Journal of Clinical Medicine

13 pages, 2915 KiB

Open AccessArticle

Superficial vs. Deep Venous System in DIEP Flaps: Lessons from 25 Years of CTA-Guided Planning

by Ferruccio Paganini, Sara Matarazzo, Beatrice Corsini, Elvio De Fiori, Andrea Manconi, Luigi Valdatta, Valeria Navach and Cristina Garusi

J. Clin. Med. 2025, 14(17), 5972; https://doi.org/10.3390/jcm14175972 (registering DOI) - 24 Aug 2025

Abstract

Background: Venous congestion is a major contributor to complications in DIEP flap breast reconstruction. Beyond superficial venous dominance, the presence or absence of anatomical connections between the superficial and deep venous systems may influence drainage physiology. This study investigates how preoperative CTA [...] Read more.

Background: Venous congestion is a major contributor to complications in DIEP flap breast reconstruction. Beyond superficial venous dominance, the presence or absence of anatomical connections between the superficial and deep venous systems may influence drainage physiology. This study investigates how preoperative CTA and targeted superdrainage impact outcomes over a 25-year period. Patients and Methods: A retrospective analysis was conducted on 208 DIEP flaps performed from 2000 to 2024 at a single center. From 2006, computed tomographic angiography (CTA) was routinely used to evaluate venous anatomy, focusing on the presence, trajectory, and connection of the superficial inferior epigastric vein (SIEV) with the deep system. Superdrainage was performed when superficial venous dominance was evident or drainage was judged insufficient intraoperatively. Primary outcomes included venous congestion, partial necrosis, and reoperations; secondary outcomes included hospital stay and safety of superdrainage. Results: Venous complications decreased significantly after CTA implementation (37.5% vs. 8.0%; p < 0.001). Superdrainage was performed in 40.9% of post-CTA cases, with 90% preoperatively planned based on CTA findings. No complications were associated with second venous anastomosis. Flap outcomes correlated not with perforator number or flap size but with venous drainage physiology. Mean hospital stay was shorter post-CTA (6 vs. 9 days; p < 0.001). Conclusions: Evaluating the anatomical connection between superficial and deep venous systems via CTA enhances venous planning and allows for safer, physiology-driven decisions. In the absence of such connections, intraoperative evaluation remains essential. Drainage physiology—rather than anatomical metrics alone—should guide surgical strategy in DIEP flap reconstruction. Full article

(This article belongs to the Special Issue Clinical Advances of Breast Surgery and Reconstruction)

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18 pages, 725 KiB

Open AccessArticle

Diagnostic Yield of the New Bárány Society Criteria for Pediatric Episodic Vestibular Syndrome

by Mar Rey-Berenguel, Javier Vallecillo-Zorrilla, Edith Karelly Burgueño-Uriarte, María del Carmen Olvera-Porcel and Juan Manuel Espinosa-Sanchez

J. Clin. Med. 2025, 14(17), 5971; https://doi.org/10.3390/jcm14175971 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: Pediatric episodic vestibular syndrome (EVS) is increasingly recognized, with recurrent vertigo of childhood (RVC) and vestibular migraine of childhood (VMC) being the most prevalent disorders. In 2021, the Bárány Society and the International Headache Society proposed new diagnostic criteria for RVC, [...] Read more.

Background/Objectives: Pediatric episodic vestibular syndrome (EVS) is increasingly recognized, with recurrent vertigo of childhood (RVC) and vestibular migraine of childhood (VMC) being the most prevalent disorders. In 2021, the Bárány Society and the International Headache Society proposed new diagnostic criteria for RVC, VMC, and probable VMC (pVMC), replacing the older term benign paroxysmal vertigo (BPV). This study aimed to evaluate the clinical applicability of these new criteria. Methods: We conducted a cross-sectional study at a pediatric neurotology clinic within a tertiary hospital, including patients under 18 years with episodic vestibular symptoms evaluated between 2018 and 2025. All patients underwent a standardized neuro-otological assessment. Diagnoses were assigned using both the 2018 ICHD-3 and the 2021 Bárány criteria. Patients who did not fulfill any of the three new diagnostic categories, nor met criteria for any other specific vestibular disorder, were grouped into an undetermined category referred to as episodic vestibular syndrome without hearing loss (EVSw/oHL). Demographic and clinical variables were compared across diagnostic groups using non-parametric and chi-squared tests. Results: Among the 202 children evaluated, 109 met the inclusion criteria and were classified as RVC (n = 55), VMC (n = 23), pVMC (n = 13), or EVSw/oHL (n = 18). All patients previously diagnosed with BPV met the new criteria for RVC. Application of the Bárány criteria significantly reduced the proportion of unclassified EVS cases (from 35.78% to 16.51%). Significant clinical differences were observed among the groups in terms of episode duration, presence of vomiting, migraine and headache, and family history of migraine. Conclusions: The new Bárány criteria provide a more inclusive and clinically meaningful framework for classifying pediatric EVS. They improve diagnostic clarity, reduce the proportion of unclassifiable cases, and support earlier and more tailored management strategies. Full article

(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Vestibular Disorders—2nd Edition)

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10 pages, 641 KiB

Open AccessStudy Protocol

Sport-Based Exercise in Pediatric Acquired Brain Injury: Protocol for a Randomized Controlled Trial

by Andrea Gutiérrez-Suárez, Marta Pérez-Rodríguez, Agurtzane Castrillo and Javier Pérez-Tejero

J. Clin. Med. 2025, 14(17), 5970; https://doi.org/10.3390/jcm14175970 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for [...] Read more.

Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for multidimensional interventions grounded in the International Classification of Functioning, Disability and Health (ICF). Sport-based exercise interventions, when developmentally adapted and tailored to individual interests, may promote intrinsic motivation, peer connection, and sustainable engagement—factors especially relevant in pediatric ABI populations, who often experience reduced physical activity and social isolation. However, standardized, replicable protocols specifically tailored to this population remain scarce. This study presents the protocol for a randomized controlled trial evaluating the effects of a 16-week sport-based intervention on QoL, social participation, physical activity engagement, and motor functioning tailored for adolescents with pediatric ABI. Methods: Participants will be randomly assigned to an intervention group or a control group receiving usual care. The intervention consists of one weekly 60-minute session, led by trained professionals in adapted physical activity and pediatric neurorehabilitation. It combines sport-based motor skill training, cooperative games, and group activities specifically tailored to each child’s developmental level, motor abilities, and preferences. Outcomes will be assessed at baseline and following the 16-week intervention period, focusing on QoL, participation, physical activity engagement, and motor functioning. Discussion: This study introduces a structured, child-centered model that bridges clinical rehabilitation and community-based sport. By integrating motor and psychosocial targets through a group sport-based intervention, it aims to enhance recovery across ICF domains. Findings may inform interdisciplinary practice and support the development of sustainable strategies to promote long-term engagement and well-being in adolescents with ABI. Full article

(This article belongs to the Special Issue Clinical Advances in Traumatic Brain Injury)

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15 pages, 530 KiB

Open AccessArticle

Association of Shift Work, Health Behaviors, and Socioeconomic Status with Diabesity in over 53,000 Spanish Employees

by Javier Tosoratto, Pedro Juan Tárraga López, Ángel Arturo López-González, Joan Obrador de Hevia, Carla Busquets-Cortés and José Ignacio Ramírez-Manent

J. Clin. Med. 2025, 14(17), 5969; https://doi.org/10.3390/jcm14175969 (registering DOI) - 23 Aug 2025

Abstract

Background: Diabesity, the coexistence of obesity and type 2 diabetes, is a major public health concern. Shift work and unhealthy lifestyle behaviors may exacerbate its prevalence, particularly in working populations. Objective: This study aims to evaluate the association between sociodemographic characteristics, [...] Read more.

Background: Diabesity, the coexistence of obesity and type 2 diabetes, is a major public health concern. Shift work and unhealthy lifestyle behaviors may exacerbate its prevalence, particularly in working populations. Objective: This study aims to evaluate the association between sociodemographic characteristics, health behaviors, and shift work and the prevalence of diabesity, using both BMI and the CUN-BAE estimator, in a large cohort of Spanish workers. Methods: This cross-sectional study included 53,053 workers (59.8% men) aged 18–69 years who underwent occupational health examinations. Diabesity was defined as obesity (BMI ≥ 30 kg/m² or high CUN-BAE) plus fasting glucose ≥ 100 mg/dL or prior diagnosis of diabetes. Adherence to the Mediterranean diet was assessed by the MEDAS questionnaire, physical activity by the IPAQ, alcohol intake by standard drink units (UBEs), and socioeconomic class by the CNAE-11 classification. Shift work was defined according to ILO criteria. Logistic regression was used to assess associations, adjusting for potential confounders. Results: Shift work was independently associated with increased odds of diabesity both in men and women. Diabesity prevalence was higher when assessed by CUN-BAE compared with BMI. Age, male sex, lower socioeconomic class, physical inactivity, smoking, poor diet adherence, and alcohol intake were all significantly associated with higher risk. The CUN-BAE index showed superior sensitivity in identifying individuals at risk. Conclusions: Shift work and unhealthy behaviors are key determinants of diabesity among Spanish workers. The use of adiposity estimators beyond BMI, such as CUN-BAE, should be encouraged in occupational health surveillance. Workplace-targeted interventions are urgently needed to address this growing metabolic burden. Full article

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

18 pages, 2743 KiB

Open AccessArticle

Sex Differences in Seasonal Variation in Metabolic Syndrome and Its Components: A 10-Year National Health Screening Study

by Hyun-Sun Kim, Hyun-Jin Kim, Dongwoo Kang and Jungkuk Lee

J. Clin. Med. 2025, 14(17), 5968; https://doi.org/10.3390/jcm14175968 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: Metabolic syndrome (MetS) comprises a cluster of cardiometabolic risk factors that vary dynamically under environmental and behavioral influences. Although there are data suggesting seasonal variability in individual metabolic components, few studies have comprehensively assessed MetS as a composite condition across seasons [...] Read more.

Background/Objectives: Metabolic syndrome (MetS) comprises a cluster of cardiometabolic risk factors that vary dynamically under environmental and behavioral influences. Although there are data suggesting seasonal variability in individual metabolic components, few studies have comprehensively assessed MetS as a composite condition across seasons using a large, nationally representative population. In this study, we aimed to evaluate the seasonal and monthly patterns of MetS prevalence and component burden, with a focus on sex-specific differences. Methods: We analyzed 5,507,251 health screening records from 2,057,897 Korean adults aged ≥40 years between 2013 and 2022, obtained from the National Health Insurance Service database. Seasons were categorized as: spring (March–May), summer (June–August), fall (September–November), and winter (December–February). Trends in MetS prevalence and its components were evaluated monthly and seasonally, stratified by sex. Results: MetS prevalence significantly varied by season in both sexes (p < 0.001), ranging from 30.2% to 34.5% in men and from 21.5% to 25.5% in women. Among men, a U-shaped pattern was observed, with the lowest prevalence during summer and a progressive increase through winter. Women showed a steady decline in prevalence from January to September, followed by a slight rebound. Winter was associated with increased odds of MetS in both sexes. A significant interaction between sex and season (p for interaction <0.001) indicated the presence of sex-specific temporal patterns. Conclusions: This nationwide study revealed clear seasonal variation in MetS prevalence and component burden, with sex-specific patterns. These findings highlight the importance of incorporating seasonality and sex in cardiometabolic risk assessments and public health interventions. Full article

(This article belongs to the Special Issue Cardiometabolic Disease and Atherosclerosis: Epidemiology, Prevention, Diagnosis, and Clinical Treatment)

14 pages, 1722 KiB

Open AccessArticle

Pediatric Drug Poisoning in Vojvodina, Serbia: A Retrospective Observational Clinical and Toxicological Assessment

by Jovan Baljak, Aleksandra Stojadinović, Dragan Zečević, Maja Đurendić-Brenesel, Nikša Ajduković, Dušan Vapa, Miljana Poparić, David Strilić, Nataša Tomić and Aleksandar Rašković

J. Clin. Med. 2025, 14(17), 5967; https://doi.org/10.3390/jcm14175967 (registering DOI) - 23 Aug 2025

Abstract

Objectives: Acute drug poisoning represents a significant public health issue among the pediatric population. The aim of this study was to evaluate the characteristics of drug poisoning in children and adolescents in the Vojvodina region from 2018 to 2023. Methods: In a retrospective [...] Read more.

Objectives: Acute drug poisoning represents a significant public health issue among the pediatric population. The aim of this study was to evaluate the characteristics of drug poisoning in children and adolescents in the Vojvodina region from 2018 to 2023. Methods: In a retrospective observational study, 82 patients with confirmed drug poisoning were included, and data was collected regarding demographic characteristics, clinical manifestations, types of drugs involved, and the therapeutic interventions administered. The severity of poisonings was evaluated using the Poisoning Severity Score, and toxicological analysis was performed using gas chromatography–mass spectrometry. Results: The results indicated that poisonings were most prevalent in adolescent girls (72%), with 78% of cases resulting from intentional poisoning, while unintentional poisoning was more common in children. Benzodiazepines, antipsychotics, and analgesics were the primary drugs causing these poisoning incidents. The majority of patients (78%) experienced mild clinical symptoms, whereas 9% of pediatric patients suffered from severe poisoning, related to complications such as aspiration pneumonia and acute renal failure. Addressing pediatric drug poisoning in Vojvodina requires an increased focus on preventive strategies, including parental education and appropriate psychosocial support for the youth. Conclusions: Through collaborative efforts among healthcare providers, educators, and policymakers, prevention, treatment, and support mechanisms can be enhanced to combat this pressing public health challenge. Full article

(This article belongs to the Special Issue Innovations and Challenges in Clinical Toxicology and Therapeutic Drug Monitoring)

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20 pages, 3529 KiB

Open AccessSystematic Review

The Effects of Whole-Body Vibration on Spasticity in Stroke: A Systematic Review and Meta-Analysis

by Jeong-Woo Seo, Jung-Dae Kim and Ji-Woo Seok

J. Clin. Med. 2025, 14(17), 5966; https://doi.org/10.3390/jcm14175966 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: Spasticity is a common and disabling sequela of stroke that limits voluntary movement and functional recovery. Vibration therapy (VT) has been proposed as a non-invasive neuromodulatory intervention, but the existing studies report inconsistent outcomes due to methodological heterogeneity. This study aimed [...] Read more.

Background/Objectives: Spasticity is a common and disabling sequela of stroke that limits voluntary movement and functional recovery. Vibration therapy (VT) has been proposed as a non-invasive neuromodulatory intervention, but the existing studies report inconsistent outcomes due to methodological heterogeneity. This study aimed to evaluate the overall effectiveness of VT in reducing post-stroke spasticity and to identify optimal stimulation parameters via meta-analytic and meta-regression approaches. Methods: A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines. Standardized effect sizes (Hedges’ g) were calculated based on the within-group pre–post changes and compared across the groups. Meta-regression and subgroup analyses explored seven potential moderators, including the vibration frequency, amplitude, and time since stroke onset. Results: Thirteen randomized controlled trials (RCTs) involving whole-body or focal vibration interventions in stroke populations were included. Vibration therapy significantly reduced spasticity, yielding a moderate overall effect size (Hedges’ g = −0.50; 95% CI: −0.65 to −0.34; p < 0.001). The greatest treatment effects were observed when VT was applied during the late subacute to early chronic phase (6–12 months post-stroke), with low-frequency (<20 Hz) and low-amplitude (≤0.5 mm) stimulation. The frequency, amplitude, and stroke onset emerged as significant moderators (p < 0.05). Conclusions: Vibration therapy is an effective and clinically meaningful intervention for post-stroke spasticity, particularly when delivered with low-intensity parameters during the optimal recovery window. These findings support the development of individualized VT protocols and provide evidence to guide future rehabilitation strategies. Full article

(This article belongs to the Special Issue Rehabilitation and Management of Stroke)

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15 pages, 865 KiB

Open AccessArticle

The Association Between Early Progesterone Rise and Serum Estradiol Levels as Well as Endometrial Thickness in IVF Cycles

by Katarina Ivanovic, Lidija Tulic, Ivan Tulic, Stefan Ivanovic, Jelena Stojnic, Jovan Bila, Tatjana Dosev, Zeljka Vukovic and Branislav Milosevic

J. Clin. Med. 2025, 14(17), 5965; https://doi.org/10.3390/jcm14175965 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: The success of artificial reproductive technologies (ARTs) depends on different factors, such as patient-specific reproductive features, ovarian response to stimulation, oocyte and embryo quality, and endometrial receptivity. This study aimed to evaluate their association with oocyte yield, fertilization, endometrial thickness, and pregnancy [...] Read more.

Background/Objectives: The success of artificial reproductive technologies (ARTs) depends on different factors, such as patient-specific reproductive features, ovarian response to stimulation, oocyte and embryo quality, and endometrial receptivity. This study aimed to evaluate their association with oocyte yield, fertilization, endometrial thickness, and pregnancy outcomes. Methods: A prospective clinical study included 128 women undergoing IVF/ICSI. Baseline hormone levels (E2, P4, FSH, LH, AMH) were assessed prior to stimulation. E2 levels were monitored during stimulation, and P4 was measured on the day of oocyte retrieval. Patients were grouped based on P4 levels (<2 ng/mL vs. ≥2 ng/mL). IVF outcomes and endometrial characteristics were statistically analyzed. Results: Lower P4 levels (<2 ng/mL) on the day of oocyte retrieval were significantly associated with higher fertilization rates (p < 0.003), more fertilized oocytes (p < 0.001), and increased pregnancy rates (p < 0.001). Elevated P4 (≥2 ng/mL) correlated with a higher frequency of thin endometrium (<7 mm, p < 0.007). E2 levels on the hCG trigger day correlated positively with the number of retrieved and mature oocytes and fertilization outcomes (p < 0.05). Patients who achieved pregnancy had lower P4 and BMI, and higher E2, AMH, and endometrial thickness. ROC identified a P4 threshold of 1.99 ng/mL with moderate predictive value. Conclusions: Elevated progesterone levels on the day of oocyte retrieval negatively impact fertilization and pregnancy outcomes, likely due to impaired endometrial receptivity. Combined assessment of P4, E2, AMH, and endometrial thickness may enhance embryo transfer planning and improve IVF success rates. Full article

(This article belongs to the Special Issue Female Infertility: Clinical Diagnosis and Treatment)

14 pages, 877 KiB

Open AccessSystematic Review

Pleurectomy/Decortication Versus Extrapleural Pneumonectomy in Pleural Mesothelioma: A Systematic Review and Meta-Analysis of Survival, Mortality, and Surgical Trends

by Margherita Brivio, Matteo Chiari, Claudia Bardoni, Antonio Mazzella, Monica Casiraghi, Lorenzo Spaggiari and Luca Bertolaccini

J. Clin. Med. 2025, 14(17), 5964; https://doi.org/10.3390/jcm14175964 (registering DOI) - 23 Aug 2025

Abstract

Background: The optimal surgical approach for malignant pleural mesothelioma (PM) remains a topic of debate. While extrapleural pneumonectomy (EPP) offers radical resection, it is associated with significant morbidity. Pleurectomy/decortication (P/D) is less extensive but may offer comparable oncologic outcomes with reduced perioperative risk. [...] Read more.

Background: The optimal surgical approach for malignant pleural mesothelioma (PM) remains a topic of debate. While extrapleural pneumonectomy (EPP) offers radical resection, it is associated with significant morbidity. Pleurectomy/decortication (P/D) is less extensive but may offer comparable oncologic outcomes with reduced perioperative risk. This study aimed to conduct a comprehensive systematic review and meta-analysis to systematically evaluate and quantitatively compare survival outcomes, 30-day postoperative mortality, and baseline characteristics between patients undergoing P/D and EPP for PM. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. MEDLINE, Embase, and Scopus were searched up to May 2025. Studies comparing EPP and P/D in PM that reported on survival, mortality, or baseline demographics were included. Data from 24 retrospective studies were extracted. Pooled estimates were calculated using random-effects models. Meta-regression and subgroup analyses were performed by geographic region and publication year. Results: P/D was associated with a significantly improved overall survival compared to EPP in the primary analysis (mean difference = 7.01 months; 95% CI: 1.15–12.86; p = 0.018), with substantial heterogeneity (I² = 98.5%). In a sensitivity analysis excluding one statistical outlier, the survival benefit remained significant (mean difference = 4.31 months; 95% CI: 1.69–6.93), and heterogeneity was markedly reduced. The 30-day mortality rate was also significantly lower for P/D (odds ratio = 0.34; 95% CI: 0.13–0.88; p = 0.027). Patients undergoing P/D were, on average, 3.78 years older than those undergoing EPP (p < 0.001), whereas no significant difference was observed in the sex distribution between groups. Subgroup analyses by region and publication year confirmed the robustness of the findings. Meta-regression did not reveal substantial modifiers of survival. Conclusions: P/D demonstrates superior overall survival and reduced perioperative mortality compared to EPP, without evidence of baseline demographic confounding. These findings, derived from retrospective comparative studies, support the preferential use of P/D in eligible patients, particularly in high-volume centers, given its favorable safety profile and superior median survival. However, the absence of randomized trials directly comparing P/D and EPP and the potential influence of patient selection warrant cautious interpretation, and surgical decisions should be tailored to individual patient factors within a multidisciplinary setting. Full article

(This article belongs to the Section Respiratory Medicine)

23 pages, 1024 KiB

Open AccessReview

Visual Function in Alzheimer’s Disease: Current Understanding and Potential Mechanisms Behind Visual Impairment

by Tania Alvite-Piñeiro, Maite López-López, Uxía Regueiro, Juan Manuel Pías-Peleteiro, Tomás Sobrino and Isabel Lema

J. Clin. Med. 2025, 14(17), 5963; https://doi.org/10.3390/jcm14175963 (registering DOI) - 23 Aug 2025

Abstract

Alzheimer’s disease (AD) is the leading cause of dementia worldwide and is becoming one of the most morbid diseases of this century. Recently, ocular research in AD has gained significance, as the eye, due to its close relationship with the brain, can reflect [...] Read more.

Alzheimer’s disease (AD) is the leading cause of dementia worldwide and is becoming one of the most morbid diseases of this century. Recently, ocular research in AD has gained significance, as the eye, due to its close relationship with the brain, can reflect the presence of neurological disorders. Several studies have reported alterations in various ocular structures in AD, ranging from tear fluid to the retina. These changes, particularly in the retina and the optic nerve, along with cerebral atrophy affecting visual brain areas, may lead to visual dysfunctions. This narrative review summarizes and critically examines current evidence on these impairments and explores their possible underlying mechanisms. A decrease in visual acuity, contrast sensitivity, and color vision has been observed, primarily associated with retinal ganglion cell loss or damage. Furthermore, alterations in the visual field, ocular motility, and visual perception have been recorded, mainly resulting from cortical changes. These optical parameters frequently correlate with patients’ cognitive status. In conclusion, these findings highlight the importance of developing strategies to preserve visual function in these patients, helping to prevent further deterioration in their quality of life, and emphasize the potential of visual function assessment as a tool for diagnosis or predicting AD progression. Full article

(This article belongs to the Special Issue Ocular Surface, Retina, and Choroid as Mirrors of Systemic and Genetic Diseases)

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13 pages, 1103 KiB

Open AccessArticle

Establishing the Clinical Utility of Glucagon-Enhanced MRCP for Improved Hepatopancreatobiliary Assessment

by Abdel-Rauf Zeina, Oren Shibolet, Mohamed Garra, Randa Taher, Oren Gal, Michael Oster, Rawi Hazzan, Ahmad Mahamid and Fadi Abu Baker

J. Clin. Med. 2025, 14(17), 5962; https://doi.org/10.3390/jcm14175962 (registering DOI) - 23 Aug 2025

Abstract

Background: Magnetic Resonance Cholangiopancreatography (MRCP) has continuously evolved to enhance visualization capabilities. However, diagnosing biliary ductal system pathology, particularly early primary sclerosing cholangitis (PSC), remains challenging. This study investigates the influence of intramuscular glucagon (IMG) administration on final image quality and pancreatobiliary ductal [...] Read more.

Background: Magnetic Resonance Cholangiopancreatography (MRCP) has continuously evolved to enhance visualization capabilities. However, diagnosing biliary ductal system pathology, particularly early primary sclerosing cholangitis (PSC), remains challenging. This study investigates the influence of intramuscular glucagon (IMG) administration on final image quality and pancreatobiliary ductal system diameter in MRCP. Methods: Forty patients (57.5% female; average age 34.45 ± 8.2) referred for Magnetic Resonance Enterography (MRE) underwent MRCP before and 8–12 min after IMG administration. Two independent MRI specialists analyzed Coronal T2-weighted fast spin-echo high-resolution 3D MRCP images quantitatively and qualitatively. Quantitative assessments involved measuring the transverse diameter of five specific biliary duct structures (inferior, mid, and upper common bile duct; right and left hepatic ducts) and three pancreatic duct segments (head, body, and tail). The qualitative evaluation used a five-point Likert-type scale (1 = perfect visualization; 5 = not visible) for the predefined segments. Interobserver variation was assessed using the Intraclass Correlation Coefficient (ICC). Results: Following IMG administration, the diameters of all corresponding biliary and pancreatic segments significantly increased, with consistently strong interobserver agreement demonstrated pre- and post-IMG administration. Moreover, in qualitative analysis, post-IMG administration scores indicated a significant decrease (p < 0.01) in visualization scores, signifying improved visualization at all corresponding points for both radiologists compared to the pre-glucagon administration scores. The ICC scores pre- and post-IMG administration demonstrated moderate to strong agreement. Conclusions: IMG administration improves MRCP imaging parameters by increasing ductal diameters and enhancing biliary tree visualization, underscoring its potential to detect subtle or early pathological changes. Full article

(This article belongs to the Special Issue Endoscopic Diagnosis and Treatments of Gastrointestinal Diseases)

17 pages, 285 KiB

Open AccessArticle

Correlation Between Cardiac Troponin Serum Concentration and Selected Parameters of Subclinical Cardiovascular Dysfunction in Patients With and Without Arterial Hypertension: Retrospective Cross-Sectional Analysis of Real-World Data

by Grzegorz K. Jakubiak, Monika Starzak, Natalia Pawlas, Artur Chwalba, Agata Stanek and Grzegorz Cieślar

J. Clin. Med. 2025, 14(17), 5961; https://doi.org/10.3390/jcm14175961 (registering DOI) - 23 Aug 2025

Abstract

Background: High-sensitivity cardiac troponin T serum concentration (hs-cTnT) measurement is a well-established tool in the diagnosis of acute cardiovascular (CV) disease. It remains unclear whether resting hs-cTnT could be useful for screening the status of the CV system. The purpose of this [...] Read more.

Background: High-sensitivity cardiac troponin T serum concentration (hs-cTnT) measurement is a well-established tool in the diagnosis of acute cardiovascular (CV) disease. It remains unclear whether resting hs-cTnT could be useful for screening the status of the CV system. The purpose of this study was to compare the correlation between hs-cTnT, determined in patients without clinical symptoms of acute illness, and selected parameters of subclinical CV dysfunction in relation to the coexistence of arterial hypertension (AH). Methods: In total, 101 patients were included in the analysis. The following methods were used to assess the CV system: transthoracic echocardiography, Doppler ultrasonography of the carotid and lower extremity arteries with intima–media thickness (IMT) measurement, pulse wave velocity (PWV), central blood pressure measurement, ankle–brachial index (ABI), and toe–brachial index (TBI). Results: In patients with AH, significant correlations were found between hs-cTnT and maximal velocity of tricuspid regurgitation (R = 0.397; p = 0.003), left atrium volume index (LAVI) (R = 0.39; p = 0.002), and IMT in carotid arteries (cIMT) (R = 0.4; p = 0.001), common femoral arteries (cfIMT) (R = 0.384; p = 0.004), and superficial femoral arteries (sfIMT) (R = 0.352; p = 0.01), as well as PWV (R = 0.63; p < 0.001), central systolic blood pressure (cSBP) (R = 0.34; p = 0.006), central pulse pressure (cPP) (R = 0.354; p = 0.004), and ankle–brachial index (ABI) (R = −0.28; p = 0.024). In multivariate analysis, the relationship between subclinical CV dysfunction and hs-cTnT remained significant for LAVI, cSBP, cPP, and ABI, as well as showing borderline significance for sfIMT. In patients without AH, only the relationship between hs-cTnT and ABI was significant. According to interaction analysis, AH significantly influenced the relationship between hs-cTnT and cSBP, cPP, and sfIMT. Conclusions: Resting hs-cTnT correlates significantly with selected parameters of subclinical CV dysfunction in patients with AH. This relationship is clearly weaker in patients without AH. Further research is needed, especially prospective studies on a larger group of patients. Full article

(This article belongs to the Special Issue Advances in Hypertension and Related Complications)

13 pages, 258 KiB

Open AccessArticle

Demographic and Premorbid Clinical Factors Predict Modified Rankin Score in Large and Medium Vessel Occlusion Ischemic Strokes

by Tara Srinivas, Dhairya A. Lakhani, Aneri B. Balar, Risheng Xu, Jee Moon, Caline Azzi, Nathan Hyson, Sijin Wen, Cynthia Greene, Janet Mei, Tyler McGaughey, Farzad Maroufi, Jeremy J. Heit, Tobias D. Faizy, Gregory W. Albers, Hamza Salim, Adam A. Dmytriw, Adrien Guenego, Meisam Hoseinyazdi and Vivek S. Yedavalli

J. Clin. Med. 2025, 14(17), 5960; https://doi.org/10.3390/jcm14175960 (registering DOI) - 23 Aug 2025

Abstract

Background/Objectives: We report on the association of clinical, demographic, and peri- and intraoperative factors with patient outcomes in large- and, separately, medium-vessel acute ischemic stroke (AIS) occlusions treated with mechanical thrombectomy or medical thrombolysis. Increasingly, neuroimaging, particularly novel markers of collateral status, has [...] Read more.

Background/Objectives: We report on the association of clinical, demographic, and peri- and intraoperative factors with patient outcomes in large- and, separately, medium-vessel acute ischemic stroke (AIS) occlusions treated with mechanical thrombectomy or medical thrombolysis. Increasingly, neuroimaging, particularly novel markers of collateral status, has become useful in predicting response to endovascular treatment (EVT) among AIS patients. However, the relationship between these neuroimaging markers, documented predictors of stroke outcomes, and post-EVT functional status in anterior circulation large-vessel occlusions (LVOs) as compared to medium-vessel occlusions (MeVOs) remains unclear. We evaluated whether shared predictors of 90-day post-EVT functional outcomes in LVO compared to MeVO AIS patients within our institution exist. Methods: We retrospectively evaluated AIS patients treated at our institution between 9 January 2017 and 10 January 2023. The following were the inclusion criteria were applied: (i) CTA confirmed anterior circulation large or medium vessel occlusion; (ii) diagnostic CT perfusion was performed; (iii) mechanical thrombectomy was performed. A low modified Rankin score (mRS) indicating good functional outcomes (i.e., functional independence) was defined as less than or equal to 2, in accordance with prior studies. Univariate and multivariate logistic regression analyses were conducted to determine associations between demographic, clinical, and radiologic factors and mRS ≤ 2. Results: A total of 249 LVO (mean age 65.3 ± 16.2, 53.8% female) and 91 MeVO (mean age 68.9 ± 13.3, 46.2% female) patients met the inclusion criteria. Upon multivariate regression adjusted for race, age, hypertension, diabetes mellitus, radiologic features, IV alteplase, admission NIHSS, and reperfusion status, young age (p = 0.004), low admission NIHSS (p = 0.0001), and good reperfusion status (p = 0.007) were associated with good functional outcomes in LVO stroke. By contrast, no factors were significantly associated with good functional outcomes in MeVO stroke. Conclusions: Known factors, including young age, low admission stroke severity, and successful reperfusion predict EVT outcomes in LVO stroke but not necessarily in MeVO stroke. Further studies regarding predictors of MeVO outcomes in nonsurgical cases, including collateral status, may guide optimal medical management for this population. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

16 pages, 717 KiB

Open AccessSystematic Review

Is There a Link Between TSH Levels and Schizophrenia? A Systematic Review and Meta-Analysis

by Elisa Gatta, Francesco Dondi, Ilenia Pirola, Andrea Delbarba, Virginia Maltese, Pietro Bellini, Massimiliano Ugoccioni, Irene Silvestrini, Mario Rotondi, Francesco Bertagna and Carlo Cappelli

J. Clin. Med. 2025, 14(17), 5959; https://doi.org/10.3390/jcm14175959 (registering DOI) - 23 Aug 2025

Abstract

Background: Thyroid dysfunction and psychiatric disorders often coexist, raising interest in their potential interplay. In particular, the relationship between thyroid-stimulating hormone (TSH) levels and schizophrenia has been investigated, though findings remain inconsistent. We performed a systematic review and meta-analysis to clarify whether [...] Read more.

Background: Thyroid dysfunction and psychiatric disorders often coexist, raising interest in their potential interplay. In particular, the relationship between thyroid-stimulating hormone (TSH) levels and schizophrenia has been investigated, though findings remain inconsistent. We performed a systematic review and meta-analysis to clarify whether TSH levels differ in patients with schizophrenia compared with healthy controls. Methods: A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted up to May 2025. Eligible studies were selected based on predefined criteria according to the PICO framework: What are the TSH levels in first-episode, drug-naïve patients diagnosed with schizophrenia compared with healthy subjects, and do TSH levels influence different psychiatric phenotypes? PRISMA guidelines were followed. Study quality and risk of bias were assessed using QUADAS-2. Results: Of 2068 records screened, 35 studies met the inclusion criteria. Quality assessment revealed a generally unclear risk of bias, with few studies showing a high risk. The meta-analysis included 3669 patients and 1391 controls from ten Asian, eight European, and three North American studies. TSH levels were similar between patients and controls (SMD = –0.059 mIU/L; 95% CI: –0.260 to 0.141), with substantial heterogeneity (I² = 84%, p < 0.001). Conclusions: This meta-analysis found no significant association between TSH levels and schizophrenia, despite decades of research and methodological diversity. Full article

(This article belongs to the Section Endocrinology & Metabolism)

24 pages, 429 KiB

Open AccessSystematic Review

Application of Artificial Intelligence in Inborn Errors of Immunity Identification and Management: Past, Present, and Future: A Systematic Review

by Ivan Taietti, Martina Votto, Marta Colaneri, Matteo Passerini, Jessica Leoni, Gian Luigi Marseglia, Amelia Licari and Riccardo Castagnoli

J. Clin. Med. 2025, 14(17), 5958; https://doi.org/10.3390/jcm14175958 (registering DOI) - 23 Aug 2025

Abstract

Background: Inborn errors of immunity (IEI) are mainly genetically driven disorders that affect immune function and present with highly heterogeneous clinical manifestations, ranging from severe combined immunodeficiency (SCID) to adult-onset immune dysregulatory diseases. This clinical heterogeneity, coupled with limited awareness and the [...] Read more.

Background: Inborn errors of immunity (IEI) are mainly genetically driven disorders that affect immune function and present with highly heterogeneous clinical manifestations, ranging from severe combined immunodeficiency (SCID) to adult-onset immune dysregulatory diseases. This clinical heterogeneity, coupled with limited awareness and the absence of a universal diagnostic test, makes early and accurate diagnosis challenging. Although genetic testing methods such as whole-exome and genome sequencing have improved detection, they are often expensive, complex, and require functional validation. Recently, artificial intelligence (AI) tools have emerged as promising for enhancing diagnostic accuracy and clinical decision-making for IEI. Methods: We conducted a systematic review of four major databases (PubMed, Scopus, Web of Science, and Embase) to identify peer-reviewed English-published studies focusing on the application of AI techniques in the diagnosis and treatment of IEI across pediatric and adult populations. Twenty-three retrospective/prospective studies and clinical trials were included. Results: AI methodologies demonstrated high diagnostic accuracy, improved detection of pathogenic mutations, and enhanced prediction of clinical outcomes. AI tools effectively integrated and analyzed electronic health records (EHRs), clinical, immunological, and genetic data, thereby accelerating the diagnostic process and supporting personalized treatment strategies. Conclusions: AI technologies show significant promise in the early detection and management of IEI by reducing diagnostic delays and healthcare costs. While offering substantial benefits, limitations such as data bias and methodological inconsistencies among studies must be addressed to ensure broader clinical applicability. Full article

(This article belongs to the Special Issue Inborn Errors of Immunity: Advances in Diagnosis and Treatment)

14 pages, 249 KiB

Open AccessFeature PaperReview

General Innovations in Pain Management

by Alison Deng, Milan Patel, Cole Eigner, Robert Moghim and Alaa Abd-Elsayed

J. Clin. Med. 2025, 14(17), 5957; https://doi.org/10.3390/jcm14175957 (registering DOI) - 23 Aug 2025

Abstract

Chronic pain management is constantly evolving, and our literature review aims to describe the general innovations happening within the field. The need for advancements in chronic pain is a necessity, as debilitating back pain and other forms of chronic pain are significant issues [...] Read more.

Chronic pain management is constantly evolving, and our literature review aims to describe the general innovations happening within the field. The need for advancements in chronic pain is a necessity, as debilitating back pain and other forms of chronic pain are significant issues in the United States. Traditionally, medications have been the initial treatment options in cases of chronic pain; however, the advancement in pharmacogenetics has led to an increased ability to create more personalized medication plans. Additionally, neuromodulation in spinal cord stimulation, transcranial magnetic stimulation, transcranial direct-current stimulation, and dorsal root ganglion stimulation continue to see increased usage in mainstream chronic pain management. These techniques have continued to prove successful in many chronic pain management cases. They are allowing practicing physicians more confidence in the variety of treatment options. Lastly, great strides have also been made in stem cell and regenerative therapies, such as platelet-rich plasma injections, and artificial intelligence, further advancing the various treatment options and overall efficiency of pain management. This review aims to critically analyze and review the most up-to-date literature within each section mentioned and comprehensively discuss the future of innovation in chronic pain management. Full article

(This article belongs to the Special Issue State of the Art in Neuromodulation or Spinal Cord Stimulation Therapy)

11 pages, 989 KiB

Open AccessArticle

Visual and Predictive Assessment of Pneumothorax Recurrence in Adolescents Using Machine Learning on Chest CT

by Kwanyong Hyun, Jae Jun Kim, Kyong Shil Im, Sang Chul Han and Jeong Hwan Ryu

J. Clin. Med. 2025, 14(17), 5956; https://doi.org/10.3390/jcm14175956 (registering DOI) - 23 Aug 2025

Abstract

Background: Spontaneous pneumothorax (SP) in adolescents has a high recurrence risk, particularly without surgical treatment. This study aimed to predict recurrence using machine learning (ML) algorithms applied to chest computed tomography (CT) and to visualize CT features associated with recurrence. Methods: We retrospectively [...] Read more.

Background: Spontaneous pneumothorax (SP) in adolescents has a high recurrence risk, particularly without surgical treatment. This study aimed to predict recurrence using machine learning (ML) algorithms applied to chest computed tomography (CT) and to visualize CT features associated with recurrence. Methods: We retrospectively reviewed 299 adolescents with conservatively managed SP from January 2018 to December 2022. Clinical risk factors were statistically analyzed. Chest CT images were evaluated using ML models, with performance assessed by AUC, accuracy, precision, recall, and F1 score. Gradient-weighted Class Activation Mapping (Grad-CAM) was used for visual interpretation. Results: Among 164 right-sided and 135 left-sided SP cases, recurrence occurred in 54 and 43 cases, respectively. Mean recurrence intervals were 10.5 ± 9.9 months (right) and 12.7 ± 9.1 months (left). Presence of blebs or bullae was significantly associated with recurrence (p < 0.001). Neural networks achieved the best performance (AUC: 0.970 right, 0.958 left). Grad-CAM confirmed the role of blebs/bullae and highlighted apical lung regions in recurrence, even in their absence. Conclusions: ML algorithms applied to chest CT demonstrate high accuracy in predicting SP recurrence in adolescents. Visual analyses support the clinical relevance of blebs/bullae and suggest a key role of apical lung regions in recurrence, even when blebs/bullae are absent. Full article

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

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16 pages, 2017 KiB

Open AccessArticle

Assessment of Serum Endocan Levels and Their Associations with Arterial Stiffness Parameters in Young Patients with Systemic Lupus Erythematosus

by Ágnes Diószegi, Hajnalka Lőrincz, Eszter Kaáli, Sára Csiha, Judit Kaluha, Éva Varga, Dénes Páll, Tünde Tarr and Mariann Harangi

J. Clin. Med. 2025, 14(17), 5955; https://doi.org/10.3390/jcm14175955 (registering DOI) - 23 Aug 2025

Abstract

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with premature atherosclerosis and vascular impairment. However, the role of endocan, a biomarker of glycocalyx injury, is not completely clarified in the detection of vascular damage. Therefore, our aim was to investigate [...] Read more.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder associated with premature atherosclerosis and vascular impairment. However, the role of endocan, a biomarker of glycocalyx injury, is not completely clarified in the detection of vascular damage. Therefore, our aim was to investigate serum endocan in comparison with conventional inflammatory markers, arterial stiffness parameters, and carotid ultrasound findings in a cohort of young patients with SLE. Methods: We enrolled 47 clinically active young SLE patients (40 females and 7 males) in the study. Arterial stiffness indicated by augmentation index and pulse wave velocity (PWV) was measured by arteriography. Brachial artery flow-mediated dilatation and common carotid intima-media thickness were detected by ultrasonography. The serum concentrations of endocan, IL-6, MPO, MCP-1, MMP-3, -7, and -9, as well as TNFα, were measured by an enzyme-linked immunosorbent assay (ELISA). Results: We found significant negative correlations between serum endocan and both CH50 and C3. Serum endocan was higher in active SLE patients compared to inactive patients, however, the difference was not statistically significant (241.4 (183–295) vs. 200.3 (167–278) pg/mL; p = 0.313). Serum TNFα and hsCRP significantly correlated with PWV. However, we did not detect significant correlations between vascular diagnostic tests and serum endocan levels. Conclusions: Based on our results, serum endocan is associated with disease activity; however, further studies are needed to clarify the value of serum endocan in the cardiovascular risk estimation of SLE patients. Measurement of serum endocan, as well as the routine assessment of arterial stiffness parameters, should be integrated into the comprehensive management plans of young patients with SLE. Full article

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

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28 pages, 639 KiB

Open AccessReview

Cancer Risk in Autoimmune and Immune-Mediated Diseases: A Narrative Review for Practising Clinicians

by David Bernal-Bello, Begoña Frutos-Pérez, Miguel Ángel Duarte-Millán, María Toledano-Macías, Beatriz Jaenes-Barrios and Alejandro Morales-Ortega

J. Clin. Med. 2025, 14(17), 5954; https://doi.org/10.3390/jcm14175954 (registering DOI) - 23 Aug 2025

Abstract

Background: Autoimmune diseases and other immune-mediated disorders are associated with an increased risk of malignancy, influenced by chronic inflammation, immune dysregulation, and treatment-related factors. Clarifying cancer risk patterns across specific conditions is essential to improve clinical vigilance and inform screening practices. Objective [...] Read more.

Background: Autoimmune diseases and other immune-mediated disorders are associated with an increased risk of malignancy, influenced by chronic inflammation, immune dysregulation, and treatment-related factors. Clarifying cancer risk patterns across specific conditions is essential to improve clinical vigilance and inform screening practices. Objective: The aim of this study was to synthesise current evidence on the association between autoimmune and immune-mediated diseases and cancer, with a focus on practical implications for clinicians. Methods: Recent cohort studies, meta-analyses, and expert consensus documents were analysed to describe cancer epidemiology, pathogenic mechanisms, high-risk phenotypes, and treatment considerations across major autoimmune diseases and other immune-mediated conditions. The review covers idiopathic inflammatory myopathies, Sjögren’s syndrome, systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome, ANCA-associated vasculitis, giant cell arteritis, polymyalgia rheumatica, sarcoidosis, mixed connective tissue disease, IgG4-related disease, VEXAS syndrome, and eosinophilic fasciitis. Special attention was given to identifying warning features for underlying malignancy and evaluating cancer screening strategies. Results: The magnitude and distribution of cancer risk vary across diseases. In some conditions such as dermatomyositis, systemic sclerosis or Sjögren’s syndrome, increased risk is well established, particularly for haematological and certain solid tumours. However, tumour patterns may differ across populations, and findings are not always consistent. Distinct clinical and serological features help stratify individual cancer risk and may guide the intensity of screening. The first years after disease onset often represent a window of higher vulnerability, during which intensified surveillance may be warranted in selected patients. Conclusions: Cancer risk in autoimmune diseases should be assessed on an individual basis. Awareness of disease-specific risk factors and clinical warning signs supports early recognition of malignancy and informs screening decisions in routine practice. Full article

(This article belongs to the Section Immunology)

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