Journal of Clinical Medicine

22 pages, 1344 KB

Open AccessArticle

Forward Head Posture and Trunk Muscle Activation Patterns During a Rapid Leg-Raise Task in Asymptomatic Young Adults: A Cross-Sectional Study

by Ibrahim M. Moustafa, Maryam M. Abdellatif, Monica Raja Kumari Raghunathan, Khadija Darwish, Zahra I. Almohsen, Hessa K. Alketbi, Noura I. Alfaraji, Iman Khowailed, Aliaa A. Diab and Deed E. Harrison

J. Clin. Med. 2026, 15(10), 3657; https://doi.org/10.3390/jcm15103657 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: Forward head posture (FHP) has been associated with alterations in cervical sensorimotor function; however, its relationship with trunk muscle activation during dynamic movement tasks remains incompletely understood. This study examined whether individuals with FHP demonstrate differences in the timing and magnitude [...] Read more.

Background/Objectives: Forward head posture (FHP) has been associated with alterations in cervical sensorimotor function; however, its relationship with trunk muscle activation during dynamic movement tasks remains incompletely understood. This study examined whether individuals with FHP demonstrate differences in the timing and magnitude of trunk muscle activation during a rapid lower-limb movement task. Methods: One hundred asymptomatic young adults (18–25 years) were classified as having normal head posture (NHP; craniovertebral angle (CVA) > 55°) or forward head posture (FHP; CVA < 50°) using PostureScreen^® Mobile. Surface electromyography (EMG) was recorded bilaterally from the external oblique (EO), lumbar multifidus (MF), and the transversus abdominis/internal oblique region (TrA/IO) during ten externally cued right-leg raises. EMG amplitude and onset latency relative to rectus femoris activation were extracted for each muscle. Two multivariate analyses of variance (MANOVA) assessed overall group differences in EMG amplitudes and onset latencies. Significant multivariate effects were followed by univariate ANOVAs. Group × Side mixed-model ANOVAs evaluated side-to-side activation patterns. Pearson correlation and regression analyses examined correlations between craniovertebral angle (CVA) and EMG variables. Results: MANOVA revealed significant overall differences between the FHP and NHP groups for EMG amplitude (Wilks’ λ = 0.20, F(6,93) = 62.14, p < 0.001, η²p = 0.80) and onset latency (Wilks’ λ = 0.10, F(6,93) = 133.73, p < 0.001, η²p = 0.90). Follow-up ANOVAs showed significant differences for all EMG variables (all p < 0.001), with large effect sizes (Cohen’s d = 1.0–3.2). Mixed-model ANOVAs demonstrated significant Group × Side interactions (all p < 0.05). CVA showed significant moderate to strong correlations with EMG amplitude and onset latency measures (r = 0.43–0.79). Conclusions: FHP was associated with later trunk muscle activation and altered EMG activation patterns during the leg-raise task, including reduced activity recorded from the TrA/IO region and increased EO activation. These findings suggest FHP is associated with different trunk neuromuscular activation strategies during dynamic tasks. Despite consistent CVA–EMG associations, extreme multicollinearity limits the interpretation of CVA as an independent predictor. Full article

(This article belongs to the Section Clinical Rehabilitation)

12 pages, 589 KB

Open AccessArticle

Frank’s Sign and Risk of Cardiovascular Events in Patients Hospitalized for Pneumonia: A Prospective Single-Center Cohort Study

by Laure Cochand, Nils Bürgisser, Clement P Buclin, Aline Habegger, Jeremy H. Martin, Marion Hell, Solenne Perrenoud and Daniel Genné

J. Clin. Med. 2026, 15(10), 3656; https://doi.org/10.3390/jcm15103656 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: Frank’s sign (FS), an acquired diagonal earlobe crease, has been associated with underlying cardiovascular (CV) disease. Pneumonia, a leading cause of hospitalization, may trigger CV events. FS may help identify patients at increased risk of CV complications following pneumonia. We aimed to [...] Read more.

Background/Objectives: Frank’s sign (FS), an acquired diagonal earlobe crease, has been associated with underlying cardiovascular (CV) disease. Pneumonia, a leading cause of hospitalization, may trigger CV events. FS may help identify patients at increased risk of CV complications following pneumonia. We aimed to evaluate the association between FS and CV events following pneumonia. Methods: We conducted a single-center prospective cohort study of internal medicine patients hospitalized with community-acquired pneumonia at a secondary hospital in Switzerland, followed for 18 months. FS was assessed at inclusion by trained investigators. Baseline characteristics were recorded. The primary outcome was a composite of CV endpoints: new-onset atrial fibrillation/flutter, myocardial infarction, hospitalization for heart failure, peripheral arterial ischemic events, or stroke. Events were identified through hospital records and general practitioner data between 2020 and 2023. Results: Among 203 patients (median age 76.0 years [IQR 65.0 to 83.0]; 41.4% female), 71.2% had FS. During follow-up, 103 CV events occurred. In univariate Cox analysis, FS was associated with an increased hazard of CV events (p = 0.042). After adjustment for confounders, FS was not significantly associated with CV events (HR 0.97; 95% CI 0.59–1.59). Only a history of CV disease and CV risk factors were associated with an increased hazard of subsequent cardiovascular events following pneumonia. Conclusions: In this population of patients hospitalized with pneumonia, Frank’s sign was not independently associated with cardiovascular events and appears to reflect underlying cardiovascular risk burden. It should not be interpreted as an independent prognostic marker. Full article

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

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12 pages, 773 KB

Open AccessArticle

Changes in Epidemiological Characteristics in Children with Mycoplasma pneumoniae Seropositivity in Southwest China from 2022 to 2023

by Zhengxiang Gao, Yifei Duan, Yu Wu, Yu Gou and Fan Yu

J. Clin. Med. 2026, 15(10), 3655; https://doi.org/10.3390/jcm15103655 (registering DOI) - 9 May 2026

Abstract

Background: Mycoplasma pneumoniae (MP) is an important pathogen responsible for community-acquired respiratory infections in children. Global surveillance during the COVID-19 pandemic revealed a marked decline in MP activity. However, beginning in early summer 2023, multiple regions across China reported an unexpected resurgence [...] Read more.

Background: Mycoplasma pneumoniae (MP) is an important pathogen responsible for community-acquired respiratory infections in children. Global surveillance during the COVID-19 pandemic revealed a marked decline in MP activity. However, beginning in early summer 2023, multiple regions across China reported an unexpected resurgence of MP infections, highlighting the need for detailed epidemiological analysis. Objective: This study aimed to characterize the epidemiological features of MP seropositivity among children in Chengdu, southwest China, and to compare its patterns between the COVID-19 pandemic and post pandemic periods. Methods: A retrospective analysis was conducted on MP testing data from 39,552 children with acute respiratory infections who were treated at West China Second University Hospital, Sichuan University, between January 2022 and December 2023. Results: Both the number of MP tests conducted and the seropositivity rate were significantly lower during the pandemic period than during the post pandemic phase. Compared with male children, female children were more susceptible to MP seropositivity. In terms of age distribution, seropositivity rates were highest among toddlers (1–3 years) and school-aged children (6–14 years). During the pandemic period (2022), MP antibody-positive cases were observed mainly between January and July, whereas in the post pandemic phase (2023), the epidemic peak shifted from June to December. Conclusions: In this single-centre study in Chengdu, nonpharmaceutical interventions (NPIs) implemented during the COVID-19 pandemic was associated with a marked reduction in MP transmission. After these restrictions were lifted, a rebound in MP antibody positivity was observed among children in Chengdu, compared to the NPI period (2022), the post-NPI period (2023) showed a later seasonal peak, which may represent a delayed return to pre-pandemic patterns. Continuous strengthening of MP surveillance is necessary to provide early warning of potential resurgences and outbreak risks. Full article

(This article belongs to the Section Clinical Pediatrics)

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18 pages, 381 KB

Open AccessArticle

Effects of Body Weight Unloading and Treadmill Belt Surface on Tibial Acceleration-Based Loading Indicators During Running on a Microgravity Treadmill

by Łukasz Oleksy, Anna Mika, Martyna Sopa, Artur Stolarczyk, Olga Adamska, Maciej Kuchciak, Miłosz Szczudło, Paulina Ciepiela, Rafał Buryta, Paweł Reichert and Renata Kielnar

J. Clin. Med. 2026, 15(10), 3654; https://doi.org/10.3390/jcm15103654 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: The aim of this study was to compare tibial acceleration and acceleration-based indicators associated with tibial loading during running under full body weight (BW) conditions and with body weight support (80%, 60%, and 40% BW) on a microgravity treadmill, and to [...] Read more.

Background/Objectives: The aim of this study was to compare tibial acceleration and acceleration-based indicators associated with tibial loading during running under full body weight (BW) conditions and with body weight support (80%, 60%, and 40% BW) on a microgravity treadmill, and to examine the effect of treadmill surface by comparison with a conventional treadmill. Methods: Twenty-six healthy, physically active adults (age 18–40 years) completed running trials at a constant speed of 8 km/h. Tibial acceleration was recorded using inertial measurement units. Results: Cadence decreased significantly with increasing levels of body weight support, while no differences were observed between a conventional treadmill running and microgravity treadmill running at 100% BW. Axial acceleration parameters demonstrated a consistent reduction in acceleration magnitude associated with progressive unloading. The magnitude of axial acceleration (MAA), as well as peak positive (PPAA) and negative (PNAA) axial accelerations, decreased significantly, with the largest reductions observed at 60% and 40% BW. Temporal parameters showed a different pattern: time to peak positive axial acceleration increased with unloading, indicating delayed peak loading. The duration of positive axial acceleration exhibited a non-linear response, increasing at moderate unloading levels (80% and 60% BW) and decreasing at 40% BW. In contrast, the duration of negative axial acceleration did not change significantly, although overall contact time increased with unloading. Conclusions: The findings of this study indicate that progressive body weight unloading during running on a microgravity treadmill leads to a significant reduction in impact-related tibial acceleration indicators associated with mechanical loading exposure, particularly in parameters describing the amplitude and dynamics of axial accelerations. Running at 100% BW on both treadmill systems demonstrated overall biomechanical similarity; however, several side-specific differences in tibial acceleration parameters suggest that treadmill surface and system characteristics may exert a subtle influence on local acceleration measurements. Moderate unloading (~80% BW) may provide an optimal balance between load reduction and preservation of natural running mechanics. Full article

(This article belongs to the Special Issue New Insights into Sports Injuries and Rehabilitation: From Injury to Performance)

14 pages, 6274 KB

Open AccessArticle

Clinical Utility of Quantitative MRI Parameters for Differentiation of Renal Tumor Subtypes and Who Grades: A Multiparametric Approach with Internal Cortical Reference

by Ekrem Anil Sari, Serap Sari, Canan Altay, Altug Didikoglu, Furkan Mert Kervan and Mustafa Secil

J. Clin. Med. 2026, 15(10), 3653; https://doi.org/10.3390/jcm15103653 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: To evaluate the clinical utility and diagnostic performance of quantitative MRI parameters (T1, T2*, R2*, and ADC) in differentiating renal tumor subtypes and WHO grades, and to assess their potential role in non-invasive tumor characterization. Methods: This retrospective study included 82 patients [...] Read more.

Background/Objectives: To evaluate the clinical utility and diagnostic performance of quantitative MRI parameters (T1, T2*, R2*, and ADC) in differentiating renal tumor subtypes and WHO grades, and to assess their potential role in non-invasive tumor characterization. Methods: This retrospective study included 82 patients with histopathologically confirmed renal tumors who underwent preoperative contrast-enhanced MRI between July 2019 and January 2024. Quantitative measurements were obtained from tumor regions and contralateral healthy renal cortex using standardized ROI-based analysis. Parameters included T2*, native and post-contrast T1, R2* (1/T2*), and ADC values. Interobserver agreement was assessed. A Random Forest model was used as a supplementary analytical tool. Results: The cohort included 82 patients (mean age: 59.3 years). Tumors were classified into multiple subtypes, with clear cell carcinoma being the most common (n = 46). High-grade tumors (WHO grades 3–4) demonstrated significantly lower ADC values (p = 0.029) and larger tumor size (p = 0.0017). Significant differences in T2*, R2*, and ADC values were observed across tumor subtypes (p < 0.05). Quantitative MRI parameters demonstrated moderate discriminatory performance, with ADC emerging as the most robust biomarker. The Random Forest model achieved an overall accuracy of 93.2%, primarily driven by ADC and post-contrast T1 values. Conclusions: Quantitative MRI parameters, particularly ADC, provide clinically meaningful non-invasive biomarkers for renal tumor characterization. Their combined interpretation, supported by contralateral renal cortex comparison, may enhance clinical decision-making. Further validation in larger cohorts is warranted. Full article

(This article belongs to the Special Issue Kidney Cancer: From Diagnostic to Therapy)

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11 pages, 1141 KB

Open AccessArticle

Outcomes of Blunt Suprahepatic Vena Cava Injuries: A Retrospective Study from a Single Trauma Center in Korea

by Donghwan Choi, Sang-Hyun Lim and Jonghwan Moon

J. Clin. Med. 2026, 15(10), 3652; https://doi.org/10.3390/jcm15103652 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: Blunt suprahepatic inferior vena cava (SHIVC) injury is a rare and highly lethal condition associated with severe thoracoabdominal trauma. This study describes the clinical characteristics and outcomes of SHIVC injuries treated at a single institution. Methods: We retrospectively reviewed patients with blunt [...] Read more.

Background/Objectives: Blunt suprahepatic inferior vena cava (SHIVC) injury is a rare and highly lethal condition associated with severe thoracoabdominal trauma. This study describes the clinical characteristics and outcomes of SHIVC injuries treated at a single institution. Methods: We retrospectively reviewed patients with blunt SHIVC injury treated between January 2014 and September 2023. Demographics, injury characteristics, management strategies, and outcomes were analyzed descriptively. The primary outcome was in-hospital mortality. Given the small sample size, statistical analyses were exploratory. Results: Ten patients were identified (mean age: 47 ± 17 years; mortality: 40%; ISS: 43 ± 19). On admission, 50% presented with systolic blood pressure < 90 mmHg and a mean Glasgow Coma Scale score of 7 ± 5. Non-survivors had lower systolic blood pressure (70 ± 12 vs. 115 ± 34 mmHg, p = 0.05), lower GCS scores (3 ± 0 vs. 9 ± 5, p = 0.02), and worse base excess (−20.1 ± 5.8 vs. −7.8 ± 7.1) than survivors. Surgical intervention was performed in 9 patients, while 1 was managed nonoperatively. Common associated injuries included right atrial injury (70%), liver injury (50%), and diaphragm injury (30%). Four patients received intraoperative circulatory support; two treated with cardiopulmonary bypass survived, whereas those treated with extracorporeal membrane oxygenation died. No definitive conclusions can be drawn regarding treatment effectiveness due to the limited sample size. Conclusions: Outcomes appear strongly influenced by initial physiological status and injury severity. This study is descriptive and hypothesis-generating; further multicenter studies remain warranted to define optimal management strategies. Full article

(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes: 2nd Edition)

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16 pages, 1527 KB

Open AccessArticle

Functional Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction Using Retrograde Femoral Socket Drilling via a Far Anteromedial Portal Combined with a Conventional Antegrade Tibial Tunnel: A Retrospective Cohort Study

by Harun Köse, Ekrem Özdemir, Enes Gündüz, Hakan Ertem, Hüseyin Utku Özdeş, Okan Aslantürk and Emre Ergen

J. Clin. Med. 2026, 15(10), 3651; https://doi.org/10.3390/jcm15103651 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction remains the accepted standard of care for ACL ruptures in physically active individuals. Various surgical techniques have been developed to achieve anatomic reconstruction and optimize functional outcomes. The aim of this study was to descriptively report [...] Read more.

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction remains the accepted standard of care for ACL ruptures in physically active individuals. Various surgical techniques have been developed to achieve anatomic reconstruction and optimize functional outcomes. The aim of this study was to descriptively report the early functional outcomes of anatomic ACL reconstruction performed using retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel, without claiming superiority over alternative techniques. Methods: This single-center, single-arm retrospective cohort study included 33 consecutive male patients with ACL rupture who underwent arthroscopic ACL reconstruction using hamstring tendon autograft between 2021 and 2022 at a tertiary academic medical center. The surgical technique employed retrograde drilling of the femoral socket using a FlipCutter device introduced through a far anteromedial portal; the tibial tunnel was created with a standard outside-in aiming guide. The pre-specified primary outcome was the change in the Tegner–Lysholm score from baseline to 12 months; secondary outcomes were the Modified Cincinnati and International Knee Documentation Committee (IKDC) subjective scores and clinical stability tests. Functional outcomes were assessed preoperatively and at 6 weeks, 3 months, and 12 months postoperatively using repeated-measures testing with the Friedman test and post hoc Wilcoxon signed-rank tests with Bonferroni correction. Reporting followed the STROBE recommendations for observational studies. Results: All 33 patients (100% male) completed the 12-month follow-up. The mean age was 28 years (range: 18–44), and sports-related injuries accounted for 84.8% of cases. Significant improvements were observed in all functional scores from preoperative to 12-month postoperative assessments (p < 0.001). The mean Tegner-Lysholm score improved from 46.8 ± 17.3 preoperatively to 83.7 ± 10.5 at 12 months (mean change +36.9, 95% CI 30.3 to 43.5; matched-pairs effect size r = 0.87). The mean IKDC score increased from 36.3 ± 14.4 to 68.4 ± 15.1 (mean change +32.1, 95% CI 25.3 to 38.9; r = 0.84), and the Cincinnati score improved from 41.3 ± 15.9 to 80.2 ± 10.9 (mean change +38.9, 95% CI 32.6 to 45.2; r = 0.86). All observed mean changes exceeded the minimal clinically important difference (MCID) reported for these instruments in ACL populations. Postoperative stability assessment demonstrated restoration of knee stability in the majority of patients, with 66.7% showing a negative anterior drawer test at final follow-up. Conclusions: Anatomic ACL reconstruction utilizing retrograde femoral socket drilling using a FlipCutter through a far anteromedial portal combined with a conventional antegrade tibial tunnel was associated with satisfactory early functional outcomes in a small, all-male cohort, comparable to those reported for contemporary anatomic ACL reconstruction techniques. Given the retrospective, single-arm design, modest sample size, homogeneous all-male cohort, absence of instrumented laxity or return-to-sport data, and absence of multivariable adjustment, any suggestion of technique-specific advantages should be regarded as hypothesis-generating. Comparative effectiveness against other anatomic techniques remains to be established in prospective, controlled studies with longer follow-up. Full article

(This article belongs to the Special Issue Advances in Anterior Cruciate Ligament Injury Treatment)

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14 pages, 1737 KB

Open AccessArticle

Short-Term Effects of Targeted Movement Training on Gait Kinematics in Children with Juvenile Idiopathic Arthritis: A Motion Analysis Study

by Sibel Özbal, Asya Albayrak, Asena Yekdaneh, İrem Dönmez, Nuray Aktay Ayaz, Nilay Arman and Hande Argunsah

J. Clin. Med. 2026, 15(10), 3650; https://doi.org/10.3390/jcm15103650 (registering DOI) - 9 May 2026

Abstract

Background: Children with juvenile idiopathic arthritis (JIA) exhibit gait abnormalities, postural instability, and compensatory movement strategies due to joint pain, inflammation, and reduced neuromuscular control. These alterations negatively affect functional mobility and movement efficiency. Although gait retraining is commonly recommended in rehabilitation, [...] Read more.

Background: Children with juvenile idiopathic arthritis (JIA) exhibit gait abnormalities, postural instability, and compensatory movement strategies due to joint pain, inflammation, and reduced neuromuscular control. These alterations negatively affect functional mobility and movement efficiency. Although gait retraining is commonly recommended in rehabilitation, objective evidence on its short-term biomechanical effects remains limited. This study aimed to evaluate the immediate impact of a single-session standardized movement training intervention on gait biomechanics in children with JIA. Methods: Seventeen children with JIA underwent pre–post gait assessments using the Xsens MVN Awinda wearable motion capture system. The intervention focused on step symmetry, stride length, heel–toe progression, and upright trunk posture, delivered by an experienced physiotherapist following a standardized protocol. Scalar kinematic outcomes were analyzed using paired statistical tests, and time-normalized kinematic waveforms were compared with healthy reference data from 25 age-matched participants derived from the COMPWALK-ACL dataset. Results: Significant improvements were observed in multiple gait parameters following the intervention. Trunk lateral lean decreased significantly (p = 0.0002; d = −1.35), indicating enhanced postural stability. Significant changes were also found in ankle dorsiflexion–plantarflexion (p = 0.0081; d = 0.83) and knee flexion–extension (p = 0.0252; d = 0.68). Waveform analyses showed increased similarity to healthy patterns, particularly in trunk and knee kinematics. Spatiotemporal parameters reflected a slower, more controlled gait pattern, with increased stride time and stance duration. Conclusions: A single session of standardized movement training can produce immediate improvements in gait biomechanics in children with JIA, especially in trunk control and lower-limb kinematics. Wearable motion analysis provides a sensitive tool for detecting these short-term adaptations and supports the inclusion of structured movement training in pediatric JIA rehabilitation. Full article

(This article belongs to the Special Issue Therapeutic Strategies in Rheumatic Diseases)

16 pages, 968 KB

Open AccessCase Report

Salvage Hepatectomy in Toxic Liver Syndrome as a Bridge to Orthotopic Liver Retransplantation—Case Series and Structured Narrative Review

by Constantin Scholz, Evangelos Tagkalos, Jens Kamuf, Eva-Verena Griemert, Maria Hoppe-Lotichius, Beate K. Straub, Lukas Müller, Maximilian Moos, Tobias Huber, Janine Baumgart, Jens Mittler and Hauke Lang

J. Clin. Med. 2026, 15(10), 3649; https://doi.org/10.3390/jcm15103649 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: Salvage hepatectomy with a prolonged anhepatic phase represents a potential life-saving strategy in patients with toxic liver syndrome (TLS) following orthotopic liver transplantation (OLT). Available evidence is limited to small case series. Methods: We retrospectively analyzed all patients undergoing OLT between 2014 [...] Read more.

Background/Objectives: Salvage hepatectomy with a prolonged anhepatic phase represents a potential life-saving strategy in patients with toxic liver syndrome (TLS) following orthotopic liver transplantation (OLT). Available evidence is limited to small case series. Methods: We retrospectively analyzed all patients undergoing OLT between 2014 and 2024 at a German transplant center. Among 497 patients, 33 required retransplantation, including four patients who underwent salvage hepatectomy due to refractory TLS. Clinical trajectories were analyzed descriptively. Additionally, a structured narrative review of the literature was performed. Results: Median age was 63 years (range 62–67), and median anhepatic time was 38.4 h (range 14.39–71.55). No patient died during the anhepatic phase. One patient died during retransplantation, and another during the postoperative course. Two patients survived long-term without neurological impairment. A literature review identified 30 relevant studies with reported mortality rates exceeding 50%. Conclusions: Salvage hepatectomy with subsequent retransplantation may serve as a life-saving bridge in selected patients with TLS. However, outcomes remain heterogeneous, and evidence is limited. This study provides detailed insights into perioperative physiological trajectories and clinical decision-making, which are insufficiently described in the current literature. Full article

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

12 pages, 1184 KB

Open AccessReview

An Overview of Meta-Analyses on the Surgical Stabilization of Rib Fractures in Adults: A Narrative Umbrella Review (2020–2025)

by Maria Chiara Sibilia, Francesca Romboni, Sara Franzi, Lorenzo Bramati, Maria Carmela Andrisani, Mario Nosotti and Davide Tosi

J. Clin. Med. 2026, 15(10), 3648; https://doi.org/10.3390/jcm15103648 (registering DOI) - 9 May 2026

Abstract

Background: Rib fractures are a common cause of morbidity in trauma patients. The surgical stabilization of rib fractures (SSRF) has gained increasing attention as a therapeutic option; however, evidence from multiple meta-analyses remains heterogeneous. Methods: We performed an overview of 11 meta-analyses, including [...] Read more.

Background: Rib fractures are a common cause of morbidity in trauma patients. The surgical stabilization of rib fractures (SSRF) has gained increasing attention as a therapeutic option; however, evidence from multiple meta-analyses remains heterogeneous. Methods: We performed an overview of 11 meta-analyses, including a total of 1,117,849 adult patients (narrative umbrella review), published between November 2020 and November 2025 to summarize and critically appraise high-level evidence comparing SSRF with non-operative management (NOM) in adults with traumatic rib fractures. PubMed (MEDLINE) and Embase were searched for eligible meta-analyses. Outcomes of interest included mechanical ventilation duration, pneumonia, ICU and hospital length of stay, mortality, pain, quality of life, and need for tracheostomy. Results: Eleven meta-analyses met the inclusion criteria. Across outcomes, the direction of effect generally favored SSRF in selected patients, particularly with respect to a shorter duration of mechanical ventilation (mean difference up to approximately 4–6 days), reduced pulmonary complications (risk ratio approximately 0.4–0.7), shorter ICU and hospital stay, and improved pain control. However, results varied substantially across studies. A consistent mortality benefit was not observed. Subgroup analyses suggested that the benefits of SSRF were more pronounced in patients with flail chest, severe fracture patterns, and early surgery, whereas findings were less consistent in elderly patients and in patients with less severe injuries. Conclusions: This narrative umbrella review suggests that SSRF is associated with improved short-term outcomes in selected adult patients with traumatic rib fractures but should not be considered a universal standard of care. Careful patient selection, timing of intervention, and multidisciplinary evaluation remain essential. Further high-quality prospective studies are needed to better define optimal indications and management strategies. Full article

(This article belongs to the Special Issue Clinical Update on Thoracic Trauma)

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10 pages, 1223 KB

Open AccessCase Report

Digital Design for Lower Incisor Position Correction in a Growing Patient with Mandibular Retrusion with ClinCheckÒ Software: A Case Report

by Lupini Daniela, Sara Caruso, Mauro Cozzani and Silvia Caruso

J. Clin. Med. 2026, 15(10), 3647; https://doi.org/10.3390/jcm15103647 (registering DOI) - 9 May 2026

Abstract

Background: The majority of Class II malocclusions stem from mandibular deficiency, leading to chin retrusion. In growing patients, the ideal correction—aiming for a skeletal mandibular response—should avoid common pitfalls such as “Point B” dropping postero-inferiorly, excessive labial proclination of mandibular incisors, or [...] Read more.

Background: The majority of Class II malocclusions stem from mandibular deficiency, leading to chin retrusion. In growing patients, the ideal correction—aiming for a skeletal mandibular response—should avoid common pitfalls such as “Point B” dropping postero-inferiorly, excessive labial proclination of mandibular incisors, or the lingual tipping and extrusion of maxillary incisors. When planning mandibular advancement (MA) using clear aligners with integrated advancement features, biomechanical forces are not the only consideration; precise management of the lower incisor position is critical for success. Current literature highlights not a good control in digital planning software: these platforms are primarily dentoalveolar-based and lack integrated cephalometric analysis. Consequently, mandibular advancement is often defined by standard linear parameters (typically 2 mm per step), while incisor position is managed through virtual alignment without correlation to cephalometric landmarks like the Pogonion, NB line, or IMPA. The software cannot monitor real-time sagittal or vertical skeletal relationships, the software will elaborate the treatment planning after doctor’s prescription, the clinician must manually adjust incisor positioning based on external cephalometric analysis to prevent dental compensation or excessive proclination. Aim: This clinical case demonstrates a specific arch preparation protocol designed to optimize mandibular advancement in a growing patient with mandibular retrusion. Methods: A 12-year-old female presented with a skeletal and dental Class II malocclusion, characterized by increased overjet and a normal overbite. Treatment was conducted using Invisalign^® clear aligners (22h/day wear, weekly changes). The treatment objectives were: transverse: Correct upper dentoalveolar contraction and coordinate arch form while restoring midline alignment; sagittal: establish Class I molar and canine relationships by correcting the overjet and reducing the labial inclination of the lower incisors; vertical: level the curve of Spee. A key clinical condition of our protocol was the pre-advancement phase: the lower arch was reshaped by reducing the buccolingual inclination (retroclination) and intruding the lower incisors. This was specifically intended to increase the available overjet space, creating the necessary room for subsequent mandibular advancement. Results Treatment was completed in 24 months with high patient compliance. Objectives were successfully met, including the correction of skeletal and dental discrepancies, the establishment of harmonious arch forms, and precise overjet reduction through enhanced control of the mandibular incisors. Conclusions: This case report outlines an optimized clinical strategy for Class II correction. Cephalometric Integration: Perform an initial analysis outside the digital planning software to define the ideal IMPA and NB angles. Anatomic Verification: Utilize radiographic overlays to ensure tooth movement remains within alveolar bone limits. Pre-MA Optimization: Prioritize a “pre-advancement” phase to maximize the sagittal inter-arch space (overjet). A larger overjet allows for a more significant orthopedic effect from the MA features. Stepwise Advancement: Implement mandibular advancement in increments (≥2 mm) with periodic clinical reassessment to facilitate the adaptation of the muscular sling and functional occlusion. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

24 pages, 759 KB

Open AccessReview

Left Ventricular Ejection Fraction in Heart Failure—A Parameter to Be Discontinued?

by Inês Freire and Manuel Vaz da Silva

J. Clin. Med. 2026, 15(10), 3646; https://doi.org/10.3390/jcm15103646 (registering DOI) - 9 May 2026

Abstract

Heart failure (HF) is a multifactorial and heterogeneous syndrome with substantial epidemiological burden, high mortality, and impact on quality of life. In the context of heart failure, left ventricular ejection fraction (LVEF) has been regarded as the most important marker of systolic function [...] Read more.

Heart failure (HF) is a multifactorial and heterogeneous syndrome with substantial epidemiological burden, high mortality, and impact on quality of life. In the context of heart failure, left ventricular ejection fraction (LVEF) has been regarded as the most important marker of systolic function and is fundamental in medical research and clinical practice. In research, LVEF has been a major inclusion criterion in most clinical trials over the past few decades. Furthermore, international heart failure guidelines rely on LVEF for the diagnosis of HF and to guide effective treatment. Additionally, our understanding of HF phenotypes and prognosis is mostly grounded in a classification based on LVEF. Nevertheless, there has been a growing debate regarding the role of LVEF in heart failure. In this context, the purpose of this review is to discuss both the advantages and contemporary relevance of LVEF in heart failure, as well as its limitations and controversies. In addition, this review aims to discuss potential alternatives and future directions in heart failure classification, such as new classification methods, alternative measurements of systolic function and imaging techniques, the HLM score, and the use of artificial intelligence and machine learning. Full article

(This article belongs to the Section Cardiology)

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19 pages, 2235 KB

Open AccessSystematic Review

Role of Ultrasound and Fetal MRI in the Prenatal Assessment of Congenital Cytomegalovirus Infection: A Systematic Review

by Katarzyna Stefanska, Krzysztof Berbeka, Dorota Madej, Piotr Witkowski, Magda Rybak-Krzyszkowska, Sambor Sawicki and Miriam Illa

J. Clin. Med. 2026, 15(10), 3645; https://doi.org/10.3390/jcm15103645 (registering DOI) - 9 May 2026

Abstract

Background: Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and a leading cause of neurodevelopment impairment. Prenatal imaging plays a central role in diagnosis and prognostic assessment. Methods: We conducted a systematic review of studies evaluating the role of ultrasound, [...] Read more.

Background: Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and a leading cause of neurodevelopment impairment. Prenatal imaging plays a central role in diagnosis and prognostic assessment. Methods: We conducted a systematic review of studies evaluating the role of ultrasound, including dedicated fetal neurosonography and magnetic resonance imaging (MRI) in the prenatal detection and assessment of CMV infection. PubMed, Web of Science, and Scopus were searched for relevant studies, and data were synthesized focusing on detected abnormalities and the incremental diagnostic value of MRI. Results: Fifty-nine studies were included. Dedicated neurosonography (NSG) was the primary modality for detecting CMV-related fetal brain abnormalities, particularly ventriculomegaly and cortical malformations. Fetal MRI provided additional diagnostic information, mainly through improved visualization of the brain parenchyma, allowing better detection of white matter abnormalities, migrational disorders and posterior fossa involvement, especially when performed later in gestation. Conclusions: Dedicated neurosonography remains the cornerstone for the evaluation of suspected congenital fetal CMV infection. Fetal MRI represents a complementary tool that can confirm, refine or extend ultrasound findings and may improve prognostic assessment when additional or subtle brain abnormalities are suspected. Full article

(This article belongs to the Special Issue Challenges and Opportunities in Prenatal Diagnosis)

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12 pages, 855 KB

Open AccessArticle

Aeroallergen Sensitization Status in West China from 2024 to 2025

by Siqi Guo, Zhengxiang Gao, Lingyi Yan, Yu Wu, Yu Gou, Leiwen Peng and Yifei Duan

J. Clin. Med. 2026, 15(10), 3644; https://doi.org/10.3390/jcm15103644 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: There is an abundance of evidence to support the associations of allergic sensitization with asthma. Reducing exposure to allergens can help prevent the progression of asthma. Given the significant regional variations in allergen distribution patterns, our objective was to characterize the [...] Read more.

Background/Objectives: There is an abundance of evidence to support the associations of allergic sensitization with asthma. Reducing exposure to allergens can help prevent the progression of asthma. Given the significant regional variations in allergen distribution patterns, our objective was to characterize the sensitization patterns of common childhood aeroallergens in a large, hospital-based pediatric cohort from West China through epidemiological surveys, thereby providing region-specific key data to guide the development of targeted prevention strategies and clinical management protocols. Methods: We analyzed data from 30,565 multiple allergosorbent tests collected by our hospital from 2024 to 2025. We additionally collected sex and age. If the level of an aeroallergen was 0.35 IU/mL or more, the test result for that aeroallergen was defined as positive, and positive cases were defined as those where one aeroallergen was positive. The positive rates for aeroallergens were calculated using the total number of tested children in each category (such as season, gender or age group). Results: A total of 30,565 children in West China were surveyed, with an overall allergen sIgE positive rate of 37.7%. Autumn had the highest positive rate (41.2%), which was significantly higher than those of the other seasons (p < 0.01). Indoor allergens had higher positive rates than outdoor ones. The top indoor allergens were Dermatophagoides pteronyssinus (30.18%), Dermatophagoides farinae (27.13%), and house dust (22.99%); the top outdoor allergens were Cupressus (10.22%), Betula platyphylla (5.01%), and Sycamore (4.24%). The positive rate increased with age: 18.49% in infants and toddlers, 38.58% in preschool children, and 45.96% in school-aged children (all p < 0.01). Males (39.76%) had a higher total positive rate than females (34.90%) (p < 0.01), with significant gender differences in five allergens, including Dermatophagoides farinae, Dermatophagoides pteronyssinus, house dust, Alternaria, and Sycamore. Conclusions: This study provides detailed epidemiological data on aeroallergen sensitization patterns among children, including seasonal, age-related, and sex-related differences. These findings may help inform region-specific preventive strategies and guide future research on allergen avoidance. Full article

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

10 pages, 1574 KB

Open AccessCase Report

Endoscopic Decompression of Radiculopathy Caused by Vertebral Artery Loop Formation: Case Report and Literature Review

by Tae Hoon Yang, In-Suk Bae, Hee In Kang, Jae Hoon Kim and Cheolsu Jwa

J. Clin. Med. 2026, 15(10), 3643; https://doi.org/10.3390/jcm15103643 (registering DOI) - 9 May 2026

Abstract

Background: Cervical radiculopathy due to vertebral artery loop formation (VALF) is rare. This case demonstrates endoscopic posterior foraminotomy after failed conservative treatment. Methods: We report a case of VALF treated by means of uniportal full-endoscopic posterior foraminotomy. A focused narrative literature review identified [...] Read more.

Background: Cervical radiculopathy due to vertebral artery loop formation (VALF) is rare. This case demonstrates endoscopic posterior foraminotomy after failed conservative treatment. Methods: We report a case of VALF treated by means of uniportal full-endoscopic posterior foraminotomy. A focused narrative literature review identified prior surgical cases of VALF-related cervical radiculopathy. Case description: A 69-year-old woman had a 4-month right C5 radiculopathy (neck pain, arm radiation, Spurling-positive) due to VALF at C4–5, confirmed via MRI and CT angiography. After failed conservative treatment, full-endoscopic posterior foraminotomy was performed; the symptoms resolved at 3 months. Conclusions: Clinicians should be aware that vertebral artery loop formation, although rare, is an important potential cause of cervical radiculopathy. In suspected cases, the vertebral artery should be carefully evaluated with MR or CT angiography to confirm the presence of a loop formation. Full-endoscopic posterior foraminotomy may be technically feasible for carefully selected patients with VALF-related cervical radiculopathy, demonstrating short-term symptom improvement in this case. Full article

(This article belongs to the Section Clinical Neurology)

19 pages, 2020 KB

Open AccessArticle

Development of an Artificial Intelligence Model to Predict Endotracheal Intubation in Critically Ill Patients in Real Time

by Da Hye Moon, Minkyu Kim, Seon-Sook Han, Tae-Hoon Kim, Dohyun Kim, Woo Jin Kim, Seung-Joon Lee, Yoon Kim, Jeongwon Heo, Hyun-Soo Choi and Yeonjeong Heo

J. Clin. Med. 2026, 15(10), 3642; https://doi.org/10.3390/jcm15103642 (registering DOI) - 9 May 2026

Abstract

Background/Objectives: In critically ill patients, endotracheal intubation (EI) is often performed to secure the airway or mechanical ventilation. Accurately predicting the timing of intubation significantly affects patient outcomes. We developed an artificial intelligence (AI) model designed for real-time risk stratification of patients [...] Read more.

Background/Objectives: In critically ill patients, endotracheal intubation (EI) is often performed to secure the airway or mechanical ventilation. Accurately predicting the timing of intubation significantly affects patient outcomes. We developed an artificial intelligence (AI) model designed for real-time risk stratification of patients requiring EI. Methods: We utilized the Medical Information Mart for Intensive Care-IV (MIMIC-IV) 2.2 dataset and performed model development using 15 clinical variables, including vital signs, Glasgow Coma Scale (GCS) score, and arterial blood gas analysis results. Patients intubated before or within 1 h of intensive care unit (ICU) admission were excluded. Clinical data from the ICU inherently consists of continuous time-series measurements. Traditional machine learning models often treat this information as static tabular data, neglecting vital temporal dynamics and patient history. Conversely, deep learning time-series approaches can capture these complex patterns over time. Thus, we applied the Gated Recurrent Unit with Decay++ (GRU-D++) model to predict the need for EI. GRU-D++ is an extension of the GRU and GRU-D. It builds upon the GRU-D to provide improved performance when handling datasets with exceptionally high rates of missing values. GRU-D++ is a time series deep learning model with an automatic mechanism for imputing missing values. This built-in capability eliminates the need for additional data preprocessing and has previously demonstrated high predictive performance. Using the 15 variables, we evaluated the optimal timing for EI in ICU-admitted patients by applying various AI models. Results: Among these, the GRU-D++ model demonstrated AUROC of 0.888, AUPR of 0.481, sensitivity of 0.474, specificity of 0.995, precision of 0.511, and F1 score of 0.491 on MIMIC-IV dataset. For KNUH dataset, the model demonstrated AUROC of 0.913, AUPR of 0.063, sensitivity of 0.162, specificity of 0.997, precision of 0.137, and F1 score of 0.147 within the 2 h in advance scenario. Furthermore, when compared with conventional scoring systems such as the Heart rate, Acidosis, Consciousness, Oxygenation, Respiratory rate (HACOR) score and Respiratory rate-Oxygenation (ROX) index, the GRU-D++ model also showed better performance predictive accuracy. Conclusions: The AI-based intubation prediction model developed in this study holds potential as a real-time risk stratification tool, providing timely risk assessments regarding the need EI. While operational threshold recalibration is essential prior to clinical deployment, further prospective multicenter studies are required to validate the clinical utility of this model in real-time practice. Full article

(This article belongs to the Special Issue Clinical Implications of Artificial Intelligence in Patient Care)

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14 pages, 892 KB

Open AccessArticle

Depot-Specific Cardiorenal Adipose Remodeling with SGLT2i in Chronic Kidney Disease

by Ana Checa-Ros, Óscar Arias, Owahabanun-Joshua Okojie, Pilar Salvador and Luis D’Marco

J. Clin. Med. 2026, 15(10), 3641; https://doi.org/10.3390/jcm15103641 (registering DOI) - 9 May 2026

Abstract

Background and hypothesis: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) provide consistent cardiorenal benefits; however, tissue-level mechanisms remain insufficiently characterized. We investigated whether SGLT2i were associated with longitudinal remodeling of organ-specific adipose depots in patients with chronic kidney disease (CKD). Methods: In this observational study [...] Read more.

Background and hypothesis: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) provide consistent cardiorenal benefits; however, tissue-level mechanisms remain insufficiently characterized. We investigated whether SGLT2i were associated with longitudinal remodeling of organ-specific adipose depots in patients with chronic kidney disease (CKD). Methods: In this observational study cohort (ADIPO-CKD; NCT07309094), adults with CKD stages 1–4 underwent clinical, biochemical and ultrasound imaging assessment at baseline (T0) and 8-month follow-up (T8). Thus, epicardial (EAT) and perirenal adipose tissue (PRAT) thickness were measured. Changes over time between patients under SGLT2i treatment and those without (Non-SGLT2i) were assessed using repeated-measures ANOVA and multivariable linear regression models adjusted for age, sex, baseline estimated glomerular filtration rate (eGFR), diabetes status, concomitant glucagon-like peptide 1 (GLP-1) receptor agonist therapy, body mass index (BMI) and visceral fat area (VFA) changes. Results: Among 189 CKD patients (50 SGLT2i and 139 non-SGLT2i), SGLT2i therapy was associated with significant reductions in PRAT (1.28 ± 0.70 to 0.91 ± 0.61 cm; ΔPRAT −0.37 cm; p < 0.002) and EAT (0.57 ± 0.27 to 0.36 ± 0.14 cm; ΔEAT −0.21 cm; p < 0.012), whereas no significant changes were observed in the Non-SGLT2i group. In multivariable models, SGLT2i exposure remained independently associated with ΔPRAT (β = 0.447; 95% CI 0.211–0.682; p < 0.001; R² = 0.371) and ΔEAT (β = 0.061; 95% CI 0.009–0.113; p < 0.021; R² = 0.053), including adjustment for changes in BMI and VFA. These findings were accompanied by trends toward improvement in renal function and systemic inflammation biomarkers in the SGLT2i group, although these changes did not reach statistical significance. In a secondary analysis, dapagliflozin was significantly associated with PRAT reduction, whereas a significant association was found between empagliflozin and EAT decrease. Conclusions: In CKD stages 1–4, SGLT2i use was independently associated with reductions in EAT and PRAT. These findings support a potential link between organ-specific adipose tissue and cardiorenal disease; however, given the observational design, these results should be interpreted as associative and hypothesis-generating. Dedicated mechanistic and adequately powered studies are warranted to determine their clinical relevance. Full article

(This article belongs to the Special Issue Clinical Epidemiology in Chronic Kidney Disease: 2nd Edition)

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24 pages, 1184 KB

Open AccessReview

The Legacy of the First Valve: Outcomes of Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Prior Surgical Aortic Valve Replacement—A Narrative Review

by Dimitrios E. Magouliotis, Serge Sicouri, Vasiliki Androutsopoulou, Andrew Xanthopoulos, Vanesa Brecher, Massimo Baudo and Basel Ramlawi

J. Clin. Med. 2026, 15(10), 3640; https://doi.org/10.3390/jcm15103640 (registering DOI) - 9 May 2026

Abstract

Transcatheter Aortic Valve Replacement (TAVR) has transformed aortic stenosis management across the full risk spectrum, but expansion into younger populations makes valve failure and reintervention central to lifetime planning. There are two pathways to follow when TAVR fails: redo transcatheter implantation and surgical [...] Read more.

Transcatheter Aortic Valve Replacement (TAVR) has transformed aortic stenosis management across the full risk spectrum, but expansion into younger populations makes valve failure and reintervention central to lifetime planning. There are two pathways to follow when TAVR fails: redo transcatheter implantation and surgical explantation with surgical aortic valve replacement (SAVR), termed TAVR-SAVR. This narrative review synthesizes evidence from four studies (35,677 patients, 2011–2024) examining the association between prior valve type and redo SAVR outcomes versus redo SAVR after prior surgical prosthesis (SAVR-SAVR). TAVR-SAVR volume grew at up to 144.6% annually, projected to surpass SAVR-SAVR by approximately 2029 based on linear extrapolation from limited registry and single-center data. Operative mortality was 12.3–17% in TAVR-SAVR versus 1.1–9% in SAVR-SAVR, persisting after propensity matching in both comparative studies (11.3% vs. 6.7%, OR 1.7; and 12.0% vs. 1.1%, OR 12.5). Observed-to-expected mortality ratios exceeded 1.0 across all risk strata, including low-risk patients (O/E up to 5.48), while SAVR-SAVR demonstrated a remarkably low ratio of 0.22–0.33. Renal failure, failure to rescue, and prolonged ventilation were significantly higher following TAVR-SAVR; stroke and pacemaker rates were comparable. Paradoxically, shorter bypass and cross-clamp times in TAVR-SAVR despite worse outcomes are consistent with cumulative organ injury, rather than operative complexity, as a predominant contributor to excess mortality, though this mechanistic explanation remains hypothetical. STS risk models, developed for standard surgical populations, showed limited applicability in this population, with observed mortality consistently exceeding predicted values. These findings raise important considerations regarding TAVR-first strategies in operable patients aged 65–80 years, although causality cannot be established from observational data alone. In the era of expanding TAVR indications, the legacy of the first valve cannot be ignored. Full article

(This article belongs to the Special Issue Clinical Outcomes Improvement and Perioperative Management of Surgical Patients: 3rd Edition)

9 pages, 373 KB

Open AccessArticle

Sucrase–Isomaltase Deficiency in Children with Functional Gastrointestinal Disorders

by Firdevs Kavas Demirci, Tuğba Gürsoy Koca, Abdulkerim Elmas and Mustafa Akçam

J. Clin. Med. 2026, 15(10), 3639; https://doi.org/10.3390/jcm15103639 (registering DOI) - 9 May 2026

Abstract

Background: Congenital sucrase–isomaltase deficiency (CSID) may mimic functional gastrointestinal disorders (FGIDs) and is likely underrecognized in pediatric practice. This study aimed to determine the frequency of sucrase–isomaltase (SI) gene variants among children with FGIDs and to evaluate genotype–phenotype associations and treatment-related quality-of-life outcomes. [...] Read more.

Background: Congenital sucrase–isomaltase deficiency (CSID) may mimic functional gastrointestinal disorders (FGIDs) and is likely underrecognized in pediatric practice. This study aimed to determine the frequency of sucrase–isomaltase (SI) gene variants among children with FGIDs and to evaluate genotype–phenotype associations and treatment-related quality-of-life outcomes. Methods: In this prospective cross-sectional study, children aged 0–18 years diagnosed with FGIDs according to Rome IV criteria were enrolled between May 2022 and January 2023. All patients underwent next-generation sequencing for SI gene variants. Clinical characteristics, FGID subtypes, and anthropometric data were recorded. Variant-positive patients received dietary sucrose restriction, and selected patients were treated with sacrosidase enzyme replacement. Symptom severity was assessed using the Numeric Rating Scale, and quality of life was evaluated with the Pediatric Quality of Life Inventory (PedsQL 4.0). Results: Among 290 children with FGIDs, SI gene variants were identified in 17 patients (5.9%). Variants were more frequently detected in children with irritable bowel syndrome–like symptoms. Clinical presentation was heterogeneous, and no consistent genotype–phenotype correlation was observed. Dietary intervention was associated with symptom improvement in compliant patients, while sacrosidase therapy led to significant improvements in both child- and parent-reported PedsQL scores. Conclusions: Sucrase–isomaltase deficiency is not uncommon among children with FGIDs and should be considered, particularly in those with IBS-like symptoms or diet-related complaints. Integrating genetic evaluation with targeted dietary and enzyme-based therapy may improve symptom control and quality of life in selected pediatric patients. Full article

(This article belongs to the Section Clinical Pediatrics)

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