Journal of Clinical Medicine

22 pages, 2550 KB

Open AccessSystematic Review

Mapping the Prevalence and Risk Factors of Low Back Pain Among University Populations in Saudi Arabia: A Systematic Review and Meta-Analysis

by Sulaiman Alanazi, Jana Alruwaili, Maysam Alruwaili, Abdulmajeed Alfayyadh, Hadeel Alsirhani, Samaher Mohammed Alowaydhah, Sultan A. Alanazi, Nesma M. Allam and Sara Elsebahy

J. Clin. Med. 2026, 15(7), 2808; https://doi.org/10.3390/jcm15072808 - 7 Apr 2026

Cited by 1 | Viewed by 816

Abstract

Background/Objectives: Low back pain (LBP) is one of the most common musculoskeletal conditions globally and a leading cause of disability. University populations may be particularly vulnerable due to prolonged sitting, academic stress, and frequently suboptimal ergonomics, especially in rapidly expanding higher education [...] Read more.

Background/Objectives: Low back pain (LBP) is one of the most common musculoskeletal conditions globally and a leading cause of disability. University populations may be particularly vulnerable due to prolonged sitting, academic stress, and frequently suboptimal ergonomics, especially in rapidly expanding higher education systems such as those in Saudi Arabia. This systematic review and meta-analysis aimed to synthesize evidence on the prevalence of LBP among university attendants in Saudi Arabia and to quantify its associations with key demographic and environmental risk factors. Methods: We systematically reviewed observational studies reporting LBP prevalence and/or risk factors among university students and faculty in Saudi Arabia published in English, following Cochrane methodological guidance and PRISMA 2020 reporting recommendations. The protocol was prospectively registered in PROSPERO (CRD420250654048). We searched PubMed, Embase and CINAHL from inception to February 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Joanna Briggs Institute checklist for analytical cross-sectional studies. Random effects meta-analyses were used to pool prevalence estimates across recall periods, regions, populations, and measurement tools, and to calculate pooled odds ratios (ORs) for age, sex, smoking, family history of LBP, and college seating conditions. Heterogeneity, subgroup, and sensitivity analyses were undertaken. Results: Thirteen cross-sectional studies were included. The overall pooled prevalence of LBP was 57% (95% confidence interval [CI] approximately 43–71), with substantial heterogeneity. Prevalence varied by recall period, region, population group, and measurement instrument; pooled prevalence was 58% among students and 50% among faculty. Increasing age (OR 1.17, 95% CI 1.01–1.34) and poor college seating conditions (OR 1.42, 95% CI 1.07–1.76) were significantly associated with LBP. Male gender, smoking, and family history showed non-significant pooled effects. These estimates are limited by substantial between-study heterogeneity, variable measurement tools, and exclusively cross-sectional designs, which restrict causal inference. Conclusions: LBP is prevalent among university attendants in Saudi Arabia, affecting both students and faculty. The consistent associations with age and seating ergonomics highlight the need for ergonomic classroom redesign and age-sensitive preventive strategies. Future work should adopt standardized LBP measures and longitudinal designs to clarify causal pathways and evaluate targeted interventions. Funding: This work was supported by the Deanship of Graduate Studies and Scientific Research at Jouf University (grant DGSSR-2026-NF-01-002). Full article

(This article belongs to the Special Issue Evidence-Based Diagnosis and Clinical Management of Low Back Pain)

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14 pages, 272 KB

Open AccessArticle

Treatment Regret in Patients Undergoing Minimally Invasive Treatments for Benign Prostatic Hyperplasia

by Riccardo Lombardo, Antonio Luigi Pastore, Beatrice Turchi, Antonio Franco, Matteo Romagnoli, Yazan Al Salhi, Andrea Fuschi, Cristian Fiori, Silvia Secco, Sabrina De Cillis, Alberto Olivero, Antonio Nacchia, Antonio Cicione, Luca Cindolo, Giorgia Tema, Andrea Tubaro and Cosimo De Nunzio

J. Clin. Med. 2026, 15(7), 2807; https://doi.org/10.3390/jcm15072807 - 7 Apr 2026

Viewed by 869

Abstract

Background: The aim of this study was to evaluate treatment satisfaction and decision regret in patients undergoing minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed prospectively collected data from [...] Read more.

Background: The aim of this study was to evaluate treatment satisfaction and decision regret in patients undergoing minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed prospectively collected data from consecutive patients undergoing MISTs across five Italian primary care urology centers. All patients underwent a comprehensive clinical assessment, including detailed medical history and physical examination. Preoperative, perioperative, and postoperative variables were recorded. Decision regret was assessed using validated questionnaires, with significant regret defined as a score >25%. Results: A total of 155 patients were included, with a median age of 64 years (IQR 58–66) and a median IPSS of 23 (IQR 18–26). Among them, 90 patients (51%) underwent Aquablation, 21 (12%) received a temporary implantable nitinol device (iTIND), 26 (15%) underwent water vapor thermal therapy (WVTT), and 37 (21%) were treated with prostatic urethral lift (PUL). The overall median decision regret score was 0 (IQR 0–15), with 23 patients (15%) reporting significant regret (>25%). Higher regret rates were observed in patients treated with PUL and WVTT compared to those undergoing iTIND and Aquablation. None of the evaluated variables—including age, BMI, prostate volume, preoperative Qmax, or preoperative IPSS—were significantly associated with treatment regret. However, although not reaching statistical significance, a prostate volume >60 cc was associated with higher regret in patients undergoing WVTT (OR = 3.33) and PUL (OR = 4.2). Conclusions: Among patients undergoing MISTs, treatment regret is not negligible and appears higher when patient selection is suboptimal. Larger studies are warranted to better identify predictors of decision regret and optimize patient selection for these procedures. Full article

(This article belongs to the Special Issue Emerging Surgical Techniques in the Management of Urological Diseases)

15 pages, 513 KB

Open AccessArticle

Comparisons of Respiratory Function and Cardiorespiratory Responses Induced by the Modified Shuttle Walk Test in Children Finswimmers and Age-Matched Sedentary Non-Athletes

by Theano Michailidou, Aspasia Mavronasou and Eleni A. Kortianou

J. Clin. Med. 2026, 15(7), 2806; https://doi.org/10.3390/jcm15072806 - 7 Apr 2026

Viewed by 475

Abstract

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male [...] Read more.

Background: Regular aerobic exercise during childhood promotes critical physiological adaptations in the cardiovascular and respiratory system. Finswimming, a unique aquatic sport, requires high-intensity demands and specific breathing patterns. The present study aimed to compare respiratory function and cardiorespiratory responses between young male finswimmers and sedentary age-matched non-athletes. Methods: Thirty-two boys aged 8 to 12 years old were stratified into the finswimmers group (FSG, n = 16) and the non-athletes group (NAG, n = 16). Assessments included pulmonary function (spirometry) and respiratory muscle strength (Maximum Inspiratory Pressure, MIP/Maximum Expiratory Pressure, MEP). Exercise capacity was evaluated using the modified shuttle walk test (MSWT). Results: The FSG exhibited significantly higher pulmonary function (Forced Vital Capacity, Forced Expiratory Volume in 1 s, Maximum Voluntary Ventilation; p < 0.05) and superior MIP compared to the NAG (105.3 ± 24.8 versus 87.3 ± 24.7 cmH₂O; p = 0.022). During the MSWT, FSG covered substantially greater distances (746.6 ± 97.2 versus 591.1 ± 86.4 m; p < 0.001) with lower levels of leg fatigue (Borg 0–10) (0.53 ± 0.39 versus 2.13 ± 1.93; p = 0.004) and demonstrated lower heart rate recovery time (4.47 ± 0.68 versus 5.75 ± 0.68 min; p < 0.001) compared to NAG. At the iso-level (8th level of MSWT), FSG scored lower levels of leg fatigue (0.13 ± 0.12 versus 2.02 ± 2.0; p = 0.001) compared to NAG, indicating better peripheral oxygen % saturation (100 ± 0.0 versus 98.14 ± 1.16; p < 0.001). Conclusions: Systematic exercise training enhances profound cardiorespiratory and peripheral muscle adaptations in children. Enhanced cardiorespiratory function allows young athletes to achieve higher workloads and recover faster than sedentary peers, highlighting the sport’s role in establishing a robust cardiorespiratory fitness. Full article

(This article belongs to the Special Issue Insights and Innovations in Sports Cardiology)

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17 pages, 627 KB

Open AccessArticle

Bevacizumab-Based Therapy Is Associated with Prolonged Progression-Free Survival in Patients with Peritoneal Mucinous Metastatic Colorectal Cancer

by Süleyman Can, Veli Çakıcı, Gizem Bakır Kahveci, Şeyma Eroğlu, Burak Tok, Gökhan Uygun, Esra Özer, Yalçın Çırak and İvo Gökmen

J. Clin. Med. 2026, 15(7), 2805; https://doi.org/10.3390/jcm15072805 - 7 Apr 2026

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Abstract

Objective: In metastatic colorectal cancer (mCRC), mucinous histology has been associated with poor clinical outcomes, particularly in the presence of peritoneal metastasis. However, it remains unclear whether mucinous histology exerts a context-dependent effect on treatment outcomes by modifying the efficacy of anti-vascular endothelial [...] Read more.

Objective: In metastatic colorectal cancer (mCRC), mucinous histology has been associated with poor clinical outcomes, particularly in the presence of peritoneal metastasis. However, it remains unclear whether mucinous histology exerts a context-dependent effect on treatment outcomes by modifying the efficacy of anti-vascular endothelial growth factor (VEGF)-based therapies independently of metastatic dissemination patterns and chemotherapy backbone. Methods: We retrospectively analyzed 250 patients with mCRC treated with bevacizumab-containing systemic therapy. Tumors were classified as mucinous (n = 52) or non-mucinous (n = 198). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using the log-rank test. Cox proportional hazards regression models were applied for univariate and multivariate analyses. Predefined subgroup analyses were conducted according to peritoneal metastasis status and chemotherapy backbone (oxaliplatin- or irinotecan-based). A 6-month landmark analysis was performed to reduce early progression bias. Interaction analyses evaluated potential effect modification between histology, peritoneal metastasis, and chemotherapy backbone. Results: Mucinous tumors were more frequently right-sided and strongly associated with peritoneal metastasis. In the overall cohort, mucinous histology was associated with significantly longer median PFS compared with non-mucinous histology (22.9 vs. 11.9 months; p < 0.001). This benefit was driven by patients with peritoneal metastasis, in whom mucinous histology was associated with markedly prolonged PFS (23.9 vs. 8.7 months; p < 0.001). No significant PFS difference according to histology was observed in patients without peritoneal metastasis. On multivariate analysis, mucinous histology remained independently associated with improved PFS (HR 0.44; 95% CI 0.25–0.78; p = 0.005), an effect preserved in the landmark cohort (HR 0.39; 95% CI 0.26–0.59; p < 0.001). A significant interaction between mucinous histology and peritoneal metastasis was observed (p for interaction = 0.040), indicating that the prognostic impact of histology differed according to metastatic pattern. No significant PFS difference or interaction was detected according to chemotherapy backbone within the mucinous subgroup. Conclusions: Among bevacizumab-treated patients with mCRC, mucinous histology—particularly in the presence of peritoneal metastasis—is associated with a pronounced PFS advantage independent of chemotherapy backbone. These findings suggest that mucinous peritoneal mCRC represents a biologically and clinically distinct subgroup that may derive context-specific and disproportionate benefit from anti-VEGF-based strategies, warranting prospective validation. Full article

(This article belongs to the Special Issue Colorectal Cancer: Screening, Diagnosis and Treatment)

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20 pages, 893 KB

Open AccessArticle

Psychosocial Determinants Among Hospital and Primary Healthcare Professionals Towards Cancer and Cancer Patients in Croatia

by Darko Kotromanovic, Ivana Kotromanovic Simic, Nika Lovrincevic Pavlovic, Marija Olujic, Sebastijan Spajic, Luka Peric, Tara Cvijic Peric, Matea Matic Licanin, Ilijan Tomas and Ivan Miskulin

J. Clin. Med. 2026, 15(7), 2804; https://doi.org/10.3390/jcm15072804 - 7 Apr 2026

Viewed by 475

Abstract

Background/Objectives: Cancer places emotional and psychosocial demands on healthcare professionals; therefore, this study aimed to examine sociodemographic and psychosocial determinants, including emotional competence, empathy, and stigma, and to assess their interrelationships with mental health, attitudes towards cancer, and cancer-related stigma among healthcare professionals [...] Read more.

Background/Objectives: Cancer places emotional and psychosocial demands on healthcare professionals; therefore, this study aimed to examine sociodemographic and psychosocial determinants, including emotional competence, empathy, and stigma, and to assess their interrelationships with mental health, attitudes towards cancer, and cancer-related stigma among healthcare professionals involved in cancer care. Methods: This cross-sectional study was conducted from July 2025 to January 2026 via a self-administered questionnaire among 264 hospital and primary care healthcare professionals in Osijek, Croatia (69 men and 195 women; median age 37 years, IQR 31–47, age range 20–64 years), all directly involved in providing healthcare to cancer patients in Croatia. Results: Significant differences were observed by gender, age, occupation, and workplace. Men were more frequently physicians and had higher education levels and socioeconomic status, whereas women achieved higher scores in emotional competence and empathy. Physicians more often had shorter overall work experience and reported greater perceived controllability of cancer. Age-related differences were found in perceived discrimination, stigma, and controllability of cancer. Primary healthcare professionals showed a higher level of empathy and proactivity and a lower perception of cancer as an incurable disease. Higher empathy was associated with lower stigma, while negative emotions and greater proactivity were associated with higher stigma, and emotional competence was a strong predictor of empathy. Conclusions: The study identified notable sociodemographic and psychosocial differences among healthcare professionals. Emotional competence strongly predicted empathy, which was inversely associated with cancer-related stigma, suggesting potential targets for interventions to improve attitudes towards cancer care. Furthermore, women exhibited significantly higher emotional competence and empathy than men, highlighting the importance of incorporating gender-specific perspectives into developing educational and support strategies for cancer healthcare professionals. Full article

(This article belongs to the Section Oncology)

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10 pages, 394 KB

Open AccessArticle

Evaluation of Latent Tuberculosis Infection Risk in Liver Transplant Recipients

by Miraç Öz Kahya, Serhat Erol, Dilara Kış Gökçecik, Elvan Onur Kırımker, Güle Çınar, Akın Fırat Kocaay, Deniz Balcı and Özlem Özdemir Kumbasar

J. Clin. Med. 2026, 15(7), 2803; https://doi.org/10.3390/jcm15072803 - 7 Apr 2026

Viewed by 488

Abstract

Background/Objectives: Tuberculosis remains one of the preventable causes of mortality among liver transplant recipients. The prevalence of tuberculosis in solid organ transplant recipients is higher than in the general population. The aim of this study was to evaluate the incidence of latent [...] Read more.

Background/Objectives: Tuberculosis remains one of the preventable causes of mortality among liver transplant recipients. The prevalence of tuberculosis in solid organ transplant recipients is higher than in the general population. The aim of this study was to evaluate the incidence of latent tuberculosis infection (LTBI) and active tuberculosis after liver transplantation. Methods: This is a retrospective, single-center, case–control study. Adult liver transplant candidates who were evaluated between 1 January 2016 and 31 December 2022 were retrospectively assessed. Patients with pre-transplant tuberculin skin test (TST) and/or interferon-gamma release assay (IGRA) results who underwent transplantation were included in this study. Results: A total of 111 liver transplant recipients with available IGRA and/or TST results were included; 70 were men (63.1%) and 41 were women (36.9%), with a mean age of 53.5 ± 11.3 years. Demographic, clinical, and laboratory characteristics were evaluated. The most common indication for liver transplantation was viral hepatitis (33.3%), followed by cryptogenic cirrhosis (19.8%) and hepatocellular carcinoma (10.8%). All patients had a Bacillus Calmette–Guérin (BCG) vaccination scar. Ten patients received grafts from deceased donors, while 101 underwent living-donor liver transplantation. No patient received LTBI treatment before transplantation, whereas LTBI treatment was initiated in four patients after transplantation. None of the patients had a diagnosis of active tuberculosis prior to transplantation. Thoracic computed tomography revealed findings compatible with tuberculosis sequelae in 11 patients (9.9%). During a median follow-up period of 49 [27–64] months after transplantation, no cases of active tuberculosis were observed among patients with positive TST and/or IGRA results. Patients were divided into two groups according to their TST and IGRA results. Group 1 consisted of patients with IGRA positivity and/or a TST ≥ 5 mm, while Group 2 included patients with a TST < 5 mm and negative IGRA results. The only statistically significant difference between the groups was the administration of LTBI treatment (p = 0.027); four patients in Group 1 received LTBI therapy. None of these patients were able to continue prophylaxis due to treatment-related adverse effects. Conclusions: Prophylaxis with hepatotoxic agents poses a substantial risk in liver transplant candidates. Since the hepatotoxicity may cause early cessation of LTBI treatment, the risk–benefit ratio of post-transplant LTBI therapy should be carefully assessed. In situations where LTBI treatment is deferred, close clinical monitoring is strongly recommended. Full article

(This article belongs to the Section Respiratory Medicine)

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16 pages, 784 KB

Open AccessArticle

The Influence of Frailty on Total Hip Arthroplasty Outcomes: A Propensity-Matched Study of 90,660 Patients Using the Modified Frailty Index

by Sri Tummala, Mehul M. Mittal, Hetsinhji Chavda, Tarun R. Sontam, Senthil N. Sambandam and Dane K. Wukich

J. Clin. Med. 2026, 15(7), 2802; https://doi.org/10.3390/jcm15072802 - 7 Apr 2026

Viewed by 649

Abstract

Background: Frailty is a key predictor of adverse surgical outcomes in older adults. However, the prognostic utility of the 5-factor modified frailty index (mFI-5) for short- and long-term outcomes following total hip arthroplasty (THA) remains inadequately defined. This study assessed the association between [...] Read more.

Background: Frailty is a key predictor of adverse surgical outcomes in older adults. However, the prognostic utility of the 5-factor modified frailty index (mFI-5) for short- and long-term outcomes following total hip arthroplasty (THA) remains inadequately defined. This study assessed the association between frailty severity, measured by the mFI-5, and postoperative complications, implant survivorship, and mortality following primary THA in a large national cohort. Methods: This retrospective cohort study included 90,660 patients aged ≥50 years undergoing primary THA for osteoarthritis from 2003 to 2020 using the TriNetX research network. Patients were stratified by frailty severity based on mFI-5 scores: non-frail (0–1), moderately frail (2), and severely frail (≥3). Cases of fractures, polytrauma, or falls were excluded. Pairwise propensity score matching was adjusted for age, sex, race, and BMI. Outcomes included 90-day medical and surgical complications, healthcare utilization, and 2- and 5-year THA revision and mortality rates. Risk ratios (RRs) with 95% confidence intervals (CIs) and Bonferroni-corrected significance thresholds (p < 0.0167) were reported. Results: Severely frail patients had significantly increased risks of 90-day mortality (RR 4.41, 95% CI 2.22–8.74), acute kidney injury (RR 2.92), myocardial infarction (RR 3.61), and periprosthetic joint infection (RR 2.02) compared to non-frail patients. At five years, severely frail patients demonstrated a 58% higher revision risk (RR 1.58) and 23.0% mortality versus 6.9% in the non-frail cohort. A dose-dependent risk gradient was observed, with moderately frail patients exhibiting intermediate risks across all outcomes. Conclusions: Frailty severity, as measured by the mFI-5, was associated with a stepwise increase in short- and long-term complications and mortality following THA. The mFI-5 may serve as a practical, scalable tool for preoperative risk stratification, counseling, and resource planning in older adults undergoing primary THA. Full article

(This article belongs to the Special Issue New Advances in Hip and Knee Reconstructive Surgery: 2nd Edition)

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22 pages, 725 KB

Open AccessReview

From In Silico Hypothesis to Validation: The Role of Real-World Evidence in the Preliminary Verification of AI-Generated Drug-Repositioning Candidates: A Comprehensive Review

by Michał Gałuszewski, Jan Olszewski, Karolina Jankowska, Krzysztof Wójcik and Anna Bielecka-Wajdman

J. Clin. Med. 2026, 15(7), 2801; https://doi.org/10.3390/jcm15072801 - 7 Apr 2026

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Abstract

Background/Objectives: Drug repositioning has emerged as a promising strategy to address the innovation crisis in pharmaceutical development. While artificial intelligence enables efficient in silico hypothesis generation, clinical translation remains challenging. This study aims to evaluate the role of Real-World Evidence (RWE) in validating [...] Read more.

Background/Objectives: Drug repositioning has emerged as a promising strategy to address the innovation crisis in pharmaceutical development. While artificial intelligence enables efficient in silico hypothesis generation, clinical translation remains challenging. This study aims to evaluate the role of Real-World Evidence (RWE) in validating AI-generated drug-repositioning candidates. Methods: A comprehensive literature review was conducted in PubMed using a predefined search strategy integrating drug repositioning, artificial intelligence, and real-world data. After multi-stage screening, 22 original research articles were included for analysis. Results: Network-based algorithms and natural language processing dominated AI-driven hypothesis generation. Validation using Electronic Health Records and insurance databases enabled retrospective assessment of drug efficacy across large populations. Successful applications were identified in neurodegenerative, metabolic, infectious, autoimmune, and psychiatric diseases. Conclusions: The integration of AI-based analytics with RWE provides a promising framework for the preliminary verification of computational predictions, potentially informing the translational pathway toward clinical practice. However, the effectiveness of this approach remains dependent on data quality and the specific therapeutic context, requiring further standardization of clinical data. Full article

(This article belongs to the Section Pharmacology)

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14 pages, 1814 KB

Open AccessArticle

Endplate Bone Quality Assessment for Preoperative Planning and Patient-Specific Implementation in Lumbar Spine Surgery

by Wesley P. Jameson, Bailey D. Lupo, Andrew M. Schwartz, Andrew Daigle, Ahmed Anwar, Smith Surendran, Huy Tran, Christian Quinones, Deepak Kumbhare, Bharat Guthikonda and Stanley Hoang

J. Clin. Med. 2026, 15(7), 2800; https://doi.org/10.3390/jcm15072800 - 7 Apr 2026

Viewed by 622

Abstract

Background/Objectives: Poor bone quality is strongly associated with adverse surgical events. Although dual-energy X-ray absorptiometry (DXA) remains the gold standard for bone mineral density (BMD) assessment, logistical barriers may limit its preoperative application. The Endplate Bone Quality (EBQ) score is an MRI-derived [...] Read more.

Background/Objectives: Poor bone quality is strongly associated with adverse surgical events. Although dual-energy X-ray absorptiometry (DXA) remains the gold standard for bone mineral density (BMD) assessment, logistical barriers may limit its preoperative application. The Endplate Bone Quality (EBQ) score is an MRI-derived metric quantifying subchondral bone quality at the vertebral endplate with demonstrated predictive value for cage subsidence following lumbar interbody fusion. However, EBQ has been measured exclusively at the operative level in surgical cohorts. This study aimed to assess level-specific EBQ scores across the entire lumbar spine and compare distributions across age, sex and osteoporosis subgroups. Methods: A single-institution retrospective review of T1-weighted lumbar MRI studies from patients evaluated for lower back pain from 2020 to 2025 was performed. EBQ was independently scored by two blinded raters at each disc space from L1–L2 to L5–S1 using 3 mm endplate ROIs normalized to a CSF ROI at L3. Interrater reliability was assessed via ICC, Pearson correlation, and RMSE. Patients were stratified by age (≤60 vs. >60 years), sex, and osteoporosis status, and subgroup comparisons were performed for overall and level-specific EBQ score. Results: A total of 96 patients with an average age of 61.0 ± 9.42 years were included in this study. The majority of patients included were female (87.5%), and 18.8% had been diagnosed with osteoporosis. EBQ scores demonstrated a progressive caudal increase across all subgroups from L2–L3 to L5–S1. Overall interrater reliability was acceptable (ICC = 0.76), with level-specific ICCs ranging from 0.70 to 0.83. No significant differences were observed between age or sex subgroups. Osteoporotic patients demonstrated significantly higher EBQ at L1–L2, L2–L3, and overall (all p < 0.05), with no significant differences at L3–L4 through L5–S1. Conclusions: This study provides normative, level-specific EBQ reference data throughout all levels of the lumbar spine. The increase in EBQ scores seen among caudal levels and reduced osteoporotic discriminatory power support the importance of level-specific context when interpreting EBQ thresholds. These findings may support future studies evaluating threshold development for EBQ. Full article

(This article belongs to the Special Issue Clinical Advancements in Spine Surgery: Best Practices and Outcomes)

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23 pages, 2670 KB

Open AccessArticle

Prevalence and Multidrug Resistance of WHO-Priority Bacterial Pathogens in a Romanian Intensive Care Unit

by Alina Simona Bereanu, Bogdan Ioana Vintilă, Lilioara-Alexandra Oprinca-Muja, Rareș Bereanu, Ioana Roxana Codru, Raluca Maria Bădilă, Sandra Ioana Neamțu, Cosmin Ioan Mohor, Liiana Carmen Prodan and Mihai Sava

J. Clin. Med. 2026, 15(7), 2799; https://doi.org/10.3390/jcm15072799 - 7 Apr 2026

Viewed by 723

Abstract

Background/Objectives: The rise in healthcare-associated infections caused by multidrug-resistant (MDR) bacteria in hospitals, particularly in intensive care units, has resulted in increased rates of morbidity and mortality, escalating costs, and has become a significant public health concern. In our Intensive Care Unit, [...] Read more.

Background/Objectives: The rise in healthcare-associated infections caused by multidrug-resistant (MDR) bacteria in hospitals, particularly in intensive care units, has resulted in increased rates of morbidity and mortality, escalating costs, and has become a significant public health concern. In our Intensive Care Unit, we address healthcare-associated infections caused by multidrug-resistant bacteria, with a specific focus on those listed in the WHO 2024 List of Critically and Highly Prioritized Pathogens. Methods: Over the course of 1 year, from 1 January to 31 December 2024, we monitored the prevalence of healthcare-associated infections in the Intensive Care Unit of the Sibiu County Emergency Clinical Hospital, Romania, and the antibiotic susceptibility of the isolated bacteria. Results: The majority of infections were caused by pathogens in the ESKAPEE group. The most frequently isolated microorganism was Klebsiella pneumoniae (36.8%), followed by Acinetobacter baumannii (24.5%), classified as a critical priority by the WHO in 2024. Most positive samples for critical priority pathogens, including Klebsiella pneumoniae and Acinetobacter baumannii, as well as all MRSA strains (high priority), were obtained from tracheal aspirates collected from intubated and mechanically ventilated patients. A significant proportion of the isolated bacteria were multidrug-resistant, including extensively drug-resistant and pan-drug-resistant strains. Conclusions: The increase in antibiotic and antimicrobial resistance among hospital strains raises serious concerns about limited treatment options. Full article

(This article belongs to the Special Issue Hospital-Acquired Infections: Insights, Prevention, and Control Strategies)

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20 pages, 3303 KB

Open AccessArticle

Multi-Granularity Mask-Guided Network: An Integrated AI Framework for Region-Level Segmentation and Grading of Cataract Subtypes on AS-OCT Images

by Yiwen Hu, Bingyan Hao, Yilin Sun, Yitian Zhao, Yuanyuan Gu and Fang Liu

J. Clin. Med. 2026, 15(7), 2798; https://doi.org/10.3390/jcm15072798 - 7 Apr 2026

Viewed by 542

Abstract

Objective: To develop and validate an artificial intelligence (AI) system for automated lens opacities classification system III (LOCS III)-based grading of all three major cataract subtypes using anterior segment optical coherence tomography (AS-OCT). Methods: This is a single-center cross-sectional study. AS-OCT [...] Read more.

Objective: To develop and validate an artificial intelligence (AI) system for automated lens opacities classification system III (LOCS III)-based grading of all three major cataract subtypes using anterior segment optical coherence tomography (AS-OCT). Methods: This is a single-center cross-sectional study. AS-OCT images were collected and manually graded by ophthalmologists according to LOCS III. The dataset was randomly split into training, validation, and test sets. We propose a novel multi-granularity mask-guided network (MMNet) that jointly performs lens substructure segmentation and severity grading. The model’s performance was assessed on an independent test set for automatic grading of cortical cataract (CC), nuclear cataract (NC), and posterior subcapsular cataract (PSC) and the grading performance of the proposed method against ophthalmologists was also evaluated. The model’s interpretability was assessed via attention heatmaps and feature visualization. Results: The proposed MMNet exhibited high agreement with ground truth conducted through gold standard. The proportions of predictions with an absolute error < 1.0 for three subtypes range from 83.02% to 89.94%. The model’s grading accuracy for cataract subtypes was between 82.20 ± 1.41% and 89.76 ± 1.31% among the three subtypes, the Area Under the Curve (AUC) was between 0.954 (95% CI, 0.952–0.969; p < 0.001) and 0.973 (95% CI, 0.964–0.985; p < 0.001). The MMNet shows a satisfactory mean absolute error (MAE) of 0.14 ± 0.35 in CC, 0.10 ± 0.30 in NC, and 0.17 ± 0.38 in PSC grading. It also achieved a fast grading speed of 0.0178 s/image against manual grading. Conclusions: The proposed AI model presented advanced performance on AS-OCT images in automated LOCS III-based cataract grading for CC and NC, and also showed feasibility in PSC assessment. Full article

(This article belongs to the Special Issue Artificial Intelligence and Eye Disease)

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14 pages, 470 KB

Open AccessArticle

Association Between Long-Term Exposure to Particulate Matter and Glycated Hemoglobin Levels: A Cohort Study from the Korean Genome and Epidemiology Study

by Kyeongmin Kwak, Saemi Jung, Daeil Kwon and Seryeon Lee

J. Clin. Med. 2026, 15(7), 2797; https://doi.org/10.3390/jcm15072797 - 7 Apr 2026

Viewed by 497

Abstract

Background: Ambient air pollution, particularly particulate matter (PM), has been linked to metabolic disorders, including diabetes. We evaluated associations between long-term exposure to coarse particulate matter (PM₁₀) and fine particulate matter (PM_2.5) and glycated hemoglobin (HbA1c) levels in a [...] Read more.

Background: Ambient air pollution, particularly particulate matter (PM), has been linked to metabolic disorders, including diabetes. We evaluated associations between long-term exposure to coarse particulate matter (PM₁₀) and fine particulate matter (PM_2.5) and glycated hemoglobin (HbA1c) levels in a Korean population and assessed whether specific subgroups exhibited heightened susceptibility. Methods: We analyzed 6940 participants without diabetes from the Korean Genome and Epidemiology Study (KoGES) Ansan-Ansung cohort. Participants contributed 35,395 observations across a mean follow-up of 5.1 visits (2005–2017). Linear mixed models estimated associations between PM exposure and HbA1c while adjusting for covariates, including body mass index (BMI), time, and region. Subgroup analyses stratified by sex, age, BMI, region, education, smoking status, drinking status, and exercise. Results: Higher long-term PM₁₀ exposure was associated with elevated HbA1c (β = 0.0347 per interquartile range [IQR] increase of 9.48 μg/m³; 95% CI: 0.0220, 0.0473; p < 0.001). PM_2.5 showed a comparable positive association (β = 0.0166 per IQR of 8.67 μg/m³; 95% CI: 0.0010, 0.0321; p = 0.037). Associations were stronger among older adults (≥60 years: β = 0.0789 vs. <60 years: β = 0.0210; p-interaction < 0.001), rural Ansung residents (β = 0.0963 vs. Ansan: β = 0.0398; p-interaction < 0.001), participants with lower educational attainment (≤middle school: β = 0.0637; p-interaction < 0.001), and never smokers (β = 0.0455; p-interaction = 0.035). Conclusions: Among nondiabetic Korean adults, long-term PM₁₀ exposure was associated with higher HbA1c; PM_2.5 demonstrated a similar positive association. Associations were more pronounced among older adults, rural residents, individuals with lower educational attainment, and never smokers. These findings support ambient air pollution as an environmental contributor to subclinical glycemic changes and underscore the need for targeted public health strategies for vulnerable populations. Full article

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

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12 pages, 929 KB

Open AccessArticle

Impact of Hemodialysis on Early and Long-Term Outcomes After Femoral Endarterectomy for Occlusive Disease

by Ai Kazama, Yohei Yamamoto, Tsuyoshi Ichinose, Toru Kikuchi, Toshifumi Kudo and Tomoyuki Fujita

J. Clin. Med. 2026, 15(7), 2796; https://doi.org/10.3390/jcm15072796 - 7 Apr 2026

Viewed by 374

Abstract

Objectives: To investigate the early- and long-term outcomes of femoral endarterectomy (FEA) in patients undergoing hemodialysis (HD) compared with patients who were not. Methods: This single-center retrospective study evaluated 199 limbs of 163 patients (HD group, n = 50; non-HD group, n = [...] Read more.

Objectives: To investigate the early- and long-term outcomes of femoral endarterectomy (FEA) in patients undergoing hemodialysis (HD) compared with patients who were not. Methods: This single-center retrospective study evaluated 199 limbs of 163 patients (HD group, n = 50; non-HD group, n = 149) who underwent elective FEA between 2013 and 2023. Clinical outcomes were compared between the groups. The primary outcomes included early postoperative morbidity and mortality, primary patency (PP), freedom from major amputation (FFMA), overall survival (OS), and amputation-free survival (AFS). Results: Early morbidity rates were similar between the groups. However, the mortality rate was significantly higher in the HD group than in the non-HD group. There was no significant difference in the 5-year PP rate between the two groups. Furthermore, FFMA, OS, and AFS were significantly lower in the HD group than in the non-HD group. Conclusions: FEA provides acceptable patency outcomes in patients undergoing HD. However, these patients have a higher early postoperative mortality rate and experience significantly poorer limb salvage and OS than non-HD patients. These findings highlight the necessity of careful perioperative management and vigilant long-term follow-up in this high-risk patient population. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

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11 pages, 819 KB

Open AccessArticle

Treatment of Pulmonary Arterial Hypertension in Lithuania: Current Situation and Analysis of Survival of Patients Treated with Different Treatment Regimens

by Skaidrius Miliauskas, Deimante Hoppenot, Ieva Dimiene, Egle Grigoniene, Lina Gumbiene, Irena Nedzelskiene, Mangirdas Vaizgela and Egle Ereminiene

J. Clin. Med. 2026, 15(7), 2795; https://doi.org/10.3390/jcm15072795 - 7 Apr 2026

Viewed by 596

Abstract

Background/Objectives: Since 2015, pulmonary arterial hypertension (PAH)-specific medications have been fully reimbursed in Lithuania. To describe the current situation of PAH treatment in the country and to determine survival during different PAH treatment regimens. Methods: The data from the Institute of [...] Read more.

Background/Objectives: Since 2015, pulmonary arterial hypertension (PAH)-specific medications have been fully reimbursed in Lithuania. To describe the current situation of PAH treatment in the country and to determine survival during different PAH treatment regimens. Methods: The data from the Institute of Hygiene and the State Data Agency of Lithuania cases with administrative codes I27.0 and I27.8 have been evaluated. Results: In 2025, 225 confirmed cases of PAH were treated with PAH-specific medications in two PH centers. At least one PAH-specific medication was prescribed to 163 (72.4%) female and 62 (27.6%) male patients. Among these, 96 (42.7%) received sildenafil monotherapy, 82 (36.4%) received a combination of sildenafil and an ERA, 36 (16.0%) were on triple PAH-specific therapy (including selexipag or treprostinil), and 11 (4.9%) received other regimens due to specific medical considerations. The age of adults treated with sildenafil monotherapy vs. other therapies was 63.9 ± 14.8 (n = 117) and 51.5 ± 17.3 (n = 116) years, respectively (p < 0.05). A total of 191 PAH patients who received targeted therapy died during the observational period 2017–2025. Of these, 105 received monotherapy, 57 sildenafil and endothelin receptor antagonist and 29 triple therapies (treprostinil [n = 19], selexipag [n = 6], or inhaled iloprost [n = 4] were prescribed as the third drug). Patients who died and received triple therapy were younger than those on mono- and dual therapy (age at diagnosis 45.0 ± 21.6, 67.2 ± 14.7 and 61.6 ± 16.3 years, respectively, p < 0.01). Survival was longer in patients on dual therapy compared with monotherapy (43.1 ± 28.1 vs. 31.7 ± 25.0 months, p = 0.04), and the longest was in those receiving triple therapy (59.9 ± 29.4 months; p < 0.05). Conclusions: The availability of reimbursed medications dramatically increased the number of treated PAH cases in Lithuania. In 2025, most of the PAH patients received sildenafil monotherapy. Patients treated with sildenafil only were significantly older than the rest of cohort. In the survival analysis, combination PAH therapies were more often prescribed to younger patients and were associated with longer duration of life than monotherapy. Full article

(This article belongs to the Special Issue Clinical Insights into Pulmonary Hypertension)

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16 pages, 1196 KB

Open AccessArticle

Genetic Modulation of Wound Healing Pathways and Postoperative Risk in Plastic and Reconstructive Surgery: A Cohort Study

by Larysa Sydorchuk, Ruslan Gumennyi, Andrii Sydorchuk, Iryna Batih, Valentina Vasiuk, Ruslan Sydorchuk, Iryna Kamyshna, Pavlo Petakh, Iryna Halabitska and Oleksandr Kamyshnyi

J. Clin. Med. 2026, 15(7), 2794; https://doi.org/10.3390/jcm15072794 - 7 Apr 2026

Viewed by 603

Abstract

Objectives: The objective of the study was to investigate the mRNA expression of critical gene patterns, including IL-6, CCL2, IL-10, MAPK1, MAPK8, MMP9, COL1A1, COL3A1, and TGFB1, and their associations with adverse postoperative outcomes in reconstructive and plastic surgery patients, depending on [...] Read more.

Objectives: The objective of the study was to investigate the mRNA expression of critical gene patterns, including IL-6, CCL2, IL-10, MAPK1, MAPK8, MMP9, COL1A1, COL3A1, and TGFB1, and their associations with adverse postoperative outcomes in reconstructive and plastic surgery patients, depending on age. Methods: A total of 95 women participated in this prospective longitudinal cohort study and underwent reconstructive/plastic surgery. The mean age was 35.48 ± 6.61 years (range: 19–57). mRNA expression of IL-6, CCL2, IL-10, MAPK1, MAPK8, MMP9, COL1A1, COL3A1, and TGFB1 genes was evaluated in peripheral blood leukocytes using a PCR-based method with reverse transcription of cDNA. Results: The risk of postoperative complications significantly increased with elevated expression levels of IL-6 and COL3A1 (7.5-fold, p = 0.007), CCL2 (6.2-fold, p = 0.012), and MAPK1 (25.5-fold, p < 0.001). Increased expression of MAPK8, IL-10, and MMP9 was associated with a 13.2-fold higher risk (p < 0.001). The strongest association was observed for COL1A1 overexpression, which increased complication risk by 58.33-fold (p < 0.001). Risk stratification using the Molecular Complication Risk Index (MCRI), incorporating weighted gene contributions, identified an unfavorable molecular profile predominantly among women aged ≥ 40 years. Receiver operating characteristic analysis confirmed the model’s discriminative ability (AUC = 0.78; 95% CI 0.68–0.87), with an optimal cut-off value of MCRI ≥ 8.5 (sensitivity 76%, specificity 71%, p < 0.05). Conclusions: The transcriptional activity of IL-6, CCL2, IL-10, MAPK1, MAPK8, MMP9, COL1A1, COL3A1, and TGFB1 is associated with postoperative wound healing risk. Women aged over 40 years are at the highest risk of complications. Implementation of the MCRI model may enable early identification of high-risk patients, support targeted preventive strategies, and improve personalized surgical planning. Full article

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

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11 pages, 554 KB

Open AccessSystematic Review

The Impact of Coronary Artery Bypass Grafting on Respiratory Function: A Systematic Review

by Gonçalo Flores, Pedro Duarte-Mendes, Hélder Fonseca, Diogo Monteiro, Fernanda M. Silva, Nuno Couto, Ana Maria Silva and João Paulo Vilas-Boas

J. Clin. Med. 2026, 15(7), 2793; https://doi.org/10.3390/jcm15072793 - 7 Apr 2026

Viewed by 644

Abstract

Background: Cardiovascular diseases are the main cause of mortality and morbidity in Portugal, with coronary artery bypass grafting (CABG) being one of the most performed surgeries in cardiothoracic centers. After cardiac surgery, patients often experience a decrease in physical capacity, which results [...] Read more.

Background: Cardiovascular diseases are the main cause of mortality and morbidity in Portugal, with coronary artery bypass grafting (CABG) being one of the most performed surgeries in cardiothoracic centers. After cardiac surgery, patients often experience a decrease in physical capacity, which results in an increased risk of mortality or hospitalization expenditures. The objective of this systematic review was to characterize changes in respiratory function in patients undergoing CABG. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Web of Science, Pubmed, SCOPUS, and Sport Discus were searched using a predefined research strategy to identify relevant original studies published until August 2025. To be included, studies must have assessed adult patients submitted to CABG who evaluated the respiratory function before and after cardiac surgery. Studies that reported other types of cardiac surgery were excluded. The Risk of Bias in Non-randomized Studies-of-Exposure and the Cochrane risk-of-bias tool for randomized trials were used to analyze the risk of bias of the selected studies. Results: After screening 1184 potential articles, six studies met the inclusion criteria. The studies included participants who underwent CABG (n = 324), with a mean age ranging from 54.05 ± 13.6 to 67 ± 10 years. Conclusions: All included studies reported significant postoperative reductions in respiratory function following CABG, including forced vital capacity, forced expiratory volume in one second, maximal inspiratory pressure, and maximal expiratory pressure. Although these findings consistently indicate a decline in pulmonary function, the limited number of available studies limits the strength of the conclusions. This systematic review suggests that monitoring respiratory impairments after CABG may be clinically relevant to improve health-related quality of life. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Rehabilitation: The Central Role of Exercise in Prevention and Care)

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17 pages, 3244 KB

Open AccessSystematic Review

Off-Clamp Versus On-Clamp Partial Nephrectomy: An Updated Systematic Review, Meta-Analysis and Meta-Regression

by Paweł Dębiński, Jakub Karwacki, Łukasz Nowak, Zuzanna Szczepaniak, Maria Jędryka, Karol Zagórski, Bartosz Małkiewicz and Tomasz Szydełko

J. Clin. Med. 2026, 15(7), 2792; https://doi.org/10.3390/jcm15072792 - 7 Apr 2026

Viewed by 598

Abstract

Objectives: The impact of renal ischemia during partial nephrectomy (PN) on postoperative renal function remains controversial. On-clamp PN provides improved surgical exposure and haemostasis but induces warm ischemia, which may impair renal function. Off-clamp PN avoids ischemia-related injury and may better preserve renal [...] Read more.

Objectives: The impact of renal ischemia during partial nephrectomy (PN) on postoperative renal function remains controversial. On-clamp PN provides improved surgical exposure and haemostasis but induces warm ischemia, which may impair renal function. Off-clamp PN avoids ischemia-related injury and may better preserve renal function, although concerns persist regarding blood loss and oncological safety. We systematically compared perioperative and functional outcomes, as well as surgical margin status between on-clamp and off-clamp PN. Methods: We performed a systematic search of PubMed, Embase, Cochrane, Web of Science, and Scopus to identify randomized controlled trials (RCTs) and observational studies comparing on-clamp versus off-clamp PN with no publication time limitations. Outcomes included estimated glomerular filtration rate (eGFR), percentage eGFR change, estimated blood loss (EBL), transfusion rates, positive surgical margins (PSMs), operative time, and complications. Results: Thirty-nine studies (four RCTs) including 10,154 patients were analysed. Off-clamp PN was associated with a smaller decline in eGFR (mean difference [MD] −4 mL/min/1.73 m², 95% CI −5.7 to −2.8) and lower percentage eGFR loss (MD −1.7%, 95% CI −2.8 to −0.7). On-clamp PN was associated with lower EBL (MD −48 mL, 95% CI −72 to −25). Transfusion rates favored on-clamp PN but were not statistically significant (OR 0.7, 95% CI 0.5–1.0). On-clamp PN was associated with a higher risk of PSM (OR 1.3, 95% CI 1.0–1.7) and postoperative complications (OR 1.3, 95% CI 1.1–1.6). Between-study heterogeneity and predominance of observational data were key limitations. Conclusions: Off-clamp PN provides superior renal functional preservation and lower risks of PSMs and complications, at the cost of increased blood loss. These findings support individualized surgical decision-making based on patient and tumor characteristics. What does the study add?: This study provides an extensive and detailed comparison of off-clamp versus on-clamp partial nephrectomy, encompassing more than 10,000 patients from 39 studies. By integrating the available evidence up to late 2024, it delivers comprehensive estimates of the renal functional benefits associated with ischemia-free surgery. Our findings delineate the trade-offs between renal preservation, blood loss, and surgical margin status, thereby informing individualised decision-making in nephron-sparing surgery and refining current understanding of when ischemia avoidance is most clinically advantageous. Patient summary: Our study suggests that performing partial nephrectomy without temporarily clamping the kidney blood vessels may better preserve kidney function and reduce cancer-related surgical risks, but can lead to increased blood loss during surgery. These findings indicate that the choice of surgical technique should be individualised, taking into account tumour features and patient-specific factors. Full article

(This article belongs to the Section Nephrology & Urology)

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22 pages, 1212 KB

Open AccessArticle

Echocardiographic Markers and Outcomes in End-Stage Liver Disease

by Teodora Radu, Speranta Maria Iacob and Liliana Gheorghe

J. Clin. Med. 2026, 15(7), 2791; https://doi.org/10.3390/jcm15072791 - 7 Apr 2026

Viewed by 513

Abstract

Background: In end-stage liver disease (ESLD), cardiovascular changes are frequent and relate to the presence of hyperdynamic circulation. In 2019, diagnostic criteria for cirrhotic cardiomyopathy (CCM) were updated to include tissue Doppler and speckle tracking imaging in defining left ventricle (LV) systolic and [...] Read more.

Background: In end-stage liver disease (ESLD), cardiovascular changes are frequent and relate to the presence of hyperdynamic circulation. In 2019, diagnostic criteria for cirrhotic cardiomyopathy (CCM) were updated to include tissue Doppler and speckle tracking imaging in defining left ventricle (LV) systolic and diastolic dysfunction. Evaluation of diastolic function remains challenging, with frequent indeterminate cases and emerging evidence of worse prognosis. The aim of the present study was to evaluate the prevalence of LV systolic and diastolic dysfunction in cirrhosis, in correlation with liver disease severity and potential prognostic implications. Methods: We performed an observational, retrospective, non-randomized, single-center study that included 99 cirrhotic patients evaluated for liver transplant (LT) in a tertiary center. Liver disease severity and complications were analyzed with survival and echocardiography data to determine potential correlations with prognosis. For statistical analysis, IBM^® SPSS^® Statistics version 20 (Chicago, IL, USA) was utilized. A two-sided p-value < 0.05 was considered statistically significant. Results: Left atrial (LA) volume index (r = 0.230, p = 0.022), LA reservoir strain (r = 0.291, p = 0.003), and LA contraction strain absolute value (r = 0.223, p = 0.027) positively correlated with the severity of liver disease expressed by MELD Na score. LA dilation (≥34 mL/m²) was the most common echocardiographic finding. It was present in 69.7% of patients, with one third having severe LA dilation (>45 mL/m²), which was associated with worse survival (log rank p = 0.019). LA contraction strain with an absolute value higher than 16% was also associated with worse survival (log rank p = 0.024). In multivariable Cox analysis, only MELD-Na and LA volume index remained independently associated with mortality. Diastolic dysfunction appeared more prevalent among the non-surviving patients irrespective of the diagnostic criteria used (p = 0.023 for American Society of Echocardiography 2016 criteria; p = 0.032 for CCM 2019 criteria). On binomial logistic regression, the presence of significant diastolic dysfunction (>grade 1) was associated with an increased probability of composite end-point of death or LT in the presence of liver disease severity confounders. The use of the LA stiffness index in discerning diastolic function in patients with standard inconclusive evaluation may warrant further investigation. Conclusions: Echocardiographic alterations, particularly LA enlargement, are associated with liver disease severity and clinical outcomes in ESLD. These findings are hypothesis-generating and suggest a potential role for echocardiography in risk stratification, warranting validation in larger prospective studies. Full article

(This article belongs to the Section Cardiology)

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10 pages, 312 KB

Open AccessArticle

The Association Between Diabetes Mellitus During Pregnancy and Retinopathy of Prematurity

by Lara Saaida, Eilon Shany, Ahed Imtirat, Nitzan Burrack, Victor Novack and Tamar Eshkoli

J. Clin. Med. 2026, 15(7), 2790; https://doi.org/10.3390/jcm15072790 - 7 Apr 2026

Viewed by 439

Abstract

Background/Objectives: We aimed to evaluate the association between diabetes mellitus (DM) during pregnancy and retinopathy of prematurity (ROP) in preterm infants younger than 32 gestational weeks or infants with low birthweight (<1500 g). Methods: We conducted a retrospective nested case–control study [...] Read more.

Background/Objectives: We aimed to evaluate the association between diabetes mellitus (DM) during pregnancy and retinopathy of prematurity (ROP) in preterm infants younger than 32 gestational weeks or infants with low birthweight (<1500 g). Methods: We conducted a retrospective nested case–control study of all premature infants who were born alive and survived the post-delivery hospitalization period in Soroka Medical Center, with either gestational age younger than 32 weeks or birthweight less than 1500 g, during the years 2013–2021. The infants were divided into two groups according to ROP status. Multivariable Generalized Estimating Equations (GEE) were used to analyze the association between ROP and DM, adjusting for potential confounders, including maternal age, diabetes type (GDM vs. pre-gestational DM), gestational age, birthweight (<1250 g), duration of oxygen supplementation, antenatal corticosteroid courses, and birth plurality. Results: During the study period, there were 881 pairs of women and newborns who met the inclusion criteria. The ROP group included 345 infants (39.1%). Twenty-two (6.4%) of the mothers in the ROP group were diagnosed with DM during pregnancy compared with 52 of 536 (9.7%) in the control group (p = 0.082). ROP was associated with oxygen treatment (OR 1.05; 95% CI, 1.03–1.08; p < 0.001), birthweight < 1250 g (OR 2.70; 95% CI, 1.93–3.78; p < 0.001) and advanced maternal age (OR 1.04; 95% CI, 1.01–1.06; p = 0.006). Prenatal steroid treatment was identified as a significant protective factor against ROP (OR 0.73; 95% CI, 0.60–0.89; p = 0.002). No statistically significant association was observed between maternal DM and ROP (OR 0.62; 95% CI 0.34–1.13; p = 0.12). These findings should be interpreted cautiously given the retrospective design and the limited availability of glycemic control data. Conclusions: Maternal diabetes mellitus was not significantly associated with the risk of ROP in this cohort. Full article

(This article belongs to the Special Issue New Advances in Prenatal Diagnosis and Newborn Medicine, 2nd Edition)

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12 pages, 1885 KB

Open AccessCase Report

Cutaneous Manifestations as a Sentinel of Colorectal Cancer: A Case Report

by Bárbara Marinho, Glória Velho and Marisa D. Santos

J. Clin. Med. 2026, 15(7), 2789; https://doi.org/10.3390/jcm15072789 - 7 Apr 2026

Viewed by 518

Abstract

Erythema gyratum repens (EGR) is a rare figurate erythema strongly associated with internal malignancy and recognized as one of the most specific cutaneous paraneoplastic syndromes. Its recognition is clinically important, as it frequently precedes the diagnosis of an underlying neoplasm. We report the [...] Read more.

Erythema gyratum repens (EGR) is a rare figurate erythema strongly associated with internal malignancy and recognized as one of the most specific cutaneous paraneoplastic syndromes. Its recognition is clinically important, as it frequently precedes the diagnosis of an underlying neoplasm. We report the case of an 80-year-old woman who presented to the emergency department with a rapidly progressive, intensely pruritic eruption displaying a characteristic concentric “wood-grain” pattern. Laboratory evaluation revealed iron-deficiency anemia. Contrast-enhanced computed tomography identified a right-sided colonic mass, and colonoscopy with biopsy confirmed adenocarcinoma of the cecum. The patient underwent elective laparoscopic right hemicolectomy with complete tumor resection (pT3N0, microsatellite stable). Following surgery, the cutaneous lesions resolved completely and did not recur during follow-up. This case highlights erythema gyratum repens as a clinically relevant early marker of colorectal cancer and emphasizes the importance of prompt recognition of this distinctive dermatosis to trigger urgent and comprehensive malignancy screening, enabling timely diagnosis and definitive treatment. Full article

(This article belongs to the Section General Surgery)

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16 pages, 2919 KB

Open AccessArticle

Dental Intervention on the Quality of Life of Metabolic Syndrome Patients: A Randomized Controlled Trial

by Sahaprom Namano, Yuriko Komagamine, Bui Ngoc Huyen Trang, Maiko Iwaki, Kaho Hoteiya, Terumi Sakaguchi, Shunsuke Minakuchi and Manabu Kanazawa

J. Clin. Med. 2026, 15(7), 2788; https://doi.org/10.3390/jcm15072788 - 7 Apr 2026

Cited by 1 | Viewed by 691

Abstract

Background/Objectives: Metabolic syndrome (MetS) causes significant oral manifestations that negatively impact oral health-related quality of life (OHRQoL). This randomized controlled trial evaluated the effects of combined dental interventions and lifestyle guidance on OHRQoL in patients with MetS. Methods: In total, 82 [...] Read more.

Background/Objectives: Metabolic syndrome (MetS) causes significant oral manifestations that negatively impact oral health-related quality of life (OHRQoL). This randomized controlled trial evaluated the effects of combined dental interventions and lifestyle guidance on OHRQoL in patients with MetS. Methods: In total, 82 participants with MetS were randomized into an intervention group (IG; n = 39), receiving dental treatment plus lifestyle guidance, or a control group (CG; n = 43), receiving lifestyle guidance only. OHRQoL was assessed using GOHAI and OHIP-14 at baseline, 1 month, and 3 months. Data were analyzed using repeated-measures ANOVA and multivariable ANCOVA, adjusting for age, sex, baseline OHRQoL, and waist circumference. Pearson correlations examined the relationship between metabolic changes (Δ) and OHRQoL. Results: At 3 months, the IG demonstrated significantly superior OHIP-14 scores (p = 0.020) and a large effect size in social disability (

η_{p}^{2}

= 0.148, p < 0.001) compared to the CG. Within-group analysis showed the IG achieved highly significant longitudinal improvements in pain and psychological discomfort (all p < 0.001). Subgroup analysis confirmed these gains were primarily driven by participants with missing teeth (

η_{p}^{2}

= 0.447, p < 0.001), whereas the periodontitis-only subgroup showed non-significant shifts. Multivariable analysis identified age and baseline scores as primary predictors. Notably, OHRQoL improvements significantly correlated with reductions in body weight (r = 0.355, p = 0.001) and waist circumference (r = 0.238, p = 0.031). Conclusions: Integrated dental and lifestyle interventions significantly improved OHRQoL in MetS patients by enhancing psychosocial well-being and social reintegration. Gains were functionally driven by systemic metabolic success. Addressing “nutritional barriers” through dental rehabilitation, while targeting weight loss goals, was essential for holistic MetS management. Full article

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

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14 pages, 927 KB

Open AccessArticle

Dual Remission in Patients with Moderate-to-Severe Asthma and CRSwNP Treated with Dupilumab: A 24-Month Real-World Study

by Francesco Menzella, Alvise Berti, Walter Cestaro, Annamaria Bosi, Sara Munari, Francesco Gialdini, Tatiana Scandiuzzi Piovesan, Marcello Cottini, Carlo Lombardi, Lorenzo Corsi and Eugenio De Corso

J. Clin. Med. 2026, 15(7), 2787; https://doi.org/10.3390/jcm15072787 - 7 Apr 2026

Viewed by 762

Abstract

Background: “Remission” is a primary therapeutic goal in severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), though definitions vary regarding olfactory function. We evaluated “Dual Remission” kinetics in patients treated with dupilumab over 24 months. Methods: This single-center retrospective study analyzed 28 [...] Read more.

Background: “Remission” is a primary therapeutic goal in severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), though definitions vary regarding olfactory function. We evaluated “Dual Remission” kinetics in patients treated with dupilumab over 24 months. Methods: This single-center retrospective study analyzed 28 patients with comorbid severe asthma and CRSwNP. Dual Remission was defined as simultaneous asthma remission (ACT ≥ 20, no exacerbations, no OCS and stable lung function) and CRSwNP remission (SNOT-22 < 40, NPS ≤ 1). We additionally analyzed “Complete Recovery” by applying a stricter composite definition requiring the restoration of normosmia (Sniffin’ Sticks score ≥ 12). Results: At baseline, patients exhibited uncontrolled disease (median ACT 19, NPS 6). Treatment led to rapid asthma remission (85.7% at 12 months, 100% at 24 months). CRSwNP remission was slower but progressive, rising from 57% at 12 months to 88% at 24 months, demonstrating a significant “catch-up” phenomenon. Consequently, Dual Remission rates increased from 54% to 88% by month 24. When applying the stricter “Complete Recovery” criteria requiring normosmia, only 32% met the goal. Conclusion: Dupilumab is highly effective, enabling 88% of patients to achieve Dual Remission after 24 months. However, full olfactory restitution is distinct from structural polyp regression and harder to achieve, likely due to persistent neuroepithelial damage. Full article

(This article belongs to the Special Issue New Clinical Advances in Chronic Asthma—2nd Edition)

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24 pages, 646 KB

Open AccessReview

Beyond Glycemic Control: GLP-1RA–Based Therapies and Emerging Targets Beyond the Metabolic Axis

by Wojciech Matuszewski, Katarzyna Wołos-Kłosowicz, Paulina Włodarczyk, Patrycja Waśniewska, Robert Modzelewski, Jan Marek Górny, Michał Szklarz, Mikołaj Madeksza and Judyta Juranek

J. Clin. Med. 2026, 15(7), 2786; https://doi.org/10.3390/jcm15072786 - 7 Apr 2026

Viewed by 1415

Abstract

Background/Objectives: Modern diabetes therapy extends beyond glycemic control and increasingly focuses on comprehensive risk reduction to prevent long-term complications, improve quality of life, and reduce premature mortality. Accordingly, modern therapeutic approaches address not only glucose metabolism but also cardiovascular, renal, and metabolic [...] Read more.

Background/Objectives: Modern diabetes therapy extends beyond glycemic control and increasingly focuses on comprehensive risk reduction to prevent long-term complications, improve quality of life, and reduce premature mortality. Accordingly, modern therapeutic approaches address not only glucose metabolism but also cardiovascular, renal, and metabolic consequences of diabetes. Within this context, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a significant therapeutic class. In addition to their well-known effects on glycemic control and the metabolic-cardiovascular-renal axis, increasing evidence suggests that these agents may exert a range of pleiotropic effects and opening new therapeutic venues, discussed in this review. Methods: A narrative review of the literature was conducted using the PubMed, Scopus, and Google Scholar databases. Publications from 2014 and 2026 were screened using predefined keywords related to GLP-1 RAs and their potential effects across multiple physiological systems and diseases. Notably, more than 80% of the included studies were published between 2020 and 2026, reflecting the recent growth of research in this field. Results: GLP-1 RAs have been associated with beneficial effects across a wide range of conditions, including substance use disorders, mental health disorders, neurodegenerative diseases, obesity-related complications, liver disease, genitourinary disorders, osteoarthritis, and sleep apnea. While they are currently the most effective pharmacological agents for the treatment of obesity, they also significantly reduce hepatic steatosis and are associated with a decreased risk of developing hepatocellular carcinoma. Furthermore, they have also demonstrated positive effects against prostate cancer, polycystic ovary syndrome (PCOS), improved libido and fertility. Conclusions: GLP-1 RAs should no longer be regarded solely as antihyperglycemic agents. Instead, they represent a versatile therapeutic class with expanding clinical relevance across multiple medical disciplines. While current evidence is promising, further large-scale, well-designed clinical trials are required to define their full therapeutic potential. Full article

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

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14 pages, 684 KB

Open AccessArticle

Observational Study of the Association Between Oral Helicobacter pylori, Fixed Orthodontic Appliances, and Gastric Cancer Risk

by Ioana Maria Crișan, Alex Crețu and Sorana-Maria Bucur

J. Clin. Med. 2026, 15(7), 2785; https://doi.org/10.3390/jcm15072785 - 7 Apr 2026

Viewed by 590

Abstract

Background: Helicobacter pylori is a well-established risk factor for gastric carcinogenesis. Increasing evidence suggests that the oral cavity may serve as an extragastric reservoir for the bacterium, potentially contributing to persistent infection and reinfection. Orthodontic appliances can modify oral biofilm ecology and [...] Read more.

Background: Helicobacter pylori is a well-established risk factor for gastric carcinogenesis. Increasing evidence suggests that the oral cavity may serve as an extragastric reservoir for the bacterium, potentially contributing to persistent infection and reinfection. Orthodontic appliances can modify oral biofilm ecology and may facilitate bacterial colonization. This study aimed to investigate the association between oral H. pylori colonization and gastric cancer, while exploring the potential modifying role of fixed orthodontic appliances. Materials and Methods: In this cross-sectional observational study, 212 participants were recruited from gastroenterology and dental clinics between January 2023 and March 2025. Oral samples were collected and analyzed for H. pylori DNA using polymerase chain reaction (PCR). Gastric diagnoses were established through endoscopic examination and histopathological evaluation, classifying participants into gastric cancer, precancerous gastric lesions, non-atrophic gastritis, and control groups. Demographic, clinical, and oral health variables were recorded. Multivariable logistic regression models were used to evaluate the association between oral H. pylori detection and gastric cancer while adjusting for potential confounders, including age, sex, smoking status, oral hygiene indicators, and socioeconomic factors. Results: Oral Helicobacter pylori DNA was detected in 35/54 (64.8%) patients with gastric cancer, 30/56 (53.6%) with precancerous lesions, 21/52 (40.4%) with non-atrophic gastritis, and 15/50 (30.0%) controls. Gastric H. pylori infection was identified in 41/54 (75.9%) gastric cancer cases compared with 18/50 (36.0%) controls. Oral H. pylori positivity was more frequent among patients undergoing active orthodontic treatment (22/36, 61.1%) than among those without orthodontic appliances (79/188, 42.0%). In multivariable analysis, oral H. pylori positivity remained independently associated with gastric cancer (adjusted OR 3.02, 95% CI 1.51–6.03, p = 0.002). Conclusions: Our findings support an association between oral–gastric microbial interactions and H. pylori–associated disease, and suggest that the oral cavity may serve as a potential reservoir for gastric infection dynamics. The presence of orthodontic appliances may be associated with altered oral microbial ecology and could be linked to sustained H. pylori colonization. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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11 pages, 968 KB

Open AccessArticle

Deep Learning-Assisted Localization of Cystic Lesions and Benign Tumors in the Maxillofacial Region Using Panoramic Radiographs: A Preliminary Feasibility Study

by Kai-Hua Lien, Sih-Yi Wu, Yun-Ya Yang, Jia-Yu Liu, Yi-Cheng Chen, Ten-Yi Huang, Yu-Wen Tang, Yen-Chu Hsiao, Chung-Bin Wu and Cheng-Chia Yu

J. Clin. Med. 2026, 15(7), 2784; https://doi.org/10.3390/jcm15072784 - 7 Apr 2026

Viewed by 515

Abstract

Background/Objectives: Automated localization of cystic lesions and benign tumors on panoramic radiographs may support lesion recognition in the maxillofacial region. This preliminary feasibility study aimed to develop and evaluate a deep learning model based on Mask R-CNN for the localization of dentigerous cysts [...] Read more.

Background/Objectives: Automated localization of cystic lesions and benign tumors on panoramic radiographs may support lesion recognition in the maxillofacial region. This preliminary feasibility study aimed to develop and evaluate a deep learning model based on Mask R-CNN for the localization of dentigerous cysts (DCs), radicular cysts (RCs), odontogenic keratocysts (OKCs), and ameloblastomas using panoramic radiographs. Methods: A total of 215 panoramic radiographs were retrospectively collected from Taichung Veterans General Hospital (2018–2023). After excluding postoperative, recurrent, or low-quality images, 184 lesions were allocated to the training set and 47 lesions to the testing set. Lesions were annotated based on pathology-confirmed diagnoses. The Mask R-CNN model was trained to localize and classify four lesion types. Model performance was evaluated using precision, sensitivity (recall), and F1 score at an Intersection over Union (IoU) threshold of 0.1. Results: In the testing set (n = 47), 26 lesions were correctly localized, yielding an overall sensitivity of 55.3% and a precision of 83.9%. The corresponding F1 score was 66.7%. Lesion-specific sensitivities were 40.0% for ameloblastomas, 37.5% for OKCs, 36.8% for RCs, and 93.3% for DCs. Conclusions: This study suggests the preliminary feasibility of a deep learning-assisted approach for lesion localization on panoramic radiographs. However, the absence of lesion-free control images and the limited dataset size restrict the generalizability and clinical applicability of the findings. Further validation using larger and more balanced datasets is required. Full article

(This article belongs to the Special Issue Artificial Intelligence (AI) in Dental Clinical Practice)

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29 pages, 3188 KB

Open AccessArticle

Gas Therapies for Chronic Wounds: Comparative Effectiveness, Safety, and Evidence Certainty—A Systematic Review and Network Meta-Analysis

by Xinghui Zheng, Tianbo Li, Jiangning Wang and Lei Gao

J. Clin. Med. 2026, 15(7), 2783; https://doi.org/10.3390/jcm15072783 - 7 Apr 2026

Viewed by 564

Abstract

Objective: To compare the efficacy and safety of gas-based therapies for chronic wounds using a systematic review and network meta-analysis (NMA). Methods: Following PRISMA 2020, we systematically searched PubMed, Embase, Web of Science, Cochrane CENTRAL, and CBM from inception to 1 [...] Read more.

Objective: To compare the efficacy and safety of gas-based therapies for chronic wounds using a systematic review and network meta-analysis (NMA). Methods: Following PRISMA 2020, we systematically searched PubMed, Embase, Web of Science, Cochrane CENTRAL, and CBM from inception to 1 October 2025, screened studies in duplicate, and resolved disagreements by arbitration (κ = 0.87). Randomized controlled trials (RCTs) enrolling adults with chronic wounds were eligible; the primary endpoint was complete wound healing. Pairwise meta-analysis used risk ratios (RRs) with 95% CIs; heterogeneity was assessed with Q/I² and random-effects models were applied when appropriate. A frequentist NMA synthesized direct and indirect evidence, and treatments were ranked with SUCRA. Publication bias (Egger/Begg) and evidence certainty (GRADE) were evaluated. Results: Twenty-seven RCTs comprising 1673 participants were included. In pairwise pooling, gas therapies significantly increased complete healing versus standard care (random-effects RR = 2.17, 95% CI 1.61–2.94), with substantial heterogeneity (I² = 75.7%); results were directionally consistent and robust to sensitivity analyses. Prespecified subgroup analyses suggested effect modification by intervention type and wound etiology. In the NMA, most gas modalities showed beneficial trends versus standard care; however, SUCRA ranking placed standard care highest (93.9%), a finding attributed by the authors to network structure and between-study variability. Ozone therapy and topical oxygen ranked next, whereas HBOT and cold atmospheric plasma ranked mid-range; CO₂ therapy ranked lowest due to sparse evidence. Small-study effects were likely (Egger p < 0.001; Begg p = 0.013), and overall certainty was graded as moderate, limited primarily by heterogeneity, imprecision, and potential publication bias. Conclusions: Across RCTs, gas therapies as a class improve the probability of complete healing in chronic wounds relative to standard care, but effect sizes vary by modality and wound type. Given heterogeneity, possible publication bias, and inconsistencies within the evidence network, these findings should be applied with caution. HBOT remains the modality supported by the broadest evidence base, while large, high-quality, multicenter RCTs are needed to refine comparative effectiveness and safety rankings across gas therapies. Full article

(This article belongs to the Section General Surgery)

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13 pages, 2293 KB

Open AccessArticle

Operating Table Height Optimization Reduces Surgeon Postural Load During Total Knee Arthroplasty: An Ergonomic Simulation Study

by Marina Sánchez-Robles, Carmelo Marín-Martínez, Vicente J. León-Muñoz, Joaquín Moya-Angeler and Francisco Lajara-Marco

J. Clin. Med. 2026, 15(7), 2782; https://doi.org/10.3390/jcm15072782 - 7 Apr 2026

Viewed by 490

Abstract

Background: Work-related musculoskeletal disorders (WMSDs) are prevalent among orthopaedic surgeons as a result of prolonged exposure to non-neutral postures and forceful manual tasks during surgery. Although working height is a key determinant of trunk and upper-limb posture, the systematic evaluation of ergonomic [...] Read more.

Background: Work-related musculoskeletal disorders (WMSDs) are prevalent among orthopaedic surgeons as a result of prolonged exposure to non-neutral postures and forceful manual tasks during surgery. Although working height is a key determinant of trunk and upper-limb posture, the systematic evaluation of ergonomic working-height recommendations in orthopaedic surgery remains limited. Methods: A simulated left total knee arthroplasty (TKA) was divided into twelve critical surgical steps and analysed across four commonly used surgeon positions (A–D). Two conditions were compared: uncorrected working height (N) and working height corrected according to Canadian Centre for Occupational Health and Safety (CCOHS) recommendations (C). Joint angles were measured from standardized photographs using Kinovea software, and postural load was quantified with the Rapid Entire Body Assessment (REBA) method. Two trained evaluators conducted three independent assessments, yielding 288 REBA scores. Results: Mean REBA scores decreased across all surgeon positions following ergonomic correction, with statistically significant reductions observed in positions A, B, and D. When pooled across all position–step combinations (n = 48), the mean reduction was 0.92 REBA points (95% CI 0.50–1.33; p < 0.001). Notably, 27 of the 48 position–step comparisons exceeded the minimal detectable change threshold. The largest reductions occurred during force-intensive surgical steps, including bone cutting, drilling, and implant impaction. Conclusions: Adjusting working height in accordance with CCOHS ergonomic recommendations reduces surgeons’ postural load during TKA. These findings support the integration of evidence-based ergonomic adjustments into routine orthopaedic surgical practice. Full article

(This article belongs to the Special Issue Total Joint Arthroplasty: Clinical Advances and Innovations in Surgical Techniques and Rehabilitation)

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12 pages, 891 KB

Open AccessArticle

Utilization of Matrix Metalloproteinase-9 Point-of-Care Immunoassay for Meibomian Gland Dysfunction Evaluation in Glaucoma Patients

by Seung Hun Lee, Jin Hwan Park, Sung Chul Park and Si Hyung Lee

J. Clin. Med. 2026, 15(7), 2781; https://doi.org/10.3390/jcm15072781 - 7 Apr 2026

Viewed by 369

Abstract

Background/Objectives: To evaluate the relationships between meibomian gland dysfunction (MGD), ocular surface parameters, and matrix metalloproteinase-9 (MMP-9)-mediated inflammation in glaucoma patients, we specifically assessed the impact of prostaglandin analogue use, preservative exposure, and number of medications. Methods: This retrospective cross-sectional study [...] Read more.

Background/Objectives: To evaluate the relationships between meibomian gland dysfunction (MGD), ocular surface parameters, and matrix metalloproteinase-9 (MMP-9)-mediated inflammation in glaucoma patients, we specifically assessed the impact of prostaglandin analogue use, preservative exposure, and number of medications. Methods: This retrospective cross-sectional study included patients treated with topical antiglaucoma medications for at least six months. Meibomian gland expressibility, meibum quality, and MGD grade were assessed along with tear film break-up time (TBUT), Schirmer I test, and Oxford staining score. Tear MMP-9 levels were measured using a Point-of-Care immunoassay (InflammaDry^®) and graded on a 0 to 4 scale. Results: Elevated MMP-9 grades were significantly correlated with worsening meibum expressibility, meibum quality, and MGD grade (all p < 0.001), whereas no significant associations were found with traditional parameters such as TBUT and Schirmer I test. Prostaglandin analogue use was associated with worse meibomian gland parameters and higher MMP-9 levels compared to non-use. Patients receiving preservative-containing medications exhibited poorer meibomian gland parameters and MMP-9 levels, as well as worse corneal staining scores. An increased number of medications was associated with a stepwise deterioration in meibomian gland function and elevated MMP-9 levels. Conclusions: Prostaglandin analogue use, preservative exposure, and increased number of medications are significant factors associated with the exacerbation of MGD and ocular surface inflammation. Semi-quantitative grading of tear MMP-9 revealed a stepwise association with meibomian gland dysfunction severity that was not detected by conventional dry eye metrics, indicating that MMP-9 may be considered a potential indicator of subclinical ocular surface inflammation in glaucoma patients. Full article

(This article belongs to the Special Issue Challenges in the Diagnosis and Treatment of Glaucoma)

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13 pages, 880 KB

Open AccessArticle

Underestimation of Prostate Cancer Grade in Transperineal Fusion Biopsy and Its Predictive Factors: Correlation of Biopsy Findings with Post-Da Vinci Radical Prostatectomy Specimens

by Hubert Andrzej Krzepkowski, Tomasz Ząbkowski, Maciej Walędziak, Tomasz Waldemar Kamiński, Hubert Dąbrowski and Tomasz Syryło

J. Clin. Med. 2026, 15(7), 2780; https://doi.org/10.3390/jcm15072780 - 7 Apr 2026

Viewed by 478

Abstract

Background/Objectives: An accurate preoperative assessment of prostate cancer malignancy is crucial for risk stratification and selection of the optimal treatment strategy. This study assessed the concordance of Gleason scores between MRI–TRUS fusion biopsy and radical prostatectomy specimens, and identified clinical and histopathological [...] Read more.

Background/Objectives: An accurate preoperative assessment of prostate cancer malignancy is crucial for risk stratification and selection of the optimal treatment strategy. This study assessed the concordance of Gleason scores between MRI–TRUS fusion biopsy and radical prostatectomy specimens, and identified clinical and histopathological factors associated with post-procedural Gleason score upgrading. Methods: This retrospective analysis involved patients who underwent transperineal MRI–TRUS fusion biopsy followed by radical prostatectomy from 2020 to 2025. Concordance, upgrading, and downgrading of the Gleason score were assessed by comparing biopsy results with the final histopathological examination. Clinical parameters (age, PSA level, prostate volume, and PSA density) and histopathological features of biopsies (Gleason score and percentage of prostate lobes affected by cancer) were analyzed. Multivariate logistic regression models were stratified by PSA level (<10 ng/mL and >10 ng/mL). Results: Gleason score concordance was found in 53.1% of the 603 patients analyzed, upgrading in 29.9%, and downgrading in 17.1%. Higher Gleason scores on biopsy were independently associated with a lower risk of upgrading in the entire cohort and in both PSA subgroups. Larger tumor extent on biopsy was associated with a lower risk of upgrading, with heterogeneous dependencies between prostate lobes. The other clinical parameters showed no independent association with upgrading. Conclusions: Gleason score upgrading remains common after radical prostatectomy. The risk of this progression is primarily related to the histopathological features of the biopsy rather than to baseline clinical parameters, reflecting the limitations of biopsy as a sampling method and the biological heterogeneity of prostate cancer. Full article

(This article belongs to the Special Issue Urologic Oncology: From Diagnosis to Treatment)

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18 pages, 535 KB

Open AccessReview

Artificial Intelligence in Intraoperative Imaging and Navigation for Spine Surgery: A Narrative Review

by Mina Girgis, Allison Kelliher, Michael S. Pheasant, Alex Tang, Siddharth Badve and Tan Chen

J. Clin. Med. 2026, 15(7), 2779; https://doi.org/10.3390/jcm15072779 - 7 Apr 2026

Viewed by 964

Abstract

Artificial intelligence (AI) is increasingly transforming spine surgery, with expanding applications in diagnostics, intraoperative imaging, and surgical navigation. As the field advances toward greater precision and safety, machine learning (ML) and deep learning technologies are being integrated to augment surgeon expertise and optimize [...] Read more.

Artificial intelligence (AI) is increasingly transforming spine surgery, with expanding applications in diagnostics, intraoperative imaging, and surgical navigation. As the field advances toward greater precision and safety, machine learning (ML) and deep learning technologies are being integrated to augment surgeon expertise and optimize operative workflows. In particular, AI-driven innovations in image acquisition and navigation are reshaping intraoperative decision-making and technical execution. This narrative review provides an overview of AI applications relevant to intraoperative imaging and navigation in spine surgery. We begin by defining key concepts in AI, ML, and deep learning and briefly outline the historical evolution of AI within spine practice. We then examine current capabilities in image recognition and automated pathology detection, emphasizing their clinical relevance. Given the central role of imaging accuracy in modern navigation-assisted procedures, we review conventional acquisition platforms, including intraoperative computed tomography (CT) systems (e.g., O-arm, GE, Airo), surface-based registration to preoperative CT (Stryker, Medtronic), and optical surface mapping technologies (e.g., 7D Surgical). Emerging AI-optimized advancements are subsequently discussed, including low-dose intraoperative CT protocols, expanded scan windows, metal artifact reduction algorithms, integration of 2D fluoroscopy with preoperative CT datasets, and 3D reconstruction derived from 2D imaging. These developments aim to improve image quality, reduce radiation exposure, and enhance navigational accuracy. By synthesizing current evidence and technological progress, this review highlights how AI-enhanced imaging systems are redefining intraoperative spine surgery and shaping the future of precision-based care. The primary purpose of this review is to outline the applications of AI and its potential for perioperative and intraoperative optimization, including radiation exposure reduction, workflow streamlining, preoperative planning, robot-assisted surgery, and navigation. The secondary purpose is to define AI, machine learning, and deep learning within the medical context, describe image and pathology recognition, and provide a historical overview of AI in orthopedic spine surgery. Full article

(This article belongs to the Special Issue Spine Surgery: Current Practice and Future Directions)

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J. Clin. Med., Volume 15, Issue 7 (April-1 2026) – 342 articles

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