Septic Cardiomyopathy: Difficult Definition, Challenging Diagnosis, Unclear Treatment
Minimally Invasive Surgery for Spontaneous Intracerebral Hemorrhage: A Review
Culprit-Lesion Drug-Coated-Balloon Percutaneous Coronary Intervention in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI)
How We Treat ANCA-Associated Vasculitis: A Focus on the Maintenance Therapy
Differential Fatigue Profile in Patients with Post-COVID Condition, Fibromyalgia, and Multiple Sclerosis

Journal Description

Journal of Clinical Medicine

Journal of Clinical Medicine is an international, peer-reviewed, open access journal of clinical medicine, published semimonthly online by MDPI. The International Bone Research Association (IBRA), Italian Resuscitation Council (IRC), Spanish Society of Hematology and Hemotherapy (SEHH), Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) and others are all affiliated with JCM, and their members receive a discount on article processing charges.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 16 days after submission; acceptance to publication is undertaken in 2.6 days (median values for papers published in this journal in the second half of 2024).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Companion journals for JCM include: Epidemiologia, Transplantology, Uro, Sinusitis, Rheumato, Journal of Clinical & Translational Ophthalmology, Journal of Vascular Diseases, Osteology, Complications, Therapeutics, Sclerosis, Pharmacoepidemiology and Journal of CardioRenal Medicine.

Impact Factor: 3.0 (2023); 5-Year Impact Factor: 3.4 (2023)

Imprint Information Journal Flyer Open Access ISSN: 2077-0383

Latest Articles

12 pages, 2013 KiB

Open AccessArticle

Effects of Virtually Led Value-Based Preoperative Assessment on Safety, Efficiency, and Patient and Professional Satisfaction

by José Luis Gracia Martínez, Miguel Ángel Morales Coca, Marta del Olmo Rodríguez, Pablo Vigoa, Jorge Martínez Gómez, Jorge Short Apellaniz, Catalina Paredes Coronel, Marco Antonio Villegas García, Juan José Serrano, Javier Arcos, Cristina Caramés Sánchez, Bernadette Pfang and Juan Antonio Álvaro de la Parra

J. Clin. Med. 2025, 14(9), 3093; https://doi.org/10.3390/jcm14093093 (registering DOI) - 29 Apr 2025

Abstract

Background: The increasing demand for elective surgery makes optimizing preoperative assessment a priority. Value-based healthcare aims to provide the highest value for patients at the lowest possible cost through various mechanisms, including reorganizing care into integrated practice units (IPUs). However, few studies have analyzed the effectiveness of implementing virtually led IPUs for preoperative assessment. Methods: We performed a retrospective observational cohort study including patients undergoing elective surgery at a teaching hospital in Madrid, Spain from 1 January 2018 to 31 December 2023, analyzing changes in surgical complications, efficiency, and patient satisfaction between the pre-implementation (2018–2019) and post-implementation (2020–2023) periods. Anesthesiologists’ satisfaction with the virtual assessments was described. During the post-implementation period, preoperative assessment was reorganized as a virtually led IPU. At the IPU appointment, preoperative testing and physical (including airway) examinations were performed by a nurse anesthesiologist. The results were uploaded to the electronic health records, and asynchronous virtual anesthesiologist assessment using a store-and-forward approach was performed. Digital patient education was carried out over the Patient Portal mobile application. Results: A total of 40,233 surgical procedures were included, of which 31,259 were from the post-intervention period. During the post-intervention period, no increase in surgical complications was observed, while same-day cancellations decreased from 4.3% to 2.8% of the total procedures (p < 0.001). The overall process time did not increase, despite the rising number of surgical procedures per year. Patient satisfaction improved. The median time to complete anesthesiologist assessment was significantly lower for virtual assessment (4.5 versus 10 min (p < 0.001), signifying estimated time savings of 716 person-hours per year. Anesthesiologists agreed that virtual assessment was more efficient than in-person evaluation, and half of the participants agreed that virtual preoperative care improved their work–life balance and reduced burnout. Conclusions: A digitally enhanced value-based model of preoperative care can improve efficiency and satisfaction metrics, reducing unnecessary costs and potentially improving the quality of care. Full article

(This article belongs to the Special Issue Advances in the Clinical Management of Perioperative Anesthesia)

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14 pages, 15936 KiB

Open AccessReview

Can Thrombosed Abdominal Aortic Dissecting Aneurysm Cause Mesenteric Artery Thrombosis and Ischemic Colitis?—A Case Report and a Review of Literature

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(9), 3092; https://doi.org/10.3390/jcm14093092 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: Ischemic colitis, typically caused by thrombosis or reduced blood flow in the inferior mesenteric artery, is the most common ischemic lesion at the colorectal level. This case contributes to existing knowledge by highlighting the rare co-occurrence of a thrombosed aortic aneurysm and ischemic colitis, pointing to a direct vascular etiology rather than a multifactorial or idiopathic cause. Methods: A thorough electronic search was conducted on PubMed to identify risk factors and etiological determinants of ischemic colitis. Results: We present the case of a 70-year-old male with diffuse abdominal pain and multiple cardiac comorbidities. A CT scan revealed aeroenteritis, aerocolia, fusiform aneurysmal dilation of the abdominal aorta (18 cm long, 7.3 cm in diameter, from below the renal arteries to the bifurcation), parietal thrombosis, a circulating lumen of 2.7 cm, and inferior mesenteric artery thrombosis. Intraoperatively, necrosis was found in the upper rectum, sigmoid colon, descending colon, and the middle third of the left transverse colon, with clear demarcation between healthy and necrotic tissue. A subtotal proctocolectomy with transverse colostomy was performed. Conclusions: This case highlights ischemic colitis as a vascular disorder, urging broader differential diagnosis when common causes are unclear. Timely imaging, a multidisciplinary approach, and attention to vascular risks are key to identifying rare causes like aneurysmal thrombosis. While thrombosed abdominal aortic aneurysms can cause mesenteric ischemia, their link to ischemic and ulcerative colitis is unique, emphasizing the importance of accurate risk assessment in treatment planning. Full article

(This article belongs to the Special Issue Colon and Rectal Surgery: Current Clinical Practice and Future Trends)

7 pages, 3735 KiB

Open AccessCase Report

Systemic Lupus Erythematosus with Refractory Immune Thrombocytopenia Progressing to Catastrophic Anti-Phospholipid Syndrome During Thrombopoietin Receptor Agonist Therapy: A Case Report

by Sang Wan Chung and You-Jung Ha

J. Clin. Med. 2025, 14(9), 3091; https://doi.org/10.3390/jcm14093091 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: Autoimmune thrombocytopenia is a common manifestation of systemic lupus erythematosus (SLE). Its main treatments are glucocorticoids, intravenous immunoglobulin, and immunosuppressants, but thrombopoietin mimetics may be considered with refractory to conventional treatment. Romiplostim, a thrombopoietin receptor agonist, has been approved for increasing platelet counts in corticosteroid-refractory chronic immune thrombocytopenia. However, data on its long-term safety and efficacy in patients with SLE are still lacking. Case Presentation: We present the case of a 55-year-old woman with SLE and refractory immune thrombocytopenia who developed bilateral adrenal hemorrhage and progressed to fatal catastrophic anti-phospholipid syndrome while using romiplostim. Full article

(This article belongs to the Section Immunology)

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12 pages, 508 KiB

Open AccessReview

Comparison of Outcomes Among Neurovascular Patients Managed in Dedicated Neurological Intensive Care Units vs. General Intensive Care Units

by Joanna M. Roy, Basel Musmar, Nassos Tziviskos, Saarang Patel, Roberto DeLeon, Ashley Thommana, Shady Mina, Stavropoula I. Tjoumakaris, Michael. Reid Gooch, Robert H. Rosenwasser and Pascal M. Jabbour

J. Clin. Med. 2025, 14(9), 3090; https://doi.org/10.3390/jcm14093090 (registering DOI) - 29 Apr 2025

Abstract

Background/Objectives: Patients with neurovascular conditions often require multidisciplinary management to optimize recovery. Our systematic review identifies literature comparing outcomes among neurovascular patients managed at dedicated neurological intensive care units (ICUs) compared to general ICUs. Methods: PubMed was searched to identify articles that reported outcomes among patients managed at dedicated neurological ICUs versus general ICUs. Articles that reported outcomes among patients with neurovascular conditions were included. Articles that reported outcomes among patients managed at stroke units were excluded. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias across individual studies. Results: After a title and abstract screen followed by a full-text review, seven studies met criteria for inclusion. These studies reported outcomes among patients managed for intracerebral hemorrhage (ICH), acute ischemic stroke (AIS) and aneurysmal subarachnoid hemorrhage (aSAH). Two studies reported lower mortality, improved functional outcome and reduced costs among patients with ICH who were managed at dedicated neurological ICUs. Among patients with aSAH, only less-severe cases experienced better functional outcome after management at dedicated neurological ICUs. Six out of seven studies were considered high quality. Conclusions: Our review highlights the potential benefits of receiving care at dedicated neurological ICUs, as evidenced by lower mortality, improved functional outcome and reduced costs in patients with ICH and low-grade aSAH. However, future research is necessary to clarify whether dedicated neurological ICU care confers significant advantage over general ICUs among patients with AIS and other neurovascular conditions. Full article

(This article belongs to the Special Issue Neurocritical Care: Clinical Advances and Practice Updates)

12 pages, 374 KiB

Open AccessArticle

Diagnosis and Monitoring of Metabolic Dysfunction Associated with Fatty Liver Disease in Primary Care Patients with Risk Factors—EsteatoGal Study

by Nerea Sánchez-Varela, Sergio Cinza-Sanjurjo, Tatiana Danif-Ferreira, Liseth I. Medina I Araujo, Diego G. Mosteiro Gabriel Miguéns, Daniel Rey-Aldana, Manuel Portela-Romero and on behalf of the EsteatoGal Researchers

J. Clin. Med. 2025, 14(9), 3089; https://doi.org/10.3390/jcm14093089 (registering DOI) - 29 Apr 2025

Abstract

Objective: The objective of this study was to calculate the epidemiological impact of metabolic dysfunction associated with fatty liver disease (MAFLD) and hepatic fibrosis in primary care (PC). Secondarily, we assessed the correlation between serological markers (FIB-4, ELF test), abdominal ultrasound, and transient elastography in the early detection of MAFLD. Methods: An observational prospective study was designed to determine the prevalence of MAFLD and to assess the correlation between complementary tests. Patients were recruited from five health centres. Eligible participants were adults aged between 18 and 70 years with at least one metabolic risk factor, including being overweight (BMI 25–29.9 kg/m²) or obese (BMI > 30 kg/m²), or diagnosed with type 2 diabetes mellitus (T2DM), dyslipidemia, or metabolic syndrome. The prevalence of MAFLD was calculated. Correlations between diagnostic tests were evaluated using Pearson’s correlation coefficient. Results: A total of 98 patients was included. Using CAP (controlled attenuation parameter) measurements, the prevalence of MAFLD was found to be 67.7%, and the prevalence of hepatic fibrosis was 6.5%. The correlation between conventional ultrasound and CAP from FibroScan^® for the diagnosis of MAFLD was low and not statistically significant (0.160 [95% CI: −0.100; 0.400], p = 0.226). In contrast, the diagnosis of hepatic fibrosis using FibroScan^® in PC showed a high correlation with diagnoses performed in gastroenterology department (0.942 [95% CI: 0.844; 0.979], p < 0.001). The correlation with biochemical markers was low and not statistically significant for both FIB-4 (0.125 [95% CI: −0.129; 0.363], p = 0.334) and the ELF test (0.159 [95% CI: −0.111; 0.407], p = 0.246). Conclusions: Two out of three patients with metabolic risk factors were diagnosed with MAFLD, while hepatic fibrosis diagnoses were uncommon. These results reinforce the validity of using FibroScan^® in PC. Full article

(This article belongs to the Special Issue Metabolic Syndrome and Its Burden on Global Health)

14 pages, 777 KiB

Open AccessArticle

Sex- and Stage-Specific Predictors of Anemia in Chronic Kidney Disease: A Retrospective Cohort Study

by Jui-Ting Chang, Chun-Ji Lin, Jiann-Horng Yeh, Chin-Hung Tsai, I-Shan Hsieh and Po-Ya Chang

J. Clin. Med. 2025, 14(9), 3088; https://doi.org/10.3390/jcm14093088 (registering DOI) - 29 Apr 2025

Abstract

Background: Anemia is a common complication of chronic kidney disease (CKD), yet no study has explored differences in anemia risk factors based on disease severity and gender. Therefore, this study investigates potential differences in anemia risk among individuals with varied kidney disease severities and sexes. Methods: This multicenter, longitudinal cohort study was conducted using data (2008–2016) from the Epidemiology and Risk Factors Surveillance of CKD database. This database was associated with Taiwan’s National Health Insurance Research Database (for the 2008–2019 period). To identify predictive risk factors for anemia, we developed a subset multivariate logistic model using stepwise variable selection. Additionally, 10-fold cross-validation was conducted to facilitate model selection and internal validation. Results: Of the 5656 patients with CKD, 519 (9.18%) with anemia and 5137 (90.82%) without. After adjusting for age, sex, and serum creatinine, stepwise logistic regression analysis identified the main independent predictive factors for anemia in CKD patients. Notably, “Receive low sodium diet education” (OR: 0.66, 95% CI: 0.446–0.975), “DBP (mmHg)” (OR: 0.98, 95% CI: 0.965–0.999), “Gout” (OR: 1.86, 95% CI: 1.175–2.937), and “Congestive heart failure” (OR: 1.85, 95% CI: 1.131–3.028) was significantly associated with the presence of anemia among CKD patients. Conclusions: This study identifies gout and cardiovascular disease as important correlates of anemia in patients with CKD. Moreover, it reveals an inverse association between elevated diastolic blood pressure and receiving education on a low-sodium diet with the occurrence of anemia. Full article

(This article belongs to the Special Issue Chronic Renal Disease: Diagnosis, Treatment, and Management)

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12 pages, 247 KiB

Open AccessArticle

High-Flow Nasal Cannula Application After Extubation in Acute Respiratory Failure Patients

by Wen-Chi Chao, Shen-Yung Wang, Chang-Yi Lin, Hou-Tai Chang, Wen-Lin Su, Chien-Hua Tseng, Kuang-Yao Yang, Shih-Chi Ku, Kuo-Chin Kao and Chieh-Jen Wang

J. Clin. Med. 2025, 14(9), 3087; https://doi.org/10.3390/jcm14093087 (registering DOI) - 29 Apr 2025

Abstract

Background: The optimal timing of high-flow nasal cannula (HFNC) application in acute respiratory failure patients remains uncertain. This study aimed to investigate the impact of HFNC on the outcomes of patients with acute respiratory failure, focusing on its use after extubation. Methods: This multicenter retrospective study enrolled adult acute respiratory failure patients requiring invasive mechanical ventilation during the first major outbreak of the COVID-19 pandemic in Taiwan from April to July 2021. Endpoints included prognosis after extubation as 28-day post-extubation mortality. Results: Among the patients, 107 received HFNC before intubation and 461 received conventional oxygen therapy (COT). Pre-intubation HFNC failure did not significantly affect hospital mortality but was associated with prolonged durations of mechanical ventilation and intensive care unit stay. Among 375 patients who underwent planned extubation, 158 received post-extubation HFNC and 217 received COT. HFNC application after extubation was associated with significantly reduced post-extubation 28-day mortality compared with COT. Conclusions: HFNC application after extubation is associated with reduced post-extubation 28-day mortality risks in acute respiratory failure patients who received planned extubation. Full article

(This article belongs to the Special Issue Clinical Advances in Critical Care Medicine)

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10 pages, 319 KiB

Open AccessArticle

Whole-Body Cryotherapy Affects Blood Vitamin D Levels in People with Multiple Sclerosis

by Bartłomiej Ptaszek, Szymon Podsiadło, Olga Czerwińska-Ledwig and Aneta Teległów

J. Clin. Med. 2025, 14(9), 3086; https://doi.org/10.3390/jcm14093086 - 29 Apr 2025

Abstract

Background: The aim of this study was to investigate and evaluate the effect of a series of 20 whole-body cryotherapy (WBC) treatments on the level of vitamin D in the blood of women with multiple sclerosis and healthy women. Methods: This study involved three participant groups. The experimental group included 15 women, aged 34 to 55 years and diagnosed with multiple sclerosis (MS), who received whole-body cryotherapy. The first control group comprised 20 women with MS who did not undergo cryotherapy. The second control group consisted of 15 women, aged 30 to 49 years, who did not have neurological or chronic conditions and who also participated in whole-body cryotherapy. Venous blood samples were taken from all participants at two points: on the first day of cryotherapy and after completing 20 sessions. These samples were analyzed to evaluate their key parameters and assess the differences between the groups. The electrochemiluminescence (ELISA) technique was employed using the 25(OH)D (total) competitive assay, which is designed to measure vitamin D concentration [ng/mL] in the human body. Results: In women with MS, a significant increase in vitamin D levels was observed after the use of WBC (CRYO-MS), while in healthy women the increase was statistically insignificant after WBC (CONTROL-CRYO). Conclusions: After 20 whole-body cryotherapy sessions, an increase in vitamin D levels was observed in women with multiple sclerosis. A trend towards an increase in vitamin D levels was observed in healthy women after WBC. Full article

(This article belongs to the Section Clinical Rehabilitation)

15 pages, 840 KiB

Open AccessReview

Rethinking Pulmonary Embolism Management with an Interventional Perspective

by Panayotis K. Vlachakis, Stergios Soulaidopoulos, Emmanouil Mantzouranis, Panagiotis Theofilis, Paschalis Karakasis, Anastasios Apostolos, Ioannis Kachrimanidis, Maria Drakopoulou, Costas Tsioufis and Konstantinos Toutouzas

J. Clin. Med. 2025, 14(9), 3085; https://doi.org/10.3390/jcm14093085 - 29 Apr 2025

Abstract

Pulmonary embolism (PE) remains a major cardiovascular emergency associated with significant morbidity and mortality. Despite advances in risk stratification models, accurately predicting which intermediate-high-risk patients will deteriorate remains challenging. Systemic thrombolysis, while effective in high-risk PE, is not a viable option for a significant proportion of patients due to contraindications, and its efficacy in the intermediate-high-risk group remains inconclusive. Drawing parallels from acute myocardial infarction and stroke, where percutaneous interventions have revolutionized treatment, interventional therapies are emerging as a promising alternative for PE management. However, challenges persist regarding optimal patient selection, procedural timing, and balancing efficacy with safety. The establishment of pulmonary embolism response teams (PERTs) has played a crucial role in streamlining decision-making and facilitating access to advanced therapies. As novel catheter-based techniques continue to evolve, the field of PE management is undergoing a paradigm shift, mirroring the transformation seen in acute coronary and cerebrovascular care, positioning interventional approaches at the forefront of therapy. Full article

(This article belongs to the Special Issue Advances in Clinical Practice and Personalized Approaches in Cardiovascular Disease)

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4 pages, 2207 KiB

Open AccessCorrection

Correction: Tsai et al. The Relationship between Sarcopenia and Injury Events: A Systematic Review and Meta-Analysis of 98,754 Older Adults. J. Clin. Med. 2022, 11, 6474

by Yu-Chen Su, Shu-Fang Chang and Hsiao-Chi Tsai

J. Clin. Med. 2025, 14(9), 3084; https://doi.org/10.3390/jcm14093084 - 29 Apr 2025

Abstract

There was an error in the original publication [...] Full article

(This article belongs to the Section Orthopedics)

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25 pages, 1535 KiB

Open AccessReview

Risk Factors and Prevention of Cancer and CVDs: A Chicken and Egg Situation

by Maurizio Giuseppe Abrignani, Fabiana Lucà, Vincenzo Abrignani, Mariacarmela Nucara, Daniele Grosseto, Chiara Lestuzzi, Marinella Mistrangelo, Bruno Passaretti, Carmelo Massimiliano Rao and Iris Parrini

J. Clin. Med. 2025, 14(9), 3083; https://doi.org/10.3390/jcm14093083 - 29 Apr 2025

Abstract

Cardiovascular diseases and cancer are the two primary causes of mortality worldwide. Although traditionally regarded as distinct pathologies, they share numerous pathophysiological mechanisms and risk factors, including chronic inflammation, insulin resistance, obesity, and metabolic dysregulation. Notably, several cancers have been identified as closely linked to cardiovascular diseases, including lung, breast, prostate, and colorectal cancers, as well as hematological malignancies, such as leukemia and lymphoma. Additionally, renal and pancreatic cancers exhibit a significant association with cardiovascular complications, partly due to shared risk factors and the cardiotoxic effects of cancer therapies. Addressing the overlapping risk factors through lifestyle modifications—such as regular physical activity, a balanced diet, and cessation of smoking and alcohol—has proven effective in reducing both CV and oncological morbidity and mortality. Furthermore, even in patients with established cancer, structured interventions targeting physical activity, nutritional optimization, and smoking cessation have been associated with improved outcomes. Beyond lifestyle modifications, pharmacological strategies play a crucial role in the prevention of both diseases. Several cardiovascular medications, including statins, aspirin, beta-blockers, and metformin, exhibit pleiotropic effects that extend beyond their primary indications, demonstrating potential anti-neoplastic properties in preclinical and observational studies. Recently, novel therapeutic agents have garnered attention for their possible cardioprotective and metabolic benefits. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is), initially developed for managing type 2 diabetes, have shown CV and renal protective effects, alongside emerging evidence of their role in modulating cancer-related metabolic pathways. Inclisiran, a small interfering RNA targeting PCSK9, effectively lowers LDL cholesterol and may contribute to reducing CV risk, with potential implications for tumor biology. Additionally, sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor, has revolutionized heart failure management by improving hemodynamic parameters and exerting anti-inflammatory effects that may have broader implications for chronic disease prevention. Given the intricate interplay between CVD and cancer, further research is essential to clarify the exact mechanisms linking these conditions and assessing the potential of CV therapies in cancer prevention. This review aims to examine shared risk factors, consider the role of pharmacological and lifestyle interventions, and emphasize crucial epidemiological and mechanistic insights into the intersection of CV and oncological health. Full article

(This article belongs to the Special Issue Cardiovascular and Cerebrovascular Emergencies: Advances in Clinical Research)

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10 pages, 688 KiB

Open AccessArticle

Impact of the Enhanced Recovery After Surgery Protocol on the Perioperative Outcomes of Robot-Assisted Radical Cystectomy

by Kosuke Kitamura, Yuto Miyoshi, Takeshi Ieda, Toshiyuki China, Fumitaka Shimizu, Shigeo Horie and Satoru Muto

J. Clin. Med. 2025, 14(9), 3082; https://doi.org/10.3390/jcm14093082 - 29 Apr 2025

Abstract

Objectives: The enhanced recovery after surgery (ERAS) protocol is a coordinated approach aimed at providing the best evidence-based perioperative care. This study examined whether combining robot-assisted radical cystectomy (RARC) with the ERAS protocol could reduce postoperative complications and hospital length of stay (LOS). We also assessed the impact of high and low adherence to the ERAS protocol on oncological outcomes. Methods: Eighty patients who underwent RARC with urinary diversion at Juntendo University Hospital and Juntendo University Nerima Hospital between April 2014 and December 2021 were included. The ERAS protocol consisted of 15 items, and the achievement rate for each item was assessed. We evaluated the effects of adherence on complications and hospital LOS, as well as the relationship between ERAS implementation and postoperative oncological prognoses. Results: Patients were divided into high-adherence (n = 39) and low-adherence (n = 41) groups based on adherence to 12 or more ERAS items. Patient demographics, including age, sex, and clinical stage, were statistically similar. The high-adherence group had a significantly shorter postoperative hospital LOS (19 days vs. 24 days; p = 0.013) and fewer complications (p = 0.015) compared to the low-adherence group. Furthermore, the high-adherence group exhibited a significantly improved overall survival rate (p = 0.029), while no significant difference was found in progression-free survival (p = 0.125). Conclusions: Integrating the ERAS protocol with RARC can reduce postoperative complications and hospital LOS. High adherence to the ERAS protocol is associated with improved prognoses and outcomes compared to low adherence. Full article

(This article belongs to the Special Issue Robotic Urological Surgery: Clinical Updates for Better Outcomes)

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15 pages, 3014 KiB

Open AccessArticle

Biomechanical Performance and Handling of Mineral–Organic Adhesive Bone Cements Based on Magnesium Under Clinical Test Conditions

by Stefanie Hoelscher-Doht, Alexandra Fabian, Lasse Bögelein, Eva Kupczyk, Rainer H. Meffert, Uwe Gbureck and Tobias Renner

J. Clin. Med. 2025, 14(9), 3081; https://doi.org/10.3390/jcm14093081 - 29 Apr 2025

Abstract

Background/Objectives: Biomineral adhesive bone adhesives composed of phosphoserine combined with magnesium oxides or phosphates exhibit exceptional adhesive properties. This study evaluates two experimental mineral–organic cementitious adhesives in a clinical test setup, investigating their potential for fracture reduction and simultaneous defect filling. Methods: The two experimental adhesives (Groups B and C) and a standard hydroxyapatite cement (Group A, reference) underwent compressive strength testing, shear strength testing, and screw pullout tests as part of a first biomechanical characterization. Furthermore, all materials were tested in a porcine tibial split depression fracture model, where they served both for fracture reduction and for filling the metaphyseal bone defect, supplementary to plate osteosynthesis. Fracture stability was assessed under cyclic loading in a materials testing machine. Results: The OPLS (O-phospho-L-serine) containing adhesive (Group B) demonstrated the highest compressive strength as well as the highest shear strength. All three materials showed comparable maximum pullout forces. Both experimental adhesives (Groups B and C) exhibited higher pullout stiffness compared to the standard cement (Group A). In the fracture model, no significant differences in displacement under cyclic loading were observed between groups. Conclusions: The biomineral adhesive bone adhesives (Groups B and C) demonstrated biomechanical advantages in axial compression, adhesive (shear) strength, and screw fixation compared to the standard hydroxyapatite cement (Group A). Furthermore, they achieved comparable stabilization of metaphyseal fractures under clinically relevant dynamic loading conditions. Full article

(This article belongs to the Special Issue Advances in Trauma and Orthopedic Surgery: 2nd Edition)

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20 pages, 3963 KiB

Open AccessReview

Role of Positron Emission Tomography (PET) in the Diagnosis of Musculoskeletal Disorders

by Raju Vaishya, Jena Amarnath, Prerana Rana, Rajesh Botchu and Abhishek Vaish

J. Clin. Med. 2025, 14(9), 3080; https://doi.org/10.3390/jcm14093080 - 29 Apr 2025

Abstract

Musculoskeletal disorders (MSDs) represent a broad spectrum of diseases and injuries that significantly affect the musculoskeletal system and impose a considerable burden on global public health. This review focuses on the landscape of MSD diagnoses and emphasizes the high prevalence of these conditions. Additionally, it recognizes the inadequacies of conventional evaluation methods, including radiography and subjective assessments, when addressing their complex pathophysiology. It also attempts to highlight the promise of positron emission tomography (PET), which offers quantitative insights into metabolic and molecular activities before structural changes become evident. The review focuses on key radiotracers, specifically, fluorodeoxyglucose ([¹⁸F]-FDG) and sodium fluoride ([¹⁸F]-NaF), discussing their efficacy in assessing inflammatory processes and bone metabolism. By exploring the abilities of these advanced imaging modalities, we aim to identify the potential of using PET in the early detection and more accurate assessment of MSDs. Furthermore, we provide a brief outline of directions for future research, advocating for the development of novel radiotracers, the integration of multiple imaging modalities, and the application of artificial intelligence in imaging analysis. This review contributes to a deeper understanding of MSDs and underscores the urgent need for innovative diagnostic strategies to improve patient care and outcomes in musculoskeletal health. Full article

(This article belongs to the Special Issue PET Imaging in Bone and Non-Bone Diseases)

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22 pages, 1222 KiB

Open AccessReview

Clinical Applications of the Cone Contrast Test in Ophthalmology and Neurology

by Priya Raju and Minzhong Yu

J. Clin. Med. 2025, 14(9), 3079; https://doi.org/10.3390/jcm14093079 - 29 Apr 2025

Abstract

Color vision is a critical aspect of human visual perception, yet traditional assessments often lack quantitative precision. The Rabin Cone Contrast Test and its successors offer objective, standardized measurements of cone-specific contrast sensitivity. These tests improve the detection and classification of color vision deficiencies and can facilitate the monitoring of color vision deficits in inherited retinal diseases, cone dystrophies, optic neuropathies, and brain injuries. Integrating quantitative color vision testing into clinical practice presents a more reliable, reproducible, and functionally relevant evaluation, highlighting its value in disease diagnosis, characterization, and management. Full article

(This article belongs to the Special Issue Clinical Diagnostics and Treatment of Macular Degeneration)

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21 pages, 3272 KiB

Open AccessArticle

Management of Burns: Multi-Center Assessment Comparing AI Models and Experienced Plastic Surgeons

by Gianluca Marcaccini, Ishith Seth, Bryan Lim, Brett K. Sacks, Jennifer Novo, Jeanette Wen Ching Ting, Roberto Cuomo and Warren M. Rozen

J. Clin. Med. 2025, 14(9), 3078; https://doi.org/10.3390/jcm14093078 - 29 Apr 2025

Abstract

Background: Burn injuries require accurate assessment for effective management, and artificial intelligence (AI) is gaining attention in burn care for diagnosis, treatment planning, and decision support. This study compares the effectiveness of AI-driven models with experienced plastic surgeons in burn assessment and management. Methods: Ten anonymized burn images of varying severity and anatomical location were selected from publicly available databases. Three AI systems (ChatGPT-4o, Claude, and Kimi AI) analyzed these images, generating clinical descriptions and management plans. Three experienced plastic surgeons reviewed the same images to establish a clinical reference standard and evaluated AI-generated recommendations using a five-point Likert scale for accuracy, relevance, and appropriateness. Statistical analyses, including Cohen’s kappa coefficient, assessed inter-rater reliability and comparative accuracy. Results: AI models showed high diagnostic agreement with clinicians, with ChatGPT-4o achieving the highest Likert ratings. However, treatment recommendations varied in specificity, occasionally lacking individualized considerations. Readability scores indicated that AI-generated outputs were more comprehensible than the traditional medical literature, though some recommendations were overly simplistic. Cohen’s kappa coefficient suggested moderate to high inter-rater agreement among human evaluators. Conclusions: While AI-driven models demonstrate strong diagnostic accuracy and readability, further refinements are needed to improve treatment specificity and personalization. This study highlights AI’s potential as a supplementary tool in burn management while emphasizing the need for clinical oversight to ensure safe and individualized patient care. Full article

(This article belongs to the Special Issue Burn Wounds Management: Challenges and New Perspectives)

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16 pages, 1262 KiB

Open AccessArticle

Repurposing Atorvastatin, HMGCO-A Reductase Inhibitor, in Patients with Ulcerative Colitis: A Randomized Controlled Study

by Hayam Ali AlRasheed, Sahar M. El-Haggar, Sahar K. Hegazy, Maha M. Maher, Monir M. Bahgat and Mostafa M. Bahaa

J. Clin. Med. 2025, 14(9), 3077; https://doi.org/10.3390/jcm14093077 - 29 Apr 2025

Abstract

Background/Objective: Among the inflammatory bowel illnesses, ulcerative colitis (UC) affects 5 million people worldwide. UC manifests as weight loss, rectal bleeding, persistent diarrhea, and abdominal pain. Experimental research focused into the potential benefits of atorvastatin for colitis, although the literature only has a small amount of clinical evidence. To examine atorvastatin’s protective effect in UC patients by assessing its impact on fecal myeloperoxidase, zonulin, and disease activity index (DAI). Methods: Two groups of patients with mild to moderate UC were randomly assigned. Over a six-month period, the control group (placebo group) received a placebo alongside mesalamine (1 g, three times daily [t.i.d.]). The atorvastatin group received atorvastatin (80 mg once daily) in addition to mesalamine (1 g t.i.d.). Disease severity was assessed by a gastroenterologist using the Disease Activity Index (DAI). Serum zonulin and fecal myeloperoxidase levels were measured before and after treatment to assess the biological efficacy of the interventions. Outcomes: Reduction in DAI and biomarker levels. Results: Both groups showed a significant decrease in DAI, zonulin, and fecal myeloperoxidase levels. However, the atorvastatin group (n = 23) demonstrated a significantly greater decrease in zonulin (p = 0.04), fecal myeloperoxidase (p = 0.03), and DAI (p = 0.001) compared to the placebo group (n = 24). In atorvastatin group, a significant correlation was observed between DAI and zonulin (p = 0.007, r = 0.4) and myeloperoxidase (p = 0.02, r = 0.36). Conclusions: The co-administration of atorvastatin may serve as a potential adjunct therapy for patients with UC. Full article

(This article belongs to the Special Issue Inflammatory Bowel Diseases in 2024 and Beyond: From Diagnosis to Treatment)

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15 pages, 2753 KiB

Open AccessReview

Autoimmune Pancreatitis: A Review

by Varun Vemulapalli, Cristina Natha and Anusha Shirwaikar Thomas

J. Clin. Med. 2025, 14(9), 3076; https://doi.org/10.3390/jcm14093076 - 29 Apr 2025

Abstract

Autoimmune pancreatitis is a rare condition of pancreatic inflammation with two classic subtypes. The emergence of a third subtype, ICI-induced pancreatitis, highlights the need for knowledge of each type to ensure accurate diagnosis and treatment. Abbreviations: AIP—Autoimmune pancreatitis; AIP-1—Type 1 autoimmune pancreatitis, also known as lymphoplasmacytic sclerosing pancreatitis (LPSP); AIP-2—Type 2 autoimmune pancreatitis, also referred to as idiopathic duct-centric pancreatitis (IDCP); AIP-3—Type 3 autoimmune pancreatitis, also known as immune checkpoint inhibitor (ICI)-induced autoimmune pancreatitis; IgG4-RD—Immunoglobulin G4-related disease. Full article

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

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10 pages, 684 KiB

Open AccessArticle

Impact of Single-Lumen Versus Double-Lumen Endotracheal Tube on Postoperative Swallowing Function in Lung Transplantation Patients: A Single-Center, Retrospective Cohort Study

by Rishi Ashok Patel, Haley Nitchie, Bethany J. Wolf, Cecilia Taylor and Loren Francis

J. Clin. Med. 2025, 14(9), 3075; https://doi.org/10.3390/jcm14093075 - 29 Apr 2025

Abstract

Background/Objectives: The role of double-lumen endotracheal tube (DLT) versus single-lumen endotracheal tube (SLT) use during lung transplantation (LTx) and its effects on postoperative dysphagia have not yet been studied. It has been shown that new-onset oropharyngeal dysphagia (OPD) is common after various thoracic surgeries including lung transplantation and that OPD is associated with increased postoperative complications. Methods: A single-center, retrospective cohort study was performed using a data exploration tool in the electronic medical record. Data included demographic characteristics, medical history, postoperative dysphagia measured by Functional Oral Intake Scale (FOIS) via modified barium swallow study (MBSS) within 5 days of surgery, and other secondary outcomes. Results: In univariate analysis, participants who had a DLT (49 patients) had significantly higher FOIS scores (indicating better swallowing function) as compared to those with an SLT (21 patients) (p = 0.035). Lumen type remained significant in a multivariable model, with use of a DLT showing more than a 5-fold increase in the odds of a higher FOIS score after controlling for other factors (p = 0.004; cumulative OR (95% CI): 5.2 (1.7–15.9)). Participants who had a DLT had shorter hospital length of stay (LOS) (p = 0.017; single 18 days (IQR = 13), double 14 days (IQR 7)). Those who had a DLT experienced significantly greater ventilator-free time at postoperative day 30 compared to those who received an SLT (p = 0.018). ICU LOS was similar between those who received a DLT vs. SLT. Conclusions: Overall, DLT seems to confer reduced new-onset OPD after lung transplantation surgery when compared with SLT. The use of DLT instead of SLT for lung isolation for LTx may have the potential to reduce morbidity and mortality in this population. Full article

(This article belongs to the Section Anesthesiology)

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14 pages, 927 KiB

Open AccessArticle

Socioeconomic Status and Vascular Access Patency in Hemodialysis: Analysis of Korean National Health Insurance Service Data from 2008 to 2019

by Jeong-Ik Park, Daehwan Kim, Hyangkyoung Kim, Seung Boo Yang, Sang Jun Park and Young-joo Kwon

J. Clin. Med. 2025, 14(9), 3074; https://doi.org/10.3390/jcm14093074 - 29 Apr 2025

Abstract

Background: Socioeconomic status (SES) disparities impact health outcomes, but their effect on vascular access (VA) in hemodialysis patients in Korea remains underexplored. Methods: This study evaluated the association between SES and VA outcomes using National Health Insurance Service data from 2008 to 2019. Incident hemodialysis patients were categorized by insurance status into the health insurance group (HG) and medical aid group (MG). The primary endpoint was VA patency, and the secondary endpoint was all-cause mortality, adjusted for demographics, comorbidities, and lifestyle factors. Results: Among 86,036 patients, the MG (12.1%) was younger at VA creation (60.4 ± 13.5 vs. 63.1 ± 13.6 years, p < 0.001) and had higher rates of comorbidities (all p < 0.05 except cancer). Mortality rates per 100 person-years were higher in the MG (11.66 vs. 9.24 for AVF; 17.94 vs. 16.92 for AVG), as was the total procedure frequency (2.10 vs. 1.87, p < 0.001), despite similar percutaneous angioplasty counts (1.20 vs. 1.24, p = 0.314). Conclusions: Lower SES patients exhibited poorer VA patency and higher mortality rates despite equitable healthcare access and cost coverage in Korea. These findings suggest that non-medical factors, such as adherence to treatment and timely intervention, play a critical role in mitigating these disparities. Full article

(This article belongs to the Section Nephrology & Urology)

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