Journal of Clinical Medicine

175 KiB

Open AccessReply

Reply to Wu, S.-N.; Tsai, C.-H. Comment on “Can Thrombosed Abdominal Aortic Dissecting Aneurysm Cause Mesenteric Artery Thrombosis and Ischemic Colitis?—A Case Report and a Review of Literature. J. Clin. Med. 2025, 14, 3092”

by Laurențiu Augustus Barbu, Nicolae-Dragoș Mărgăritescu, Liliana Cercelaru, Daniel-Cosmin Caragea, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Ștefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Liviu Vasile and Tiberiu Ștefăniță Țenea Cojan

J. Clin. Med. 2025, 14(13), 4698; https://doi.org/10.3390/jcm14134698 (registering DOI) - 3 Jul 2025

Abstract

We sincerely thank the authors for their interest in our article titled “Can Thrombosed Abdominal Aortic Dissecting Aneurysm Cause Mesenteric Artery Thrombosis and Ischemic Colitis [...] Full article

(This article belongs to the Section General Surgery)

18 pages, 2177 KiB

Open AccessArticle

Comparison of the Risk of Pneumonia Between Fluticasone Furoate/Umeclidinium/Vilanterol and Multiple-Inhaler Triple Therapy in Patients with COPD Using Health Insurance Claims Data: Final Analysis of Post-Marketing Database Surveillance in Japan

by Shoko Akiyama, Kenji Oda, Hiroko Mizohata, Natsuki Sasakura, Kenichi Hashimoto and Hiroki Maruoka

J. Clin. Med. 2025, 14(13), 4697; https://doi.org/10.3390/jcm14134697 (registering DOI) - 2 Jul 2025

Abstract

Background/Objectives: Due to limited current evidence, this post-marketing database surveillance study aimed to investigate the occurrence of hospitalization due to community-acquired pneumonia (CAP) among patients with chronic obstructive pulmonary disease in Japan who received single-inhaler triple therapy (fluticasone furoate/umeclidinium/vilanterol; FF/UMEC/VI) or multiple-inhaler triple [...] Read more.

Background/Objectives: Due to limited current evidence, this post-marketing database surveillance study aimed to investigate the occurrence of hospitalization due to community-acquired pneumonia (CAP) among patients with chronic obstructive pulmonary disease in Japan who received single-inhaler triple therapy (fluticasone furoate/umeclidinium/vilanterol; FF/UMEC/VI) or multiple-inhaler triple therapy (MITT). Methods: This retrospective cohort study used health insurance claims data from the Medical Data Vision Co., Ltd. database (November 2017–April 2023) to identify overall and incident users of FF/UMEC/VI or MITT. Index date was the start of FF/UMEC/VI or MITT. Hazard ratios (HRs) for CAP hospitalization were assessed using inverse probability of treatment weighting based on propensity scores (PS). Incidence rates and time to occurrence of CAP hospitalization were also assessed. Adjustments were made to the PS model to address missing body mass index data. Results: In total, 8790 and 10,881 patients were included in the overall FF/UMEC/VI and MITT cohorts, and 3939 and 4017 patients were included in the incident FF/UMEC/VI and MITT cohorts, respectively. HR for CAP hospitalization among incident users ranged from 1.05 to 1.15 across all PS adjustments. Similar incidence rates of CAP hospitalization were reported among both cohorts and across all PS adjustments. The cumulative adjusted incidence rates of first CAP hospitalization at 360 days post-index among incident users was 0.060 and 0.054 in the FF/UMEC/VI and MITT cohorts, respectively. Conclusions: There was no difference in the risk of CAP between patients treated with FF/UMEC/VI and MITT. This safety information may help healthcare providers select appropriate treatments. Full article

(This article belongs to the Section Respiratory Medicine)

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16 pages, 357 KiB

Open AccessArticle

Be Kind to Yourself: Testing Self-Compassion, Fear of Recurrence, and Generalized Anxiety in Women with Cancer Within a Multiple-Mediation Model

by Dariusz Krok, Ewa Telka and Sebastian Binyamin Skalski-Bednarz

J. Clin. Med. 2025, 14(13), 4696; https://doi.org/10.3390/jcm14134696 (registering DOI) - 2 Jul 2025

Abstract

Background/Objectives: Self-compassion, characterized by treating oneself with kindness during challenges, has been shown to alleviate anxiety and fear of recurrence in cancer patients by mitigating negative emotions such as depression and fatigue. Psychological flexibility and coping strategies have emerged as potential mediators [...] Read more.

Background/Objectives: Self-compassion, characterized by treating oneself with kindness during challenges, has been shown to alleviate anxiety and fear of recurrence in cancer patients by mitigating negative emotions such as depression and fatigue. Psychological flexibility and coping strategies have emerged as potential mediators in the relationship between self-compassion and emotional well-being, suggesting that these factors play a critical role in managing distress in cancer patients. However, further research is needed to clarify the mechanisms through which self-compassion, psychological flexibility, and coping interact to influence fear of recurrence and anxiety in cancer populations. Methods: Two hundred and ninety-six women who had completed cancer treatment completed self-report assessments of self-compassion, psychological flexibility, coping, fear of recurrence, and generalized anxiety. Structural equation modeling (SEM) was applied to test a multiple-mediation model, including serial and parallel pathways among the study variables. Results: Self-compassion was positively associated with psychological flexibility and coping strategies, and negatively associated with fear of recurrence and generalized anxiety. Path analysis identified significant serial and parallel mediation effects, where both positive and negative self-compassion were associated with lower fear of recurrence and generalized anxiety through pathways involving psychological flexibility and emotion- and meaning-focused coping. The findings highlight the protective role of self-compassion in reducing psychological distress, suggesting that enhancing self-compassion may improve emotional adjustment in cancer patients. Conclusions: Attitudes based on self-kindness and a nonjudgmental approach have significant potential in reducing fear of cancer recurrence and generalized anxiety in female cancer patients, emphasizing the mediating role of psychological flexibility and coping strategies. According to the acceptance and commitment therapy (ACT) model, these relationships highlight the important roles of personal resources and coping mechanisms in alleviating negative emotional states in women with cancer. Interventions focused on self-compassion and psychological flexibility could provide valuable support in coping with the emotional suffering associated with cancer. Full article

(This article belongs to the Special Issue Challenges in the Field of Psycho-Oncology: Insights from Research)

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13 pages, 986 KiB

Open AccessReview

Chronic Total Occlusions: Current Approaches, Evidence and Outcomes

by Remi Arnold, Richard Gervasoni and Florence Leclercq

J. Clin. Med. 2025, 14(13), 4695; https://doi.org/10.3390/jcm14134695 (registering DOI) - 2 Jul 2025

Abstract

Chronic total occlusions (CTOs), defined as complete coronary artery blockages persisting for over three months, are frequently encountered in up to 25% of coronary angiograms. Although percutaneous coronary intervention (PCI) for CTO remains technically challenging, advancements in guidewires, microcatheters, re-entry devices, and intravascular [...] Read more.

Chronic total occlusions (CTOs), defined as complete coronary artery blockages persisting for over three months, are frequently encountered in up to 25% of coronary angiograms. Although percutaneous coronary intervention (PCI) for CTO remains technically challenging, advancements in guidewires, microcatheters, re-entry devices, and intravascular imaging, along with the expertise of specialized operators, have significantly improved procedural success rates, now exceeding 90% in expert centers. While recent evidence, such as the SYNTAX II study, emphasizes the importance of complete revascularization, over half of CTO cases continue to be managed conservatively with optimal medical therapy (OMT), partly due to the limited high-quality randomized evidence supporting revascularization. Observational studies have demonstrated that successful CTO-PCI is associated with improved angina relief, quality of life, left ventricular function, and possibly long-term survival. Extended observational follow-up, such as the Korean and Canadian registries, suggests long-term reductions in cardiac and all-cause mortality with CTO revascularization. However, randomized controlled trials (RCTs) have primarily shown symptomatic benefit, with no consistent reduction in major adverse cardiac events (MACE) or mortality, likely due to limited sample sizes, short follow-up, and treatment crossovers. Various strategies, including the hybrid algorithm, guide CTO interventions by balancing antegrade and retrograde techniques based on lesion complexity. Imaging modalities such as coronary CT angiography and intravascular ultrasound play a pivotal role in planning and optimizing these procedures. Future innovations, such as real-time fusion imaging of CCTA with coronary angiography, may enhance lesion visualization and guidewire navigation. While current guidelines recommend CTO-PCI in selected symptomatic patients with demonstrable ischemia or viable myocardium, the decision should be individualized, incorporating anatomical feasibility, comorbidities, patient preferences, and input from a multidisciplinary Heart Team. Looking ahead, adequately powered RCTs with extended follow-up are essential to determine the long-term clinical impact of CTO-PCI on hard outcomes such as mortality and myocardial infarction. Full article

(This article belongs to the Special Issue Advances in Coronary Artery Disease)

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13 pages, 3552 KiB

Open AccessReview

Bifocal Radial Fracture/Dislocation and Distal Ulnar Fracture—A Rare Case of Proximal Forearm Instability Not Yet Classified and Literature Review

by Michele Dario Gurzì, Giacomo Capece, Guido Bocchino, Alessandro El Motassime, Rocco Maria Comodo, Massimiliano Nannerini, Giulio Maccauro and Raffaele Vitiello

J. Clin. Med. 2025, 14(13), 4694; https://doi.org/10.3390/jcm14134694 (registering DOI) - 2 Jul 2025

Abstract

Introduction: Monteggia fractures, first described by Giovanni Battista Monteggia, involve a fracture of the proximal ulna with anterior dislocation of the radial head. Bado’s 1967 classification divides these injuries into four types. Rare mixed patterns exist, overlapping with other forearm injuries such as [...] Read more.

Introduction: Monteggia fractures, first described by Giovanni Battista Monteggia, involve a fracture of the proximal ulna with anterior dislocation of the radial head. Bado’s 1967 classification divides these injuries into four types. Rare mixed patterns exist, overlapping with other forearm injuries such as Galeazzi and Essex–Lopresti lesions. These complex fractures/dislocations pose significant diagnostic and therapeutic challenges and are not adequately represented in current classification systems. Methods and Case Presentation: We report the case of a 56-year-old woman with a complex forearm injury sustained from a fall, presenting with radial head fracture/dislocation, mid-shaft radial fracture, distal ulna fracture, and ulnar collateral ligament rupture.Intraoperative imaging confirmed DRUJ stability and partial interosseous membrane disruption. Surgical management included radial head prosthesis implantation, radial shaft fixation with an anatomical locking plate, intramedullary nailing of the distal ulna, and ligament reconstruction.At two-year follow-up, the patient demonstrated full recovery of elbow flexion–extension and satisfactory forearm function. A narrative literature review was also conducted, focusing on hybrid injury variants. Results: Intraoperative examination under anesthesia revealed good elbow stability with 130° flexion, 15° extension lag, and forearm pronation/supination of 70°/60°. An initial Mayo Elbow Performance Score (MEPS) of 65 was recorded, limited by range of motion and stability. Pain during passive mobilization was mild, with a Visual Analogue Scale (VAS) score of 3/10. Postoperative recovery included 15 days of immobilization followed by structured rehabilitation. At two years, the patient regained full elbow flexion–extension but had residual deficits in pronation–supination, attributed to pre-existing conditions. Conclusions: This case illustrates a previously unreported hybrid Monteggia variant, combining features of Monteggia, Galeazzi, and Essex–Lopresti injuries. It highlights the limitations of current classification systems and supports the need for an expanded diagnostic framework. Successful management required a multidisciplinary surgical approach tailored to the injury’s complexity. Further studies are warranted to refine classification and treatment strategies for these rare combined injuries. Full article

(This article belongs to the Special Issue Current Measures for Diagnosis, Monitoring, and Outcome Assessment in Orthopedics, Traumatology, and Hand Surgery)

11 pages, 434 KiB

Open AccessArticle

An Analysis of Major Adverse Cardiovascular Events, Other Adverse Events, and Efficacy in Patients with Rheumatic Disease Receiving Targeted Therapy: Experience from a Third-Level Hospital

by Marta Rojas-Giménez, Paloma Muñoz-Reinoso, María Dolores Arcila-Durán, Virginia Moreira-Navarrete, Manuel Maqueda López, María Dolores Fernández-Alba, Rafael Ariza-Ariza, Maria Daniela Decan-Bardasz, Blanca Hernández Cruz, Francisco Javier Toyos, Dolores Virginia Mendoza Mendoza and José Javier Pérez Venegas

J. Clin. Med. 2025, 14(13), 4693; https://doi.org/10.3390/jcm14134693 (registering DOI) - 2 Jul 2025

Abstract

Objectives: We wished to evaluate the safety profile of the Janus kinase (JAK) inhibitors used in the Spanish population; to study the onset of major adverse cardiovascular events (MACEs) and thrombotic events (arterial and venous); and to analyze the factors associated with the [...] Read more.

Objectives: We wished to evaluate the safety profile of the Janus kinase (JAK) inhibitors used in the Spanish population; to study the onset of major adverse cardiovascular events (MACEs) and thrombotic events (arterial and venous); and to analyze the factors associated with the onset of these events. Methods: We conducted a retrospective observational study of a cohort of patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), and psoriatic arthritis (PsA) included in the biological therapy registry of the Rheumatology Department of Virgen Macarena University Hospital (HUVM), Seville, Spain, who started targeted treatment between 2019 and late 2024. We collected data on disease activity, traditional cardiovascular risk factors, the Charlson comorbidity index, previous synthetic or biologic drug therapy, the use of corticosteroids (and their dose), severity data (structural damage, extra-articular manifestations), and adverse events at the end of follow-up (e.g., MACEs, infections, neoplasms, and herpes zoster). We performed a descriptive bivariate analysis and a multivariate logistic regression analysis (dependent variable: MACEs) to identify factors that were independently associated with MACEs. Results: The study population comprised 137 patients (110 with RA, 18 with PsA, and 9 with SpA) who were followed up for a mean of 3.9 (2.6) years. Most patients had received JAK inhibitors as their second-line or subsequent treatment. At the end of the follow-up, 82 patients (66.7%) continued their treatment. Nine patients (6.6%) experienced a MACE, and five experienced a heart attack. All of these patients had RA. We found no differences between JAK inhibitors in terms of the incidence of the adverse events studied. Patients who experienced MACEs were more often male and smokers (current or former) and more often had hypertension and diabetes. No significant differences were found in the association with disease activity or previous or concomitant treatment. The factors that were independently associated with MACEs were a previous cardiovascular event (OR, 10.74; 95%CI, 1.05–113.7; p = 0.036), male sex (OR, 9.7; 95%CI, 1.6–76.5; p = 0.016), diabetes mellitus (OR, 10.3; 95%CI, 1.75–83; p = 0.013), and the duration of treatment with JAK inhibitors (OR, 1.47; 95%CI, 1.13–2.01; p = 0.005). Conclusions: We found no differences in the onset of adverse events, specifically MACEs, between the different JAK inhibitors analyzed. These events are more common in patients who already have cardiovascular risk factors, such as diabetes mellitus, or who have already experienced a cardiovascular event. JAK inhibitors broadly suppress cytokines in patients whose disease is refractory to other treatments. However, we must continue to evaluate their long-term safety in real-world studies. Full article

(This article belongs to the Section Cardiovascular Medicine)

12 pages, 239 KiB

Open AccessArticle

Ten Years’ Experience Using Proxymetacaine Hydrochloride 0.5% for Postoperative Pain Control in Epithelium-Off Corneal Crosslinking

by Mohamed Gamal Elghobaier, Issac Levy and Mayank A. Nanavaty

J. Clin. Med. 2025, 14(13), 4692; https://doi.org/10.3390/jcm14134692 (registering DOI) - 2 Jul 2025

Abstract

Background/Objectives: To evaluate the efficacy and safety of using the preservative-free topical proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) to control postoperative pain after epithelium-off corneal crosslinking (CXL) for keratoconus. Methods: This is an observational study [...] Read more.

Background/Objectives: To evaluate the efficacy and safety of using the preservative-free topical proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) to control postoperative pain after epithelium-off corneal crosslinking (CXL) for keratoconus. Methods: This is an observational study of patients with mild to severe keratoconus who have undergone epithelium-off CXL. CXL was completed by applying dextran-free riboflavin (0.1%) for 10 min (Vibex Rapid; Avedro, Inc.), followed by continuous UV-A light (Avedro KXL system; Avedro, Inc.) for 30 min at an intensity of 3 mW/cm² and an energy of 5.4 J/cm². All patients were prescribed postoperative proxymetacaine hydrochloride PRN with an allowed frequency of up to eight times per 24 h for the first 3 days to control postoperative pain. Patients were reviewed at 1–2 weeks postoperatively for a comprehensive examination, including assessment of delayed corneal healing, removal of the bandage contact lens, and recording of subjective symptoms. Results: There were 223 eyes of 180 patients with a mean age of 24.9 ± 8.6 years (range: 13–38 years). Male patients were 72%. At their planned first postoperative visit, we found no corneal healing abnormalities, such as persistent epithelial defects, epithelial irregularities, or early postoperative stromal haze, in any patient. All patients subjectively reported that proxymetacaine drops helped them to control postoperative pain, particularly in the first 48 h. Conclusions: None of the patients reported pain after 3 days of using proxymetacaine drops up to eight times a day for the first 3 days. It appears to be a safe and effective solution to control postoperative pain without any complications. Full article

(This article belongs to the Special Issue Advances in Anterior Segment Surgery: Second Edition)

14 pages, 6490 KiB

Open AccessArticle

Dorsal Cortical Alignment Predicts Functional Outcomes in Proximal Phalangeal Fractures Treated with Intramedullary Headless Compression Screws but Not in Metacarpal Fractures

by Bert Vanmierlo, Hans Lowyck, Charles Matthys, Tim Vanmierlo, Joris Duerinckx and Bert O. Eijnde

J. Clin. Med. 2025, 14(13), 4691; https://doi.org/10.3390/jcm14134691 (registering DOI) - 2 Jul 2025

Abstract

Background/Objectives: Intramedullary headless compression screw (IMHCS) fixation has emerged as a minimally invasive and biomechanically robust method for treating metacarpal and proximal phalangeal fractures. While the clinical outcomes are generally favorable, the impact of anatomical fracture reduction on postoperative function has not [...] Read more.

Background/Objectives: Intramedullary headless compression screw (IMHCS) fixation has emerged as a minimally invasive and biomechanically robust method for treating metacarpal and proximal phalangeal fractures. While the clinical outcomes are generally favorable, the impact of anatomical fracture reduction on postoperative function has not been systematically examined. Methods: We retrospectively analyzed 69 patients (41 metacarpal, 28 proximal phalanx) treated with IMHCSs between June 2020 and March 2025. Fractures were classified radiographically as reduced or non-reduced. Functional outcomes were assessed using the Total Active Motion (TAM) scoring system. The association between the reduction quality and TAM outcome was analyzed separately for metacarpal and proximal phalangeal fractures using the Fisher–Freeman–Halton exact test. Results: All fractures achieved radiographic union. In the metacarpal fractures, 90% of the patients attained good-to-excellent TAM scores, with no statistically significant association between the reduction quality and functional outcome (p = 0.1303). In contrast, for the proximal phalangeal fractures, anatomical reduction was significantly associated with superior TAM outcomes (p = 0.0014; Cohen’s w = 0.802). The postoperative radiographs in this group revealed smooth dorsal cortical alignment in the patients with good outcomes, suggesting preserved tendon gliding surfaces. Conclusions: Anatomical fracture reduction significantly predicts postoperative function in proximal phalangeal fractures treated with IMHCSs. In contrast, metacarpal fractures appear more tolerant of minor malalignment. These findings underscore the importance of achieving cortical continuity in phalangeal fractures to optimize digital biomechanics. A minimal open approach should be considered to ensure proper alignment during IMHCS fixation. Full article

(This article belongs to the Special Issue Current Trends in Hand Surgery)

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12 pages, 851 KiB

Open AccessArticle

Novel Oral Anticoagulants Versus Antiplatelet Therapy in Post-TAVR Patients: A Single-Center Retrospective Study

by Ricardo A. Rodriguez Mejia, Eric Acker, Vinh Dao and Humza Rana

J. Clin. Med. 2025, 14(13), 4690; https://doi.org/10.3390/jcm14134690 (registering DOI) - 2 Jul 2025

Abstract

Background: The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) remains uncertain. Limited data exist comparing novel oral anticoagulants (NOACs) with standard antiplatelet therapy in this population. Methods: We conducted a retrospective analysis of 171 patients who underwent TAVR between [...] Read more.

Background: The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) remains uncertain. Limited data exist comparing novel oral anticoagulants (NOACs) with standard antiplatelet therapy in this population. Methods: We conducted a retrospective analysis of 171 patients who underwent TAVR between January 2018 and August 2024. Patients were categorized according to the discharge antithrombotic regimen as follows: NOACs (n = 27, 16%), vitamin K antagonists (VKAs; n = 8, 5%), and antiplatelet therapy only (APT-only; aspirin and/or clopidogrel without oral anticoagulation; n = 136, 79%). Due to the small VKA sample size, the primary analysis compared NOACs with APT-only. VKA outcomes were reported descriptively without statistical comparisons. Results: Compared with APT-only, NOAC users had significantly higher 30-day mortality (33% vs. 12%, p = 0.017) and 1-year mortality (41% vs. 20%, p = 0.048). NOACs were associated with higher rates of major adverse cardiovascular events (MACCE) at 30 days (22% vs. 8%, p = 0.051) and 1 year (34% vs. 17%, p < 0.001). After inverse probability treatment weighting, NOACs showed increased odds of 30-day MACCE (OR 5.59, 95% CI 2.56–12.18, p < 0.001) and increased hazard of 1-year mortality (HR 2.22, 95% CI 1.22–4.03, p = 0.009). Conclusions: NOAC use was associated with inferior outcomes compared to antiplatelet therapy in post-TAVR patients, although residual confounding cannot be excluded. Given the limited sample size and retrospective design, these hypothesis-generating findings require validation in larger prospective studies before they can influence clinical practice. Full article

(This article belongs to the Section Cardiology)

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29 pages, 584 KiB

Open AccessOpinion

International Consensus Guidelines on the Safe and Evidence-Based Practice of Mesotherapy: A Multidisciplinary Statement

by Massimo Mammucari, Domenico Russo, Enrica Maggiori, Marco Rossi, Marzia Lugli, Raffaele Di Marzo, Alberto Migliore, Raimondo Leone, Kamil Koszela, Giustino Varrassi and On behalf of the International Expert Panel

J. Clin. Med. 2025, 14(13), 4689; https://doi.org/10.3390/jcm14134689 - 2 Jul 2025

Abstract

Introduction. Mesotherapy is a widely used technique around the world. However, there is currently no internationally recognized, evidence-based standard for its various clinical applications. To address this gap, we have reviewed the current state of the art, critically evaluated its clinical benefits and [...] Read more.

Introduction. Mesotherapy is a widely used technique around the world. However, there is currently no internationally recognized, evidence-based standard for its various clinical applications. To address this gap, we have reviewed the current state of the art, critically evaluated its clinical benefits and limitations, and proposed a set of standards including procedural steps, recommended actions, and practical instructions in the form of protocols, guidelines, and expert recommendations. Methods. A team of researchers conducted a comprehensive literature review, selecting studies published between 1976 and 2023. Drawing on the available evidence and the needs expressed by patient associations, 23 clinical questions were developed and presented to a panel of experts. Through multiple rounds of evaluation, evidence-based recommendations were formulated and subsequently submitted for structured evaluation and voting by a broad, multidisciplinary panel of international experts, representing numerous national and international scientific societies. Results. The recommendations outlined in this guideline support the use of mesotherapy across diverse clinical and organizational settings, providing a standardized framework that ensures both efficacy and patient safety in osteoarticular pain, rehabilitation, and dermatological fields. Conclusions. The era of mesotherapy based on personal beliefs now gives way to evidence-based practice. The limitations underscore the need for continued high-quality research and scheduled guideline updates. Full article

(This article belongs to the Section Anesthesiology)

19 pages, 586 KiB

Open AccessSystematic Review

Upper Eyelid Static Surgical Approaches for the Treatment of Facial Palsy-Induced Lagophthalmos: A Systematic Review

by Giovanni Ottonelli, Jacopo Celada Ballanti, Alessandro Gaeta, Gianmaria Barone, Novella Montericcio and Alessandra Di Maria

J. Clin. Med. 2025, 14(13), 4688; https://doi.org/10.3390/jcm14134688 (registering DOI) - 2 Jul 2025

Abstract

Background: Incomplete eyelid closure and lagophthalmos due to facial nerve palsy are significant functional and aesthetic concerns often requiring surgical correction. The aim of this systematic review is to quantitatively assess the efficacy, safety, and patient satisfaction associated with gold or platinum [...] Read more.

Background: Incomplete eyelid closure and lagophthalmos due to facial nerve palsy are significant functional and aesthetic concerns often requiring surgical correction. The aim of this systematic review is to quantitatively assess the efficacy, safety, and patient satisfaction associated with gold or platinum weight implantation, autologous fat grafting (lipofilling), and müllerectomy. Methods: A systematic review was performed following PRISMA guidelines, searching PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to March 2025. Studies included clinical data on surgical correction for incomplete eyelid closure in facial palsy, reporting functional, anatomical, and satisfaction outcomes. Quality was assessed using the Newcastle–Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Twenty-six studies including a total of 1205 patients were included. Gold/platinum weight implantation achieved complete or near-complete eyelid closure in 83–92% of cases, with a reduction in lagophthalmos to <1 mm. Complication rates ranged from 5–15% (mainly extrusion/migration), and patient satisfaction averaged 7.9/10. Lipofilling showed persistent benefit in 77% of cases, with 9–20% requiring repeat procedures and 10–12% experiencing minor complications. Müllerectomy yielded symptomatic improvement or resolution in 92% of cases, with a mean lagophthalmos reduction of 1.18 mm. Conclusions: Gold or platinum weight implantation provides the most reliable improvement for severe upper eyelid dysfunction in facial palsy. Lipofilling is a viable autologous alternative, while müllerectomy is effective in selected cases. Further prospective comparative trials are needed to refine surgical selection and optimize outcomes. Full article

(This article belongs to the Section Ophthalmology)

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14 pages, 539 KiB

Open AccessArticle

Association of Epicardial Adipose Tissue with Novel Inflammation and Heart Failure Biomarkers in Type 2 Diabetes Patients: Effect of Metabolic Control

by Pedro Gil-Millan, José Rives, David Viladés, Álvaro García-Osuna, Idoia Genua, Inka Miñambres, Margarita Grau-Agramunt, Ignasi Gich, Mercedes Camacho, Sonia Benitez, Josep Julve, José Luis Sánchez-Quesada and Antonio Pérez

J. Clin. Med. 2025, 14(13), 4687; https://doi.org/10.3390/jcm14134687 - 2 Jul 2025

Abstract

Background: Type 2 diabetes (T2D patients) have a 74% increased risk of heart failure (HF), but traditional HF biomarkers lack sensitivity in early disease detection. Increased epicardial adipose tissue volume (EATv) is associated with cardiovascular risk in T2D, and novel biomarkers such [...] Read more.

Background: Type 2 diabetes (T2D patients) have a 74% increased risk of heart failure (HF), but traditional HF biomarkers lack sensitivity in early disease detection. Increased epicardial adipose tissue volume (EATv) is associated with cardiovascular risk in T2D, and novel biomarkers such as growth differentiation factor 15 (GDF15), Galectin-3, and soluble suppression of tumorigenicity 2 (sST2) are inflammation biomarkers linked to HF. Methods: We investigated associations between EATv, inflammation biomarkers, and the effect of metabolic control in 14 healthy controls (HCs) and 36 newly diagnosed T2D patients both before (poor glycemic control, PGC) and after 12 months of glycemic optimization (good glycemic control, GGC). EATv indexed to body surface area (iEATv) was quantified by multidetector computed tomography, and biomarker levels were measured by immunoassays. Results: PGC patients had higher iEATv (59.53 ± 21.67 vs. 36.84 ± 16.57 cm³/m², p = 0.0017) and elevated GDF15, Galectin-3, and sST2 levels (all p < 0.05) than HC subjects. The glycemic optimization reduced iEATv (p = 0.0232) and sST2 (p = 0.048), while GDF15 and Galectin-3 remained unchanged. Multivariable analysis confirmed independent associations between iEATv, GDF15 (β = 0.27, p = 0.027) and sST2 (β = 0.29, p = 0.02). Conclusions: These results support the link between systemic inflammation, EAT expansion, and cardiac dysfunction, and they point to the role of epicardial fat in early HF risk of T2D patients. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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14 pages, 2428 KiB

Open AccessArticle

Machine Learning Models for Pancreatic Cancer Survival Prediction: A Multi-Model Analysis Across Stages and Treatments Using the Surveillance, Epidemiology, and End Results (SEER) Database

by Aditya Chakraborty and Mohan D. Pant

J. Clin. Med. 2025, 14(13), 4686; https://doi.org/10.3390/jcm14134686 - 2 Jul 2025

Abstract

Background: Pancreatic cancer is among the most lethal malignancies, with poor prognosis and limited survival despite treatment advances. Accurate survival modeling is critical for prognostication and clinical decision-making. This study had three primary aims: (1) to determine the best-fitting survival distribution among patients [...] Read more.

Background: Pancreatic cancer is among the most lethal malignancies, with poor prognosis and limited survival despite treatment advances. Accurate survival modeling is critical for prognostication and clinical decision-making. This study had three primary aims: (1) to determine the best-fitting survival distribution among patients diagnosed and deceased from pancreatic cancer across stages and treatment types; (2) to construct and compare predictive risk classification models; and (3) to evaluate survival probabilities using parametric, semi-parametric, non-parametric, machine learning, and deep learning methods for Stage IV patients receiving both chemotherapy and radiation. Methods: Using data from the SEER database, parametric models (Generalized Extreme Value, Generalized Pareto, Log-Pearson 3), semi-parametric (Cox), and non-parametric (Kaplan–Meier) methods were compared with four machine learning models (gradient boosting, neural network, elastic net, and random forest). Survival probability heatmaps were constructed, and six classification models were developed for risk stratification. ROC curves, accuracy, and goodness-of-fit tests were used for model validation. Statistical tests included Kruskal–Wallis, pairwise Wilcoxon, and chi-square. Results: Generalized Extreme Value (GEV) was found to be the best-fitting distribution in most of the scenarios. Stage-specific survival differences were statistically significant. The highest predictive accuracy (AUC: 0.947; accuracy: 56.8%) was observed in patients receiving both chemotherapy and radiation. The gradient boosting model predicted the most optimistic survival, while random forest showed a sharp decline after 15 months. Conclusions: This study emphasizes the importance of selecting appropriate analytical models for survival prediction and risk classification. Adopting these innovations, with the help of advanced machine learning and deep learning models, can enhance patient outcomes and advance precision medicine initiatives. Full article

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

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11 pages, 586 KiB

Open AccessArticle

The Safety of Apixaban Compared to Warfarin in Hospitalized Patients with Acute Kidney Injury

by Majed S. Al Yami, Lama Alfehaid, Abdulmajeed M. Alshehri, Norah Alqahtani, Ghadah Almuaither, Shaden H. Alonazi, Mohammed Y. Alzahrani, Amal M. Badawoud and Omar A. Almohammed

J. Clin. Med. 2025, 14(13), 4685; https://doi.org/10.3390/jcm14134685 - 2 Jul 2025

Abstract

Background/Objectives: Apixaban is favored over warfarin for atrial fibrillation (Afib) and venous thromboembolism (VTE) due to its effectiveness, safety, and lack of routine monitoring. However, managing anticoagulation in hospitalized patients with acute kidney injury (AKI) is challenging due to altered pharmacokinetics and [...] Read more.

Background/Objectives: Apixaban is favored over warfarin for atrial fibrillation (Afib) and venous thromboembolism (VTE) due to its effectiveness, safety, and lack of routine monitoring. However, managing anticoagulation in hospitalized patients with acute kidney injury (AKI) is challenging due to altered pharmacokinetics and limited safety data. This study assesses the safety and efficacy of apixaban versus warfarin in these patients. Methods: This retrospective chart review at King Abdulaziz Medical City in Riyadh included adult patients (≥18 years) with AKI, as defined by the Kidney Disease Improving Global Outcome (KDIGO) guideline. Primary outcomes were rates of major and minor bleeding within 30 days, as defined by the International Society on Thrombosis and Haemostasis (ISTH), and thrombotic events. Secondary outcomes included 30-day rates of all-cause mortality and hospital readmissions. Results: Among 513 patients, 294 received apixaban and 219 received warfarin. Major bleeding within 30 days was significantly lower in the apixaban group (3.4%) compared to warfarin (7.3%) (p = 0.0461). Minor bleeding rates were similar (6.5% apixaban vs. 5.5% warfarin; p = 0.616). Thrombotic events occurred in 6.8% of patients, with no significant difference between apixaban (6.5%) and warfarin (7.3%) (p = 0.739). Mortality rates were 8.0%, with no significant difference (8.8% apixaban vs. 6.8% warfarin; p = 0.3846). Readmission rates were comparable (38.8% for apixaban vs. 39.7% for warfarin; p = 0.9499). Conclusions: In hospitalized AKI patients, apixaban was associated with a lower major bleeding risk compared to warfarin, with similar rates of thrombotic events, mortality, and readmissions, suggesting apixaban may be a safer option, warranting further research. Full article

(This article belongs to the Special Issue Thromboembolic Disease and Antithrombotic Therapy)

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12 pages, 3247 KiB

Open AccessArticle

Changes of Knee Phenotypes Following Osteotomy Around the Knee in Patients with Valgus or Varus Deformities—A Retrospective Cross-Sectional Study

by Jennyfer A. Mitterer, Stephanie Huber, Matthias Pallamar, Sebastian Simon, Jan Nolte, Catharina Chiari and Jochen G. Hofstaetter

J. Clin. Med. 2025, 14(13), 4684; https://doi.org/10.3390/jcm14134684 - 2 Jul 2025

Abstract

Background: Osteotomies around the knee aim to correct varus or valgus malalignment and improve biomechanics. However, little is known about their effect on knee phenotypes, as defined by the Coronal-Plane-Alignment-of-the-Knee (CPAK) and Hirschmann’s functional classification. This study evaluated pre- and postoperative phenotypes in [...] Read more.

Background: Osteotomies around the knee aim to correct varus or valgus malalignment and improve biomechanics. However, little is known about their effect on knee phenotypes, as defined by the Coronal-Plane-Alignment-of-the-Knee (CPAK) and Hirschmann’s functional classification. This study evaluated pre- and postoperative phenotypes in patients undergoing high-tibial-osteotomy (HTO) or distal-femoral-osteotomy (DFO). Methods: We retrospectively analysed 214 osteotomies around the knee (HTO: 145; DFO: 69) of 188 patients from our institutional registry. Radiographic parameters were measured using a validated artificial intelligence software, with phenotypes classified by CPAK and Hirschmann classification. Preoperative osteotomy planning was compared to postoperative alignment. Regression was used to assess the influence of demographic and radiographic factors. Results: CPAK types changed in 95.3% of cases. Medial opening HTOs most frequently shifted from CPAK type I (73.8%) to VI (42.3%), while medial closing DFOs transitioned from type III (81.5%) to V (24.1%). Concordance between planned and achieved CPAK types was highest for types III, IV, and V. Postoperative angles were generally smaller than planned for joint-line-obliquity (JLO), lateral-distal-femur-angle, and medial-proximal-tibial-angle (p < 0.001). Neutral JLO was restored in only 48.1%. Preoperative phenotypes NEUmLDFA0° (40.1%) and VARmMPTA3° (32.3%) were most common, while postoperative phenotypes included VALmLDFA3° (52.4%) and VALmMPTA3° (37.7%). Age, sex, and BMI significantly influenced alignment outcomes. Conclusions: Postoperative CPAK classifications shifted significantly across all osteotomy types, with minimal retention of preoperative types. Although most procedures achieved correction within the target HKA range, restoration of a neutral JLO was observed in only half of the cases, emphasizing the importance of phenotype-specific planning and highlight potential limitations of CPAK classification. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 2590 KiB

Open AccessArticle

Factors Associated with Changes in Skeletal Muscle Mass in Medical Health Checkups

by Saori Onishi, Akira Fukuda, Masahiro Matsui, Kosuke Ushiro, Tomohiro Nishikawa, Akira Asai, Soo Ki Kim, Sachiyo Yoshio and Hiroki Nishikawa

J. Clin. Med. 2025, 14(13), 4683; https://doi.org/10.3390/jcm14134683 - 2 Jul 2025

Abstract

Background/Objectives: To explore the factors associated with changes in skeletal muscle mass among Japanese health checkup subjects (5214 men and 6614 women). Methods: Fat-free index (FF index) was defined as FF mass divided by height squared (kg/m²). Change rate in FF [...] Read more.

Background/Objectives: To explore the factors associated with changes in skeletal muscle mass among Japanese health checkup subjects (5214 men and 6614 women). Methods: Fat-free index (FF index) was defined as FF mass divided by height squared (kg/m²). Change rate in FF index (kg/m²/year) was defined as [FF index (second time) − FF index (first time (i.e., baseline))]/interval between first and second times (years). Factors associated with change rate in FF index >0 kg/m²/year were primarily examined. Results: The average age, body mass index (BMI) were 52.4 years and 23.9 kg/m² for men, and 50.5 years and 21.8 kg/m² for women. In the multivariate analyses, age (p < 0.0001), body mass index (BMI, p < 0.0001), baseline FF index (p < 0.0001), waist circumference (p = 0.0365), fasting blood sugar (FBS, p = 0.0012), alanine aminotransferase (p < 0.0001) and alcohol intake were found to be significant in men, while BMI (p < 0.0001), baseline FF index (p < 0.0001), triglyceride (p = 0.0031), FBS (p = 0.0064) and alcohol intake were found to be significant in women. Conclusions: Lifestyle guidance from various aspects including metabolic factors may be important to maintain skeletal muscle mass. Full article

(This article belongs to the Section Clinical Nutrition & Dietetics)

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12 pages, 535 KiB

Open AccessArticle

Prevalence of Autonomic Dysfunction and Correlation with Markers of Disease Severity in Cardiac Amyloidosis

by Michael Poledniczek, Konstantin Hölzl, Christina Kronberger, Nikita Ermolaev, Lena Marie Schmid, René Rettl, Christina Binder, Luciana Camuz Ligios, Mahshid Eslami, Christian Hengstenberg, Roza Badr Eslam, Jutta Bergler-Klein, Johannes Kastner, Andreas Anselm Kammerlander and Franz Duca

J. Clin. Med. 2025, 14(13), 4682; https://doi.org/10.3390/jcm14134682 - 2 Jul 2025

Abstract

Background: Transthyretin amyloidosis is a multi-system disease that may manifest as cardiomyopathy (ATTR-CM) and/or polyneuropathy. Both disease manifestations are associated with autonomic dysfunction. However, the prevalence of autonomic dysfunction in ATTR-CM remains to be evaluated. Methods: Within the scope of a [...] Read more.

Background: Transthyretin amyloidosis is a multi-system disease that may manifest as cardiomyopathy (ATTR-CM) and/or polyneuropathy. Both disease manifestations are associated with autonomic dysfunction. However, the prevalence of autonomic dysfunction in ATTR-CM remains to be evaluated. Methods: Within the scope of a prospective ATTR-CM registry, the Composite Autonomic Symptom Score-31 (COMPASS-31) questionnaire was applied to consecutive patients between November 2022 and November 2024. Baseline characteristics are described, and associations of the COMPASS-31 score with markers of disease severity were assessed. Kaplan–Meier analysis was utilized to assess the COMPASS-31 score’s association with a combined endpoint of all-cause mortality and heart failure-related hospitalizations. Results: A total of 129 ATTR-CM patients [81.7 years (IQR: 77.4–84.3), 108 male (83.7%)] were included in the final study cohort. After stratification using the COMPASS-31 median [14 points, interquartile range (IQR): 6–29], statistically significant differences with regard to New York Heart Association (NYHA) stage and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were observed. Furthermore, the COMPASS-31 score was moderately correlated with the KCCQ score in Spearman correlation analysis (r = −0.55, p < 0.001). The primary endpoint occurred in 16 patients (13 HF-hospitalizations/3 deaths) after 6.3 (IQR: 2.8–17.1) months. In Kaplan–Meier analysis, a COMPASS-31 score above the median of 14 was also associated with the primary endpoint of all-cause mortality and HF-related hospitalization (log-rank p = 0.047). Conclusions: Autonomic dysfunction is highly prevalent in ATTR-CM, affecting almost two-thirds of patients. As the presence of autonomic dysfunction is likely associated with more severely impaired quality of life, routine screening for this disease manifestation of transthyretin amyloidosis may be advisable. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)

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17 pages, 1321 KiB

Open AccessReview

Emerging Trends in Endoscopic Bariatric Therapies: Personalization Through Genomics and Synergistic Pharmacotherapy

by Wissam Ghusn, Annika Divakar, Yara Salameh, Kamal Abi Mosleh and Andrew C. Storm

J. Clin. Med. 2025, 14(13), 4681; https://doi.org/10.3390/jcm14134681 - 2 Jul 2025

Abstract

Obesity is a major global health challenge associated with significant metabolic and gastrointestinal comorbidities. While metabolic and bariatric surgery remains the gold standard for durable weight loss, the desire for additional options has fueled the development of endoscopic bariatric therapies (EBTs) as another [...] Read more.

Obesity is a major global health challenge associated with significant metabolic and gastrointestinal comorbidities. While metabolic and bariatric surgery remains the gold standard for durable weight loss, the desire for additional options has fueled the development of endoscopic bariatric therapies (EBTs) as another tool for weight loss. This review examines established EBTs, including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGBs), and transoral outlet reduction (TORe), alongside emerging therapies such as duodenal mucosal resurfacing (DMR), incisionless anastomosis creation, and fully automated endoscopic gastric remodeling systems. ESG has demonstrated durable weight loss, favorable safety, and superior cost-effectiveness compared to pharmacotherapy alone, while combination strategies using EBTs and anti-obesity medications (AOMs), particularly GLP-1 receptor agonists, have resulted in greater total-body weight loss than either modality alone. Genetic variation, particularly within the leptin–melanocortin pathway, may predict response to endoscopic interventions and guide personalized treatment selection. Novel investigational procedures such as DMR, automated or robotic gastric remodeling, and magnetic or ultrasound-assisted gastric bypass show promising early results. Endoscopic therapies are poised to become increasingly central to the personalized, scalable management of obesity and related metabolic diseases. Full article

(This article belongs to the Special Issue Differential Effects of Bariatric Surgery (BS) and Endoscopic Bariatric Therapy (EBT) on Long and Short-Term Metabolic Outcomes)

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14 pages, 1354 KiB

Open AccessArticle

Mean Corpuscular Volume Is Correlated with Liver Fibrosis Defined by Noninvasive Blood Biochemical Indices in Individuals with Metabolic Disorders Aged 60 Years or Older

by Yousuke Kaneko, Yutaka Kawano, Saki Kawata, Kensuke Mori, Minae Hosoki, Taiki Hori, Kohsuke Miyataka, Seijiro Tsuji, Tomoyo Hara, Hiroki Yamagami, Toshiki Otoda, Tomoyuki Yuasa, Akio Kuroda, Takeshi Harada, Hirokazu Miki, Shingen Nakamura, Itsuro Endo, Munehide Matsuhisa, Ken-ichi Matsuoka and Ken-ichi Aihara

J. Clin. Med. 2025, 14(13), 4680; https://doi.org/10.3390/jcm14134680 - 2 Jul 2025

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) causes progressive liver fibrosis. Although erythrocyte mean corpuscular volume (MCV) has been shown to have a positive correlation with all-cause mortality, the association between MCV and the development of MASLD has not been fully elucidated. Here, [...] Read more.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) causes progressive liver fibrosis. Although erythrocyte mean corpuscular volume (MCV) has been shown to have a positive correlation with all-cause mortality, the association between MCV and the development of MASLD has not been fully elucidated. Here, we examined the clinical significance of the association between MCV and MASLD. Methods: A cross-sectional study was carried out in 1009 Japanese individuals (including 186 individuals aged < 60 years and 823 individuals aged ≥ 60 years) with metabolic disorders. The relationships between MCV and noninvasive clinical markers of liver fibrosis, including fibrosis-4 (FIB-4) index, aspartate aminotransferase-to-platelet ratio index (APRI), and non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS), were statistically evaluated. Results: Using multiple and logistic regression analyses in overall subjects, it was found that MCV was positively and independently associated with the values of FIB-4 index, APRI, NFS, and the prevalence of liver fibrosis defined by each index. However, the associations between the MCV value and MASLD indices were found to be positive in subjects aged ≥ 60 years but not in those aged < 60 years. Conclusions: MCV might be a simple and useful biomarker for the development of MASLD in the elderly. Full article

(This article belongs to the Section Hematology)

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