived micronutrient data did not improve prediction. Maternal age and pre-pregnancy BMI were the strongest individual predictors by SHAP analysis. No model reached the AUC >0.80 threshold for good discrimination. Substantial miscalibration was observed (slope: 0.56; intercept: −1.83), limiting use for absolute risk estimation. Conclusions: This exploratory study demonstrates that first-trimester ML models achieve modest discriminative ability for early GDM prediction, with routine clinical variables performing comparably to models incorporating detailed dietary assessment. These findings should be interpreted with caution, as no external validation cohort was available and the low events-per-variable ratio (~3.8) constrains the reliability of individual model estimates. Substantial miscalibration further limits use for absolute risk estimation. Accordingly, these models should be regarded as exploratory risk-ranking tools only and require external validation and recalibration before any clinical implementation. Full article

(This article belongs to the Special Issue Navigating Pregnancy and Its Complications: Challenges and Innovations in Maternal–Fetal Medicine)

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24 pages, 6209 KB

Open AccessReview

High-Frame-Rate Echocardiography: A New Frontier in Noninvasive Functional Assessment

by Fatemeh Mashayekhi, Fatemeh Shahbazi, Andressa Araujo Andrade Sousa, Miaomiao Liu, Jens-Uwe Voigt, Annette Caenen and Jan D’hooge

J. Clin. Med. 2026, 15(6), 2460; https://doi.org/10.3390/jcm15062460 - 23 Mar 2026

Viewed by 1082

Abstract

High-frame-rate (HFR) ultrasound imaging enables the acquisition of up to several thousand frames per second, substantially improving the temporal resolution of echocardiography. This technical advancement allows visualization of rapid mechanical and hemodynamic events that are not captured by conventional systems. In this review, [...] Read more.

High-frame-rate (HFR) ultrasound imaging enables the acquisition of up to several thousand frames per second, substantially improving the temporal resolution of echocardiography. This technical advancement allows visualization of rapid mechanical and hemodynamic events that are not captured by conventional systems. In this review, we summarize the methods used to achieve HFR acquisition and examine their application across three principal domains: deformation imaging, mechanical wave imaging, and blood flow imaging. In deformation imaging, clinical studies have demonstrated higher feasibility for myocardial motion tracking and more reliable temporal deformation parameters. Mechanical wave imaging has emerged as a complementary domain, using HFR acquisition to capture transient mechanical events and estimate regional myocardial stiffness under both physiological and pathological conditions. In flow imaging, improved temporal resolution enables detailed visualization of rapid intracardiac flow and the evaluation of complex hemodynamic patterns. This technology expands the scope of functional and quantitative cardiac assessment and is emerging as a valuable modality for noninvasive diagnosis and monitoring in cardiovascular disorders. Full article

(This article belongs to the Special Issue Innovations in Advanced Echocardiography)

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17 pages, 2069 KB

Open AccessArticle

Evaluation of Gingival Sulcus Width Gain After Nd: YAG Laser and Astringent Retraction Paste Using Intraoral and Laboratory STL Analysis: A Pilot Split-Mouth Study

by Edwin Sever Bechir, Andrei-Mario Bădărău-Șuster, Mircea Suciu, Anca-Georgiana Zamfir, Zsuzsanna Bardocz-Veres and Farah Bechir

J. Clin. Med. 2026, 15(6), 2459; https://doi.org/10.3390/jcm15062459 - 23 Mar 2026

Viewed by 555

Abstract

Background/Objectives: Advancements in digital dentistry have led to new approaches for soft tissue management aimed at improving impression accuracy. This pilot split-mouth study included a single 39-year-old male patient with 19 abutment teeth (114 measurement points). Sulcus width gain was measured at [...] Read more.

Background/Objectives: Advancements in digital dentistry have led to new approaches for soft tissue management aimed at improving impression accuracy. This pilot split-mouth study included a single 39-year-old male patient with 19 abutment teeth (114 measurement points). Sulcus width gain was measured at six standardized points per abutment tooth (mesio-buccal, centro-buccal, disto-buccal, disto-oral, centro-oral, mesio-oral) using Exocad software. Methods: Nineteen abutment teeth (114 measurement sections) from one patient were included in a randomized split-mouth design. Gingival displacement was performed either with a Nd: YAG laser or astringent retraction paste. Sulcus width gain was measured at six standardized points per abutment using Exocad software version 3.1 on superimposed STL files obtained by intraoral (IOS) and laboratory (LABSCAN) scanners. Statistical analysis was conducted in JASP (α = 0.05). Results: Both gingival displacement methods achieved sufficient sulcus widening above the clinical threshold of 0.20 mm. Mean gains ranged from 0.270 mm (LASER, IOS) to 0.378 mm (PASTE, LABSCAN). Intergroup comparisons revealed no statistically significant differences between the two gingival displacement methods (p > 0.05), whereas a significant difference was found between scanning modalities (p < 0.001), with higher values recorded for the laboratory scanner. The results should be interpreted cautiously due to the pilot design and limited sample size. Conclusions: Both techniques proved clinically effective for soft tissue displacement, with the laboratory scanner yielding higher sulcus width measurements. As a preliminary investigation, these findings should be interpreted cautiously due to the pilot nature of the study and the inclusion of a single participant. Full article

(This article belongs to the Special Issue Oral Health and Dental Care: Current Advances and Future Options)

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29 pages, 11181 KB

Open AccessReview

Ocular Color Doppler Ultrasound (OCDUS) in Diagnosis and Monitoring of Ophthalmological, Cerebrovascular and Systemic Diseases: A Narrative Review

by Massimo Venturini, Silvia Malnati, Noemi Teresa Catania, Andrea Coppola, Chiara Recaldini, Aroa Gnesutta, Marianna Ciani, Silvia Tamietti, Emilio Simonini, Alberta Cappelli, Simone Donati, Filippo Piacentino and Federico Fontana

J. Clin. Med. 2026, 15(6), 2458; https://doi.org/10.3390/jcm15062458 - 23 Mar 2026

Viewed by 801

Abstract

Ocular Color Doppler ultrasound (OCDUS) has been underutilized in the past as a diagnostic technique, although several OCDUS-based studies were performed in the last 30 years for diagnosis or monitoring of some ophthalmological, cerebrovascular or systemic diseases. OCDUS can provide quantitative and reproducible [...] Read more.

Ocular Color Doppler ultrasound (OCDUS) has been underutilized in the past as a diagnostic technique, although several OCDUS-based studies were performed in the last 30 years for diagnosis or monitoring of some ophthalmological, cerebrovascular or systemic diseases. OCDUS can provide quantitative and reproducible measurements of the blood flow of the main orbital vessels at the retrobulbar level. In this narrative review we aimed to investigate the relevance of OCDUS as an imaging modality in several ophthalmological, cerebrovascular and systemic diseases based on the current literature. Full article

(This article belongs to the Special Issue Technological Advancements and Clinical Innovations in Diagnostic and Interventional Radiology: 2nd Edition)

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13 pages, 651 KB

Open AccessArticle

AI-Generated Exercise Prescriptions for At-Risk Populations: Safety and Feasibility of a Large Language Model Assessed by Expert Evaluation

by Minkyung Choi, Jaeyong Park, Myeounggon Lee, Jaewon Beom, Se Young Jung and Kihyuk Lee

J. Clin. Med. 2026, 15(6), 2457; https://doi.org/10.3390/jcm15062457 - 23 Mar 2026

Viewed by 977

Abstract

Background/Objectives: In exercise science and sports medicine, the potential use of large language models for generating personalized exercise programs is being explored. However, the practical applicability of AI-generated exercise prescriptions has not yet been sufficiently validated, particularly in complex clinical contexts. This study [...] Read more.

Background/Objectives: In exercise science and sports medicine, the potential use of large language models for generating personalized exercise programs is being explored. However, the practical applicability of AI-generated exercise prescriptions has not yet been sufficiently validated, particularly in complex clinical contexts. This study aimed to evaluate their practical utility under expert supervision. Methods: Exercise prescription outputs generated by a large language model (Gemini 2.5, Google LLC) were analyzed using clinical cases incorporating complex exercise-related considerations. Three levels of prompt structuring were applied. Experts evaluated the outputs using a structured rubric assessing safety, feasibility, guideline alignment, and personalization. Inter-expert agreement was assessed using intraclass correlation coefficients (ICC), and expert-specific internal consistency was evaluated using Cronbach’s alpha. Results: AI-generated exercise prescriptions demonstrated a certain level of structural completeness. However, inter-expert agreement was low (ICC (2,3) = 0.139), whereas expert-specific internal consistency was high (Cronbach’s alpha > 0.92). Prompt structuring from Stage 1 to Stage 2 was associated with improved mean scores in safety and guideline alignment. Additional structuring did not consistently yield further improvements. Conclusions: AI-generated exercise prescriptions may have practical potential as supportive decision-making tools when expert involvement is assumed. Nonetheless, expert judgments did not converge toward a single evaluative standard, reflecting the inherently expert-dependent nature of exercise prescription. Full article

(This article belongs to the Special Issue Artificial Intelligence in Exercise, Rehabilitation and Health Promotion: A Clinical Perspective)

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11 pages, 358 KB

Open AccessArticle

Pan-Immune-Inflammation Value as a Novel Predictor of Contrast-Associated Acute Kidney Injury in Patients Treated with Primary PCI for STEMI

by Gökhan Çiçek, Sadık Kadri Açıkgöz, Eser Açıkgöz and Servet Altay

J. Clin. Med. 2026, 15(6), 2456; https://doi.org/10.3390/jcm15062456 - 23 Mar 2026

Cited by 1 | Viewed by 644

Abstract

Background/Objectives: Contrast-associated acute kidney injury (CA-AKI) remains an important cause of morbidity and mortality in patients undergoing procedures that require intravascular contrast administration. Therefore, the early identification of high-risk individuals is paramount, above all for ST-segment elevation myocardial infarction (STEMI) patients in need [...] Read more.

Background/Objectives: Contrast-associated acute kidney injury (CA-AKI) remains an important cause of morbidity and mortality in patients undergoing procedures that require intravascular contrast administration. Therefore, the early identification of high-risk individuals is paramount, above all for ST-segment elevation myocardial infarction (STEMI) patients in need of urgent percutaneous coronary intervention (PCI). Methods: This retrospective study evaluated the prognostic value of the Pan-Immune-Inflammation Value (PIV), a composite inflammatory index, in predicting CA-AKI among patients presenting with STEMI who received urgent PCI within a 12 h window from the onset of symptoms. Results: This study recruited 2325 patient. CA-AKI was defined as a >25% or ≥0.5 mg/dL increase in serum creatinine within 48–72 h after the procedure. Patients were categorized into CA-AKI (+) and CA-AKI (−) groups. PIV levels were significantly higher in patients who developed CA-AKI (502.5 ± 324.5 vs. 264.7 ± 165.8; p < 0.001). ROC analysis identified a PIV cutoff value of >320, yielding an AUC of 0.753 (95% CI: 0.740–0.787; p < 0.001), with 67% sensitivity and 66.9% specificity. Multivariate logistic regression confirmed that PIV > 320 independently predicted CA-AKI (OR 2.118; 95% CI: 1.329–3.790; p < 0.001). In multivariable analysis, age, Killip class, contrast volume, and PIV > 320 were identified as independent predictors of CA-AKI. Conclusions: Elevated admission PIV serves as an independent and practical biomarker for predicting CA-AKI in STEMI patients undergoing PCI. Full article

(This article belongs to the Section Cardiology)

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12 pages, 255 KB

Open AccessReview

Reporting Standards and Quality Assurance Methods for Pancreatoduodenectomy in Randomised Controlled Trials: A Structured Narrative Review

by Abdullah K. Malik, Bishow B. Karki, Balaji Mahendran, John A. G. Moir, Shailesh V. Shrikhande, Andrew M. Smith, Deborah D. Stocken, Natalie S. Blencowe and Samir Pathak

J. Clin. Med. 2026, 15(6), 2455; https://doi.org/10.3390/jcm15062455 - 23 Mar 2026

Viewed by 590

Abstract

Background: Surgical interventions are complex and comprise multiple components, creating difficulties when considering how they might be described, standardised, and monitored (i.e., quality assurance) within randomised controlled trials (RCTs). Consolidated Standards of Reporting Trials – Non-Pharmacological Treatment (CONSORT-NPT) provides specific recommendations to improve [...] Read more.

Background: Surgical interventions are complex and comprise multiple components, creating difficulties when considering how they might be described, standardised, and monitored (i.e., quality assurance) within randomised controlled trials (RCTs). Consolidated Standards of Reporting Trials – Non-Pharmacological Treatment (CONSORT-NPT) provides specific recommendations to improve the quality, transparency, and replicability of RCTs involving a surgical intervention. This structured narrative review explores and summarizes the reporting of quality assurance measures for surgical interventions in RCTs, using pancreatoduodenectomy (PD) as an exploratory case study. Methods: Searches for RCTs of PD were undertaken in PubMed, Medline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from 2020 to 2024. Pancreatoduodenectomy (PD) was deconstructed into its constituent components (n = 40), and selected RCTs were scrutinised to explore reporting of quality assurance measures against the deconstructed components as described in CONSORT-NPT. Results: Of 189 screened articles, 37 RCTs were included, reporting on 5659 patients across 16 countries. No studies described all components of PD, and four did not report any components at all. Nine studies described some form of standardisation, and three measured adherence to standards, using intra-operative photographs. Minimum surgeon and centre volumes were specified in two and six trials, respectively. Conclusions: Quality assurance measures were poorly reported in selected RCTs involving PD, creating uncertainty in interpreting results. To enhance the design of future RCTs, a wider consensus regarding the core components of a PD is required. This will facilitate subsequent consideration of how these might need to be reported in future pancreatic surgical RCTs. Full article

(This article belongs to the Special Issue The Current Status and Future Directions of Pancreatoduodenectomy and Pancreatectomy)

11 pages, 597 KB

Open AccessArticle

The Influence of Passive Ultrasonic Irrigation (PUI) on the Healing of Maxillary Sinusitis of Endodontic Origin (MSEO) After Non-Surgical Endodontic Treatment

by Paweł Szczurowski, Michał Gontarz, Krzysztof Gronkiewicz, Piotr Majewski and Barbara Czopik

J. Clin. Med. 2026, 15(6), 2454; https://doi.org/10.3390/jcm15062454 - 23 Mar 2026

Cited by 1 | Viewed by 1358

Abstract

Background/Objectives: Half of diagnosed unilateral maxillary sinusitis may have odontogenic origin, and root canal treatment (RCT) can be beneficial as a single-mode treatment for full resolution of maxillary sinusitis of endodontic origin (MSEO) symptoms. The aim of the study was to investigate [...] Read more.

Background/Objectives: Half of diagnosed unilateral maxillary sinusitis may have odontogenic origin, and root canal treatment (RCT) can be beneficial as a single-mode treatment for full resolution of maxillary sinusitis of endodontic origin (MSEO) symptoms. The aim of the study was to investigate the influence of passive ultrasonic irrigation (PUI) on the healing of MSEO after non-surgical endodontic treatment. Methods: A single-center, retrospective study was conducted on CBCT data and medical records of 240 patients, who underwent non-surgical endodontic treatment, performed by the same operator between 2016 and 2025. One hundred and thirty-six teeth entered the study due to inclusion/exclusion criteria. Results: Complete healing was observed in 75.74% of the cases (n = 103). The tooth most frequently associated with MSEO was the first upper molar (52.21%, n = 71). PUI was applied in 66.91% of the treatments (n = 91). PUI was an independent predictor of MSEO healing (p = 0.001; 95% CI [1.768; 9.136]). When PUI was introduced in RCT, complete healing of MSEO was observed in 84.62% of the cases (n = 77). PUI was independently associated with higher odds of radiological resolution of MSEO in univariate logistic regression (OR = 4.019) and multiple logistic regression (OR = 12.388) models. Conclusions: PUI application in the irrigation protocol was associated with higher rates of MSEO healing after non-surgical endodontic treatment (p = 0.001; 95% CI [1.768; 9.136]). The rate of MSEO healing after non-surgical RCT is high (75.74%); therefore it should be considered as a single-mode treatment option in cases of unilateral maxillary sinusitis. Full article

(This article belongs to the Special Issue Oral Health and Systemic Diseases: Clinical Insights)

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13 pages, 1341 KB

Open AccessArticle

Incidental Hepatic Findings in Cardiac Magnetic Resonance Imaging Examinations in Patients with Congenital Heart Disease: A Pilot Study

by Gretha Hecke, Bianca Haase, Nikolaus Clodi, Karolin Hauptvogel, David Plajer, Jakob Spogis, Anja Hanser, Jürgen F. Schäfer, Konstantin Nikolaou, Johannes Nordmeyer and Sarah Nordmeyer

J. Clin. Med. 2026, 15(6), 2453; https://doi.org/10.3390/jcm15062453 - 23 Mar 2026

Viewed by 545

Abstract

Objectives: During cardiac magnetic resonance imaging (cMRI) exams in patients with congenital heart disease (CHD), incidental liver abnormalities are increasingly found. However, no systematic data exist on the incidence of liver lesions in patients with different CHDs. In order to gain a [...] Read more.

Objectives: During cardiac magnetic resonance imaging (cMRI) exams in patients with congenital heart disease (CHD), incidental liver abnormalities are increasingly found. However, no systematic data exist on the incidence of liver lesions in patients with different CHDs. In order to gain a first overview, we retrospectively analyzed cMRI examinations from the last 10 years at our institution. Methods: CMRI examinations including T2-weighted images covering parts of the liver were performed on 899 patients with CHD at our institution between 2014 and 2024. The cMRI examinations were analyzed by a medical student, a pediatrician, a radiologist, and a pediatric cardiologist. Liver lesions were defined as atypical liver parenchyma, showing T2 hyper- or hypointensity compared to the surrounding liver tissue. Results: Liver lesions were found in 9.5% (85/899) of all cMRI studies; of these, 89% ((76/85) of cases) were unknown at time of cMRI, 96% (82/85) were T2 hyperintense, and 38% (32/85) were larger than 1 cm. The patients with liver lesions were older (29 years vs. 22 years, p < 0.0001). There were no sex differences in the incidence of liver lesions or differences in right or left ventricular function (LVEF: 57% vs. 58%, p = 0.78; RVEF: 55% vs. 54%, p = 0.35). The patients with univentricular hearts, transposition of great arteries after atrial switch operation, and atrial septal defects showed the highest incidence (18%, 17%, and 21%, respectively). However, 9% of patients with left heart-sided valve disease also showed liver lesions. Conclusions: Incidental findings of liver lesions in cMRI examinations of patients with CHD are reasonably high with almost 10%. In the growing population of adults with CHD, liver monitoring might be helpful to assure overall patient health. Full article

(This article belongs to the Section Cardiovascular Medicine)

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16 pages, 827 KB

Open AccessReview

Oncofertility in Women with Renal Cell Carcinoma in the Immune Checkpoint Inhibitors Era: A Multidisciplinary Perspective

by Michele Miscia, Antonio Raffone, Veronica Mollica, Pietro Piazza, Linda Cipriani, Manuela Maletta, Stefano Ferla, Maria Perucci, Federica Cortese, Irene Pesaresi, Enrico Pazzaglia, Luigi Cobellis, Renato Seracchioli and Diego Raimondo

J. Clin. Med. 2026, 15(6), 2452; https://doi.org/10.3390/jcm15062452 - 23 Mar 2026

Viewed by 683

Abstract

Background/Objectives: Renal cell carcinoma (RCC) care has been reshaped by immune checkpoint inhibitors (ICIs), now used across adjuvant and metastatic settings as PD-1/PD-L1 blockade alone, combined with anti-CTLA-4 agents, or in combination with vascular endothelial growth factor (VEGF)-targeting tyrosine kinase inhibitors (TKIs). [...] Read more.

Background/Objectives: Renal cell carcinoma (RCC) care has been reshaped by immune checkpoint inhibitors (ICIs), now used across adjuvant and metastatic settings as PD-1/PD-L1 blockade alone, combined with anti-CTLA-4 agents, or in combination with vascular endothelial growth factor (VEGF)-targeting tyrosine kinase inhibitors (TKIs). As survival improves and systemic therapy courses extend, survivorship priorities—including fertility preservation, reproductive endocrine health, contraception, and pregnancy counselling—become increasingly relevant, even though RCC-specific oncofertility evidence remains sparse. This review examines the biological rationale and clinical considerations underpinning reproductive counselling for women of reproductive age exposed to ICIs (alone or with TKIs) in RCC. Methods: A narrative review was conducted in accordance with the SANRA framework, integrating targeted PubMed/MEDLINE searches up to 20 February 2026 and consultation of regulatory product labels to synthesize mechanistic, clinical, and safety data relevant to fertility, endocrine function, contraception, pregnancy, and breastfeeding in RCC. Results: We delineate the contemporary RCC treatment landscape to identify feasible timepoints for fertility preservation discussions and propose a pragmatic, implementation-oriented counselling framework that distinguishes evidence-secure recommendations (pregnancy avoidance during therapy, endocrine monitoring, agent-specific washout) from extrapolative domains (long-term ovarian reserve effects and post-ICI periconception safety beyond label intervals). Conclusions: By integrating a ‘multi-hit’ biological rationale, treatment context, and available human data, this review highlights RCC-specific research priorities while supporting transparent, evidence-aligned, and multidisciplinary counselling for both fertility preservation and pregnancy safety in the ICI era. Full article

(This article belongs to the Section Oncology)

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19 pages, 2190 KB

Open AccessSystematic Review

Constraint-Induced Movement Therapy in the Rehabilitation of Adults After Stroke: An Umbrella Review

by José Conchillo-Liria, Iván Cavero-Redondo, Alicia Saz-Lara, Nerea Moreno-Herraiz, Candela Calvo-Utrilla, Ana González-Collado and Iris Otero-Luis

J. Clin. Med. 2026, 15(6), 2451; https://doi.org/10.3390/jcm15062451 - 23 Mar 2026

Viewed by 1768

Abstract

Background/Objectives: Stroke is among the leading causes of disability in adults, as hemiparesis affects motor function and daily activities. Constraint-induced movement therapy (CIMT) has proven effective in functional recovery through intensive use of the affected limb. This study aimed to assess the [...] Read more.

Background/Objectives: Stroke is among the leading causes of disability in adults, as hemiparesis affects motor function and daily activities. Constraint-induced movement therapy (CIMT) has proven effective in functional recovery through intensive use of the affected limb. This study aimed to assess the impact of CIMT on upper limb (UL) rehabilitation in stroke patients, with a focus on motor recovery, integration into activities of daily living (ADLs), and overcoming clinical implementation barriers. Methods: A systematic review was conducted by searching PubMed, Scopus, and Web of Science from their inception to March 2026. Systematic reviews and meta-analyses evaluating the effectiveness of CIMT in adult patients after stroke were included. The outcome variables included motor function, movement quality, independence in ADLs, and quality of life (QoL). Results: Twenty-five systematic reviews and sixteen meta-analyses were included. The participants were adults who had suffered a stroke at acute, subacute, or chronic stages and were aged between 18 and 95 years. With respect to upper limb motor function, ten studies reported statistically significant results in favor of CIMT. With respect to ADLs, four studies reported significant differences in favor of CIMT, with strong effects in intensive interventions. With respect to QoL, three studies reported significant improvements after the intervention. Conclusions: The results of this umbrella review support the effectiveness of CIMT in UL rehabilitation after stroke, especially in the subacute and chronic phases. CIMT, alone or in combination with adjuvant therapies, contributes to improving motor function, independence in ADLs, and QoL in patients. Full article

(This article belongs to the Special Issue Enhancing and Rehabilitation of Gait and Mobility in Chronic Stroke)

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15 pages, 815 KB

Open AccessArticle

Cardiac Syncope: An Underestimated Cause of Unexplained Syncope in the Elderly-Data from a Single High-Volume Syncope Unit

by Stefanos Archontakis, Evangelos Oikonomou, Nikias Milaras, Panagiotis Dourvas, Tzonatan Klogkeri, Dimitrios Kalantzis, Anastasios Markakos, Michail Ampeliotis, Artemis Papadima, Dimitrios Venetsanos, Sotirios Tsalamandris, Dimitrios Syrseloudis and Skevos Sideris

J. Clin. Med. 2026, 15(6), 2450; https://doi.org/10.3390/jcm15062450 - 23 Mar 2026

Viewed by 828

Abstract

Background/Objectives: Syncope remains a common problem in the elderly, adversely affecting quality of life, morbidity and mortality. Diagnosis is challenging due to the atypical presentation, multifactorial aetiology, overlap with non-syncoptic falls and increased prevalence of cardiac disease. This study aims to investigate [...] Read more.

Background/Objectives: Syncope remains a common problem in the elderly, adversely affecting quality of life, morbidity and mortality. Diagnosis is challenging due to the atypical presentation, multifactorial aetiology, overlap with non-syncoptic falls and increased prevalence of cardiac disease. This study aims to investigate the impact of cardiac syncope in this high-risk population. Methods: A retrospective single-centre observational cohort study, including 171 patients ≥65 years old with syncope of unknown origin or other falls, was conducted. Different diagnostic tests and strategies were utilised during the investigational process, based on clinical judgement and the latest guidelines. Patients were classified either in the ‘high risk’ (‘cardiac’) or ‘low-risk’ (‘autonomic’) pathway. Results: Mean age was 76.4 ± 6.6 years (range: 65–92 years old) and the mean follow-up period was 40.5 months. Our study population was characterised by a high incidence of comorbidities and underlying heart disease, and polypharmacy. One third of the patients did not report prodromals, 81.9% had no recognisable trigger and 43.3% had various 12-lead ECG abnormalities. Overall, 67.8% of the patients were stratified in the ‘cardiac pathway’. Eventually, a final diagnosis was established in 126 patients (73.7%). The cause was cardiac syncope in 56.4%, reflex syncope in 26.2%, orthostatic hypotension in 7.9% and non-syncopal falls in 9.5%. An ILR was implanted in 90.1% with a diagnostic yield of 43%. ECG-based diagnosis occurred in 53.2% whereas time to diagnosis was 4.8 ± 3.3 months. Conclusions: Cardiac disease, mostly arrythmias, represent a common and possibly underestimated cause of unexplained syncope in the elderly. A structured approach including a targeted use of ILRs improves investigational process. Full article

(This article belongs to the Special Issue Cardiovascular Disease in the Elderly: Cardiogeriatric Assessment, Prevention, Treatment Outcomes and Perspectives)

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20 pages, 1364 KB

Open AccessArticle

Basosquamous Cell Carcinoma: A Summary of the Definitions and Demographic, Clinical, Therapeutic, Histological, and Outcome Analysis of 20 Consecutive Basosquamous Cell Carcinomas in Comparison with 130 Basal Cell and 81 Squamous Cell Carcinomas in a Single Institution

by En Hyung Kim, Chang Gok Woo and Eui-Tae Lee

J. Clin. Med. 2026, 15(6), 2449; https://doi.org/10.3390/jcm15062449 - 23 Mar 2026

Viewed by 595

Abstract

Objectives: To clarify the characteristics of Basosquamous cell carcinoma (BSC), this study compares demographic, clinical, therapeutic, histological, and outcome findings of BSCs with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: The authors classified various definitions of [...] Read more.

Objectives: To clarify the characteristics of Basosquamous cell carcinoma (BSC), this study compares demographic, clinical, therapeutic, histological, and outcome findings of BSCs with those of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods: The authors classified various definitions of BSC into three groups: the broadest, modest, and narrowest definitions. This study adopted the narrowest definition (both BCC and SCC features with transition zones in between) due to its wide use, its adoption by the World Health Organization, and the least heterogeneous definition. From 2009 to 2018, 20 consecutive cases of BSC presented in a single institution, along with 130 cases of BCC and 81 cases of SCC. Results: The statistically different parameters of BSC compared to BCC or SCC were age (SCC > BSC, BCC), duration (BSC, BCC > SCC), unclear border (BSC > BCC, SCC), higher NCCN classification (BSC, SCC > BCC), safety margin (SCC > BSC > BCC), operation time (BSC, SCC > BCC), reconstruction (less primary closure in BSC than BCC), microscopic size (BSC, SCC > BCC), perineural invasion (BSC > BCC), free lateral margin (BSC, SCC > BCC), and follow-up period (BSC > BCC, SCC). Regarding outcome, one distant metastasis (6.3%) in BSCs, no aggressive consequences in BCCs, and four local recurrences (11.1%), two lymph node metastases (5.6%), and one distant metastasis (2.7%) in SCCs were observed. Conclusions: In this Asian cohort, BSC has a trend toward higher rates of overall adverse outcomes compared to BCC, although this difference did not reach definitive statistical significance, unlike the findings reported in Caucasian populations. Early detection and appropriate treatment at the individual patient level are warranted to minimize rare but clinically relevant adverse events and reproduce favorable outcomes at the population level. Wide local excision followed by local flaps could be a successful surgical option with an adequate safety margin and double histopathologic intraoperative and postoperative check-up. Full article

(This article belongs to the Special Issue Skin Cancers: Update on Clinical Treatment and Management)

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14 pages, 1692 KB

Open AccessArticle

Minimal One-Quarter Incision and Four-Step (MOQIF) Excision Method for Subcutaneous Lipoma

by Seung Yun Oh and Seokchan Eun

J. Clin. Med. 2026, 15(6), 2448; https://doi.org/10.3390/jcm15062448 - 23 Mar 2026

Viewed by 936

Abstract

Background: Lipomas are common benign subcutaneous neoplasms treated surgically for cosmetic or symptomatic reasons. The minimal one-third incision and four-step (MOTIF) technique provides reliable excision with minimal scarring, but smaller proportional incisions remain unstudied. This study evaluates the minimal one-quarter incision and four-step [...] Read more.

Background: Lipomas are common benign subcutaneous neoplasms treated surgically for cosmetic or symptomatic reasons. The minimal one-third incision and four-step (MOTIF) technique provides reliable excision with minimal scarring, but smaller proportional incisions remain unstudied. This study evaluates the minimal one-quarter incision and four-step (MOQIF) technique. Methods: Retrospective review of 82 patients undergoing MOQIF excision of histologically confirmed subcutaneous lipomas by a single surgeon from July 2024–December 2025 was done. Lipomas were stratified by maximum diameter: small-intermediate (<5 cm) and large (≥5 cm). MOQIF used a one-quarter incision of the lipoma’s long axis determined by preoperative ultrasound measurement and palpation with four steps: hydro dissection preserving superficial subcutaneous tissue, superficial dissection, staged deep dissection with selective cautery of fibrovascular septa, and intact mass delivery. Outcomes included excision length, postoperative complications, Vancouver Scar Scale (VSS) scores, recurrence, and subjective treatment satisfaction of patients. Results: Mean lipoma size was 6.8 ± 2.0 cm (75.6% ≥5 cm). All lipomas were completely excised through 1.69 ± 0.49 cm incisions (ratio 0.25). Complications were low: seroma 10.98% (16.7% vs. 9.4%, p = 0.404), hematoma 7.3% (11.1% vs. 6.3%, p = 0.608), with no infections, nerve injuries, or recurrences at a mean 8.9-month follow-up. VSS scores were equivalent between groups (0.83 vs. 1.06; p = 0.438) and overall patient satisfaction was high (3.54 ± 0.53 (2–4)). Conclusions: MOQIF achieves complete lipoma excision through one-quarter incisions with safety and cosmetic outcomes across lipoma sizes, demonstrating feasibility through standardized technique refinement and careful case selection. Full article

(This article belongs to the Special Issue New Insights into Skin Tumors: From Pathogenesis to Therapy)

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18 pages, 2747 KB

Open AccessSystematic Review

Artificial Intelligence in the Diagnosis of Odontogenous Cysts and Ameloblastomas—A Systematic Review and Meta-Analysis

by Anna Takács, Dalma Tábi, Bianca Golzio Navarro Cavalcante, Bence Szabó, Alexander Schulze Wenning, Gábor Gerber, Péter Hermann, Gábor Varga, Péter Hegyi and Márton Kivovics

J. Clin. Med. 2026, 15(6), 2447; https://doi.org/10.3390/jcm15062447 - 23 Mar 2026

Viewed by 1018

Abstract

Background/Objectives: Odontogenic cysts and ameloblastomas (AB) are mostly asymptomatic, often discovered later due to severe symptoms, and only histopathological examination provides definitive diagnosis. AI-assisted diagnostics offer a fast, noninvasive, painless diagnostic tool. To our knowledge, this is the first meta-analysis aiming to [...] Read more.

Background/Objectives: Odontogenic cysts and ameloblastomas (AB) are mostly asymptomatic, often discovered later due to severe symptoms, and only histopathological examination provides definitive diagnosis. AI-assisted diagnostics offer a fast, noninvasive, painless diagnostic tool. To our knowledge, this is the first meta-analysis aiming to evaluate the classification, detection, and segmentation performance of artificial intelligence (AI) for odontogenic cysts and ABs as distinct entities and to determine if it can achieve clinically acceptable accuracy. Methods: Our systematic search was conducted on 11 January 2026, in Medline, EMBASE, and Cochrane Central Register of Controlled Trials without restrictions or filters. Studies comparing AI diagnostics with histopathological diagnostics for odontogenic cysts and ABs were included. Diagnostic parameters, including sensitivity, specificity, and accuracy, were extracted and analyzed; additionally, diagnostic odds ratios were calculated. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Recommendations of the GRADE workgroup were followed to determine the certainty of evidence. Results: Thirteen articles were found eligible, of which seven were included in our meta-analysis. The group with the highest sensitivity (Se) was the “no lesion” (N) group (0.9726, 95% CI 0.9284–1; I2 = 46%), followed by the radicular cyst (RC) (mean 0.9054, 95% CI 0.8051–1; I2 = 89%), dentigerous cyst (DC) (mean 0.8788, 95% CI 0.7828–0.9749; I2 = 93%), odontogenic keratocyst (OKC) (0.763, 95% CI 0.6999–0.8262; I2 = 14%) and AB (mean 0.4369, 95% CI 0.231–0.6429; I2 = 79%) groups. Results for AB, RC, and DC were statistically significant. The AB achieved the highest specificity (Sp) (mean 0.9889, 95% CI 0.9736–1; I2 = 0%), followed by RC (mean 0.9724, 95% CI 0.9431–1; I2 = 79%), DC (mean 0.9516, 95% CI 0.9116 0.9917; I2 = 90%), N (mean 0.9226, 95% CI 0.8385–1; I2 = 95%) and OKC (mean 0.8991, 95% CI 0.8683–0.9298; I2 = 8%) groups. DC, N, and RC had statistically significant results. Diagnostic odds ratios (DOR) showed that classification was better than chance for all lesion types. Conclusions: AI demonstrated high specificity, and is therefore effective in identifying healthy individuals. However, its sensitivity in detecting diseased patients remains suboptimal and requires further improvement. Full article

(This article belongs to the Special Issue Oral Surgery: Recent Advances and Future Perspectives)

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18 pages, 763 KB

Open AccessReview

The Current Landscape of Artificial Intelligence in Positron Emission Tomography (PET) Imaging Across the Cancer Continuum

by Wut Yee The Zar, Mi Rim Kim, Aruni Ghose, Sola Adeleke, Manoj Gupta, Partha S. Choudhary, Anirudh Shankar, Srishti Mohapatra, Stergios Boussios and Akash Maniam

J. Clin. Med. 2026, 15(6), 2446; https://doi.org/10.3390/jcm15062446 - 23 Mar 2026

Viewed by 1292

Abstract

PET scans have long been used in oncology imaging to provide molecular and metabolic information about diseases. The use of artificial intelligence (AI) in PET scans in oncology theranostics has the potential to optimise PET modality and overcome the constraints that PET scans [...] Read more.

PET scans have long been used in oncology imaging to provide molecular and metabolic information about diseases. The use of artificial intelligence (AI) in PET scans in oncology theranostics has the potential to optimise PET modality and overcome the constraints that PET scans have, such as semi-quantitative metrics, reader subjectivity, and variability across scanners/institutions. Advances in AI and radiomics are overcoming those limitations by deep learning lesion detection, enhancing image reconstruction, and improving noise resolution, which allows ultra-low dose acquisitions, while physics-informed models integrate with PET systems to strengthen interpretability and quantitative accuracy. There are also predictive AI frameworks that link PET imaging biomarkers to therapy response and outcomes, create individualised care and are even able to simulate treatment response and help with treatment planning. However, challenges do exist. Most AI PET studies are retrospective, single-centre, and underpowered (small sample), with limited external validation and inconsistent standardisation (in acquisition, segmentation, and extraction), leading to poor reproducibility and higher performance estimates. Furthermore, ethical considerations, including data protection and transparency, need to be considered before implementation. Federated learning, physics-informed frameworks, and adherence to standardised protocols offer steps towards regulated AI systems. In summary, PET is evolving from an imaging modality to a platform with the integration of deep learning, radiomics and reconstruction capable of predicting treatment response and guiding treatment. With rigorous prospective validation, cross-institutional collaboration, and regulatory standardisation, AI in PET would create an advancement in nuclear medicine imaging in oncology. Full article

(This article belongs to the Special Issue AI-Enhanced Medical Imaging for Cancer Diagnosis)

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17 pages, 2990 KB

Open AccessReview

Artificial Intelligence in Asthma and COPD: Current Status and Future Potential

by Federica Marrelli, Chiara Lupia, Saverio Nucera, Daniela Pastore, Paolo Zaffino, Carolina Muscoli, Girolamo Pelaia and Corrado Pelaia

J. Clin. Med. 2026, 15(6), 2445; https://doi.org/10.3390/jcm15062445 - 23 Mar 2026

Viewed by 1193

Abstract

Interest in artificial intelligence (AI) is rapidly growing. In healthcare, especially through machine learning and deep learning, AI is emerging as a promising tool to support the diagnosis, management, and prevention of lung diseases and to advance personalized care, although it requires large, [...] Read more.

Interest in artificial intelligence (AI) is rapidly growing. In healthcare, especially through machine learning and deep learning, AI is emerging as a promising tool to support the diagnosis, management, and prevention of lung diseases and to advance personalized care, although it requires large, well-structured datasets. Clinicians must learn how to integrate AI into routine practice for conditions such as asthma and chronic obstructive pulmonary disease (COPD), while ensuring patient safety and building trust in these tools. Chronic respiratory diseases are major global causes of morbidity and mortality and place a substantial burden on healthcare systems; among them, asthma and COPD are chronic disorders characterized by airway obstruction and inflammation. This review highlights the rapid advancement of AI, and it aims to explore the literature’s evidence of its applicability in controlling chronic respiratory disorders, particularly in asthma and COPD. We conducted a narrative literature review by searching ScienceDirect, PubMed, and Google Scholar for English-language studies on artificial intelligence applications in asthma and COPD and by screening the references of relevant articles. The reviewed literature suggests that AI-based approaches are being applied across the asthma–COPD spectrum to support diagnosis and phenotyping, improve risk stratification and prediction of clinically relevant outcomes, and enable more continuous monitoring using heterogeneous data sources (e.g., clinical records, imaging, and digital health data). AI-based tools are poised to support clinicians in asthma and COPD across diagnosis, phenotyping, and monitoring; however, their safe implementation in routine care will require robust validation, transparency, and governance to ensure reliability and patient safety. Full article

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

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12 pages, 278 KB

Open AccessArticle

Long-Term Clinical and Biological Outcomes of Biologic Therapy in Severe Asthma: 24-Month Real-World Cohort Study from Romania

by Corina Mărginean, Andreea Cristina Safta, Dragoș Huțanu, Corina Eugenia Budin, Maria Beatrice Ianosi, Gabriela Jimborean and Edith-Simona Ianosi

J. Clin. Med. 2026, 15(6), 2444; https://doi.org/10.3390/jcm15062444 - 23 Mar 2026

Viewed by 594

Abstract

Background: Severe asthma remains associated with substantial morbidity despite optimized inhaled therapy. Biologic agents targeting type 2 inflammation improve clinical outcomes; however, real-world evidence regarding the durability of these effects beyond the first treatment year remains limited. The present study extends the [...] Read more.

Background: Severe asthma remains associated with substantial morbidity despite optimized inhaled therapy. Biologic agents targeting type 2 inflammation improve clinical outcomes; however, real-world evidence regarding the durability of these effects beyond the first treatment year remains limited. The present study extends the follow-up of a previously reported real-world cohort in which 12-month outcomes of biologic therapy were evaluated. Methods: We conducted a retrospective observational longitudinal study of adults with severe asthma treated with omalizumab, benralizumab, or dupilumab at a tertiary center in Târgu-Mureș, Romania, between 2020 and 2025, extending follow-up of a previously published real-world cohort. The same patient cohort was followed for an additional period, with longitudinal data collected up to 24 months after biologic therapy initiation. Clinical, functional, and biomarker outcomes were assessed at baseline, 12 months, and 24 months, including Asthma Control Test (ACT) score, forced expiratory volume in one second (FEV₁% predicted), annual exacerbation rate, blood eosinophil count, and fractional exhaled nitric oxide (FeNO). Remission was defined as clinical (ACT ≥ 20, no severe exacerbations, and no maintenance oral corticosteroids), biological (FeNO < 20 ppb and blood eosinophils < 150/µL), and complete (both clinical and biological). Longitudinal changes were analyzed using the Friedman test with post hoc Wilcoxon signed-rank tests. Results: Forty-eight patients were included at baseline, and 41 had available data at 24 months. ACT scores improved from 12 (IQR 11–14) at baseline to 23 (21–25) at 12 months and remained stable at 22 (20–25) at 24 months (p < 0.001). Predicted FEV₁% increased from 50 (39–59) to 78 (68–88) at 12 months and 79 (66–96) at 24 months (p < 0.001). Blood eosinophil counts were markedly suppressed, and FeNO levels continued to decrease over time. Exacerbations declined from 2 (2–3) per year at baseline to 0 and 0.5 (0–1) at 12 and 24 months, respectively (p < 0.001). At 24 months, clinical, biological, and complete remission were observed in 61.0%, 78.0%, and 41.5% of patients with available paired data, respectively. Conclusions: Biologic therapy was associated with sustained clinical and functional improvement over 24 months, accompanied by sustained improvement in type 2 airway inflammation and increasing proportions of patients meeting remission criteria in real-world practice. Full article

(This article belongs to the Section Respiratory Medicine)

3 pages, 147 KB

Open AccessEditorial

Cystic Fibrosis in the Era of Precision Medicine: Transformative Progress and Persistent Challenges

by Michal Gur and Lea Bentur

J. Clin. Med. 2026, 15(6), 2443; https://doi.org/10.3390/jcm15062443 - 23 Mar 2026

Viewed by 706

Abstract

Over the past decade, the therapeutic landscape of cystic fibrosis (CF) has undergone a historic transformation; once considered a progressive, life-limiting multisystem disease treated exclusively with symptomatic therapies, CF has entered the era of mutation-specific treatment, for Contribution 1 [...] Full article

(This article belongs to the Special Issue Cystic Fibrosis: Novel Strategies of Diagnosis and Treatments)

14 pages, 937 KB

Open AccessArticle

Identification of High-Risk Individuals for Osteoporosis and Fragility Fractures in Cushing’s Syndrome: A Promising Predictive Approach

by Enes Ucgul, Burak Menekse, Ogulcan Boz, Huseyin Demirci, Bekir Ucan, Erman Cakal, Takako Araki and Muhammed Kizilgul

J. Clin. Med. 2026, 15(6), 2442; https://doi.org/10.3390/jcm15062442 - 23 Mar 2026

Viewed by 540

Abstract

Background: Cushing’s syndrome (CS) causes excessive cortisol exposure, leading to significant skeletal complications. However, there is no validated, CS-specific model to predict osteoporosis and fracture risk. This study aimed to identify independent predictors and develop a practical clinical scoring system. Methods: [...] Read more.

Background: Cushing’s syndrome (CS) causes excessive cortisol exposure, leading to significant skeletal complications. However, there is no validated, CS-specific model to predict osteoporosis and fracture risk. This study aimed to identify independent predictors and develop a practical clinical scoring system. Methods: A retrospective study was conducted on 139 patients with CS diagnosed between 2014 and 2025. Demographic, clinical, and biochemical data were analyzed. Osteoporosis was defined using dual-energy X-Ray absorptiometry criteria. Logistic regression analyses identified independent predictors, and the Cushing-Related Osteoporosis Risk Estimation (CORE) Score was constructed from normalized beta coefficients of significant variables. Results: Osteoporosis was present in 35.9% and fragility fractures in 13.4% of patients. Independent predictors included age ≥ 51 years, symptom duration ≥ 13.5 months, diabetes mellitus, late-night salivary cortisol ≥ 0.42 μg/dL, and midnight serum cortisol ≥ 10.25 μg/dL (all p < 0.05). The CORE Score (0–6 points) showed strong diagnostic performance for osteoporosis (AUC 0.827; sensitivity 88%, specificity 72%) and fractures (AUC 0.866; sensitivity 84%, specificity 78%). Each one-point increase in the CORE Score elevates the risk of osteoporotic fracture by 3.13 times (p < 0.001). Conclusions: The CORE Score represents a promising disease-specific tool for early identification of CS patients at increased risk of osteoporosis and fragility fractures, enabling more personalized management and follow-up strategies, such as prioritizing bone-protective interventions and closer skeletal monitoring. Early identification of high-risk individuals may also facilitate timely therapeutic interventions, potentially reducing future fracture risk. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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11 pages, 484 KB

Open AccessArticle

Patient-Specific Restoration of Constitutional Alignment Within Predefined Safety Boundaries Using Three-Dimensional Navigation in Primary Total Knee Arthroplasty: One-Year Clinical and Radiographic Outcomes

by Maximilian F. Kasparek, Tobias Scheidl, Oliver Haider, Gyula Kiss, Anna Jungwirth-Weinberger, Maximilian Muellner, Valerie Ladstaetter and Thomas Muellner

J. Clin. Med. 2026, 15(6), 2441; https://doi.org/10.3390/jcm15062441 - 23 Mar 2026

Viewed by 448

Abstract

Background/Objectives: This study investigates a surgical concept that restores constitutional bony alignment within predefined safety boundaries in primary total knee arthroplasty (TKA) using modern 3D navigation. The technique combines a standard knee implant with advanced navigation technology to achieve patient-specific alignment and [...] Read more.

Background/Objectives: This study investigates a surgical concept that restores constitutional bony alignment within predefined safety boundaries in primary total knee arthroplasty (TKA) using modern 3D navigation. The technique combines a standard knee implant with advanced navigation technology to achieve patient-specific alignment and recreate native joint mechanics. One-year outcome was evaluated to assess first clinical results. Methods: In this retrospective study, a consecutive series of 185 TKAs (171 patients) was analyzed. All patients underwent patient-specific restoration of constitutional alignment within predefined safety boundaries using a 3D navigation system and a standard knee arthroplasty implant. The clinical outcomes were assessed using the 2011 Knee Society Score (KSS), the Forgotten Joint Score (FJS-12), the UCLA Activity Scale, and a five-step Likert scale to evaluate satisfaction. Results: In a total of 87.6% of cases, the patients reported being either satisfied or very satisfied with their TKA. No patients reported strong dissatisfaction. The KSS demonstrated significant improvements in all subcategories (all p < 0.001). The FJS-12 increased significantly from a preoperative average of 32.5 points to 79.3 points postoperatively (p < 0.001). The mean UCLA activity score rose from 4.9 preoperatively to 6.6 postoperatively (p < 0.001). In 97.7% and 90.2% of cases, the femoral mechanical angle (FMA) and tibial mechanical angle (TMA) bone cuts were within ± 1° of the planned angles. A strong correlation was observed between the planned and verified bone cuts for the FMA (ρ = 0.939) and the TMA (ρ = 0.875). Conclusions: Patient-specific restoration of constitutional alignment within predefined safety boundaries in primary TKA using modern 3D navigation is a promising strategy for personalized joint reconstruction using a standard knee arthroplasty implant. It combines precision and reproducibility with high patient satisfaction by respecting each patient’s constitutional alignment. Full article

(This article belongs to the Special Issue New Insights in Joint Arthroplasty—2nd Edition)

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11 pages, 226 KB

Open AccessArticle

Cardiorenal Biomarkers and Cerebrovascular Risk in Patients with Congenital Heart Disease

by Efrén Martínez-Quintana and Fayna Rodríguez-González

J. Clin. Med. 2026, 15(6), 2440; https://doi.org/10.3390/jcm15062440 - 23 Mar 2026

Viewed by 507

Abstract

Background/Objectives: Adults with congenital heart disease (CHD) have a substantially higher risk of ischemic stroke than the general population. Circulating biomarkers such as N-terminal pro B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and microalbuminuria have been associated with adverse cardiovascular outcomes [...] Read more.

Background/Objectives: Adults with congenital heart disease (CHD) have a substantially higher risk of ischemic stroke than the general population. Circulating biomarkers such as N-terminal pro B-type natriuretic peptide (NT-pro-BNP), high-sensitivity C-reactive protein (hs-CRP), and microalbuminuria have been associated with adverse cardiovascular outcomes in CHD, but their role in predicting cerebrovascular events remains uncertain. Methods: Prospective cohort study including 372 adults with CHD [median age 34 years (IQR 23–42); 57.8% male] followed at a tertiary center between 2017 and 2022. Baseline assessments included demographic characteristics, CHD anatomical complexity, cardiovascular risk factors, NT-pro-BNP, hs-CRP, lipid profile, and 24-h urinary albumin excretion. The primary endpoint was incident ischemic stroke during a median follow-up of 6.3 years (IQR 3.9–8.3). Univariable Cox proportional hazards models were used to identify predictors of stroke. Results: During follow-up, 13 patients (3.5%) experienced ischemic stroke. Patients with stroke were significantly older [51 (46–64) vs. 30 (23–40) years; p < 0.001] and had a higher prevalence of dyslipidemia (61.5% vs. 15.0%; p < 0.001). NT-pro-BNP levels were markedly higher in patients with stroke [369 (218–604) vs. 64 (21–172) pg/mL; p < 0.001]. No significant differences were observed between groups in renal function parameters, hs-CRP, thyroid-stimulating hormone, or urinary albumin excretion rate. In Cox analyses, older age and dyslipidemia were the strongest predictors of stroke (p < 0.001). Arterial hypertension, diabetes mellitus, and higher NT-pro-BNP levels were also associated with increased stroke risk (p < 0.05), whereas CHD anatomical complexity, NYHA functional class, and cyanosis were not. Conclusions: In adults with CHD, ischemic stroke was mainly associated with traditional cardiovascular risk factors and elevated NT-pro-BNP levels rather than anatomical disease complexity or functional status. Full article

(This article belongs to the Special Issue Current Challenges in Adult Congenital Heart Diseases)

22 pages, 1037 KB

Open AccessArticle

Risk Factors for Mortality in Critically Ill Patients with Diabetes Admitted to the ICU: A Single-Center Retrospective Observational Study

by Mădălina Diana Daina (Fehér), Codrin Dan Nicolae Ilea, Cosmin Mihai Vesa, Alina Cristiana Venter, Simona Daciana Birsan, Timea Claudia Ghitea, László Fehér and Cristian Marius Daina

J. Clin. Med. 2026, 15(6), 2439; https://doi.org/10.3390/jcm15062439 - 23 Mar 2026

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Abstract

Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, [...] Read more.

Background and Objectives: Diabetes mellitus (DM) is a highly prevalent comorbidity among critically ill patients and may significantly influence intensive care unit (ICU) outcomes through metabolic, immune, and cardiovascular mechanisms. This study aimed to evaluate the impact of DM on clinical profile, comorbidities, complications, need for intensive support, and mortality in adult ICU patients. Materials and Methods: A retrospective observational study was conducted between January and December 2024 in a tertiary ICU, including 1344 adult patients. Among them, 435 (32.37%) had DM. Demographic data, admission diagnoses, laboratory parameters, comorbidities, complications, therapeutic interventions, and outcomes were analyzed. Comparative statistical analysis and multivariate logistic regression were performed to identify independent predictors of ICU mortality. Results: Patients with DM were significantly older than patients without diabetes mellitus (non-DM group) (69.62 ± 10.26 vs. 67.16 ± 14.26 years, p < 0.001) and more frequently female (57%, p = 0.0002). At admission, they presented higher glycemia (204.7 vs. 134.0 mg/dL, p < 0.00001), reduced glomerular filtration rate (47.2 vs. 59.5 mL/min/1.73 m², p < 0.00001), and more pronounced lymphocytopenia (p = 0.025). Cardiovascular and renal comorbidities were significantly more prevalent in DM, including hypertension (76.3%), heart failure (32.4%), and chronic kidney disease (33.1%) (all p < 0.01). DM was associated with increased odds of sepsis (OR 1.56), acute kidney injury (OR 1.51), and obesity (OR 2.57). ICU mortality was significantly higher in patients with DM (54.9% vs. 46.3%, p = 0.004; RR 1.19). Independent predictors of death included mechanical ventilation (OR 36.48), inotropic therapy (OR 4.74), hemodialysis (OR 2.57), elevated lactate, neutrophilia, and reduced glomerular filtration rate (GFR). Conclusions: DM was associated with increased ICU mortality and a higher burden of cardio-renal comorbidities and complications; however, mortality in the multivariate model was primarily driven by markers of organ dysfunction and the need for advanced supportive therapies. Early risk stratification and individualized management strategies are essential to improve outcomes in critically ill patients with diabetes. Full article

(This article belongs to the Section Intensive Care)

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12 pages, 462 KB

Open AccessArticle

Safety Profile and Tumor Response of EGFR-TKIs in Clinical Practice: A Real-World Study in Thailand

by Pattama Jainan, Chayanat Pongsathabordee, Kamala Sadabpod, Titima Junkrut, Thanakorn Jerasirichot, Oran Phetchuensakun, Taniya Paiboonvong and Saranporn Srithonrat

J. Clin. Med. 2026, 15(6), 2437; https://doi.org/10.3390/jcm15062437 - 23 Mar 2026

Viewed by 678

Abstract

Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the first-line treatment for patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations. Although EGFR-TKIs can cause various adverse events (AEs), their profiles have not been fully elucidated in Thai patients. [...] Read more.

Background: Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the first-line treatment for patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations. Although EGFR-TKIs can cause various adverse events (AEs), their profiles have not been fully elucidated in Thai patients. This study aimed to determine the incidence, characteristics, severity, and duration of the first AEs and to evaluate their association with tumor response in patients with NSCLC receiving EGFR-TKIs. Method: This retrospective cohort study was conducted at a super-tertiary care hospital in Thailand. Patients with NSCLC who received EGFR-TKIs between August 2021 and July 2024 were included. Descriptive statistics were used to summarize safety profiles and tumor response. The association between AEs and objective response was assessed using logistic regression. Results: A total of 187 patients were included in this study. Overall, 177 AEs were observed in patients receiving erlotinib, osimertinib, or gefitinib. The most common cutaneous AEs were rash (30.7%), xerosis (24.1%), and acneiform rash (19.3%), while diarrhea (20.3%) was the most frequent gastrointestinal toxicity. Most AEs were grade 1–2 and occurred within 1 month after treatment initiation. In multivariable logistic regression analysis, pruritus (OR 8.26, 95% CI: 1.00–67.75, p = 0.049) and treatment line (OR 0.27, 95% CI: 0.10–0.68, p = 0.006) were independently associated with objective response. Conclusion: Most of the AEs occurred early during EGFR-TKI therapy, with cutaneous reactions being the most common and generally mild to moderate. Pruritus and treatment line were independently associated with objective response, suggesting that pruritus may serve as a potential clinical indicator of treatment response and highlighting the importance of monitoring of the EGFR-TKI-related AEs during therapy. Full article

(This article belongs to the Section Oncology)

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13 pages, 613 KB

Open AccessArticle

Comparative Diagnostic Accuracy of EUS-Guided Fine-Needle Biopsy Versus Aspiration for Pancreatic Serous Cystic Neoplasms: A Retrospective Cohort Study

by Alan Chuncharunee, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Shimpei Matsumoto, Hiroki Koda and Tomoki Ogata

J. Clin. Med. 2026, 15(6), 2438; https://doi.org/10.3390/jcm15062438 - 22 Mar 2026

Viewed by 532

Abstract

Background: Serous cystic neoplasm (SCN) is a common benign pancreatic lesion frequently encountered in practice. However, diagnostic confirmation by Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is often limited by inadequate tissue acquisition. Fine-needle biopsy (FNB) has been increasingly performed. We aimed to [...] Read more.

Background: Serous cystic neoplasm (SCN) is a common benign pancreatic lesion frequently encountered in practice. However, diagnostic confirmation by Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is often limited by inadequate tissue acquisition. Fine-needle biopsy (FNB) has been increasingly performed. We aimed to compare the diagnostic yield of SCN using FNB and FNA needles and to identify factors associated with successful diagnosis. Methods: We retrospectively analyzed 77 patients with pancreatic lesions suspected to be SCN who underwent either EUS-FNB (n = 47 procedures) or EUS-FNA (n = 50 procedures). The primary outcome was diagnostic yield. Secondary outcomes included predictors of diagnostic yield, which were evaluated using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) analyses were performed to identify the optimal biopsy strategy. Results: Diagnostic yield was significantly higher with EUS-FNB than with EUS-FNA (44.68% vs. 14.00%; OR 4.96, 95% CI 1.85–13.28, p < 0.01). From univariate and multivariate analysis, larger cyst size, use of the Franseen FNB needle, and a higher number of needle passes were independent factors associated with diagnostic yield. ROC analysis showed modest discrimination for cyst size (AUC 0.69), with an optimal cutoff of ≥17 mm (sensitivity 87.50%, specificity 41.51%). Conclusions: EUS-FNB provided superior diagnostic yield compared with EUS-FNA for pancreatic SCN. Lesion size, use of a Franseen needle, and the number of needle passes are key factors associated with successful tissue diagnosis. Full article

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

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J. Clin. Med., Volume 15, Issue 6 (March-2 2026) – 377 articles

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