Journal of Clinical Medicine

Background: There is limited contemporary evidence on predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI) involving the right coronary artery (RCA). We examined this in a single-centre retrospective cohort study, focusing on 30-day outcomes. Methods: Consecutive patients presenting to an Australian tertiary hospital between May 2022 and April 2024 with acute STEMI who underwent primary percutaneous coronary intervention (PCI) or rescue PCI were eligible. Patients were divided into STEMI due to RCA and non-RCA culprit lesions, and their characteristics were compared. The primary outcome was a composite of 30-day all-cause mortality and cardiogenic shock. Results: Among 320 included patients, the primary composite outcome was similar between the RCA and non-RCA groups (12% vs. 15%, p = 0.44), although 30-day mortality was lower in the RCA-STEMI group (2% vs. 8%, p = 0.01). In the RCA-STEMI cohort, right ventricular (RV) longitudinal dysfunction on echocardiogram, defined as a tricuspid annular plane systolic excursion (TAPSE) < 17 mm or RV tissue doppler lateral annular systolic velocity (RV S′) < 10 cm/s (p = 0.04), and Thrombolysis in Myocardial Infarction (TIMI) flow < 3 in the RV marginal branch post-PCI (p = 0.04) were independently associated with the primary outcome. The latter was also associated with a higher risk of intensive care unit admission for cardiogenic shock (p < 0.01) and heart failure requiring inpatient diuresis (p = 0.02). Conclusions: In patients with RCA-STEMI, compromised RV marginal branch flow post-PCI and impaired RV function were independently associated with the composite primary outcome of 30-day all-cause mortality and cardiogenic shock. These characteristics may assist early identification of at-risk individuals who could benefit from pro-active monitoring and early implementation of therapies for cardiogenic shock. Full article

Objectives: The long-term effects of rheumatoid arthritis (RA) therapies on bone mineral density (BMD) remain incompletely characterized. We aimed to evaluate BMD trajectories over an 8-year follow-up in patients with RA treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biological DMARDs (bDMARDs) in real-world practice. Methods: Patients were selected from an observational RA cohort established at Nice University Hospital between 2001 and 2016. Participants were classified into two groups according to treatment regimen (csDMARD only or any bDMARD exposure). BMD was assessed by dual-energy X-ray absorptiometry at baseline and after 1, 2, 3, 5, and 8 years at the lumbar spine, femoral neck, and total hip. Longitudinal changes in BMD were analyzed using multivariable linear mixed-effects models adjusted for age, sex, body mass index (BMI), disease duration, seropositivity, glucocorticoid use, anti-osteoporosis treatment, and clinical response. Results: A total of 312 patients were included, of whom 181 received bDMARDs and 131 were treated exclusively with csDMARDs. BMD showed limited change during the first two years in both groups. Beyond two years, modest declines were observed at hip sites at subsequent time points, whereas lumbar spine BMD did not demonstrate significant longitudinal change in pointwise analyses. In mixed-effects models, the treatment group–time interaction was significant for lumbar spine (p = 0.004) and total hip (p = 0.04), but not for the femoral neck (p = 0.34), indicating differential BMD trajectories over time between treatment groups. In the csDMARD group, lumbar spine and total hip BMD decreased by a mean of 0.0006 and 0.0005 g/cm² per month, respectively, whereas no significant slopes were observed in the bDMARD group. Older age was associated with lower BMD, while male sex and higher BMI were associated with higher BMD across sites. Conclusions: In this long-term real-world cohort, BMD remained relatively stable during the first two years of follow-up. Longitudinal analyses suggested a less pronounced decline in lumbar spine and total hip BMD trajectories among bDMARD-treated patients compared with those receiving csDMARD alone, underscoring the need for ongoing bone health monitoring in RA. Full article

Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity encompassing multiple ischemic mechanisms, including atherosclerotic plaque disruption, coronary artery spasm, coronary microvascular dysfunction, coronary embolism, and spontaneous coronary artery dissection. Despite the absence of obstructive coronary disease, patients with MINOCA remain at substantial risk of adverse cardiovascular outcomes, underscoring the need for accurate early diagnosis and effective risk stratification. In this context, accumulating evidence indicates that circulating serum biomarkers may provide additional pathophysiological and prognostic insights in patients with a working diagnosis of MINOCA. Moreover, distinct biomarker profiles may help support the differential diagnostic evaluation between MINOCA and other causes of acute myocardial injury, such as myocardial infarction with obstructive coronary arteries, myocarditis, and Takotsubo syndrome. This narrative review summarizes current evidence on serum biomarkers in MINOCA, highlights their potential role in guiding tailored diagnostic strategies, and discusses future perspectives toward biomarker-driven precision medicine in patients presenting with acute myocardial injury. Full article

Background/Objectives: Secondary prevention after a first acute myocardial infarction (AMI) is crucial to reduce complications and improve long-term outcomes. Persistent gender inequalities in cardiovascular care suggest differences in post-AMI healthcare pathways between men and women. Understanding these trajectories could guide post-discharge clinical management, secondary prevention, and follow-up after acute myocardial infarction. This study aimed to describe healthcare pathways following a first AMI and explore gender inequalities within these trajectories. Methods: We conducted an observational, population-based study using real-world data (RWD) from the CARhES cohort. A total of 4298 individuals discharged alive after a first AMI between 2017 and 2022 were included. Healthcare trajectories during the 90 days following discharge were reconstructed across primary and specialised care, emergency services, and hospital admissions, and stratified by sex and the occurrence of clinical outcomes. Results: Post-AMI care pathways were highly heterogeneous. Although general practitioners often served as the first point of contact, most trajectories began in emergency departments. Patients with clinical outcomes showed higher healthcare utilisation. Women accessed primary care more frequently, whereas men showed greater use of specialised services and higher readmission rates, patterns that may reflect differences in follow-up strategies and clinical management during the early post-discharge period. Despite this variability, overall trajectories showed no significant sex-based differences. Conclusions: Post-AMI care pathways are complex and variable, with gender differences in patterns of service use. Women more often accessed scheduled care, while men relied more on emergency services. These findings highlight the need for gender-sensitive post-discharge follow-up to guide clinicians in secondary prevention strategies for AMI. Full article

Background: The Biologically Oriented Preparation Technique (BOPT) protocol has demonstrated excellent clinical and biological outcomes in restorations with vertical preparation designs. However, its provisional phase remains highly dependent on the operator’s skill. The EasyBOPT (eBOPT) protocol introduces a standardized digital workflow aimed at simplifying this process and enhancing its reproducibility. The primary objective of this study is to describe the eBOPT protocol and to compare its clinical outcomes with the conventional BOPT approach in a prospective case series. Materials and Methods: A case series was conducted including ten patients requiring full-coverage restorations in the maxillary anterior region. The study protocol was registered on 15 July 2024 at ClinicalTrials.gov, with the following registry name: Periodontal outcomes and digital volumetric variation following BOPT restorations, and with the following registration number: NCT06485999. Five patients were treated using the conventional BOPT protocol and five with the eBOPT protocol. Both groups followed identical diagnostic, preparation, and definitive restoration phases, differing only in the provisionalization technique. In the eBOPT group, a digital workflow based on dual scanning (physiologic and retracted gingiva), “best-fit” alignment, and CAD-CAM fabrication of a standardized 45° emergence provisional restoration was employed. Operative time per tooth, gingival healing time, and the need for additional adjustments were recorded. Results: The mean clinical time per tooth was significantly lower with the eBOPT protocol (12.30 ± 1.50 min) compared to the conventional protocol (31.20 ± 2.10 min; p < 0.001). The mean gingival healing time was also reduced with eBOPT (4.4 ± 0.9 weeks) relative to the traditional approach (9.6 ± 1.5 weeks; p = 0.0014). Only the conventional group required additional provisional adjustments (80% of cases; p = 0.048). Conclusions: The EasyBOPT protocol enables faster, more predictable, and less operator-dependent provisionalization while maintaining the biological stability and gingival health achieved with conventional BOPT. This digital workflow simplifies the clinical application of the BOPT concept and enhances its reproducibility. Full article

Background: An unfavorable course of SARS-CoV-2 infection can lead to significant morbidity and mortality. The study aimed to develop a simple, accessible, and reliable tool to anticipate the poor results among COVID-19 pneumonia patients. Methods: This retrospective cohort study involves 306 individuals with severe COVID-19 pneumonia enrolled between March 2021 and June 2021. Each patient had confirmed SARS-CoV-2 infection and required oxygen therapy. Differential blood count and serum CRP were taken on admission day. Medical data were collected from the hospital’s information system. Results: Of 306 patients (133 females, 173 males, aged 66.3 ± 15.2 years), 105 (34.3%) died. Counts of neutrophils, lymphocytes, and eosinophils differed significantly between survivors and deceased (p < 0.001; p = 0.002; p = 0.009, respectively) and had substantially differentiating properties in ROC analysis. Built with the counts of neutrophils, lymphocytes, and eosinophils, the White Blood Cell Score (WBCS) was developed. WBCS robustly predicted mortality (OR = 2.821; CI: 2.037–3.906; p < 0.001) in the investigated population. Cumulative risk of death according to WBCS (ranging from 0 to 3 points) was as follows: 0 points—10.9%, 1 point—23.5%, 2 points—33.1%, 3 points—34.1%. Conclusions: Based on differential blood count, the proposed WBCS is easy to use and can be helpful in predicting mortality among severe COVID-19 patients. Full article

Background/Objectives: Psoriatic disease is a systemic inflammatory condition associated with increased cardiometabolic risk, but the impact of contemporary systemic therapies and narrowband ultraviolet B (NB-UVB) phototherapy on vascular and systemic inflammatory markers remains incompletely characterized. We aimed to systematically synthesize prospective evidence on treatment-associated changes in vascular inflammation and systemic inflammatory biomarkers in adults with moderate-to-severe psoriatic disease. Specifically, we evaluated changes assessed by 18F-FDG PET/CT imaging and circulating biomarkers following biologic therapies or NB-UVB phototherapy. Methods: We systematically searched MEDLINE, Embase, Web of Science, Scopus, and CENTRAL from inception to 31 January 2026 for prospective interventional and observational studies in adults with psoriasis or psoriatic arthritis treated with biologic agents targeting TNF-α, IL-12/23, IL-17, or IL-23, or with NB-UVB phototherapy. Eligible studies were required to report serial assessments of vascular inflammation by 18F-FDG PET/CT (typically aortic target-to-background ratio) and/or systemic inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, TNF-α, GlycA, or hematologic indices such as the neutrophil-to-lymphocyte ratio) over at least 8 weeks of follow-up. We imposed no language restrictions and included only full-text, peer-reviewed prospective studies. Risk of bias was evaluated using RoB 2 for randomized trials and ROBINS-I for nonrandomized studies. Random-effects meta-analyses were prespecified for outcomes reported by at least two clinically comparable studies; however, because of substantial heterogeneity in reporting and methodology, effect estimates were summarized using a structured narrative synthesis. Results: Thirteen prospective studies (n ≈ 900 adults, published 2015–2025) met inclusion criteria, including four studies with serial 18F-FDG PET/CT imaging and one additional PET/CT study providing baseline observational data on vascular inflammation, as well as eight biomarker-focused prospective cohorts. Across randomized mechanistic trials and observational studies, biologic therapies reduced aortic target-to-background ratio by approximately 6–12% over 12–24 weeks (e.g., mean change from 2.42 to 2.18 with TNF-α inhibition and from 2.51 to 2.20 with IL-17 blockade), and no study reported worsening of PET-derived vascular indices under effective systemic treatment. Biologic and other systemic therapies produced concordant reductions in hs-CRP (typically by 30–50%), IL-6, TNF-α, GlycA, and blood-count-derived indices including neutrophil-to-lymphocyte ratio, with biomarker improvements frequently paralleling reductions in cutaneous disease activity and cardiometabolic risk markers. Two NB-UVB cohorts demonstrated significant hs-CRP reductions of roughly 20–30% and modulation of vitamin D-related inflammatory proteins, suggesting systemic anti-inflammatory effects, although these changes appeared less pronounced than with biologic therapy and were not accompanied by vascular imaging. Conclusions: Contemporary systemic psoriasis therapies, particularly biologic agents targeting the IL-23/Th17 axis and TNF-α, are associated with consistent reductions in aortic vascular inflammation and broad improvements in systemic inflammatory biomarkers, whereas NB-UVB phototherapy confers more modest but measurable systemic anti-inflammatory effects, although the current evidence does not allow differentiation between individual biologic classes in terms of magnitude of effect. Although reductions in vascular and systemic inflammatory markers were observed across therapies targeting TNF-α, IL-12/23, IL-17, and IL-23, the small number of mechanistic imaging studies and absence of head-to-head comparisons do not allow robust differentiation between biologic classes or support a uniform class effect. The convergence of imaging and biomarker data reinforces psoriasis as a clinically relevant model of inflammation-driven atherosclerosis and supports the concept that effective control of psoriatic inflammation may contribute to cardiovascular risk modification, highlighting the need for integrated cardiovascular risk assessment in routine care. However, the imaging evidence base remains limited to four small mechanistic PET/CT studies with relatively short follow-up, which constrains the strength and generalizability of conclusions regarding vascular inflammation. Larger, adequately powered, event-driven prospective trials with standardized imaging and biomarker endpoints are needed to determine whether these vascular and systemic anti-inflammatory effects translate into reduced cardiovascular events in psoriatic disease; because of methodological and reporting heterogeneity across the 13 included studies, these conclusions are based on a structured narrative synthesis rather than a formal quantitative meta-analysis. PROSPERO registration number: CRD420261296646. Full article

Postural balance is a foundational component of human motor behavior, yet it remains conceptually ambiguous and methodologically heterogeneous across the clinical, educational, and sport sciences. This narrative review aims to provide an integrative framework that clarifies key concepts (postural control vs. postural balance), synthesizes the main sensorimotor and biomechanical mechanisms underpinning balance, and organizes current assessment approaches and functional implications across populations. Narrative literature synthesis was conducted to integrate evidence covering multisensory integration and sensory reweighting, central neural control (spinal, brainstem, cerebellar, and cortical contributions), neuromuscular and biomechanical strategies (e.g., ankle/hip/stepping), and cognitive influences (e.g., dual-task effects). We further summarize commonly used instrumental outcomes derived from force-platform center-of-pressure metrics and widely adopted clinical and functional balance tests, highlighting their typical applications and limitations across the lifespan including pediatric, general adults, older adults, and athletic populations. This review proposes a closed-loop, systems-based model in which postural balance is conceptualized as an emergent functional outcome arising from distributed postural control processes shaped by task, environmental, and individual constraints. In conclusion, integrating mechanistic understanding with population-specific assessment enhances interpretability and supports more precise, context-sensitive balance evaluation and intervention in both health and performance settings. Full article

Background/Objectives: Teratomas are the most common germ cell tumors, occurring mainly in the gonads. Extragonadal germ cell teratomas (EGGCTs) are less common but can develop anywhere along the midline structures, with uterine location being extremely rare. On an ultrasound, uterine teratomas are frequently misinterpreted as polyps or myomas. Case Presentation: We report a 27-year-old asymptomatic woman who was diagnosed with a mature uterine teratoma originating from the lower uterine segment and extending to the cervix. We treated this patient with the IBS^® Integrated Bigatti Shaver. This is the first reported case of the IBS^® being used to remove uterine teratomas. At follow-up, the patient recovered uneventfully and subsequently achieved a successful term pregnancy. Conclusions: Preoperative MRI is recommended for uterine teratomas. The IBS^® technique offers an effective and fertility-preserving approach for excising uterine teratomas, providing rapid procedure, superior visualization, and the prevention of tumor dissemination. In this report, we discuss the mechanism, diagnosis, and treatment of teratomas and review the previous literature. Full article

Objective: The aim of this systematic review was to evaluate the skeletal stability, predictability, and safety of using autogenous iliac crest bone grafts (ICBG) during large maxillary advancement performed with Le Fort I osteotomy. Methods: A systematic literature search was performed in November 2025 using PubMed, Scopus, Embase, Web of Science, and WorldCat databases. Clinical studies reporting large maxillary advancement performed with Le Fort I osteotomy and incorporating ICBG were included. Study selection followed PRISMA guidelines. Data extraction focused on the magnitude of maxillary advancement, surgical protocols, stabilization methods, skeletal stability, relapse patterns, graft integration, implant-related outcomes, and complications. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). Results: The review included clinical studies predominantly consisting of case reports, case series, and retrospective cohort studies. ICBG were consistently used in complex clinical scenarios, such as severe maxillary atrophy, hypoplasia, and congenital craniofacial deformities. Large maxillary advancements were generally associated with favorable postoperative skeletal stability, with most relapse occurring during the early healing phase and minimal changes observed during long-term follow-up when rigid fixation and adequate graft integration were achieved. Interpositional grafting facilitated predictable advancement by bridging extensive osteotomy gaps. Donor-site morbidity related to iliac crest harvesting was typically mild and transient. Implant-related outcomes, reported as secondary findings, were generally favorable when implants were placed after an adequate healing period. Conclusions: Despite predominantly observational evidence, ICBG during large maxillary advancement with Le Fort I osteotomy appears to offer predictable advancement, acceptable skeletal stability, and a favorable safety profile, warranting further prospective investigation. Full article

Background/Objectives: Real-world evidence on ofatumumab (OFA) beyond 12 months remains limited in relapsing–remitting multiple sclerosis (RRMS). We assessed 24-month effectiveness and safety, compared treatment-naïve and previously treated patients, and explored predictors of failure to achieve No Evidence of Disease Activity-3 (NEDA-3). Methods: This multicenter retrospective cohort study included adult RRMS patients treated with OFA in routine clinical practice. Effectiveness analyses were restricted to patients with complete 24-month follow-up and full clinical and magnetic resonance imaging (MRI) assessment (complete-case analysis). Outcomes included relapses, MRI activity, Expanded Disability Status Scale (EDSS) progression, NEDA-3, and adverse events (AEs). Exploratory multivariable logistic regression was used to assess baseline predictors of NEDA-3 non-achievement. Results: Of 258 patients who initiated OFA, 148 had completed 24-month clinical and MRI follow-up and were evaluable for effectiveness. Over 24 months, 71.5% achieved NEDA-3; relapses occurred in 15.5% of patients, MRI activity in 15.5%, gadolinium-enhancing lesions (GELs) in 4.7%, and EDSS progression in 17.6%. Disease activity was minimal during months 12–24, with relapses in 2.7%, MRI activity in 2.0%, and no GELs. In unadjusted analyses, no statistically significant differences were observed between treatment-naïve and previously treated patients. Higher baseline EDSS was associated with failure to achieve NEDA-3. In the 24-month safety subgroup, AEs were recorded in 28.4% of patients; infections occurred in 26.4% of patients (all grade 1–2), and no serious adverse events were observed. Conclusions: In this multicenter real-world cohort, OFA was associated with low inflammatory disease activity over 24 months in RRMS patients with complete follow-up. These findings should be interpreted cautiously because the effectiveness analysis was restricted to a complete-case cohort and safety data were collected retrospectively. Full article

Finite element analysis is widely used to study spinal biomechanics and to compare surgical strategies under controlled loading conditions. By allowing variation in alignment, fixation, and implant design, these models provide insight into stress redistribution and motion changes that are difficult to isolate experimentally. This review examines spine surgery-focused finite element studies published between 2018 and 2024, with emphasis on interbody fusion techniques, adjacent segment mechanics, and implant-related stress behavior. Across lumbar fusion models, constructs incorporating anterior column support demonstrate lower posterior instrumentation stress than posterior-only approaches, with lateral lumbar interbody techniques showing reduced rod and screw stresses across multiple loading conditions compared with posterior lumbar interbody or posterolateral fusion constructs. In the cervical spine, comparisons of plated and zero-profile anterior cervical discectomy and fusion devices show smaller increases in adjacent-level motion and intradiscal pressure with zero-profile constructs, alongside higher localized stress at fixation interfaces. More recent studies apply finite element methods to implant optimization, alignment planning, and patient-specific modeling. Together, these findings suggest that finite element analysis is increasingly used to support surgical planning and implant design, with continued advances in validation and patient-specific simulation likely to strengthen its clinical relevance. Full article

Background/Objectives: Osteoporosis and osteoarthritis are age-related musculoskeletal disorders with a high socio-health burden, affecting both healthcare systems and individuals’ quality of life. Both conditions are generally accompanied by a concomitant decline in muscle mass and strength, referred to as sarcopenia. In this context, tensiomyography emerges as a novel, non-invasive potential diagnostic strategy for assessing muscle quality, as this parameter influences the progression of both conditions. Methods: Histomorphometric and immunohistochemical analyses were performed on vastus lateralis muscle tissue obtained from patients undergoing surgery for femoral fracture affected by osteoporosis or osteopenia, patients operated for hip osteoarthritis, and patients undergoing hip arthroplasty for osteoarthritis, concomitantly affected by osteoporosis or osteopenia. In addition, muscle function was assessed in these patients using tensiomyographic analysis. Results: In osteoarthritic, osteoporotic, and osteopenic patients, a reduction in muscle quality and function was observed compared with the other two experimental groups, indicating an unfavorable effect of the coexistence of the two conditions on the muscular component. Furthermore, contraction time (Tc) measured by tensiomyography was negatively correlated with lumbar spine bone mineral density values and positively correlated with the percentage of type II muscle fibers. Conclusions: This study highlights how tensiomyography may represent a valuable non-invasive diagnostic strategy for assessing muscle status in osteoporotic and osteoarthritic patients, as it is able to detect muscle alterations that parallel the worsening of bone status and that cannot be inferred from simple biopsy analysis. Thus, tensiomyography could be considered a practical adjunct tool in the clinical assessment of musculoskeletal frailty. Full article

Objectives: To assess diurnal changes, topographical differences, and day-to-day repeatability of ocular surface epithelial immune cell (EIC) density and morphology in dry eye disease (DED). Methods: Sixteen participants with moderate-to-severe DED (mean (SE) age 49.4 (4.2) years) underwent in vivo confocal microscopy at three timepoints (day-1 morning and evening and day-2 morning) at six locations: central cornea, inferior whorl, inferior cornea, and temporal cornea, limbus and conjunctiva. Diurnal and topographical variation in EIC density and morphology were analyzed using linear mixed-effects models with adjusted pairwise comparisons. Day-to-day repeatability was assessed using the coefficient of repeatability (CoR) for density and Cohen’s kappa for morphology. Results: EIC density and morphology varied by location (p < 0.001) but not by timepoint at any location (p = 0.59–0.90). Density was highest at the inferior cornea (model-estimated mean: 101.2 (SE: 21.7) cells/mm²) and temporal limbus (104.3 (22.7) cells/mm²), and lowest at the central cornea (26.8 [5.1] cells/mm² and inferior whorl (38.3 [8.2] cells/mm²; all pairwise, p < 0.001). EICs with large bodies were more frequent in conjunctiva (100%), inferior cornea (94%), and temporal cornea (87%), than in central cornea (34%) and whorl (19%) (all p ≤ 0.007). EICs with dendrites, and with long dendrites were similarly distributed (p < 0.001). Bland–Altman analysis showed low mean bias and EIC density was more repeatable at the central (CoR ± 23.8 cells/mm²) and temporal cornea (±27.5 cells/mm²) than the inferior cornea (±47.9 cells/mm²) or temporal conjunctiva (±42.3 cells/mm²). Morphology agreement was substantial to near-perfect (κ = 0.71–0.97). Conclusions: In DED, EIC density and morphology are diurnally stable and maintain topographic distribution patterns similar to healthy eyes. Day-to-day repeatability show location dependent patterns. The study provides feasibility data for using IVCM for EIC metrics in disease monitoring. Full article

Background: Short-chain fatty acids (SCFAs) support mucosal integrity and reduce inflammation, while nesfatin-1 is a neuropeptide with antiapoptotic, anti-inflammatory, antioxidant, and anorexigenic actions. Their roles in inflammatory bowel disease (IBD) and links to quality of life (QoL) are unclear. Methods: We conducted a cross-sectional study including adults with Crohn’s disease (CD), ulcerative colitis (UC), and healthy controls (HC). Serum total short-chain fatty acids and nesfatin-1 were measured using enzyme-linked immunosorbent assays (ELISA). Quality of life was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ). Group comparisons and correlation analyses were performed using non-parametric statistical methods. Results: Serum total SCFA concentrations did not differ significantly between patients with CD, UC, and HC (p = 0.29). Nesfatin-1 levels showed between-group variability, with lower values in CD compared with healthy controls, while patients with UC showed intermediate and variable levels (p = 0.064). An inverse correlation between SCFAs and nesfatin-1 was observed in UC and in the combined IBD cohort, but not in CD. Quality of life was comparably impaired in CD and UC. No statistically significant associations were observed between serum SCFAs or nesfatin-1 and IBDQ scores. Conclusions: In this pilot exploratory study, circulating SCFAs and nesfatin-1 showed distinct patterns across IBD subtypes, with evidence of subtype-specific associations between these biomarkers. However, no relationship with quality of life was demonstrated. Larger longitudinal studies are required to confirm these findings and clarify their clinical relevance. Full article

Introduction: Acute gallstone pancreatitis is a potentially severe disease associated with morbidity and mortality. Cholecystectomy is recommended to prevent recurrence. During pregnancy, surgical management is challenging, and in the post-partum period small gallstones may spontaneously disappear. Ursodeoxycholic acid (UDCA) is safe during the last 6 months of pregnancy and effective in dissolving small gallstones, although recurrence after discontinuation is common in the general population. The optimal strategy to prevent recurrent acute pancreatitis during and after pregnancy remains unclear. Methods: Between 2002 and 2017 we prospectively treated women with acute pancreatitis related to small gallstones (≤1 cm in diameter) during the last six months of pregnancy or within the first post-partum year who declined surgery. Patients received UDCA until stone dissolution. A patent cystic duct was confirmed by ultrasonography; after delivery, a non-contrast CT scan was performed to exclude calcified stones. Patients were followed for at least 6 years or until recurrence, with serial clinical and ultrasonographic examinations. Results: UDCA was associated with complete dissolution in 13/14 women within a mean ± SD of 7.77 + 3.1 months. One patient experienced gallstone recurrence 75 months after treatment discontinuation. Two patients developed recurrent pancreatitis (at 1 and 88 months respectively). Twelve women remained free of recurrence over a mean ± SD follow-up of 79.5 + 9.4 months. Discussion: This is an observational study in which we document that UDCA may facilitate the spontaneous dissolution of small gallstones after delivery and can be considered a bridge strategy during pregnancy when surgery is not feasible. However, this study cannot determine the additional benefit of UDCA over the spontaneous disappearance of stones observed after delivery because we had no control group. Cholecystectomy remains the standard of care post-partum. Medical therapy should be reserved for women who refuse surgery and it requires close ultrasonographic surveillance. The main strength of this study is the prospective long-term follow-up of a consecutive cohort with a rare condition. Limitations include the small sample size, missing control group and single-center design. Full article

Background: The endoscopic approach to the spine has a steep learning curve, primarily due to challenges in learning how to access Kambin’s triangle, leading to significant radiation exposure. Real-time live instrument tracking using two-dimensional fluoroscopic navigation has been shown to significantly reduce the time and radiation exposure needed to perform a trans-Kambin approach; however, the impact on the learning curve for those in training has not been studied. Methods: Physicians in training (PITs) in a single program were evaluated while accessing Kambin’s triangle using a gel sawbone model. The PITs were randomized in terms of spinal level, the technology used first, and the approach side. Time to access Kambin’s triangle and radiation were recorded for each cohort. A linear regression model was used to assess associations between procedure time and radiation exposure and endoscopic experience and PGY level. Results: Seven PITs were studied with a range of prior experience, consisting of three PITs with high exposure (HE) (≥30 cases) and four with low exposure (LE) (0–20 cases, averaging 7.5). Unassisted by instrument tracking, the SE group was 63% faster and was exposed to 63% less radiation. Further, there was a moderate correlation with experience and time (R = −0.52) and radiation (R = −0.60). Using instrument tracking allowed all the PITs to be 40% faster, taking 6.6 min (range 2.9–12.4) without instrument tracking and 4.0 min (1.9–6.3) with it. Radiation also decreased by 91% (2.52 vs. 0.23 mGy with instrument tracking). Conclusions: Experience significantly enhanced the accessibility of Kambin’s triangle, reducing time and radiation exposure by about two-thirds. Regardless of experience, instrument tracking reduced radiation exposure by 90%. Additionally, familiarizing PITs with instrument location can eliminate 70% of the learning curve for those inexperienced with accessing Kambin’s triangle. Full article

Background: Difficulties in recruiting patients for clinical trials increase costs and delay the implementation of new therapies. A better understanding of participants’ motivations and barriers can help with developing effective recruitment strategies. The aim of the study was to identify the factors influencing the decisions of adult Poles to participate in clinical trials. Methods: The survey was conducted among Polish adults aged 18 years and older by the independent research company Ariadna between January and February 2023. The questionnaire consisted of 22 questions, nine of which related to the determinants of participation in clinical trials. 1079 people took part in the survey. Results: The study population included 568 women (52.6%) and 511 men (47.4%). The mean age of respondents was 44.96 years (SD = 16.30). 49.9% of respondents (n = 538) declared their willingness to participate in clinical trials in the future. Among those who were reluctant (n = 158, 14.6%), the main barriers were: safety concerns (n = 59, 5.5%), lack of trust (n = 43, 4.0%), and insufficient knowledge (n = 33, 3.1%). The strongest motivation was the desire to improve health (n = 869, 80.5%), and the most frequently indicated reason for participation was cancer (n = 740, 68.6%). The least frequently indicated were diseases of the urinary and reproductive systems (n = 125; 11.6%). Conclusions: The results highlight key aspects important to patients when deciding whether to participate in clinical trials. Such findings may prove useful for researchers in getting to know their patients better and in developing effective strategies to recruit and retain participants in clinical trials. Full article

Background/Objectives: The peroneus longus tendon (PLT) is increasingly used as an autograft for anterior cruciate ligament reconstruction (ACLR). However, during PLT harvest, the necessity of distal peroneus longus-to-peroneus brevis (PL-to-PB) tenodesis for the potential preservation of donor ankle function and medial longitudinal arch alignment remains unclear. This study compared ankle function, donor-site morbidity, complications, and weight-bearing radiographic foot alignment after PLT harvest with and without distal tenodesis. Methods: Between January 2020 and December 2024, 92 primary ACLR cases using an ipsilateral PLT autograft were retrospectively screened; 60 patients with available bilateral weight-bearing comparative foot radiographs were included and categorized into a tenodesis group (n = 30) or a non-tenodesis group (n = 30). Ankle outcomes included American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot and Foot and Ankle Disability Index (FADI) scores, ankle range of motion (ROM), and donor-site complications. Radiographic alignment was assessed using Meary’s angle and calcaneal pitch angle on bilateral weight-bearing lateral foot radiographs, including side-to-side differences. Results: Follow-up duration was comparable between groups (18.5 ± 4.4 vs. 16.8 ± 3.4 months, p = 0.113). No patient demonstrated clinically relevant loss of ankle range of motion or strength at final follow-up. AOFAS (97.3 ± 4.9 vs. 95.0 ± 5.5, p = 0.078) and FADI (96.8 ± 5.2 vs. 95.3 ± 5.5, p = 0.091) scores were similarly high in the tenodesis and non-tenodesis groups, respectively. Sural nerve sensory disturbance occurred in 6/30 (20.0%) versus 5/30 (16.7%) patients (p = 0.739), and no harvest-site infection was observed. On weight-bearing radiographs, Meary’s angle and calcaneal pitch angle did not differ significantly between groups on the operated side (Meary: 7.99 ± 6.76 vs. 4.76 ± 6.32°, p = 0.061; calcaneal pitch: 23.19 ± 5.94 vs. 21.41 ± 4.64°, p = 0.201) or intact side (Meary: 7.05 ± 6.89 vs. 5.36 ± 6.11°, p = 0.320; calcaneal pitch: 23.33 ± 5.43 vs. 22.00 ± 4.48°, p = 0.305). Side-to-side differences were small and comparable (Δ Meary: 0.94 ± 3.97 vs. −0.60 ± 3.58°, p = 0.120; Δ calcaneal pitch: −0.14 ± 3.35 vs. −0.59 ± 3.29°, p = 0.603). Conclusions: Distal PL-to-PB tenodesis did not appear to provide measurable advantages in donor-ankle patient-reported outcomes or weight-bearing radiographic foot alignment compared with no tenodesis after PLT harvest for ACLR. Full article