Journal of Clinical Medicine

13 pages, 540 KiB

Open AccessArticle

Crystal Ball in a Blood’s Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) andthe Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients

by Andrea Perna, Giuseppe Rovere, Marco Passiatore, Andrea Franchini, Luca Macchiarola, Francesco Maruccia, Raffaele Vitiello and Franco Lucio Gorgoglione

J. Clin. Med. 2025, 14(10), 3584; https://doi.org/10.3390/jcm14103584 (registering DOI) - 20 May 2025

Abstract

Background/Objectives: Hip fractures in elderly patients are associated with high morbidity and mortality, requiring early risk stratification to optimize management. Systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools. This study aimed [...] Read more.

Background/Objectives: Hip fractures in elderly patients are associated with high morbidity and mortality, requiring early risk stratification to optimize management. Systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools. This study aimed to evaluate the predictive value of the NLR and PLR measured at admission for adverse outcomes following hip fracture surgery in elderly patients. Methods: This retrospective, single-center cohort study included patients aged 65 years or older admitted for hip fractures between January 2019 and December 2023. Baseline demographic, clinical, surgical, and laboratory data were collected. Primary outcomes were 30-day, 90-day, and 1-year mortality; secondary outcomes included postoperative ICU admission and prolonged hospitalization (>15 days). Univariable and multivariable Cox regression analyses were performed. Receiver operating characteristic (ROC) curve analysis determined optimal cut-offs for the NLR and PLR. Results: Among 395 included patients (mean age 84 years, 56.4% female), the 30-day, 90-day, and 1-year mortality rates were 4.8%, 10.5%, and 13.9%, respectively. ROC analysis identified cut-offs of 7.2 for the NLR (AUC 0.78, sensitivity 69.7%, specificity 85.4%) and 189.4 for the PLR (AUC 0.73, sensitivity 65.1%, specificity 76.1%). Elevated NLR and PLR were independently associated with increased risk of mortality, ICU admission, and prolonged hospitalization. Conclusions: Elevated NLR and PLR at admission are independent, strong predictors of adverse outcomes in elderly patients with hip fractures. These inexpensive, readily available biomarkers could enhance early risk stratification and inform perioperative management strategies. Full article

(This article belongs to the Section Orthopedics)

18 pages, 644 KiB

Open AccessReview

Perspective on Perinatal Birth Canal Injuries: An Analysis of Risk Factors, Injury Mechanisms, Treatment Methods, and Patients’ Quality of Life: A Literature Review

by Patrycja Głoćko, Sylwia Janczak, Agnieszka Nowosielska-Ogórek, Wiktoria Patora, Olga Wielgoszewska, Mateusz Kozłowski and Aneta Cymbaluk-Płoska

J. Clin. Med. 2025, 14(10), 3583; https://doi.org/10.3390/jcm14103583 - 20 May 2025

Abstract

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. [...] Read more.

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause (Third Edition))

9 pages, 390 KiB

Open AccessArticle

Cognitive Impairment in ANCA-Associated Vasculitis: A Cross-Sectional Pilot Study

by Marion Camard, Ana Moises, Katia Bourdic, Laura Venditti, Christian Denier, Julien Henry, Raluca Sterpu, Perla David, Mathilde De Menthon, Olivier Lambotte, Anne-Cécile Petit, Matthias Babin, Nicolas Noel and Fanny Urbain

J. Clin. Med. 2025, 14(10), 3582; https://doi.org/10.3390/jcm14103582 (registering DOI) - 20 May 2025

Abstract

Objectives: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises rare systemic vasculitides that can present with cognitive dysfunction. However, data on the screening and characterization of cognitive dysfunction in AAV remain limited. Methods: Cognitive complaints in AAV patients were screened using self-report questionnaires. Objective [...] Read more.

Objectives: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises rare systemic vasculitides that can present with cognitive dysfunction. However, data on the screening and characterization of cognitive dysfunction in AAV remain limited. Methods: Cognitive complaints in AAV patients were screened using self-report questionnaires. Objective cognitive impairment was assessed with a standardized neurocognitive test battery. Results were compared with clinical evaluations, brain MRI findings, treatment history, and neuropsychiatric symptoms. All test results were standardized for the overall population. Results: Twelve patients (five women, seven men) with a median [IQR] age of 68 [59–71] and a median [IQR] disease duration of 92 months [55–127] were included. None of the patients showed evidence of vasculitis activity on brain MRI. Cognition was assessed using a standardized neurocognitive test battery in all patients except one. Four patients (36%) were found to have cognitive impairment, defined as three or more altered tests. The most affected functions were attentional and executive, with the d2-R (4/4), Rey–Osterrieth Complex Figure Delayed Recall (3/4), and Trail Making Test Part B (3/4) showing the most frequent deficiencies. Objective cognitive disorders were not associated with self-reported cognitive complaints. No significant association was found between cognitive impairment and vasculitis activity or sequelae, corticosteroid and immunosuppressive treatments, or neuropsychiatric symptoms. Conclusion: This study highlights the presence of cognitive impairments in AAV, predominantly affecting attentional and executive functions, which may reflect vascular involvement. Early and tailored approaches to cognitive screening and management are essential to improve patient care and quality of life. Full article

(This article belongs to the Section Immunology)

16 pages, 895 KiB

Open AccessArticle

Disproportionality Analysis of Renal Adverse Events Associated with a Combination of Immune Checkpoint Inhibitors and Acid-Suppressing Agents—A Pharmacovigilance Study Based on the FAERS Database

by Jinmei Liu, Xu Chen, Cong Zhang, Huiping Hu, Shijun Li, Zhiwen Fu and Ruxu You

J. Clin. Med. 2025, 14(10), 3581; https://doi.org/10.3390/jcm14103581 - 20 May 2025

Abstract

Background/Objectives: The nephrotoxicity of immune checkpoint inhibitors (ICIs) combined with proton pump inhibitors (PPIs) has been recognized but lacks a comprehensive analysis. We conducted an in-depth investigation of renal adverse events (rAEs) associated with ICIs and different acid-suppressing agents (ASAs)—including PPIs, histamine-2 [...] Read more.

Background/Objectives: The nephrotoxicity of immune checkpoint inhibitors (ICIs) combined with proton pump inhibitors (PPIs) has been recognized but lacks a comprehensive analysis. We conducted an in-depth investigation of renal adverse events (rAEs) associated with ICIs and different acid-suppressing agents (ASAs)—including PPIs, histamine-2 receptor antagonists (H₂RAs), and potassium-competitive acid blockers (P-CABs)—using real-world data from the FDA’s Adverse Event Reporting System (FAERS). Methods: We analyzed rAE reports from the FAERS database covering Q1 2004 to Q1 2023. Disproportionality analysis was conducted to identify rAEs associated with ICI or ASA monotherapy or combination therapy. Univariate logistic regression was employed to explore influencing factors. Results: No eligible rAE reports were retrieved for H₂RAs and P-CABs. However, 6,775 reports in the ICI group, 54,055 reports in the PPI group, and 210 reports in the ICI–PPI combination therapy group were included in the final analysis. In PPI–ICI combination settings, tubulointerstitial nephritis had the highest reporting frequency and signal intensity; the overall risk of rAEs was significantly elevated compared to ICI or PPI monotherapy, with reporting odds ratios of 14. 65 (95% confidence interval [CI] 12.93–16.58) and 3.24 (95% CI 2.87–3.66), respectively; the median onset time was shortest at 21 days (interquartile range 5.5–135); and PD-1 monotherapy, omeprazole, and rabeprazole were associated with higher rAE risks. Conclusions: Our findings confirm that the combination of PPIs (but not other ASAs) with ICIs further increases the risk of various acute and chronic rAEs. Healthcare providers should exercise caution when managing patients on these therapies. Full article

(This article belongs to the Section Pharmacology)

11 pages, 1407 KiB

Open AccessReview

PSMA PET as a Tool for Active Surveillance of Prostate Cancer—Where Are We at?

by Jonathon Carll, Jacinta Bonaddio and Nathan Lawrentschuk

J. Clin. Med. 2025, 14(10), 3580; https://doi.org/10.3390/jcm14103580 - 20 May 2025

Abstract

Active surveillance remains the preferred treatment for men with low-risk prostate cancer and select men with favourable intermediate-risk prostate cancer. It involves the close observation of clinicopathological parameters to assess for disease progression, aiming to delay or avoid definitive treatment and related toxicities [...] Read more.

Active surveillance remains the preferred treatment for men with low-risk prostate cancer and select men with favourable intermediate-risk prostate cancer. It involves the close observation of clinicopathological parameters to assess for disease progression, aiming to delay or avoid definitive treatment and related toxicities for as long as possible, without compromising oncological outcomes. A recent advancement in prostate cancer staging is the PSMA PET scan, which uses a tracer that strongly binds a highly expressed cellular biomarker for prostate cancer. Recent articles have also demonstrated that PSMA PET may be a useful tool for risk-stratifying prostate cancer, with the SUVMax of the scan correlated with higher-grade prostate cancer. This has ignited interest in the potential use of PSMA PET to identify men with higher-risk prostate cancer who may be unsuitable for active surveillance, particularly those who were incorrectly classified as lower risk upon initial diagnosis. This review article aims to assess the current state of the literature and clinical guidelines regarding the use of PSMA PET as a tool to risk-stratify prostate cancer, and whether it can be incorporated into active surveillance protocols to identify men who were incorrectly risk-stratified at time of initial diagnosis. Full article

(This article belongs to the Special Issue Nuclear Medicine Procedures in Oncology: New Prospects)

10 pages, 532 KiB

Open AccessArticle

Socioeconomic Disadvantage, Residential Remoteness and Access to Specialised Interventions in Cerebral Palsy: A Cross-Sectional Study

by Simon P. Paget, Kirsty Stewart, Lisa Copeland, Emma Waight, Nadine Smith, Felicity Baker, Jennifer Lewis and Australian Selective Dorsal Rhizotomy Research Group

J. Clin. Med. 2025, 14(10), 3579; https://doi.org/10.3390/jcm14103579 - 20 May 2025

Abstract

Aim: Socioeconomic factors are known to influence access to health services, including for children with cerebral palsy (CP). This study aims to determine whether socioeconomic disadvantage and/or geographical remoteness influence access to specialised CP interventions: selective dorsal rhizotomy (SDR) and intrathecal baclofen [...] Read more.

Aim: Socioeconomic factors are known to influence access to health services, including for children with cerebral palsy (CP). This study aims to determine whether socioeconomic disadvantage and/or geographical remoteness influence access to specialised CP interventions: selective dorsal rhizotomy (SDR) and intrathecal baclofen (ITB). Methods: This was a cross-sectional study of children with CP from (i) the Australian SDR Research Registry and (ii) an Australian ITB audit study. Socioeconomic disadvantage was grouped (quintiles) using the Index of Relative Socioeconomic Disadvantage (IRSD). Geographical remoteness was determined using the Australian Statistical Geographical Standard. IRSD quintiles and remoteness were compared with the Australian CP Register (ACPR) (birth years 1995–2016). Results: A total of 64 children (31.3% female) had received SDR surgery and 52 children (48.1% female) had received ITB therapy. Of these, 7 (11.1%) (SDR) and 7 (13.5%) (ITB) lived in the most disadvantaged neighbourhoods (IRSD quintile 1); 41 children (65.1%) (SDR) and 42 (82.4%) (ITB) lived in major cities. In comparison, 1630 (18.8%) of children on the ACPR resided in IRSD quintile 1; 6122 (70.4%) resided in major cities. There were no statistical differences in IRSD distribution between ACPR, SDR, and ITB groups. More children in major cities received ITB therapy (p = 0.03) and more children in outer regional/remote areas had received SDR (p = 0.03). Conclusions: Access to SDR and ITB in Australia varies by geographical remoteness. Equity of access is important to monitor, and interventions should be considered to reduce inequity. Full article

(This article belongs to the Special Issue Toward Improved Evaluation, Treatment, and Management of Movement Disorders and Cognitive Impairments in People with Cerebral Palsy)

15 pages, 280 KiB

Open AccessArticle

Perceived and Dispositional Hope as Health-Related Constructs: Adaptation and Validation of the Polish Version of the Perceived Hope Scale

by Elżbieta Katarzyna Kasprzak, Karolina Mudło-Głagolska and Andreas Krafft

J. Clin. Med. 2025, 14(10), 3578; https://doi.org/10.3390/jcm14103578 - 20 May 2025

Abstract

Background: The effectiveness of treatment depends on recognizing the needs and limitations of patients. Hope is a personal resource that facilitates the treatment and recovery process. Dispositional hope encompasses goal-directed action, whereas perceived hope lacks reference to specific content or behavior. This [...] Read more.

Background: The effectiveness of treatment depends on recognizing the needs and limitations of patients. Hope is a personal resource that facilitates the treatment and recovery process. Dispositional hope encompasses goal-directed action, whereas perceived hope lacks reference to specific content or behavior. This study examined which construct is more strongly related to psychological, physical, and emotional health. Perceived hope requires a new tool for measurement. Adaptation to the Polish cultural context is the second goal of this research. Methods: Data were collected in the international online study Barometer of Hope (n = 1608). Adult participants completed the PSH, ADHS, and a battery of self-report questionnaires assessing several key well-being outcomes. Results: Perceived hope appears to be a more salient construct related to psychological health than dispositional hope, although both aspects of hope demonstrate similar associations with physical health. Confirmatory factor analysis (CFA) supported the hypothesized one-factor structure of the Polish version of the Perceived Hope Scale (PHS-PL), indicating high internal consistency as well as strong convergent and discriminant validity. The PHS-PL showed positive correlations with optimism, life satisfaction, happiness, positive affect, and dispositional hope, and negative correlations with depression/anxiety, loneliness, and negative affect. Additionally, perceived hope was negatively associated with the likelihood of a crisis scenario and positively associated with the likelihood of a flourishing scenario. Conclusions: Our findings confirm that hope is a health-enhancing resource. The PHS is a simple, short, culturally universal method that directly measures hope and can also be successfully used by non-psychologists, such as nurses, physicians, and caregivers. Full article

(This article belongs to the Special Issue Treatment Personalization in Clinical Psychology and Psychotherapy)

14 pages, 957 KiB

Open AccessArticle

Comparative Outcomes of Amblyopia Treatment in High Astigmatism: Stability and Sustained Improvements

by Chia-Chen Hsu, Lung-Chi Lee, Hsu-Chieh Chang, Chun-Hao Huang and Ke-Hung Chien

J. Clin. Med. 2025, 14(10), 3577; https://doi.org/10.3390/jcm14103577 - 20 May 2025

Abstract

Background/Objectives: Astigmatism is a major risk factor for amblyopia. While optical correction improves visual acuity (VA), the long-term treatment outcomes, particularly in children with high astigmatism, remain understudied. This study aimed to determine the treatment effects, time course, and visual outcomes in [...] Read more.

Background/Objectives: Astigmatism is a major risk factor for amblyopia. While optical correction improves visual acuity (VA), the long-term treatment outcomes, particularly in children with high astigmatism, remain understudied. This study aimed to determine the treatment effects, time course, and visual outcomes in children aged 3–7 years with high astigmatism and compared their VA improvement with those with low astigmatism. Methods: This retrospective cohort study included 63 children with untreated high with-the-rule astigmatism (≥+2.50 diopters [D]) and 46 with low astigmatism (≤1.50 D). The children with high astigmatism were classified based on their baseline best-corrected VA (BCVA) into good-VA (20/25 or better, n = 24), mild-VA-impairment (20/25–20/40, n = 19), and amblyopia (20/40 or worse, n = 20) groups. The primary outcomes include maximal improvement in mean BCVA post treatment, the cumulative probability of achieving a VA of 20/25 or better, and being within one line of the fellow eye. Results: The amblyopia, mild-VA-impairment, good-VA, and low astigmatism control groups showed mean improvements of logarithm of the minimum angle of resolution of 0.36 ± 0.08, 0.15 ± 0.05, 0.03 ± 0.04, and 0.01 ± 0.04, respectively. Post treatment with optical correction and/or patching over a mean duration of 46.61 ± 35.22 weeks, amblyopia resolved in all affected children. In the mild-VA-impairment group, only one child did not respond successfully to the treatment. The mean final VA showed no significant intergroup differences (p = 0.115). No amblyopia recurrence was observed at a mean follow-up of 118.33 weeks post resolution. Conclusions: Timely optical correction and patching effectively improve VA in children with high astigmatism, achieving outcomes comparable to those with low astigmatism. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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35 pages, 4927 KiB

Open AccessReview

The Role of Cardiovascular Magnetic Resonance Imaging in Athletic Individuals—A Narrative Review

by Neil Grech and Mark Abela

J. Clin. Med. 2025, 14(10), 3576; https://doi.org/10.3390/jcm14103576 - 20 May 2025

Abstract

Cardiovascular magnetic resonance imaging (MRI) is an advanced cardiac imaging modality that is often required when evaluating athletic individuals. Unrestricted imaging planes, excellent spatial resolution, and a lack of ionising radiation are some of the benefits of this modality. Cardiac MRI has been [...] Read more.

Cardiovascular magnetic resonance imaging (MRI) is an advanced cardiac imaging modality that is often required when evaluating athletic individuals. Unrestricted imaging planes, excellent spatial resolution, and a lack of ionising radiation are some of the benefits of this modality. Cardiac MRI has been established as the gold standard imaging modality for morphological assessment, volumetric analysis, and tissue characterisation. Cardiac MRI without any doubt is an excellent diagnostic tool when evaluating athletes with symptoms or those individuals exhibiting equivocal findings at screening. It is also useful for athletes who fall within the grey zone and is especially important among athletes with a suspected or confirmed diagnosis. Cardiac MRI plays a strategic role when adopting a shared decision-making model in athletes with heart disease, tailoring and personalising medical care to the condition and the athlete’s wishes. The aim of this review is to provide a comprehensive yet practical overview of the role of cardiac MRI when evaluating athletes in clinic. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Imaging)

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8 pages, 199 KiB

Open AccessArticle

An Investigation of the Effect of Combining Tolterodine and Duloxetine in the Treatment of Mixed-Type Urinary Incontinence and the Factors Affecting Success

by Resul Sobay and Eyüp Veli Küçük

J. Clin. Med. 2025, 14(10), 3575; https://doi.org/10.3390/jcm14103575 - 20 May 2025

Abstract

Background: Mixed urinary incontinence (MUI), particularly the urge-predominant subtype, involves both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), posing a therapeutic challenge. Duloxetine, a serotonin–norepinephrine reuptake inhibitor (SNRI), enhances urethral tone, while tolterodine, an antimuscarinic agent, reduces detrusor overactivity. Their [...] Read more.

Background: Mixed urinary incontinence (MUI), particularly the urge-predominant subtype, involves both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), posing a therapeutic challenge. Duloxetine, a serotonin–norepinephrine reuptake inhibitor (SNRI), enhances urethral tone, while tolterodine, an antimuscarinic agent, reduces detrusor overactivity. Their combination may offer synergistic benefits. Aim: The aim of this study was to evaluate the efficacy of duloxetine and tolterodine combination therapy in urge-predominant MUI and identify factors influencing treatment success. Method: A retrospective study was conducted on 106 patients (mean age: 56.45 years) with urge-predominant MUI treated with duloxetine (40 mg twice daily) and tolterodine (4 mg once daily) for 12 weeks. Treatment outcomes were evaluated using the overactive bladder symptom score (OABSS), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), 24 h pad test, and Clinical Global Impression Scale (CGI). Univariate and multivariate regression analyses were performed to determine predictors of success. Results: Significant improvements were observed: OABSS decreased from 11.08 to 6.95, ICIQ-SF decreased from 15.69 to 8.84, and pad use decreased from 3.58 to 0.73/day (all p 0.0001). Bladder capacity increased from 315.09 mL to 436.32 mL. Baseline ICIQ-SF scores were independent predictors of success (odds ratio [OR] = 2.919, p = 0.001). Patient satisfaction reached 77.4%, with mild side effects (constipation and dizziness) in 14 patients. Conclusions: Duloxetine and tolterodine combination therapy significantly improved symptoms and quality of life in urge-predominant MUI. Baseline ICIQ-SF scores may predict treatment success. Further prospective studies are needed. Full article

(This article belongs to the Special Issue Current Clinical Advances in Urinary Incontinence)

40 pages, 1816 KiB

Open AccessReview

Exploring the Potential of Digital Twins in Cancer Treatment: A Narrative Review of Reviews

by Daniele Giansanti and Sandra Morelli

J. Clin. Med. 2025, 14(10), 3574; https://doi.org/10.3390/jcm14103574 - 20 May 2025

Abstract

Background: Digital twin (DT) technology, integrated with artificial intelligence (AI) and machine learning (ML), holds significant potential to transform oncology care. By creating dynamic virtual replicas of patients, DTs allow clinicians to simulate disease progression and treatment responses, offering a personalized approach to [...] Read more.

Background: Digital twin (DT) technology, integrated with artificial intelligence (AI) and machine learning (ML), holds significant potential to transform oncology care. By creating dynamic virtual replicas of patients, DTs allow clinicians to simulate disease progression and treatment responses, offering a personalized approach to cancer treatment. Aim: This narrative review aimed to synthesize existing review studies on the application of digital twins in oncology, focusing on their potential benefits, challenges, and ethical considerations. Methods: The narrative review of reviews (NRR) followed a structured selection process using a standardized checklist. Searches were conducted in PubMed and Scopus with a predefined query on digital twins in oncology. Reviews were prioritized based on their synthesis of prior studies, with a focus on digital twins in oncology. Studies were evaluated using quality parameters (clear rationale, research design, methodology, results, conclusions, and conflict disclosure). Only studies with scores above a prefixed threshold and disclosed conflicts of interest were included in the final synthesis; seventeen studies were selected. Results and Discussion: DTs in oncology offer advantages such as enhanced decision-making, optimized treatment regimens, and improved clinical trial design. Moreover, economic forecasts suggest that the integration of digital twins into healthcare systems may significantly reduce treatment costs and drive growth in the precision medicine market. However, challenges include data integration issues, the complexity of biological modeling, and the need for robust computational resources. A comparison to cutting-edge research studies contributes to this direction and confirms also that ethical and legal considerations, particularly concerning AI, data privacy, and accountability, remain significant barriers. Conclusions: The integration of digital twins in oncology holds great promise, but requires careful attention to ethical, legal, and operational challenges. Multidisciplinary efforts, supported by evolving regulatory frameworks like those in the EU, are essential for ensuring responsible and effective implementation to improve patient outcomes. Full article

(This article belongs to the Topic Artificial Intelligence in Public Health: Current Trends and Future Possibilities, 2nd Edition)

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10 pages, 1395 KiB

Open AccessArticle

Real-Time Measurement of Intrarenal Pressure Using LithoVue™ Elite: Focus on Small Ureteral Access Sheaths and Appropriate Irrigation Settings

by Naoto Tanaka, Jose Carlo Elises, Fukashi Yamamichi, Yasuhiro Kaku, Yosuke Fukiishi, Masaichiro Fujita and Takaaki Inoue

J. Clin. Med. 2025, 14(10), 3573; https://doi.org/10.3390/jcm14103573 - 20 May 2025

Abstract

Background/Objectives: Intrarenal pressure (IRP) plays a critical role in ensuring the safety of retrograde intrarenal surgery (RIRS), as elevated IRP is associated with complications such as pyelovenous backflow, infection, and renal injury. LithoVue™ Elite (LVE) is the first commercially available ureteroscope (URS) [...] Read more.

Background/Objectives: Intrarenal pressure (IRP) plays a critical role in ensuring the safety of retrograde intrarenal surgery (RIRS), as elevated IRP is associated with complications such as pyelovenous backflow, infection, and renal injury. LithoVue™ Elite (LVE) is the first commercially available ureteroscope (URS) capable of providing real-time IRP measurements. Conventionally, IRP has been measured via a percutaneous nephrostomy catheter (PNC), which may not accurately reflect dynamic changes during endoscopic procedures. Recently, small ureteral access sheaths (UASs) have been increasingly used to minimize ureteral injury risk. This study aimed (1) to assess the accuracy of LVE compared with that of IRP measured by a PNC and (2) to evaluate appropriate irrigation settings suitable for small UASs using porcine kidney models and LVE. Methods: An 11/13-Fr UAS and a 10/12-Fr UAS were inserted into each model, and an automatic irrigation pump (AIP) and hand pumping (HP) with a 20-cc syringe were used. IRP was measured at various LVE tip positions (renal pelvis and upper, middle, and lower calyces) with different irrigation settings, repeated four times in each. Simultaneously, the IRP via the PNC located in the upper calyx and renal pelvis was measured. Results: LVE showed high concordance with the PNC across the upper, middle, and lower calyces (p > 0.05). However, at the renal pelvis, LVE measured IRP values that were significantly higher than the PNC by a mean of 1.93 ± 0.93 mmHg (p < 0.001). For the 11/13-Fr UAS, the IRP remained below 30 mmHg across all irrigation settings with an AIP and HP. In contrast, the 10/12-Fr UAS maintained 30 mmHg only with limited AIP settings, while HP resulted in high IRP, exceeding 100 mmHg at any location. Intergroup comparisons demonstrated that the IRP with the 10/12-Fr UAS was significantly higher than that with the 11/13-Fr UAS at any irrigation pressure setting across all URS tip positions (p < 0.05). Intragroup comparisons indicated a significant pressure difference between the upper, middle, and lower calyces and the renal pelvis in both models at all irrigation settings (p < 0.05). Conclusions: LVE provided accurate IRP measurements compared to the PNC. The IRP was significantly influenced by UAS size, irrigation setting, and URS tip position. When using small UASs, selecting appropriate irrigation settings is essential to maintain the safe threshold. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Kidney Stones)

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9 pages, 470 KiB

Open AccessArticle

Long-Term Outcomes Associated with the Use of a Soft, Partially Absorbable Transobturator Mid-Urethral Tape for the Treatment of Stress Urinary Incontinence

by Ronen S. Gold, Jonatan Neuman, Menahem Neuman and Asnat Groutz

J. Clin. Med. 2025, 14(10), 3572; https://doi.org/10.3390/jcm14103572 - 20 May 2025

Abstract

Objectives: To assess the long-term safety and efficacy of the Serasis^® inside-out transobturator midurethral sling (MUS), a partially absorbable soft tape for stress urinary incontinence (SUI). Methods: A cohort study of 146 consecutive women who underwent the Serasis^® MUS procedure from [...] Read more.

Objectives: To assess the long-term safety and efficacy of the Serasis^® inside-out transobturator midurethral sling (MUS), a partially absorbable soft tape for stress urinary incontinence (SUI). Methods: A cohort study of 146 consecutive women who underwent the Serasis^® MUS procedure from January 2013 to January 2014 was investigated. All patients had SUI as the main complaint. Patients with predominant urgency urinary incontinence (UUI) and stage III-IV pelvic organ prolapse were excluded. Clinical, intraoperative, and postoperative data were retrospectively retrieved from a computerized database. At 10 years postoperatively, a follow-up telephone survey was conducted. The patients were interviewed regarding tape-related complications, repeated SUI surgery, and decision regret or satisfaction. Results: All patients underwent the Serasis^® MUS procedure, most of whom also had concomitant colporrhaphies. The mean duration of surgery was 26.03 min, and the mean blood loss was 32.4 cc. All patients were discharged within a few hours after surgery or on the following day. No significant intraoperative or early postoperative complications were reported. Overall, 107 (73.3%) patients were available for the 10-year follow-up, 17 (15.9%) of whom reported symptoms of SUI, but only half of them underwent a repeated MUS. The rate of tape erosion was 1.9%, and no symptoms of tape-related pain were reported. Additionally, 10.3% of the patients were categorized as a subjective failure, most of whom considered persistent UUI as the main reason for dissatisfaction. Conclusions: The long-term outcomes of the transobturator Serasis^® MUS, a partially absorbable soft tape, are favorable and are associated with significantly fewer tape-related complications. Full article

(This article belongs to the Section Nephrology & Urology)

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13 pages, 427 KiB

Open AccessArticle

Glycocalyx Disintegration Is Associated with Mortality in Chronic Heart Failure

by Patricia P. Wadowski, Martin Hülsmann, Irene M. Lang, Christian Schörgenhofer, Joseph Pultar, Constantin Weikert, Thomas Gremmel, Sabine Steiner, Renate Koppensteiner, Christoph W. Kopp and Bernd Jilma

J. Clin. Med. 2025, 14(10), 3571; https://doi.org/10.3390/jcm14103571 - 20 May 2025

Abstract

Background: Glycocalyx disintegration is associated with adverse outcomes in patients with trauma or sepsis. As microvascular dysfunction has an impact on disease progression in chronic heart failure (CHF) patients, we hypothesized that changes in microcirculation might be associated with mortality. Methods: Fifty patients [...] Read more.

Background: Glycocalyx disintegration is associated with adverse outcomes in patients with trauma or sepsis. As microvascular dysfunction has an impact on disease progression in chronic heart failure (CHF) patients, we hypothesized that changes in microcirculation might be associated with mortality. Methods: Fifty patients with ischemic and non-ischemic cardiomyopathy and conservative treatment with baseline measurements of the sublingual microcirculation (via Sidestream Darkfield videomicroscopy) were followed up for two years. Glycocalyx thickness was assessed indirectly by calculation of the perfused boundary region (PBR). Results: Loss of glycocalyx was pronounced in non-survivors after one, n = 10, and two years, n = 16; PBR: 2.05 μm (1.88–2.15 μm) vs. 1.87 μm (1.66–2.03 μm) and 2.04 (1.93–2.11) vs. 1.84 (1.62–1.97); p = 0.042 and p = 0.003, respectively. Area under the ROC curve for the analysis of the predictive value of PBR on two-year mortality was 0.77 (p = 0.003; SE: 0.07, CI (95%): 0.63–0.91). ROC curve analysis determined a PBR of 1.9 μm as the best predictor for two-year mortality (sensitivity: 0.81; specificity: 0.59). Moreover, multivariate regression analysis revealed PBR and functional capillary density as significant predictors of two-year mortality, p = 0.036 and p = 0.048, respectively. Conclusions: Glycocalyx disintegration is related to poor overall survival in CHF patients. Full article

(This article belongs to the Special Issue European Independent Foundation in Angiology/Vascular Medicine (VAS) Collection on Vascular Medicine)

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11 pages, 648 KiB

Open AccessArticle

Heart Rate Variability Prediction of Stimulant-Induced Creativity Gains in Attention-Deficit/Hyperactivity Disorder

by Carrina Appling, Nanan Nuraini, Eric Hart, David Wang, Aneesh Tosh, David Beversdorf and Bradley Ferguson

J. Clin. Med. 2025, 14(10), 3570; https://doi.org/10.3390/jcm14103570 - 20 May 2025

Abstract

Background/Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent condition etiologically related to suboptimal levels of dopamine (DA) and norepinephrine (NE) that is typically treated with psychostimulant medication. In individuals with ADHD, divergent thinking abilities have been shown to improve with the use of [...] Read more.

Background/Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent condition etiologically related to suboptimal levels of dopamine (DA) and norepinephrine (NE) that is typically treated with psychostimulant medication. In individuals with ADHD, divergent thinking abilities have been shown to improve with the use of psychostimulants. Furthermore, psychostimulants affect autonomic nervous system (ANS) functioning, which can impact creative cognition. However, it is not known how DA and NE affect creative cognition in this setting and how this effect is related to autonomic activity in ADHD. Therefore, our objective was to elucidate ANS function and its relationship with divergent creativity gains related to psychostimulant treatment in ADHD. Method: Seventeen individuals diagnosed with ADHD (age 27.9 ± 6.7 sd) participated in two counterbalanced sessions—one while on their prescribed stimulant medication and another after abstaining for at least 24 h. During each session, participants completed convergent (anagrams) and divergent (Torrance Test of Creative Thinking) thinking tasks. An 8 min electrocardiogram prior to cognitive testing was taken to measure heart rate variability (HRV), which is an index of ANS functioning. Results: The hypothesized baseline pNN50 HRV measure was not predictive of enhanced creativity gains on convergent anagrams or divergent creativity on the Torrance when taking stimulants. Conclusions: In this pilot study, the relationship between baseline HRV and the impact of stimulants on anagram performance suggests the noradrenergic system may not play a role in the effect of stimulants on convergent or divergent creativity. The lack of a relationship between baseline HRV and stimulant-related changes in TTCT and anagram scores lends some support to the hypothesis that dopaminergic effects may be the predominant factor in the effect of stimulants on creativity in ADHD. Future research should further investigate the interaction between hypoactive neurotransmitter systems, particularly dopamine in divergent and norepinephrine in convergent creativity, using neuroimaging techniques to assess neurotransmitter dynamics during creativity-based tasks. Full article

(This article belongs to the Special Issue Clinical Advances in Child Neurology)

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15 pages, 304 KiB

Open AccessReview

Is Targeting LDL-C Levels Below 70 mg/dL Beneficial for Cardiovascular and Overall Health? A Critical Examination of the Evidence

by Folkert H. van Bruggen and David M. Diamond

J. Clin. Med. 2025, 14(10), 3569; https://doi.org/10.3390/jcm14103569 - 20 May 2025

Abstract

Over the past two decades, cardiovascular disease (CVD) prevention guidelines have progressively lowered LDL-C targets to <70 mg/dL for high-risk individuals based on the assumption of a linear relationship between LDL-C levels and CVD risk. However, the available evidence challenges this premise. Multiple [...] Read more.

Over the past two decades, cardiovascular disease (CVD) prevention guidelines have progressively lowered LDL-C targets to <70 mg/dL for high-risk individuals based on the assumption of a linear relationship between LDL-C levels and CVD risk. However, the available evidence challenges this premise. Multiple studies demonstrate a weak or inconsistent association between LDL-C levels and atherosclerosis progression at the individual patient-level. Systematic reviews supporting the linearity assumption have notable limitations, including extrapolation beyond observed LDL-C ranges and potential ecological fallacy, as meta-regression analyses rely on study-level data, while patient-level data within the same trials often show no association between LDL-C reduction and CVD outcomes. Moreover, randomized controlled trials explicitly designed to assess LDL-C targets have yielded inconclusive and biased results. LDL-C itself is a heterogeneous marker, with particle size and composition influencing its atherogenicity. The cardiovascular benefits of lipid-lowering therapies may arise in part from pleiotropic effects unrelated to LDL-C lowering. Additionally, several studies indicate that higher LDL-C levels are paradoxically associated with longevity in elderly populations that is equal to or even greater than that of the general population. Collectively, this body of evidence raises questions about the validity of current LDL-C targets < 70 mg/dL in high-risk patients. Full article

(This article belongs to the Section Cardiovascular Medicine)

10 pages, 1308 KiB

Open AccessArticle

Postoperative Refractory Diarrhea After Margin Accentuation of the Superior Mesenteric Artery with Irreversible Electroporation in Pancreaticoduodenectomy

by Eline-Alice Brys, Filip Gryspeerdt, Nikdokht Rashidian, An Verena Lerut, Pieter Dries, Luís Abreu de Carvalho and Frederik Berrevoet

J. Clin. Med. 2025, 14(10), 3568; https://doi.org/10.3390/jcm14103568 - 20 May 2025

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) presents a challenge due to its poor prognosis. Irreversible electroporation (IRE) shows promise in improving margin clearance and increasing R0 and R1 indirect resection rates. Although IRE is believed to preserve surrounding tissues, this study aimed to [...] Read more.

Background: Pancreatic ductal adenocarcinoma (PDAC) presents a challenge due to its poor prognosis. Irreversible electroporation (IRE) shows promise in improving margin clearance and increasing R0 and R1 indirect resection rates. Although IRE is believed to preserve surrounding tissues, this study aimed to assess postoperative refractory diarrhea as a severe complication and challenge the assumption of consistent tissue preservation. Methods: Patients undergoing pancreaticoduodenectomy (PD) with IRE for superior mesenteric artery (SMA) margin accentuation between May 2022 and April 2024 were included. Primary endpoints were diarrhea-related morbidity and mortality; secondary endpoints included R-status, recurrence, and metastases. IRE electrodes were initially positioned circumferentially around the SMA, but this approach was modified to hemi-circumferential placement and applied in six additional patients. Results: All five patients (median age 70, 80% female) in the initial cohort developed secretory diarrhea lasting a median of 6 months (IQR 5–6.5), with a median frequency of 5 stools/day (IQR 5–6.5). Two patients (40%) died due to diarrhea-associated cachexia. In contrast, among the six patients treated with the modified technique, patients’ diarrhea resolved within a median of 8 days (IQR 6–10) without need for opioid or advanced antidiarrheal therapy. Conclusions: Circumferential IRE for SMA margin accentuation may damage the superior mesenteric plexus and induce severe, prolonged diarrhea. Hemi-circumferential application may mitigate this risk. Larger studies are required to validate these findings and optimize the use of IRE in PD. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Surgery: Diagnosis, Management and Future Opportunities)

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14 pages, 1638 KiB

Open AccessArticle

Ramadanov–Zabler Safe Zone for Sacroiliac Screw Placement: A CT-Based Computational Pilot Study

by Nikolai Ramadanov and Simon Zabler

J. Clin. Med. 2025, 14(10), 3567; https://doi.org/10.3390/jcm14103567 - 20 May 2025

Abstract

Background/Objectives: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical [...] Read more.

Background/Objectives: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical accuracy and reducing complications. Methods: A computational study was conducted using a CT scan of a 75-year-old male patient to establish a safe zone for SI screw placement. Manual segmentation and 3D modeling techniques were used to analyze bone density distribution. A 2D lateral projection of the sacrum was generated to identify high-density regions optimal for screw placement. While the general principle of targeting areas of higher bone density for screw insertion is well established, this study introduces a novel computational method to define and visualize such a safe zone. The resulting region, termed the Ramadanov–Zabler Safe Zone, was delineated based on this analysis to ensure maximal intraosseous fixation with minimal risk of cortical breaches. Results: A high-resolution 3D model of the sacral region was successfully generated. Standard thresholding methods for segmentation proved ineffective due to low bone density, necessitating a freehand approach. The derived 2D projection revealed regions of higher bone density, which were defined as the Ramadanov-Zabler Safe Zone for screw insertion. This zone correlates with areas providing the best structural integrity, thereby reducing risks associated with screw misplacement. Additionally, intraoperative and postoperative imaging from a representative case is included to illustrate the translational feasibility of the proposed technique. Conclusions: The Ramadanov–Zabler Safe Zone offers a reproducible, CT-based computational approach to guide for SI screw placement, enhancing surgical precision and patient safety. This CT-based computational approach provides a standardized reference for preoperative planning, minimizing neurovascular complications and improving surgical outcomes. This pilot technique is supported by preliminary clinical imaging that demonstrates feasibility for intraoperative application. Further validation across diverse patient populations is recommended to confirm its clinical applicability. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 391 KiB

Open AccessArticle

The Effect of Eight Weeks of Passive Heat Therapy on Mental Health, Sleep, and Chronic Pain in Persons with Spinal Cord Injury: A Pilot Study

by Hannah Uhlig-Reche, Sven Hoekstra, Yubo Wu, Dean Lundt Kellogg, Jr., Terry Romo, Christof A. Leicht and Michelle B. Trbovich

J. Clin. Med. 2025, 14(10), 3566; https://doi.org/10.3390/jcm14103566 - 20 May 2025

Abstract

Background/Objectives: Rates of depression, anxiety, sleep disturbances, and chronic pain are higher in people with spinal cord injury (SCI) compared with able-bodied individuals. Passive heat therapy (PHT), which raises core body temperature, may be an accessible therapeutic intervention. The effects [...] Read more.

Background/Objectives: Rates of depression, anxiety, sleep disturbances, and chronic pain are higher in people with spinal cord injury (SCI) compared with able-bodied individuals. Passive heat therapy (PHT), which raises core body temperature, may be an accessible therapeutic intervention. The effects of PHT on mental health, sleep, and pain in persons with SCI are unknown. Methods: We performed a time-controlled pre–post intervention pilot study in which ten veterans with chronic SCI underwent an 8-week supervised PHT intervention to raise oral temperature by 1 °C each session. Outcome measures were the 5-item Mental Health Inventory, Epworth Sleepiness Scale, and International Spinal Cord Injury Pain Extended Data Sets version 1.0. Results: There were no adverse events related to the intervention and nine out of ten participants completed all their intervention sessions. There was a reduction in pain intensity (p = 0.039) upon completing the intervention (from a median (IQR) of 2.0 (0.0, 3.5) to 1.0 (0.0, 4.5) on a 0–10 scale). However, there were no improvements in self-reported mental health or sleep outcomes (p > 0.339). Conclusions: This pilot study suggests that supervised repeated passive heat therapy may confer benefits for chronic pain in veterans with chronic SCI. Follow-up studies with larger sample sizes and more extensive sets of chronic pain outcomes are needed to confirm these findings. Full article

(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)

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