Journal of Clinical Medicine

12 pages, 842 KB

Open AccessSystematic Review

Management of Ogilvie’s Syndrome: A Network Meta-Analysis

by Orestis Ioannidis, Christos Chatzakis, Ioannis Mitrogiannis, Elissavet Anestiadou, Aliki Brenta, Savvas Symeonidis, Stefanos Bitsianis, Efstathios Kotidis, Manousos George Pramateftakis, Ioannis Mantzoros and Stamatios Angelopoulos

J. Clin. Med. 2026, 15(8), 3177; https://doi.org/10.3390/jcm15083177 - 21 Apr 2026

Cited by 1 | Viewed by 808

Abstract

Background/Objectives: Ogilvie’s syndrome, or acute colonic pseudo-obstruction (ACPO), is defined by acute colonic dilatation without mechanical obstruction and carries a risk of ischemia and perforation if not promptly managed. Treatment strategies include conservative supportive care, neostigmine administration, colonoscopic decompression, and combinations of these [...] Read more.

Background/Objectives: Ogilvie’s syndrome, or acute colonic pseudo-obstruction (ACPO), is defined by acute colonic dilatation without mechanical obstruction and carries a risk of ischemia and perforation if not promptly managed. Treatment strategies include conservative supportive care, neostigmine administration, colonoscopic decompression, and combinations of these approaches. The aim of this study was to compare the relative effectiveness of these interventions for symptom resolution using a network meta-analysis. Methods: A systematic search of PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and grey literature was conducted from inception in February 2025 to November 2025. Prospective cohort and case–control studies evaluating conservative supportive care, neostigmine, colonoscopic decompression, or their combinations were included. A random-effects network meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS). Results: Four studies comprising 172 patients were included. Compared with supportive care alone, supportive care combined with neostigmine was associated with higher odds of symptom resolution (network OR 13.86, 95% CI 3.06–62.83). Supportive care combined with colonoscopic decompression demonstrated an even greater effect (network OR 65.65, 95% CI 11.70–368.50). Colonoscopic decompression versus neostigmine yielded a network OR of 4.74 (95% CI 1.17–19.25). SUCRA rankings indicated that colonoscopic decompression combined with supportive care had the highest probability of being the most effective strategy. Conclusions: Active interventions, particularly colonoscopic decompression or neostigmine combined with supportive care, were associated with a higher incidence of symptom resolution compared to supportive care alone. Larger comparative studies are needed to confirm these findings and refine treatment selection. Full article

(This article belongs to the Special Issue Personalized Management of Abdominal Surgery and Complications)

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12 pages, 531 KB

Open AccessArticle

The Impact of Bacterial Infections on Delayed Hematopoietic Recovery in Patients with Acute Leukemia After Induction and Consolidation Therapy

by Krzysztof Gawronski, Nadia Hussein, Agnieszka Woźniak-Kosek, Agata Zakrzewska, Elżbieta Rutkowska, Piotr Rzepecki and Aneta Guzek

J. Clin. Med. 2026, 15(8), 3176; https://doi.org/10.3390/jcm15083176 - 21 Apr 2026

Cited by 1 | Viewed by 648

Abstract

Objective: To evaluate whether documented bacterial infection or neutropenic fever is associated with delayed hematopoietic recovery in patients with acute leukemia undergoing induction or consolidation chemotherapy. Methods: We conducted a retrospective observational study of 171 adult patients with acute myeloid leukemia (AML) or [...] Read more.

Objective: To evaluate whether documented bacterial infection or neutropenic fever is associated with delayed hematopoietic recovery in patients with acute leukemia undergoing induction or consolidation chemotherapy. Methods: We conducted a retrospective observational study of 171 adult patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) treated between 2022 and 2025. Patients were divided into three groups: (1) microbiologically documented infection (n = 73); (2) neutropenic fever without pathogen identification (n = 73); and (3) no fever or infection (n = 25). Hematopoietic recovery was assessed by time to neutrophil recovery (>0.5 × 10⁹/L) and time to reticulocyte production index (RPI) > 1.0. Statistical comparisons were performed using ANOVA or Kruskal–Wallis tests as appropriate. Results: The mean time to neutrophil recovery was 32.0 days (95% CI: 30.0–34.0) in Group 1, 28.4 days (95% CI: 27.3–29.6) in Group 2, and 15.2 days (95% CI: 14.3–16.2) in Group 3 (p = 0.0039). The mean time to RPI > 1.0 was 36.3 days (95% CI: 34.2–38.4), 33.0 days (95% CI: 31.8–34.2), and 19.4 days (95% CI: 18.5–20.3), respectively (p = 0.0018). Differences between Groups 1 and 2 were not statistically significant. Conclusions: Infection and neutropenic fever are associated with significantly prolonged hematopoietic recovery following chemotherapy for acute leukemia. Delayed regeneration may increase the risk of complications and negatively affect treatment outcomes. Full article

(This article belongs to the Section Hematology)

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28 pages, 11290 KB

Open AccessReview

Anti-Thrombotic Therapy Following Transcatheter Structural Heart Intervention

by Francesco Tartaglia, Giulia Antonelli, Alessandro Gabrielli, Mauro Gitto, Arif A. Khokhar, Francesca Soriente, Pier Pasquale Leone, Damiano Regazzoli, Ole de Backer, Antonio Mangieri and Giulio Stefanini

J. Clin. Med. 2026, 15(8), 3175; https://doi.org/10.3390/jcm15083175 - 21 Apr 2026

Viewed by 1102

Abstract

Transcatheter structural heart interventions, including aortic, mitral and tricuspid valve replacement or repair, and patent foramen ovale, atrial septal defect, and left atrial appendage closure, have dramatically expanded over the past two decades, providing substantial improvements in both clinical outcomes and quality of [...] Read more.

Transcatheter structural heart interventions, including aortic, mitral and tricuspid valve replacement or repair, and patent foramen ovale, atrial septal defect, and left atrial appendage closure, have dramatically expanded over the past two decades, providing substantial improvements in both clinical outcomes and quality of life. These interventions are performed in a high-risk patient population, which is at risk for both thrombotic and bleeding complications. The introduction of prosthetic devices into the arterial or venous circulation under heterogeneous hemodynamic conditions inevitably increases the risk for thrombotic events and thromboembolic complications. Consequently, the selection of antithrombotic therapy (AT) regimen and its duration is complex and should be tailored to each patient’s risk profile, balancing the expected risk and benefits. This state-of-the-art review critically examines the thrombotic risks inherent to transcatheter structural heart interventions, synthesizes available evidence and current guidelines recommendations on antithrombotic management, and defines persisting gaps in knowledge while discussing the most relevant ongoing clinical trials. Full article

(This article belongs to the Special Issue Advances in Antithrombotic Therapy in Cardiovascular Medicine)

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13 pages, 998 KB

Open AccessArticle

Continuous Spinal Anesthesia in Frail Patients Undergoing Orthopedic Hip and Knee Revision Surgery: Advantages, Indications, and Risk Management—A Single-Center Retrospective Experience

by Yazan Abu Salem, Emilia Cialdella, Vincenzo Simili, Federica Martorelli, Giuseppe Monteleone, Francesco Tasso, Berardo Di Matteo, Giuseppe Anzillotti, Elizaveta Kon and Marco Scardino

J. Clin. Med. 2026, 15(8), 3174; https://doi.org/10.3390/jcm15083174 - 21 Apr 2026

Viewed by 787

Abstract

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia [...] Read more.

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia in this high-risk population. Methods: A retrospective review was conducted of ASA II-III patients who underwent complex hip and knee revision surgeries between February and October 2024 under CSA. The technique was performed using a 25-gauge spinal catheter with incremental boluses of 0.25% levobupivacaine (2.5 mg). Hemodynamic parameters, including mean arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI), were continuously monitored using the EV1000 hemodynamic monitoring system. Postoperative complications were recorded. Results: 37 high-risk patients were included in the study. Catheter placement was successful in all patients, with no conversions to general anesthesia. MAP decreased by a mean of 14.6% after boluses (p < 0.05); 9 patients (24.3%) experienced reductions ≥ 20%, but all remained >65 mmHg and responded to fluid therapy. CI and SVI decreased by 10.1% and 10.5%, respectively (p < 0.05), without clinical instability. No major complications (neurological injury, infection, post-dural puncture headache) were observed. Conclusions: In this retrospective single-center experience, CSA with titrated low-dose levobupivacaine was feasible and associated with stable hemodynamic profiles and a low rate of complications in frail patients undergoing complex lower-limb revision surgery. However, given the absence of a control group and the limited sample size, these findings should be interpreted cautiously. Further prospective comparative studies are needed to better define the role of CSA in high-risk orthopedic patients. 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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16 pages, 634 KB

Open AccessEditor’s ChoiceReview

Belimumab in Systemic Lupus Erythematosus: From B-Cell Biology to Disease Modification

by Marc Xipell, María Cecilia Garbarino, Cristina Serrano del Castillo, Laura Morantes, Carla Bastida, Ignasi Rodríguez-Pintó, Jose A. Gómez-Puerta, Gerard Espinosa, Luis F. Quintana and Ricard Cervera

J. Clin. Med. 2026, 15(8), 3173; https://doi.org/10.3390/jcm15083173 - 21 Apr 2026

Cited by 3 | Viewed by 1481

Abstract

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease in which B-cell dysregulation plays a central pathogenic role beyond autoantibody production. Advances in B-cell biology have led to the development of targeted therapies, including inhibition of the B-cell activating factor (BAFF) pathway. Belimumab, [...] Read more.

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease in which B-cell dysregulation plays a central pathogenic role beyond autoantibody production. Advances in B-cell biology have led to the development of targeted therapies, including inhibition of the B-cell activating factor (BAFF) pathway. Belimumab, a monoclonal antibody that neutralizes soluble BAFF, modulates B-cell survival signals upstream, promoting progressive immunologic remodeling rather than rapid depletion. This review integrates current knowledge on BAFF-dependent B-cell biology with mechanistic, pharmacokinetic, and clinical data to provide a comprehensive framework for understanding belimumab’s effects in SLE and lupus nephritis (LN). Belimumab preferentially reduces transitional and naïve B cells, while memory B cells show a relative transient increase followed by a gradual return to baseline levels, reflecting redistribution rather than expansion, and long-lived plasma cells are largely unaffected. These effects result in progressive remodeling of B-cell compartment dynamics and contribute to broader modulation of adaptive immune amplification pathways. Pharmacokinetic data support a threshold-based model of BAFF neutralization, with exposure influenced by disease-related factors such as proteinuria in LN. Clinical response is primarily determined by baseline disease biology, with greater benefit observed in patients with serologically active disease and less established organ involvement. Across clinical trials and real-world studies, belimumab reduces disease activity and flares, enables glucocorticoid tapering, and slows organ damage accrual. In LN, it improves renal outcomes and reduces the risk of kidney-related events. Collectively, these findings support belimumab as a disease-modifying therapy in SLE. Further research is needed to refine patient selection and optimize treatment sequencing and combination strategies. Full article

(This article belongs to the Special Issue Systemic Lupus Erythematosus: Current Trends and Therapeutic Innovations)

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14 pages, 915 KB

Open AccessArticle

Differential Effects of Oral Antidiabetic Drugs on Skeletal Muscle Mass and Hemoglobin Levels in Adults with Type 2 Diabetes Mellitus: A Prospective Real-World Cohort Study

by Fatma Pınar Ziyadanoğlu, Ece Çiftçi Öztürk, Gamze Şengün, Seher İrem Şahin, Büşra Çetintulum Aydın and Hayriye Esra Ataoğlu

J. Clin. Med. 2026, 15(8), 3172; https://doi.org/10.3390/jcm15083172 - 21 Apr 2026

Viewed by 648

Abstract

Background/Objectives: Beyond glycemic control, oral antidiabetic drugs (OADs) may exert class-specific effects on muscle mass and hematologic parameters. However, real-world evidence comparing these effects across OAD classes remains limited. This study aimed to evaluate the differential effects of commonly prescribed OADs on skeletal [...] Read more.

Background/Objectives: Beyond glycemic control, oral antidiabetic drugs (OADs) may exert class-specific effects on muscle mass and hematologic parameters. However, real-world evidence comparing these effects across OAD classes remains limited. This study aimed to evaluate the differential effects of commonly prescribed OADs on skeletal muscle mass (SMM) and hemoglobin (Hb) levels in adults with type 2 diabetes mellitus (T2DM). Methods: In this prospective observational cohort study, 60 adults with newly initiated OAD therapy were followed for six months at a tertiary care center in Türkiye. Patients were classified according to the OAD class newly added to their regimen (metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, pioglitazone, or sodium–glucose cotransporter-2 inhibitors [SGLT2-i]). Multi-frequency bioelectrical impedance analysis was used to evaluate body composition, and hematologic parameters including Hb were obtained at both time points. To account for potential confounders—including age, sex, BMI, baseline Hb, and eGFR—binary logistic regression analyses were performed. Results: Patients initiated on pioglitazone (n = 11) demonstrated a borderline within-group increase in SMM in unadjusted analysis (median delta +0.17 kg, IQR −0.55 to +0.50; p = 0.050); however, this association was attenuated and no longer statistically significant after multivariable adjustment (OR 2.16, 95% CI 0.60–7.83; p = 0.240). In contrast, SGLT2-i users (n = 28) showed a significant increase in Hb (median delta +0.10 g/dL, IQR −0.30 to +0.50; p = 0.022), which remained significant after adjustment (OR 4.22, 95% CI 1.32–13.44; p = 0.015). Other OAD classes were not associated with meaningful changes in SMM or Hb. Conclusions: In this real-world prospective cohort, pioglitazone showed a trend toward increased SMM in unadjusted analysis that did not reach significance after adjustment, suggesting a hypothesis-generating signal warranting further investigation. SGLT2 inhibitors were independently associated with increased Hb levels, though the observed median increment was modest in absolute terms. These findings highlight potentially clinically relevant, non-glycemic effects of OAD classes and may inform individualized treatment selection, particularly in patients at risk of sarcopenia or anemia. Adequately powered, prospective studies are needed to validate and extend these preliminary observations. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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7 pages, 2532 KB

Open AccessCase Report

Accidental Bowel Transgression/Close Proximity During Percutaneous Microwave Ablation of Liver Tumors: A Retrospective Case Series

by Krish Vennam, George Ashji and Ashwani Kumar Sharma

J. Clin. Med. 2026, 15(8), 3171; https://doi.org/10.3390/jcm15083171 - 21 Apr 2026

Viewed by 501

Abstract

Aim: Percutaneous liver ablation is a challenging procedure and operator-dependent. During the time when transarterial liver oncological therapies are favored over percutaneous liver ablation, we discuss the challenges of liver ablation with bowel interposition within the needle tract. Materials and Methods: [...] Read more.

Aim: Percutaneous liver ablation is a challenging procedure and operator-dependent. During the time when transarterial liver oncological therapies are favored over percutaneous liver ablation, we discuss the challenges of liver ablation with bowel interposition within the needle tract. Materials and Methods: In this IRB-approved retrospective review, we analyzed 481 cases of percutaneous microwave ablation performed between 2012 and 2025 using the NeuWave microwave ablation system with 15 or 20 mm probes under non-contrast CT guidance, with needle trajectories planned based on ultrasound. Dissection techniques were not performed, as intraprocedural ultrasound and CT assessment suggested that the ablation zone would remain confined to hepatic parenchyma. Cases of bowel transgression or close proximity were identified on post-procedural CT imaging, with a follow-up duration of 3 months performed consistently across all cases. Results: Three cases (0.6%) of bowel transgression or close proximity to bowel loops during needle placement were identified. There was no evidence of transmural bowel perforation or clinically significant bowel injury on clinical or radiologic follow-up. Post-procedural imaging demonstrated no free intraperitoneal air or fluid collections. Conclusions: In cases where the ablation zone is confined to hepatic parenchyma, bowel proximity to or inadvertent traversal by the cooled antenna shaft may not result in clinically significant injury and can be managed conservatively in selected patients. Full article

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

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13 pages, 711 KB

Open AccessArticle

The Potential Role of Large Language Models in Assisting Patients and Guiding Emergency Care Visits

by Kristina Gerhardinger, Josina Straub, Julia Lenz, Siegmund Lang, Volker Alt, Borys Frankewycz, Maximilian Kerschbaum and Lisa Klute

J. Clin. Med. 2026, 15(8), 3170; https://doi.org/10.3390/jcm15083170 - 21 Apr 2026

Viewed by 669

Abstract

Background/Objectives: Overcrowding in emergency departments (EDs) remains a critical challenge in modern healthcare systems, driven in part by patient uncertainty regarding symptom urgency and a lack of accessible medical guidance. Recent advances in artificial intelligence, particularly large language models (LLMs), present a [...] Read more.

Background/Objectives: Overcrowding in emergency departments (EDs) remains a critical challenge in modern healthcare systems, driven in part by patient uncertainty regarding symptom urgency and a lack of accessible medical guidance. Recent advances in artificial intelligence, particularly large language models (LLMs), present a novel opportunity to support patient navigation and relieve pressure on ED infrastructures. Methods: A total of 238 unique patient questions were identified through a structured web search. Following deduplication and thematic clustering, 15 representative questions were selected. Each question was submitted to the three LLMs—ChatGPT (v3.5), DeepSeek, and Gemini—using a standardized prompt. Responses were assessed by clinical experts (N = 8) who were blinded to the model source. Reviewers selected the best overall response per question, as well as the individual responses of the three LLMs for each respective question. Results: ChatGPT was selected as the best-performing model in 60% of cases, with DeepSeek and Gemini selected in 23% and 17%, respectively. ChatGPT responses also achieved the highest proportion of “excellent” quality ratings and the lowest proportion of “unsatisfactory” outputs. Across all models, clarity was the most positively rated domain (79% agreement), followed by empathy (72%), length/detail appropriateness (71%), and completeness (65%). Over two-thirds of raters expressed willingness to integrate LLM-based tools into clinical practice for patient education and pre-triage counseling. Conclusions: Large language models demonstrate promising capabilities in responding to emergency care-related patient queries. Their ability to deliver medically sound and communicatively effective answers positions them as potential digital adjuncts in the management of low-acuity ED presentations and prehospital triage. Full article

(This article belongs to the Special Issue Novel Technologies to Assist Emergency Medical Care)

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19 pages, 1544 KB

Open AccessArticle

Short-Term Effects of Structured Physical Activity With or Without Dietary Counselling in Early-Stage Chronic Kidney Disease Managed in Primary Care: A Non-Randomised Controlled Study

by Lorena Bosnar Zelenika, Dragana Tišma, Tamara Ciko, Pero Hrabač, Ivana Vuković Brinar and Valerija Bralić Lang

J. Clin. Med. 2026, 15(8), 3169; https://doi.org/10.3390/jcm15083169 - 21 Apr 2026

Viewed by 580

Abstract

Background/Objectives: To evaluate the short-term effects of structured physical activity (PA), alone or combined with dietary counselling, in early-stage chronic kidney disease (CKD) patients managed in primary healthcare (PHC). Methods: This non-randomised controlled study was conducted in Croatia from 1 September to [...] Read more.

Background/Objectives: To evaluate the short-term effects of structured physical activity (PA), alone or combined with dietary counselling, in early-stage chronic kidney disease (CKD) patients managed in primary healthcare (PHC). Methods: This non-randomised controlled study was conducted in Croatia from 1 September to 30 November 2025. Ninety adults aged 40–75 years with early-stage CKD were allocated to three groups: structured PA, combined PA and dietary counselling, or control. Interventions included kinesiologist-led PA and, in the combined group, dietitian-led Mediterranean/plant-based counselling. Outcomes included estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (ACR), cardiometabolic risk factors, behavioural measures, quality of life, and sleep quality. Statistical significance was set at p < 0.01. Results: Seventy-eight participants completed follow-up. Changes in eGFR did not differ between groups (p = 0.310). Mean ± standard deviation changes in ACR were −1.10 ± 6.37, −0.86 ± 2.88, and +1.18 ± 3.13 in the PA, combined, and control groups, respectively (p = 0.017, not meeting the prespecified significance threshold). Significant between-group differences were observed for selected patient-reported and PA outcomes, including emotional well-being, energy/fatigue, role limitations due to emotional problems, sedentary time, and total PA (all p ≤ 0.006). Conclusions: Structured PA, with or without dietary counselling, improved PA behaviour and selected patient-reported outcomes in early-stage CKD managed in PHC but did not demonstrate significant short-term effects on kidney-related outcomes. These findings support the feasibility of integrating lifestyle-oriented interventions into PHC as part of integrated CKD care, while larger, longer-term studies are needed. Full article

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

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8 pages, 214 KB

Open AccessArticle

Diagnostic Performance of Prenatal Ultrasound to Detect Velamentous Cord Insertion in Twin Pregnancies

by Kodai Minoura, Hiroyuki Tsuda, Yumiko Itoh, Atsuko Tezuka and Tomoko Ando

J. Clin. Med. 2026, 15(8), 3168; https://doi.org/10.3390/jcm15083168 - 21 Apr 2026

Viewed by 1469

Abstract

Objective: We aimed to determine the ability of prenatal ultrasound to detect velamentous cord insertion (VCI) in twin pregnancies and identify factors influencing diagnostic sensitivity. Methods: This single-center retrospective study included twins delivered between April 2018 and March 2024. We excluded monochorionic monoamniotic [...] Read more.

Objective: We aimed to determine the ability of prenatal ultrasound to detect velamentous cord insertion (VCI) in twin pregnancies and identify factors influencing diagnostic sensitivity. Methods: This single-center retrospective study included twins delivered between April 2018 and March 2024. We excluded monochorionic monoamniotic twins, those without chorionicity or umbilical cord insertion data, and fetuses that died in utero. Umbilical cord insertion sites assessed by second-trimester transabdominal ultrasound (16 + 0 to 21 + 6 weeks of gestation) using color Doppler imaging were classified as normal, marginal, or velamentous. The results of postnatal macroscopic examinations served as reference standards. We calculated accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. The effects of examiner expertise, chorionicity, placental location, ultrasound device, and maternal body mass index (BMI) on diagnostic sensitivity were analyzed in subgroups. Results: We confirmed VCI in 45 (8.8%) of 514 delivered fetuses. Prenatal ultrasound correctly identified 14 VCI cases. Sensitivity, specificity, PPV, and NPV were 31.1% (14/45), 98.9% (464/469), 73.7% (14/19), and 93.7% (464/495), respectively. The overall accuracy was 93.0% (478/514). Sensitivity was significantly higher when ultrasound specialists conducted examinations compared with non-specialists and when twins were monochorionic diamniotic twins than dichorionic. Anterior placental location and high-performance ultrasound equipment were also associated with increased sensitivity, but were not statistically significant. Maternal BMI did not affect diagnostic sensitivity. Conclusions: Prenatal ultrasonographic detection of VCI in twin pregnancies has high specificity but limited sensitivity. Diagnostic performance was influenced by examiners’ experience and chorionicity. Routine assessment of cord insertion sites and targeted training might improve detection and support the optimized perinatal management of twin pregnancies. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 582 KB

Open AccessArticle

Real-World Antiplatelet Use and Clinical Outcomes in Patients with Advanced Chronic Kidney Disease Following Acute Coronary Syndrome: A Descriptive Cohort Study

by Lama Alfehaid, Eman Alzahrani, Amani Alsubaie, Majed Almutairi, Mansour Alomran and Saleh Alghadeer

J. Clin. Med. 2026, 15(8), 3167; https://doi.org/10.3390/jcm15083167 - 21 Apr 2026

Viewed by 651

Abstract

Background: Patients with advanced chronic kidney disease (CKD) experience disproportionately high ischemic and bleeding risks following acute coronary syndrome (ACS), yet remain markedly underrepresented in randomized trials of antiplatelet therapy. Consequently, real-world data describing antiplatelet prescribing patterns and clinical outcomes in this population [...] Read more.

Background: Patients with advanced chronic kidney disease (CKD) experience disproportionately high ischemic and bleeding risks following acute coronary syndrome (ACS), yet remain markedly underrepresented in randomized trials of antiplatelet therapy. Consequently, real-world data describing antiplatelet prescribing patterns and clinical outcomes in this population are limited. Objectives: To describe real-world antiplatelet use and 12-month clinical outcomes in patients with advanced CKD and end-stage renal disease (ESRD) following ACS. Methods: We conducted a single-center, retrospective cohort study including adults with advanced CKD (stage 4–5) or dialysis-dependent ESRD hospitalized with ACS and discharged on dual antiplatelet therapy. Baseline characteristics, revascularization strategies, and clinical outcomes were collected. Outcomes of interest included all-cause mortality, recurrent ischemic events (recurrent myocardial infarction, stroke or transient ischemic attack, or repeat revascularization), and bleeding events defined by Thrombolysis in Myocardial Infarction (TIMI) criteria over 12 months. All analyses were descriptive in nature. Results: A total of 222 patients were included; clopidogrel was prescribed in 96.0% of patients and ticagrelor in 4.0%. The cohort was elderly, highly comorbid, and predominantly dialysis-dependent. At 12 months, all-cause mortality occurred in approximately one-third of patients, recurrent ischemic events were frequent, and bleeding complications were common. Most bleeding events occurred in dialysis-dependent individuals. Outcomes among ticagrelor-treated patients are reported descriptively only due to the very small sample size. Conclusions: In this real-world cohort of patients with advanced CKD and ESRD following ACS, a substantial burden of mortality, recurrent ischemic events, and bleeding complications was observed, underscoring the narrow therapeutic window in this high-risk population. These findings are descriptive and hypothesis-generating, supporting the need for individualized antiplatelet strategies and prospective studies specifically enrolling patients with advanced CKD. Full article

(This article belongs to the Section Nephrology & Urology)

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12 pages, 1134 KB

Open AccessArticle

Ultrasound Characteristics of an Isolated Redundant Foramen Ovale Flap in Fetuses and Its Differential Diagnosis from Aortic Coarctation

by Liya Li, Yuxin Li, Shijie Zhang, Shaozheng He, Qiuyue Chen and Guorong Lyu

J. Clin. Med. 2026, 15(8), 3166; https://doi.org/10.3390/jcm15083166 - 21 Apr 2026

Viewed by 749

Abstract

Objective: To evaluate the potential utility of the ratio of the maximal diameter of the bulging foramen ovale flap to the left atrial diameter (FOFD/LAD) for distinguishing false-positive prenatal suspicion of fetal coarctation of the aorta (CoA), and to examine its association with [...] Read more.

Objective: To evaluate the potential utility of the ratio of the maximal diameter of the bulging foramen ovale flap to the left atrial diameter (FOFD/LAD) for distinguishing false-positive prenatal suspicion of fetal coarctation of the aorta (CoA), and to examine its association with fetal cardiac structural parameters. Materials and Methods: This retrospective study included a selected referral cohort of 44 fetuses with prenatal suspicion of CoA, who were classified postnatally into the false-positive prenatal suspicion group (n = 29) or the true CoA group (n = 15), along with 50 gestational age-matched controls. FOFD, LAD, atrial and ventricular diameters, great-vessel diameters, and aortic isthmus Z-scores were measured. Associations were assessed using Spearman rank correlation, and intergroup differences were evaluated using the Kruskal–Wallis test with Bonferroni-adjusted Mann–Whitney U tests. Results: FOFD/LAD was significantly higher in the false-positive prenatal suspicion group than in the true CoA and control groups (all p < 0.001), whereas no difference was observed between the true CoA and control groups (p = 0.059). In the false-positive and control groups, FOFD/LAD was positively associated with RAD/LAD, RVD/LVD, and PAD/AoD (all p < 0.001). Both suspected CoA groups showed higher right-to-left cardiac structural ratios and aortic isthmus Z-scores than controls (all p < 0.001), but these indices did not differ between false-positive prenatal suspicion and true CoA cases. Conclusions: In a selected cohort of fetuses with prenatal suspicion of CoA, an increased FOFD/LAD may reflect the presence of a redundant foramen ovale flap and may serve as a promising adjunctive parameter for distinguishing RFOF-related CoA mimicry from true CoA. However, given the limited sample size and moderate reproducibility, these findings should be considered exploratory and require validation in larger independent cohorts. Full article

(This article belongs to the Special Issue Clinical Update on Prenatal Diagnosis and Maternal Fetal Medicine)

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24 pages, 21402 KB

Open AccessArticle

KDH-Net: Explainable Medical AI for Multiclass Kidney Disease Characterization from CT Images

by Md Serajun Nabi, Su Waddy Tun, Shahaba Alam, Muhammad Kabir Abdullahi, Hasanul Bannah, Istiyak Amin Santo, Arbab Sufyan Wadood, Golam Md Mohiuddin, Zaka Ur Rehman and Hezerul Bin Abdul Karim

J. Clin. Med. 2026, 15(8), 3165; https://doi.org/10.3390/jcm15083165 - 21 Apr 2026

Cited by 2 | Viewed by 935

Abstract

Background: Accurate differentiation of kidney diseases such as cysts, tumors, stones, and normal tissue from computed tomography (CT) images remains challenging due to overlapping visual characteristics and variability in data distributions. While deep learning approaches have shown promising results, many existing studies rely [...] Read more.

Background: Accurate differentiation of kidney diseases such as cysts, tumors, stones, and normal tissue from computed tomography (CT) images remains challenging due to overlapping visual characteristics and variability in data distributions. While deep learning approaches have shown promising results, many existing studies rely on image-level data splitting and focus primarily on accuracy, which may lead to overly optimistic performance and limited clinical reliability. Methods: This study proposes KDH-Net (Kidney Disease Hybrid Network), a hybrid deep learning framework for multiclass kidney disease characterization that integrates EfficientNetB0, ResNet50, and MobileNetV2 through feature-level fusion. A two-stage training strategy is adopted to enhance optimization stability. To ensure realistic performance assessment, experiments on the primary dataset are conducted under a patient-level evaluation protocol, eliminating potential data leakage. The framework further incorporates calibration analysis, statistical validation, and explainable artificial intelligence to evaluate prediction reliability and interpretability. Results: On the patient-level dataset, KDH-Net achieves an overall accuracy of 0.93 with a macro-average F1-score of 0.91, demonstrating balanced performance across all classes. Confidence analysis indicates meaningful alignment between prediction confidence and correctness, while Grad-CAM visualizations highlight anatomically relevant regions associated with each class. Conclusions: The results demonstrate that KDH-Net provides a stable, reliable, and interpretable framework for kidney CT characterization. The proposed system is designed to support clinical decision-making by offering trustworthy predictions under realistic evaluation conditions, rather than replacing clinical expertise. Full article

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

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17 pages, 382 KB

Open AccessSystematic Review

Revisiting Radiotherapy for Hidradenitis Suppurativa: Clinical Outcomes, Safety, and Optimization Strategies: A Systematic Review

by Michal Poltorak, Pawel Banatkiewicz, Lukasz Poltorak, Maciej Szwast and Irena Walecka

J. Clin. Med. 2026, 15(8), 3164; https://doi.org/10.3390/jcm15083164 - 21 Apr 2026

Viewed by 798

Abstract

Objectives: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that significantly impairs patients’ quality of life, especially in its moderate to severe forms. Traditional treatments, including antibiotics, hormonal therapies, and surgery, often fail to provide long-term relief in such cases. This [...] Read more.

Objectives: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that significantly impairs patients’ quality of life, especially in its moderate to severe forms. Traditional treatments, including antibiotics, hormonal therapies, and surgery, often fail to provide long-term relief in such cases. This study aims to explore the role of radiotherapy, particularly with the use of 3D printing technology to create personalized boluses and applicators, as an adjunctive treatment for refractory HS. A systematic review of published studies was conducted to assess the efficacy of radiotherapy in managing HS, with a specific focus on studies using 3D printing technology to create customized boluses and applicators. Methods: Publications from databases such as PubMed, Scopus, and Google Scholar were analyzed for studies detailing radiotherapy techniques, dosing regimens, and the use of 3D-printed devices in HS treatment. The studies selected included those employing both external beam radiotherapy and brachytherapy, with particular emphasis on patient outcomes and adverse effects. Results: The reviewed studies highlighted a growing body of evidence supporting the use of radiotherapy for HS, especially in severe or treatment-resistant cases. The use of 3D-printed boluses and applicators in radiotherapy demonstrated significant improvements in treatment precision and patient comfort. Personalized treatment plans allowed for more accurate dose distribution, minimized air gaps, and reduced exposure of healthy tissue. No major long-term toxicity was reported across the majority of studies. Conclusions: Radiotherapy, particularly when combined with 3D printing technology, presents a promising treatment option for patients with severe or refractory HS. Customizable boluses and applicators enhance the precision of radiotherapy by conforming to irregular skin surfaces, thereby improving dose conformity and reducing side effects. Despite the positive results, further research is needed to assess the long-term safety and clinical feasibility of this approach. The integration of 3D printing in radiotherapy could significantly improve treatment outcomes, offering a more personalized and effective therapeutic option for HS patients. Full article

(This article belongs to the Special Issue Hidradenitis Suppurativa: Clinical Diagnosis, Treatment, and Management)

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11 pages, 2069 KB

Open AccessTechnical Note

A Novel Percutaneous Technique for Coaxial Treatment of Large Coronary Vessel Perforations—The RIP (Rip and Inflate in Perforations) Technique

by Maximilian Will, Konstantin Schwarz and Gregor Leibundgut

J. Clin. Med. 2026, 15(8), 3163; https://doi.org/10.3390/jcm15083163 - 21 Apr 2026

Viewed by 4675

Abstract

Background/Objectives: Coronary perforations are infrequent but potentially fatal complications during percutaneous coronary intervention (PCI). Interventional management aims to stop extravasation and restore distal flow to prevent tamponade and cardiogenic shock. In current practice, the ping-pong technique is recommended to ensure sealing of [...] Read more.

Background/Objectives: Coronary perforations are infrequent but potentially fatal complications during percutaneous coronary intervention (PCI). Interventional management aims to stop extravasation and restore distal flow to prevent tamponade and cardiogenic shock. In current practice, the ping-pong technique is recommended to ensure sealing of the perforation during covered stent delivery. However, this method is complex, time-consuming, and requires a second vascular access. Therefore, we developed a technique that seals the perforation and enables covered stent implantation using a single guide catheter. Methods: This technical note describes a novel technique in which a guide extension catheter (GEC) can be advanced across a vascular perforation after balloon inflation. The insertion of the GEC is made possible by detachment of the balloon hypotube. To minimize leakage, a regular coronary wire introducer needle is attached to the snapped hypotube after GEC loading and continuously inflated to hold nominal pressure. Advancement of the GEC across the perforation immediately limits hemorrhage and facilitates covered stent deployment via a single vascular access. The technique was first evaluated in bench testing and subsequently applied in three illustrative clinical cases at a tertiary referral center using standard, commercially available devices. Results: Bench testing confirmed the reproducibility of the ripping maneuver and successful ballon inflation over enough time to advance the GEC with the introducer married with the ripped hypotube. In all clinical cases, the GEC was successfully advanced across the perforation, allowing prompt covered stent deployment where necessary using a single guide catheter and access site without technical failure. Conclusions: The RIP (Rip and Inflate in Perforations)—technique is a feasible and reproducible alternative to the ping-pong technique. Bench validation and initial clinical application suggest that it may simplify the management of large-vessel perforations while reducing procedural complexity and the need for additional vascular access. Full article

(This article belongs to the Special Issue Clinical Insights and Emerging Techniques in Interventional Cardiology)

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9 pages, 383 KB

Open AccessArticle

Unexpected Positive Cultures After Failed Proximal Humerus Osteosynthesis: Why a Two-Stage Procedure Could Be Safer

by Raffaele Garofalo, Nunzio Lassandro, Angelo De Crescenzo, Riccardo Ranieri, Angelo Del Buono and Alberto Fontanarosa

J. Clin. Med. 2026, 15(8), 3162; https://doi.org/10.3390/jcm15083162 - 21 Apr 2026

Viewed by 424

Abstract

Background: Treatment of failed osteosynthesis of fractures of the proximal humerus with one-stage or two-stage surgery is difficult and clinical results are poor. The aim of this work is to evaluate the microbiological positivity of devices removed due to osteosynthesis failure. Furthermore, [...] Read more.

Background: Treatment of failed osteosynthesis of fractures of the proximal humerus with one-stage or two-stage surgery is difficult and clinical results are poor. The aim of this work is to evaluate the microbiological positivity of devices removed due to osteosynthesis failure. Furthermore, the clinical outcomes of these patients were evaluated at a follow-up of minimum 6 months, to assess the recovery of range of motion and the reduction in pain. Methods: A retrospective analysis was performed on 15 patients treated from September 2021 to September 2023 for failure of previous proximal humerus synthesis. These treatments included implant removal and arthrolysis. None of these patients showed signs of infection. Demographic data, VAS, ASES, Constant score, and range of motion (ROM) were assessed before surgery and at least 6 months of follow-up. Removed devices were processed in MicroDTTect^® system, to increase the sensitivity of microbiological cultures. The cultural and clinical results of device removal surgery were analyzed. Results: Culture results were positive in eight out of 15 patients. Slow-growing anaerobic bacteria were the most isolated microorganisms, particularly C. acnes (62.5%). Improvement in patients’ passive ROM was observed. The patients went from a preoperative VAS of 8.4 (±1.1) to a VAS of 2 (±1.1) at follow-up. Similarly, we observed an increase in ASES from 9 ± 6 to 50.2 ± 2.3 and Constant score from 17 (15–18) to 40.7 ± 3.3 at a follow-up of at least 6 months. Conclusions: Two-stage procedure should always be considered in the context of proximal humerus synthesis failure. Arthrolysis with postoperative physiotherapy prepares the shoulder for definitive prosthesis implantation. Full article

(This article belongs to the Special Issue Orthopedic Surgery: Latest Advances and Future Prospects—2nd Edition)

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Open AccessSystematic Review

Periodontal Disease and Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis of Risk and Survival Outcomes

by Gabriela Guadalupe Zambrano Manzaba, Luis Chauca-Bajaña, Carlos Andrés Guim Martínez, Sara Isabel Marcalupo Llerena, Andrea Ordoñez Balladares, Byron Velasquez Ron, Carlos Enrique Cuevas-Suárez, Abigailt Flores-Ledesma, Veronica Natalia Maroto Hidalgo and Gina Fernanda Vásquez Armas

J. Clin. Med. 2026, 15(8), 3161; https://doi.org/10.3390/jcm15083161 - 21 Apr 2026

Cited by 1 | Viewed by 861

Abstract

Background/Objectives: Oral squamous cell carcinoma (OSCC) accounts for over 90% of oral malignancies and remains associated with substantial global morbidity and mortality. Although tobacco and alcohol are established risk factors, they do not fully explain OSCC incidence, highlighting the need to explore additional [...] Read more.

Background/Objectives: Oral squamous cell carcinoma (OSCC) accounts for over 90% of oral malignancies and remains associated with substantial global morbidity and mortality. Although tobacco and alcohol are established risk factors, they do not fully explain OSCC incidence, highlighting the need to explore additional contributors such as chronic inflammatory conditions. Periodontal disease, characterized by persistent inflammation and microbial dysbiosis, has emerged as a plausible factor in oral carcinogenesis and tumor progression. To systematically evaluate the association between periodontal disease and the risk of developing OSCC, and to assess the prognostic impact of periodontal disease–related factors, particularly intratumoral Porphyromonas gingivalis, on survival outcomes in patients with OSCC. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420261296479). Comprehensive searches were performed in PubMed, EMBASE, Web of Science, Scopus, the Cochrane Library, ClinicalTrials.gov, and World Health Organization regional databases. Case–control studies evaluating OSCC risk and cohort studies assessing survival outcomes were included. Random-effects meta-analyses using inverse-variance models were applied. Heterogeneity was assessed using the I² statistic, and robustness was evaluated through Hartung–Knapp adjustment, leave-one-out sensitivity analyses, and Trial Sequential Analysis. Results: Five case–control studies were included in the etiological analysis. Periodontal disease was significantly associated with an increased risk of OSCC (pooled OR = 3.17; 95% CI: 1.94–5.21), with moderate heterogeneity (I² = 58.7%). Two cohort studies were included in the prognostic analysis. High intratumoral expression of P. gingivalis was significantly associated with poorer overall survival (pooled HR = 2.15; 95% CI: 1.33–3.47), with no detected heterogeneity (I² = 0%). Conclusions: Periodontal disease is strongly associated with an increased risk of OSCC, and intratumoral P. gingivalis appears to be an adverse prognostic marker. These findings underscore the relevance of periodontal inflammation and microbial factors across the OSCC continuum, from carcinogenesis to clinical outcomes, and support their consideration as potential targets for risk stratification and prevention strategies. Full article

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

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13 pages, 588 KB

Open AccessArticle

Complete Blood Count-Derived Inflammatory Indices in Prediabetes: A Head-to-Head Comparison

by Kemal Ozan Lule, Ozge Ozsoy, Omer Yildirim and Hamit Yildiz

J. Clin. Med. 2026, 15(8), 3160; https://doi.org/10.3390/jcm15083160 - 21 Apr 2026

Viewed by 754

Abstract

Background: Chronic low-grade inflammation contributes to early glucose dysregulation, but comparative evidence on complete blood count-derived inflammatory indices in prediabetes remains limited. This study aimed to compare the associations of five complete blood count-derived inflammatory indices with prediabetes and to assess their discriminative [...] Read more.

Background: Chronic low-grade inflammation contributes to early glucose dysregulation, but comparative evidence on complete blood count-derived inflammatory indices in prediabetes remains limited. This study aimed to compare the associations of five complete blood count-derived inflammatory indices with prediabetes and to assess their discriminative performance. Methods: In this retrospective cross-sectional study, 255 adults (128 with prediabetes and 127 with normoglycemia) were identified from 12,540 individuals screened at the internal medicine outpatient clinics of a university hospital. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index were compared between groups. Adjusted logistic regression, hierarchical regression, and receiver operating characteristic curve analyses were performed. Results: All indices except the monocyte-to-lymphocyte ratio were significantly higher in the prediabetes group (all p < 0.001). Among the evaluated indices, the neutrophil-to-lymphocyte ratio showed the strongest association with prediabetes, with the largest standardized odds ratio (2.691; 95% confidence interval, 1.839–3.938) and the highest explanatory power (Nagelkerke R² = 0.326). Its addition to the base model significantly improved model fit (likelihood ratio χ² = 33.62, p < 0.001), and the association remained significant after adjustment for body mass index, C-reactive protein, and lipid parameters. It also yielded the highest area under the curve (0.714). Conclusions: In this cross-sectional analysis, the neutrophil-to-lymphocyte ratio showed the most robust independent association with prediabetes among the evaluated complete blood count-derived inflammatory indices. However, the overall discriminative performance was modest, supporting the use of these indices as adjunctive rather than standalone screening markers. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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Open AccessArticle

Impact of Allergic Diseases or Obstructive Sleep Apnea Risk on Severe Mycoplasma pneumoniae Pneumonia in Children: A Clinical Study and Nomogram Construction

by Zonglang Yu, Jingrong Song, Yu Fu, Rui Li, Ruimeng Ma, Tienan Feng, Mengting Zhang, Shuping Jin and Xiaoying Zhang

J. Clin. Med. 2026, 15(8), 3159; https://doi.org/10.3390/jcm15083159 - 21 Apr 2026

Cited by 1 | Viewed by 763

Abstract

Background/Objectives: This study aimed to investigate the impact of allergic diseases (AD) or obstructive sleep apnea (OSA) risk, as a host factor, on the development of severe Mycoplasma pneumoniae Pneumonia (SMPP) in children by analyzing the clinical data of pediatric patients with [...] Read more.

Background/Objectives: This study aimed to investigate the impact of allergic diseases (AD) or obstructive sleep apnea (OSA) risk, as a host factor, on the development of severe Mycoplasma pneumoniae Pneumonia (SMPP) in children by analyzing the clinical data of pediatric patients with Mycoplasma pneumoniae Pneumonia (MPP). Methods: This retrospective study enrolled children hospitalized with Mycoplasma pneumoniae pneumonia (MPP) at Shanghai Ninth People’s Hospital from November 2024 to November 2025. Patients were classified into severe (SMPP) and mild (MMPP) groups. Demographic, clinical, laboratory, and questionnaire data were collected and compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of SMPP and construct a nomogram. The model was validated for discrimination, calibration, and clinical utility using ROC curves, calibration plots, and decision curve analysis, with internal validation by bootstrap resampling. Results: Among the 150 enrolled children with MPP, 35 (23.3%) were classified as severe (SMPP) and 115 (76.7%) as mild (MMPP). Patients with SMPP exhibited significantly higher frequencies of allergic diseases, prolonged fever and steroid use, elevated inflammatory markers (CRP, LDH, D-dimer, ferritin, ALT), and higher PSQ and RQLQ scores (all p < 0.05). Disease severity was positively correlated with these clinical, laboratory, and questionnaire-based parameters. Multivariate logistic regression identified allergic diseases, PSQ score, LDH, and ferritin as independent predictors of SMPP. A nomogram incorporating these four factors demonstrated good predictive performance, with an internally validated C-index of 0.827, satisfactory calibration (Hosmer–Lemeshow p = 0.116), and clinical utility within a 0–25% threshold probability range on decision curve analysis. Conclusions: Children with MPP and comorbid AD or OSA risk are more likely to develop SMPP. Among children aged 6–12 years, RQLQ score is positively correlated with the severity of MPP. AD, PSQ score, LDH, and ferritin are independent risk factors for SMPP. Clinicians should be alert to the development of SMPP when children with MPP present with a history of AD, PSQ score >3.5, LDH >327.50 U/L, or ferritin >120.05 ng/mL. The visual nomogram model constructed by combining these risk factors demonstrates improved predictive performance for SMPP, with high predictive efficacy and accuracy. It has great clinical value and can be used for individualized risk assessment and early intervention. However, our proposed nomogram requires external validation prior to broader implementation. Full article

(This article belongs to the Section Clinical Pediatrics)

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23 pages, 1344 KB

Open AccessSystematic Review

Association Between Vitamin D Deficiency and Cardiovascular Disease Risk Factors in the MENA Population: A Systematic Review and Meta-Analysis

by Shahd Bucheeri, Abdulla Mubarak, Jarrah Aldoseri, Ayah Redha, Nitya Kumar and Sara Mohamed

J. Clin. Med. 2026, 15(8), 3158; https://doi.org/10.3390/jcm15083158 - 21 Apr 2026

Viewed by 883

Abstract

Background: The Middle East and North Africa (MENA) region faces a high cardiovascular disease (CVD) burden alongside endemic serum 25(OH)D (vitamin D) deficiency. This systematic review examines the relationship between vitamin D deficiency and CVD risk factors in MENA populations. Methods: [...] Read more.

Background: The Middle East and North Africa (MENA) region faces a high cardiovascular disease (CVD) burden alongside endemic serum 25(OH)D (vitamin D) deficiency. This systematic review examines the relationship between vitamin D deficiency and CVD risk factors in MENA populations. Methods: PubMed, Cochrane Library, and Scopus were searched from inception to 18 October 2024, for observational studies in the MENA region examining vitamin D deficiency and cardiovascular risk factors in adults. Independent data extraction was conducted. Study quality was appraised using the Joanna Briggs Institute tool and the Newcastle–Ottawa Scale, with risk of bias visualized using Robvis. Weighted mean differences in cholesterol, body mass index (BMI), and HbA1c between those with and without vitamin D deficiency were computed with random-effects meta-analysis. The protocol was registered in PROSPERO (ID: CRD42025615188) and funded by the Royal College of Surgeons in Ireland—Medical University of Bahrain. Results: Seventeen studies from nine MENA countries were included, predominantly cross-sectional, involving community-based and disease-specific cohorts. Vitamin D deficiency was highly prevalent and consistently associated with higher adiposity and central obesity. Several studies reported significant links between deficiency and poor glycemic control, particularly in obese and prediabetic groups. Meta-analysis demonstrated significantly higher total cholesterol (MD = 0.32; 95% CI = 0.11 to 0.52, p < 0.001), BMI (MD = 1.81; 95% CI = 0.68 to 2.94, p < 0.001), and HbA1c levels (MD = 0.31; 95% CI = 0.06 to 0.57, p = 0.02) in vitamin D deficient individuals, with notable heterogeneity. Conclusions: Vitamin D deficiency is highly prevalent in the MENA region and consistently associated with adiposity-related risk factors. Despite heterogeneity, findings underscore the need for public health strategies and further research to clarify causal pathways and population-specific interventions. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 1236 KB

Open AccessArticle

Imaging and Clinicopathological Features of Squamous Cell Metaplastic Breast Carcinoma: A 22-Case Retrospective Study

by Feng Pan, Lei Liu, Dingbao Chen and Yuan Peng

J. Clin. Med. 2026, 15(8), 3157; https://doi.org/10.3390/jcm15083157 - 21 Apr 2026

Viewed by 751

Abstract

Background/Objectives: Squamous cell metaplastic breast carcinoma (SCMBC) is a rare and aggressive breast cancer subtype with limited imaging and prognostic data. This study aimed to characterize the multimodal imaging features, clinicopathological profiles, and prognostic outcomes of SCMBC in a single-center cohort. Methods [...] Read more.

Background/Objectives: Squamous cell metaplastic breast carcinoma (SCMBC) is a rare and aggressive breast cancer subtype with limited imaging and prognostic data. This study aimed to characterize the multimodal imaging features, clinicopathological profiles, and prognostic outcomes of SCMBC in a single-center cohort. Methods: We retrospectively analyzed 22 patients with histopathologically confirmed SCMBC treated between January 2012 and May 2025. Clinicopathological profiles, multimodal imaging features, and prognostic outcomes were collected and evaluated. Results: All patients were female (median age 64.5 years; range, 34–82). The majority (59.1%) presented with clinical stage II disease. Axillary lymph node metastasis was present in eight (36.4%) patients at diagnosis, with one case of distant lung metastasis. The mean tumor diameter was 4.24 cm (range, 2.1–11.8). MRI findings (n = 13) included heterogeneous internal structure, a low mean apparent diffusion coefficient (ADC) value of 0.98 × 10⁻³ mm²/s, and frequent necrosis (92.3%). Pathologically, 54.5% of tumors were high-grade, and 81.8% exhibited a triple-negative phenotype. After a median follow-up of 34 months, the 5-year overall survival (OS) rate was 64.3%, while the 3-year disease-free survival (DFS) rate was 42.1%. The recurrence/metastasis rate was 22.7% (5/22), and all five deaths occurred in this subgroup. Conclusions: SCMBC is characterized by suggestive multimodal imaging features, a predominant triple-negative phenotype, and a high risk of early recurrence. Given the exploratory nature of this single-center study with a limited sample size, these findings require validation in larger, prospective cohorts. Early radiological identification and aggressive personalized treatment strategies may improve outcomes for patients with this aggressive disease. Full article

(This article belongs to the Special Issue Breast Cancer: Advances in Clinical and Personalized Practices)

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14 pages, 634 KB

Open AccessArticle

Orbital Doppler Ultrasonography and Optic Nerve Sheath Diameter in Pediatric Brain Death Evaluation

by Mehmet Ali Durmuş, Alper Karacan, Onur Taydaş, Mehmet Özgür Arslanoğlu, Zeynep Yıldız, Onur Paşa, Sinan Taşdoğan, Tunahan Dertli, Laçin Tatlı Ayhan, Mustafa Özdemir and Mehmet Halil Öztürk

J. Clin. Med. 2026, 15(8), 3156; https://doi.org/10.3390/jcm15083156 - 21 Apr 2026

Viewed by 633

Abstract

Background/Objectives: Brain death determination in children is clinically challenging. When standard clinical examination cannot be completed or reliably interpreted, ancillary testing is required—yet many established methods depend on infrastructure or patient transport that may not be feasible in critically ill pediatric patients. [...] Read more.

Background/Objectives: Brain death determination in children is clinically challenging. When standard clinical examination cannot be completed or reliably interpreted, ancillary testing is required—yet many established methods depend on infrastructure or patient transport that may not be feasible in critically ill pediatric patients. Orbital ultrasonography is bedside-applicable and non-invasive, but remains poorly characterized in children. Methods: We conducted a single-center retrospective study of 28 pediatric patients evaluated for suspected brain death between January 2021 and February 2025. Patients were classified as brain death-positive [BD(+), n = 20] or brain death-negative [BD(−), n = 8] based on clinical criteria independent of imaging findings. Orbital color Doppler parameters (ophthalmic artery, central retinal artery, posterior ciliary artery) and optic nerve sheath diameter (ONSD) were measured under a standardized protocol by a single experienced operator. Ophthalmic artery resistive index (OA-RI) was defined a priori as the primary outcome; ONSD was the secondary outcome. Group comparisons used the Mann–Whitney U test with Cliff’s delta effect sizes; false discovery rate correction was applied to secondary and exploratory comparisons. ROC analyses were performed to assess discriminative performance. The study was reported in accordance with the STARD 2015 guidelines for diagnostic accuracy research. Results: OA-RI was markedly higher in BD(+) patients (0.84 [IQR 0.80–0.90] vs. 0.65 [0.58–0.69]; p < 0.001; δ = 0.975). ROC analysis yielded an AUC of 0.99 (95% CI: 0.96–1.00); at a cut-off of ≥0.77, sensitivity was 95.0% and specificity 100.0%. ONSD also differed significantly between groups (4.75 [4.15–5.08] mm vs. 3.90 [3.40–4.15] mm; p = 0.012; δ = 0.619; AUC = 0.81, 95% CI: 0.62–1.00; cut-off ≥ 4.2 mm; sensitivity and specificity both 75.0%). Across all three orbital vessels, end-diastolic velocity was consistently reduced and resistive indices elevated in BD(+) patients. Systolic velocities did not differ meaningfully between groups. Cut-off values represent cohort-specific statistical optima and should be interpreted as exploratory. Conclusions: Orbital Doppler ultrasonography demonstrates a coherent high-resistance hemodynamic pattern in pediatric brain death. OA-RI showed strong discriminative performance and may serve as a useful bedside adjunct in selected cases where ancillary testing is indicated. ONSD provides complementary anatomical evidence. These findings are exploratory and require prospective validation in larger, multicenter pediatric cohorts. Full article

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

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16 pages, 812 KB

Open AccessArticle

The Efficacy of an Optimized, Low-Intensity Photodynamic Therapy Protocol with 10% 5-ALA Nanoemulsion in Refractory Vulvar Lichen Sclerosus: Impact on Quality of Life and Sexual Function

by Katarzyna Beutler, Alina Jankowska-Konsur and Danuta Nowicka

J. Clin. Med. 2026, 15(8), 3155; https://doi.org/10.3390/jcm15083155 - 21 Apr 2026

Viewed by 702

Abstract

Background: Treatment options for vulvar lichen sclerosus (VLS) remain limited; therefore, therapies that improve quality of life and reduce neoplastic risk are needed. Photodynamic therapy (PDT) is a potential option. This study aimed to evaluate quality of life and sexual function in patients [...] Read more.

Background: Treatment options for vulvar lichen sclerosus (VLS) remain limited; therefore, therapies that improve quality of life and reduce neoplastic risk are needed. Photodynamic therapy (PDT) is a potential option. This study aimed to evaluate quality of life and sexual function in patients treated according to the protocol used at our institution. Methods: Forty patients with refractory VLS underwent PDT using a 10% 5-aminolevulinic acid nanoemulsion (Ameluz^®) applied to lesions under an occlusive aluminum foil dressing. Patients received 1–6 sessions of 10 min illumination (LED: 37 J/cm², ~77 mW/cm²) at 4–6-week intervals. The Dermatology Life Quality Index (DLQI) and Female Sexual Function Index (FSFI) were used for assessment. Results: Thirty-seven participants answered DLQI, while 20 declared themselves to be sexually active and were included in the analysis. Greater number of PDT sessions was associated with a lower DLQI score (τ = −0.583; adjusted p < 0.001). The number of PDT sessions and the total FSFI score (p = 0.014), as well as desire (p = 0.016), arousal (p = 0.020), orgasm (p = 0.020), and satisfaction (p = 0.016) domains were significantly correlated. Age correlated positively with DLQI scores (p = 0.016), indicating greater disease burden in older patients. Longer disease duration was also associated with poorer quality of life (p = 0.020). Conclusions: PDT can be considered an effective treatment for patients with VLS refractory to standard topical corticosteroid and calcineurin inhibitor therapies when delivered using a refined, patient-centered protocol. This optimized approach used in our institution is based on short irradiation time and precise light delivery, providing a favorable balance between therapeutic efficacy, patient comfort, and treatment feasibility. Our findings also suggest that the cumulative number of PDT sessions is a key factor for clinical response. Further studies should address long-term outcomes. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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18 pages, 2477 KB

Open AccessSystematic Review

Periodontitis and Pancreatic Cancer Risk: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis

by Kareelend Andreina Segura Cueva, Andrea Bermúdez Velásquez, Carlos Andrés Guim Martínez, Luis Chauca-Bajaña, Leonardo Javier Siguencia Suárez, Byron Velásquez Ron, Carlos E. Cuevas-Suárez, Abigailt Flores-Ledesma, Alejandro Ismael Lorenzo-Pouso and Andrea Ordoñez Balladares

J. Clin. Med. 2026, 15(8), 3154; https://doi.org/10.3390/jcm15083154 - 21 Apr 2026

Cited by 1 | Viewed by 843

Abstract

Introduction: Pancreatic cancer is one of the most lethal malignancies worldwide, and its incidence continues to rise. Periodontitis, a highly prevalent chronic inflammatory disease, has been linked to several systemic conditions, including a potential increase in pancreatic cancer risk. However, the available [...] Read more.

Introduction: Pancreatic cancer is one of the most lethal malignancies worldwide, and its incidence continues to rise. Periodontitis, a highly prevalent chronic inflammatory disease, has been linked to several systemic conditions, including a potential increase in pancreatic cancer risk. However, the available epidemiological evidence remains heterogeneous and fragmented. Objective: To evaluate whether periodontitis is associated with an increased risk of pancreatic cancer through a systematic review and meta-analysis of observational studies. Materials and Methods: A comprehensive search was conducted in PubMed, EMBASE, Web of Science, Scopus, the Cochrane Library, ClinicalTrials.gov, and the WHO regional databases, following PRISMA guidelines. Cohort, case–control, and cross-sectional studies assessing periodontitis through clinical parameters, radiographic measures, or tooth loss—and reporting pancreatic cancer risk (HR, RR, or OR)—were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analyses, meta-regressions, leave-one-out sensitivity analyses, influence diagnostics, publication bias assessment, and Trial Sequential Analysis (TSA) were performed. Results: Eight observational studies (primarily cohort designs) (n = 476,245 participants) met the inclusion criteria. Periodontitis was associated with an increased risk of pancreatic cancer (pooled HR = 1.56; 95% CI: 1.28–1.89), with moderate heterogeneity (I² = 55.5%). Sensitivity and influence analyses confirmed the robustness of the estimate. TSA showed a consistent trend, although the cumulative evidence remains insufficient for a definitive conclusion. Conclusions: Observational evidence suggests a modest statistical association between periodontitis and pancreatic cancer risk. However, the absolute risk increase is very small, and Trial Sequential Analysis indicates that cumulative evidence remains insufficient to establish causality or to support preventive or clinical recommendations. Further large-scale prospective studies with standardized periodontal assessments are required. Full article

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

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17 pages, 1975 KB

Open AccessArticle

Phenotype-Specific Mortality Outcomes with Dipeptidyl Peptidase-4 Inhibitors in Heart Failure and Diabetes: Real-World Evidence from a Retrospective Single-Center Cohort Study

by Lama Alfehaid, Ahmad Alamer, Atheer Alhantush and Majed S. Al Yami

J. Clin. Med. 2026, 15(8), 3153; https://doi.org/10.3390/jcm15083153 - 21 Apr 2026

Viewed by 704

Abstract

Background/Objectives: Type 2 diabetes mellitus (DM) commonly coexists with heart failure (HF) and is associated with increased cardiovascular (CV) morbidity and mortality. Although dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used for glycemic control, their CV safety in patients with established HF, particularly [...] Read more.

Background/Objectives: Type 2 diabetes mellitus (DM) commonly coexists with heart failure (HF) and is associated with increased cardiovascular (CV) morbidity and mortality. Although dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used for glycemic control, their CV safety in patients with established HF, particularly across HF phenotypes, remains uncertain. To evaluate the association between DPP-4 inhibitor use and 6-month CV mortality in patients with DM and HF, and to assess whether this association differs across HF phenotypes: HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction (HFmrEF), HF with reduced ejection fraction (HFrEF). Methods: We conducted a retrospective cohort study at King Abdulaziz Medical City from January 2017 to December 2024 that included adults with DM and echocardiographically confirmed HF. Patients receiving DPP-4 inhibitors were compared with non-users. The primary outcome was 6-month CV mortality. Propensity score overlap weighting targeting the average treatment effect in the overlap population was applied to balance baseline characteristics. Weighted logistic regression with interaction terms was used to assess effect modification by HF phenotype. Results: Among 3435 patients (median age 69 years; 51.3% female), 1921 (55.9%) received a DPP-4 inhibitor, predominantly sitagliptin. In unadjusted analyses, CV mortality was numerically lower among DPP-4 inhibitor users across HF phenotypes. However, after overlap weighting, CV mortality was similar between users and non-users within HFpEF (7.1% vs. 8.0%; OR 0.88, 95% CI 0.51–1.52; p = 0.646), HFmrEF (2.6% vs. 5.0%; OR 0.50, 95% CI 0.09–2.86; p = 0.436), and HFrEF (6.4% vs. 6.4%; OR 1.00, 95% CI 0.48–2.07; p = 0.992). No significant interaction was observed between DPP-4 inhibitor use and HF phenotype (interaction p > 0.05). Conclusions: In this large real-world cohort of patients with DM and established HF, DPP-4 inhibitor use was not associated with increased or reduced 6-month CV mortality after robust adjustment. The neutral association was consistent across HF phenotypes, supporting the CV safety of DPP-4 inhibitors, predominantly sitagliptin, in contemporary HF management. Full article

(This article belongs to the Section Cardiovascular Medicine)

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2 pages, 154 KB

Open AccessReply

Reply to Edward, R. Comment on “Fernandez Martin et al. Analgesia for Upper Abdominal Surgery, a Scoping Review of the Current Fascial Plane Block Techniques. J. Clin. Med. 2025, 14, 8632”

by Maria T. Fernandez Martin, Edward R. Mariano, Luis F. Valdes-Vilches, Servando Lopez Alvarez and Nabil Elkassabany

J. Clin. Med. 2026, 15(8), 3152; https://doi.org/10.3390/jcm15083152 - 21 Apr 2026

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Dear Editor, [...] Full article

(This article belongs to the Section Anesthesiology)

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Open AccessComment

Comment on Fernandez Martin et al. Analgesia for Upper Abdominal Surgery, a Scoping Review of the Current Fascial Plane Block Techniques. J. Clin. Med. 2025, 14, 8632

by Reginald Edward

J. Clin. Med. 2026, 15(8), 3151; https://doi.org/10.3390/jcm15083151 - 21 Apr 2026

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Thank you for the opportunity to respond [...] Full article

(This article belongs to the Section Anesthesiology)

19 pages, 2004 KB

Open AccessArticle

Health Outcomes Associated with Blood Lipid Levels and Korean Medicine Utilization in Elderly Population from the NHIS Database: A Retrospective Cohort Study

by Seungcheol Hong, Ji-cheon Jeong and Dong-jun Choi

J. Clin. Med. 2026, 15(8), 3150; https://doi.org/10.3390/jcm15083150 - 20 Apr 2026

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Abstract

Background: The elderly are vulnerable to chronic diseases and altered lipid metabolism, leading to poor outcomes, including mortality. We investigated the association between Korean Medicine (KM) utilization, blood lipid levels, and health outcomes using the National Health Insurance Service Sample Cohort (NHIS-NSC) [...] Read more.

Background: The elderly are vulnerable to chronic diseases and altered lipid metabolism, leading to poor outcomes, including mortality. We investigated the association between Korean Medicine (KM) utilization, blood lipid levels, and health outcomes using the National Health Insurance Service Sample Cohort (NHIS-NSC) database. Methods: This retrospective cohort study included elderly participants who underwent health examinations (2009–2010). Participants were divided into KM and non-KM groups and matched 1:1 using propensity score matching (PSM) for age, sex, income, and comorbidities. Primary outcomes were mortality and disease diagnosis; secondary outcomes included medical spending and utilization. Results: After PSM, 13,044 subjects were analyzed. KM utilization was associated with a significantly lower risk of all-cause mortality (HR 0.93; 95% CI 0.87–1.00; p = 0.048). However, the hypolipidemia subgroup showed no significant differences in all-cause mortality and medical expenses compared to other lipid status subgroups. While the KM group showed a higher incidence of disease diagnosis (HR 1.09; 95% CI 1.04–1.14; p < 0.001), this may reflect increased healthcare engagement and proactive health-seeking behavior. Subgroup analysis revealed that statin users in the KM group had a significantly reduced mortality risk (HR 0.91; 95% CI 0.84–0.99; p = 0.022). Medical expenses and utilization were higher in the KM group. Being underweight or aged over 85 was associated with higher mortality. Conclusions: KM utilization is associated with reduced all-cause mortality after propensity score matching, particularly among statin users. Although KM users had a higher cumulative incidence of disease diagnosis, this potentially reflects increased diagnostic opportunities from prolonged survival. Hypolipidemia, underweight, and late-elderly status remain significant risk factors associated with frailty. KM may support improved survival in the elderly, warranting further prospective studies. Full article

(This article belongs to the Special Issue Innovations in Geriatric Care: Managing Chronic Diseases and Emerging Challenges in an Aging World)

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14 pages, 1004 KB

Open AccessSystematic Review

The Outcome of Immediate Adjuvant Postoperative External Beam Radiotherapy Versus Observation Alone After Radical Prostatectomy in High-Risk Prostate Cancer: A Meta Analysis

by Walaa Borhan and Emad Rajih

J. Clin. Med. 2026, 15(8), 3149; https://doi.org/10.3390/jcm15083149 - 20 Apr 2026

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Abstract

Background/Objectives: High-risk prostate cancer patients undergoing radical prostatectomy remain at significant risk of biochemical recurrence and metastasis. Immediate adjuvant external beam radiotherapy (EBRT) has been proposed to improve outcomes, but its role compared to observation remains debated due to potential [...] Read more.

Background/Objectives: High-risk prostate cancer patients undergoing radical prostatectomy remain at significant risk of biochemical recurrence and metastasis. Immediate adjuvant external beam radiotherapy (EBRT) has been proposed to improve outcomes, but its role compared to observation remains debated due to potential toxicity and uncertain overall survival benefit. To evaluate the efficacy and safety of immediate adjuvant EBRT versus observation following radical prostatectomy in men with high-risk prostate cancer. Methods: A meta-analysis was conducted according to PRISMA guidelines. We sought to include both randomized controlled trials (RCTs) and observational studies published between 2005 and 2025; however, no observational studies meeting the predefined criteria were identified. Therefore, only RCTs comparing immediate adjuvant EBRT with observation in patients with adverse pathological features and undetectable postoperative PSA were included. Primary outcomes were biochemical recurrence-free survival (BCR-FS), metastasis-free survival (MFS), and overall survival (OS). Secondary outcomes included toxicity and quality of life (QoL). Data were pooled using Mantel–Haenszel and inverse variance methods, and heterogeneity was assessed with I² statistics. Results: Four RCTs (n = 1987) met the inclusion criteria. Adjuvant EBRT significantly improved progression-free survival (PFS) (HR = 0.38; 95% CI: 0.20–0.74; p = 0.004) and metastasis-free survival (HR = 0.70; 95% CI: 0.54–0.92; p = 0.01). However, OS benefit was not statistically significant (HR = 0.88; 95% CI: 0.59–1.32; p = 0.55). Heterogeneity was substantial for some outcomes (I² up to 71%). Adjuvant EBRT was associated with higher genitourinary and gastrointestinal toxicity compared to observation. Conclusions: Immediate adjuvant EBRT after radical prostatectomy improves PFS and MFS in high-risk prostate cancer but does not confer a clear OS advantage. Treatment decisions should be individualized, balancing disease-control benefits against toxicity risks. Observation with early salvage RT remains a reasonable alternative in selected patients. Full article

(This article belongs to the Special Issue Urologic Neoplasms: Recent Advances and Future Perspectives)

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11 pages, 437 KB

Open AccessFeature PaperArticle

Male Sex and Obesity are Associated with Sarcopenia in Patients with Rheumatoid Arthritis in the 2008–2011 Korea National Health and Nutrition Examination Survey

by Yoon-Jeong Oh and Chang-Nam Son

J. Clin. Med. 2026, 15(8), 3148; https://doi.org/10.3390/jcm15083148 - 20 Apr 2026

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Abstract

Background/Objectives: The objective of this investigation was to assess the prevalence of sarcopenia and identify its related risk factors in patients with rheumatoid arthritis (RA) using data from the nationally representative 2008–2011 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: [...] Read more.

Background/Objectives: The objective of this investigation was to assess the prevalence of sarcopenia and identify its related risk factors in patients with rheumatoid arthritis (RA) using data from the nationally representative 2008–2011 Korea National Health and Nutrition Examination Survey (KNHANES). Methods: We analyzed data from the 2008–2011 KNHANES to identify the factors associated with sarcopenia in patients with RA. Sarcopenia was defined as the ratio of appendicular skeletal muscle mass to total body weight (multiplied by 100), with cut-offs of <29.0% for men and <22.9% for women. To identify the specific factors independently associated with sarcopenia, a multivariate logistic regression model was employed, accounting for sample weights and the complex survey design. Results: Among 238 patients with RA included in the analysis, 44 (weighted prevalence: 22.7%) had sarcopenia. The sarcopenia group had a higher proportion of males (55.0% vs. 15.3%, p < 0.001), body mass index (BMI) (26.1 vs. 23.3 kg/m², p < 0.001), and waist circumference (86.9 vs. 79.0 cm, p < 0.001) than the non-sarcopenia group. After adjustment for potential confounders, including age, sex, obesity, physical activity, and daily protein intake, male sex (odds ratio [OR]: 4.17; 95% confidence interval [CI]: 1.48–11.77, p = 0.007) and obesity (OR: 3.06; 95% CI: 1.16–8.07, p = 0.024) were independently associated with sarcopenia. In sex-specific analyses, low physical activity was significantly associated with sarcopenia only in male patients (OR: 13.00; 95% CI: 1.90–88.75, p = 0.012). Conclusions: Our findings indicate that being male and having a higher BMI are significant independent indicators of sarcopenia risk within the Korean RA population. This highlights their critical role in the development of sarcopenia among RA patients. Full article

(This article belongs to the Section Immunology & Rheumatology)

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