Journal of Clinical Medicine

14 pages, 628 KiB

Open AccessReview

MicroRNAs in Preeclampsia: Bridging Diagnosis and Treatment

by Angeliki Gerede, Sofoklis Stavros, Maria Danavasi, Anastasios Potiris, Efthalia Moustakli, Nikolaos Machairiotis, Athanasios Zikopoulos, Konstantinos Nikolettos, Peter Drakakis, Nikolaos Nikolettos, Makarios Eleftheriades and Ekaterini Domali

J. Clin. Med. 2025, 14(6), 2003; https://doi.org/10.3390/jcm14062003 (registering DOI) - 15 Mar 2025

Abstract

Preeclampsia (PE) is a multifactorial hypertensive disorder that typically manifests after the twentieth week of pregnancy, significantly impacting perinatal mortality and neonatal morbidity. Its development is influenced by immunological components, systemic inflammation, and genetic factors, with placental malfunction playing a crucial role. While [...] Read more.

Preeclampsia (PE) is a multifactorial hypertensive disorder that typically manifests after the twentieth week of pregnancy, significantly impacting perinatal mortality and neonatal morbidity. Its development is influenced by immunological components, systemic inflammation, and genetic factors, with placental malfunction playing a crucial role. While many aspects of its pathophysiology have been elucidated, its key mechanisms remain incompletely understood. MicroRNAs (miRNAs), small noncoding RNA molecules that regulate gene expression, have emerged as promising biomarkers and therapeutic targets in PE. Dysregulated miRNAs have been identified in pregnant PE patients, highlighting their role in disease onset. Placenta-specific miRNAs, such as miR-210 and miR-155, influence inflammation, endothelial function, and hypoxia responses, which are closely associated with PE development. These miRNAs play a crucial role in regulating trophoblast invasion, angiogenesis, and immune modulation, further linking their dysregulation to the pathophysiology of PE. This review aims to provide a comprehensive overview of the role of miRNAs in PE, focusing on their potential as diagnostic biomarkers and therapeutic targets. By integrating recent advancements in molecular research, we explore their implications in clinical practice, particularly in risk assessment, early detection, and novel treatment strategies. Full article

(This article belongs to the Special Issue Navigating Pregnancy and Its Complications: Challenges and Innovations in Maternal–Fetal Medicine)

12 pages, 588 KiB

Open AccessArticle

A Usefulness of Delta Neutrophil Index (DNI) for Prediction of 28 Day Mortality in Patients with Pneumonia-Induced Sepsis in the Intensive Care Unit

by SooYoon Moon, YongBum Park, Chang-Won Hong, Sunghoon Park, YunSu Sim, Yousang Ko and SoYoung Park

J. Clin. Med. 2025, 14(6), 2002; https://doi.org/10.3390/jcm14062002 (registering DOI) - 15 Mar 2025

Abstract

Background: The delta neutrophil index (DNI) represents the immature granulocyte fraction and is determined by subtracting the fraction of mature polymorphonuclear leucocytes from the sum of myeloperoxidase-reactive cells. The DNI has been proposed as a useful prognostic marker for sepsis. This study [...] Read more.

Background: The delta neutrophil index (DNI) represents the immature granulocyte fraction and is determined by subtracting the fraction of mature polymorphonuclear leucocytes from the sum of myeloperoxidase-reactive cells. The DNI has been proposed as a useful prognostic marker for sepsis. This study evaluated the clinical utility of DNI as a predictive marker in patients with pneumonia-induced sepsis in the intensive care unit (ICU). Methods: We conducted a retrospective study of pneumonia-induced sepsis in patients who were admitted to the Kangdong Sacred Heart Hospital’s medical ICUs from July 2022 to March 2024. The DNI was measured on three consecutive days after ICU admission. The primary outcome of this study was a 28-day mortality. Results: A total of 227 patients with pneumonia-induced sepsis were included in this study. A 28-day mortality occurred 20.3% of the time in our study. In a univariate analysis, age (p = 0.05), lymphocyte (p = 0.02), DNI 1 (p = 0.01), DNI 2 (p = 0.00), DNI 3 (p = 0.00), and lactic acid (p = 0.00) were significantly associated with 28-day mortality. In a multivariable analysis, lactate (adj. OR: 0.86, 95% CI: 0.78–0.95, p = 0.002), and DNI 3 (adj. OR: 0.94, 95% CI: 0.89–0.99, p = 0.048) were significantly associated with 28-day mortality. In our study, the most appropriate cut-off values were DNI 1 (7.15), DNI 2 (8.9), and DNI 3 (2.6). Patients with higher DNI 3 (≥2.6) showed higher 28-day mortality than patients with lower DNI 3 values of <2.6 (67.4% vs. 32.6%; p < 0.001). However, those aged ≥70 did not show statistically significantly different DNI 1 values between the survivor and non- survivor groups. Conclusions: The DNI at 72 h after ICU admission is a promising predictive prognostic marker of 28-day mortality in patients with pneumonia-induced sepsis in the ICU. However, the interpretation of the DNI in sepsis patients aged 70 and older on the first day of hospitalization should be approached with caution. Full article

(This article belongs to the Section Intensive Care)

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18 pages, 1062 KiB

Open AccessArticle

Unmasking the Silent Threat: Prevalence of Cardiovascular Risk Factors in MS Patients in Bucharest, Romania

by Florentina Cristina Pleșa, Elena Andreea Arsene, Andreea Pleșa, Săndica Bucurică, Daniela Anghel, Carmen Adella Sîrbu, Monica Marilena Țânțu, Alexandru Andrei Badea, Octavian Vasiliu and Alice Elena Munteanu

J. Clin. Med. 2025, 14(6), 2001; https://doi.org/10.3390/jcm14062001 (registering DOI) - 15 Mar 2025

Abstract

Background and Objectives: This study aims to identify cardiovascular risk factors among 91 patients with multiple sclerosis in Bucharest, Romania, using data from medical records and a self-administered questionnaire. Materials and Methods: The research focuses on smoking status, body mass index, blood sugar, [...] Read more.

Background and Objectives: This study aims to identify cardiovascular risk factors among 91 patients with multiple sclerosis in Bucharest, Romania, using data from medical records and a self-administered questionnaire. Materials and Methods: The research focuses on smoking status, body mass index, blood sugar, cholesterol, triglycerides, blood pressure, and renal function. The average age of the patients was 42.90 ± 10.60 years, and 74.73% were female. The average BMI was 23.89 kg/m² ± 4.74 kg/m² (lower than in the general population), with 41.76% of patients having a BMI outside normal limits. The majority were former smokers (35.87%), followed by non-smokers (28.26%), and the fewest were smokers of more than 20 cigarettes/day (7.61%). The average total cholesterol was 198.48 ± 38.56 mg/dL, triglycerides were 114.22 mg/dL ± 76.2281 mg/dL, and blood glucose was 97.54 ± 36.58 mg/dL. While 25.27% of the patients had fasting blood glucose > 126 mg/dL, only five patients were diagnosed with DM. The average blood pressure was 137.5165 ± 19.5047 mmHg, with only 11 patients diagnosed with HTA. Results: The study found an average cardiovascular risk of 6.6133% ± 7.1412%, with higher values among males, rural patients, those with secondary-progressive MS, and those with a disease progression >10 years (after age adjustment). Conclusions: The study underscores the importance of identifying and combating cardiovascular risk factors in patients with multiple sclerosis. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Multiple Sclerosis (MS))

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14 pages, 916 KiB

Open AccessArticle

Causes of Mortality in Intensive Care Units for Patients with Chronic Inflammatory Diseases from the French National Health Data System

by Yannis Hamidou, Jean Marc Sobhy Danial, Thibault Balcaen, Sophie Liabeuf, Solène Laville, Claire Jesson, Pierre Antoine Bruy, Camille Farnos, Marie Doussiere and Vincent Goeb

J. Clin. Med. 2025, 14(6), 2000; https://doi.org/10.3390/jcm14062000 (registering DOI) - 15 Mar 2025

Abstract

Background/Objectives: Inflammatory pathologies are at the center of various medical specialties and benefit from conventional treatments as well as biological treatments. These latter ones have often been the subject of studies yielding heterogeneous results regarding their infectious and mortality risks. This work [...] Read more.

Background/Objectives: Inflammatory pathologies are at the center of various medical specialties and benefit from conventional treatments as well as biological treatments. These latter ones have often been the subject of studies yielding heterogeneous results regarding their infectious and mortality risks. This work aims to describe mortality and its causes in patients afflicted by inflammatory pathologies, receiving either conventional or biological therapy during their first stay in intensive care units. Methods: Our study was conducted using the French national health database, encompassing all hospital stays on a national scale. All comparisons between conventional treatment and biological therapies were performed using the Chi-square test, Fisher’s exact test, or Student’s t-test. Results: In total, 13,816 patients were included. Within 90 days of the first admission to the intensive care/reanimation service, 11.6% of the patients died, including 9.4% within 30 days and 7.3% during hospitalization. More patients died in the conventional treatment group in comparison to the biological treatment group. More deaths were observed due to cardiovascular (27%), infectious (15%), gastroenterological (12%), and oncological (12%) conditions in the conventional treatment group. However, there were as many deaths from oncological causes (19%) as from cardiovascular causes (19%) in the biological therapy group. Hypertension (66.8%) and renal insufficiency (50.4%) were the most frequently associated comorbidities with mortality. Conclusions: Mortality in intensive care/reanimation during the initial stay of patients afflicted by inflammatory pathologies is of greater concern for those treated with conventional treatments. Causes of death tend to be more cardiovascular and require more prevention and care management. Full article

(This article belongs to the Section Immunology)

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14 pages, 1082 KiB

Open AccessArticle

Trends in Initial Hospitalizations of Patients with Newly Diagnosed Sjogren’s Disease in Poland Between 2012 and 2023: A Retrospective Data Analysis

by Julia Domańska-Poboża, Łukasz Kapica, Krzysztof Kanecki, Katarzyna Lewtak, Paweł Goryński and Małgorzata Wisłowska

J. Clin. Med. 2025, 14(6), 1999; https://doi.org/10.3390/jcm14061999 (registering DOI) - 15 Mar 2025

Abstract

Background/Objectives: Sjögren’s disease (SjD) is a chronic autoimmune disease primarily affecting exocrine glands, often leading to systemic complications and comorbidities. While SjD is known to impact quality of life, research on hospitalization trends, demographic characteristics, and factors influencing hospital stay duration remains [...] Read more.

Background/Objectives: Sjögren’s disease (SjD) is a chronic autoimmune disease primarily affecting exocrine glands, often leading to systemic complications and comorbidities. While SjD is known to impact quality of life, research on hospitalization trends, demographic characteristics, and factors influencing hospital stay duration remains limited. This study aims to analyze hospitalizations due to SjD in Poland between 2012 and 2023, identifying key trends, risk factors, and healthcare implications. Methods: A retrospective analysis was conducted using data from the National General Hospital Morbidity Study, covering 13,999 first-time hospitalizations with an SjD diagnosis (ICD-10: M35.0). Descriptive statistics were applied to evaluate patient demographics, hospitalization trends, and comorbidities. The Mann–Whitney U test and chi-square test were used to compare groups, while a linear regression model identified predictors of hospital stay duration. Results: Women accounted for 90.3% of hospitalizations, with a median age of 57 years, compared to 53 years for men. The hospitalization rate fluctuated over time, with a decline in 2020, possibly due to the COVID-19 pandemic, followed by an increase in 2021–2023. The most common comorbidities included musculoskeletal disorders (17.8%), cardiovascular diseases (16.6%), and endocrine disorders (13.6%). Women had longer hospital stays than men (median 5 vs. 4 days, p < 0.001). Older patients and those admitted in emergency settings had significantly longer hospital stays. The overall mortality rate was low (0.2%), with a slightly higher but statistically insignificant mortality rate among men. Conclusions: The study highlighted the increasing burden of SjD-related hospitalizations and the need for improved outpatient management to reduce inpatient admissions. Factors such as older age, female sex, and emergency admissions were associated with prolonged hospitalization. Strengthening early diagnostic strategies, optimizing access to specialist care, and monitoring comorbidities could enhance patient outcomes and reduce hospital resource utilization. Full article

(This article belongs to the Section Immunology)

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14 pages, 3960 KiB

Open AccessArticle

Early Macular Ganglion Cell Loss in Leber Hereditary Optic Neuropathy, an Optical Coherence Tomography Biomarker to Differentiate Optic Neuritis

by Julian A. Zimmermann, Martin Dominik Leclaire, Jens Julian Storp, Tobias J. Brix, Nicole Eter, Julia Krämer and Julia Biermann

J. Clin. Med. 2025, 14(6), 1998; https://doi.org/10.3390/jcm14061998 (registering DOI) - 15 Mar 2025

Abstract

Background/Objectives: Leber hereditary optic neuropathy (LHON) is often misdiagnosed in its early stages as idiopathic single isolated optic neuritis (SION) or multiple-sclerosis-associated optic neuritis (MS-ON) due to the young age of the patients, the subacute vision loss, and the central visual field [...] Read more.

Background/Objectives: Leber hereditary optic neuropathy (LHON) is often misdiagnosed in its early stages as idiopathic single isolated optic neuritis (SION) or multiple-sclerosis-associated optic neuritis (MS-ON) due to the young age of the patients, the subacute vision loss, and the central visual field defect. The aim of this retrospective study was to evaluate changes in the peripapillary RNFL and GCLT over time in patients with early LHON, MS-ON, and SION in order to differentiate Leber hereditary optic neuropathy (LHON) from optic neuritis (ON) in the early stages of the disease. Methods: Patients with LHON and ON (either idiopathic single isolated optic neuritis (SION) or ON as the first symptom of relapsing–remitting multiple sclerosis (MS-ON) were included. Optical coherence tomography (OCT) scans were reviewed. The inclusion criteria were at least one follow-up OCT examination and a definite diagnosis after examination. Changes in the peripapillary retinal nerve fibre layer (RNFL) and macular ganglion cell layer thickness (GCLT) in both groups were evaluated over time and compared with normative data. The analysis focused on the early phase (0–45 days) after symptom onset. Results: Nine LHON patients with early OCT scans and twenty patients with ON were included. Quantitative OCT analysis showed greater RNFL swelling in LHON compared to ON during the first 60 days after symptom onset. Between day 61 and day 120, subnormal RNFL values were observed in both groups compared to controls. Thereafter, the RNFL decreased continuously and severely in the LHON group. The RNFL of ON patients did not show a clear progression after day 120. The GCLT in five LHON eyes showed a strong and solid decrease from day 0 to day 45, which was stronger than the moderate atrophy measured in ON eyes. Continuous GCL atrophy was measured until day 121 in LHON, after which a floor effect was reached. The GCLT in the inner nasal and inner inferior sectors was significantly smaller in LHON compared to ON patients on days 0–45. Conclusions: Thinning of the GCLT occurs at an early stage in LHON patients. Thus, GCLT may become a diagnostic tool to differentiate LHON from ON in the early phase of disease. Full article

(This article belongs to the Section Ophthalmology)

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12 pages, 863 KiB

Open AccessReview

Unmasking Gastroparesis in Diabetes During Ramadan: Challenges and Management Strategies

by Mohammed Abdulrasak, Nael Shaat, Ali M. Someili and Mostafa Mohrag

J. Clin. Med. 2025, 14(6), 1997; https://doi.org/10.3390/jcm14061997 (registering DOI) - 15 Mar 2025

Abstract

Gastroparesis, characterized by delayed gastric emptying without mechanical obstruction, is a recognized complication of long-standing diabetes. Its pathophysiology involves, amongst other mechanisms, autonomic dysfunction due to vagal nerve damage, impaired smooth muscle contractility, and hormonal dysregulation of intestinal motility. During Ramadan, fasting causes [...] Read more.

Gastroparesis, characterized by delayed gastric emptying without mechanical obstruction, is a recognized complication of long-standing diabetes. Its pathophysiology involves, amongst other mechanisms, autonomic dysfunction due to vagal nerve damage, impaired smooth muscle contractility, and hormonal dysregulation of intestinal motility. During Ramadan, fasting causes significant dietary changes due to prolonged fasting and the consumption of large meals for Iftar (breaking of fast), which may unmask or worsen gastroparesis symptoms in individuals with diabetes. Symptoms such as early satiety, bloating, nausea, and glycemic fluctuations can further complicate diabetes management during fasting. This paper highlights the relationship between Ramadan fasting and gastroparesis in individuals with diabetes, exploring underlying mechanisms, clinical manifestations, diagnostic approaches, and management strategies. A multidisciplinary approach involving dietary modifications, medication adjustments, lifestyle changes, and individualized medical counseling is essential for safe fasting, alongside the option to avoid fasting in individuals who are deemed too high at risk for fasting. Further research is needed to assess the prevalence of subclinical gastroparesis in fasting individuals with diabetes and to optimize risk stratification and management in these patients. Full article

(This article belongs to the Special Issue Type 2 Diabetes and Complications: From Diagnosis to Treatment)

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13 pages, 1533 KiB

Open AccessArticle

Development and Validation of an MRI-Based Brain Volumetry Model Predicting Poor Psychomotor Outcomes in Preterm Neonates

by Joonsik Park, Jungho Han, In Gyu Song, Ho Seon Eun, Min Soo Park, Beomseok Sohn and Jeong Eun Shin

J. Clin. Med. 2025, 14(6), 1996; https://doi.org/10.3390/jcm14061996 (registering DOI) - 15 Mar 2025

Abstract

Background/Objectives: Infant FreeSurfer was introduced to address robust quantification and segmentation in the infant brain. The purpose of this study is to develop a new model for predicting the long-term neurodevelopmental outcomes of very low birth weight preterm infants using automated volumetry [...] Read more.

Background/Objectives: Infant FreeSurfer was introduced to address robust quantification and segmentation in the infant brain. The purpose of this study is to develop a new model for predicting the long-term neurodevelopmental outcomes of very low birth weight preterm infants using automated volumetry extracted from term-equivalent age (TEA) brain MRIs, diffusion tensor imaging, and clinical information. Methods: Preterm infants hospitalized at Severance Children’s Hospital, born between January 2012 and December 2019, were consecutively enrolled. Inclusion criteria included infants with birth weights under 1500 g who underwent both TEA MRI and Bayley Scales of Infant and Toddler Development, Second Edition (BSID-II), assessments at 18–24 months of corrected age (CA). Brain volumetric information was derived from Infant FreeSurfer using 3D T1WI of TEA MRI. Mean and standard deviation of fractional anisotropy of posterior limb of internal capsules were measured. Demographic information and comorbidities were used as clinical information. Study cohorts were split into training and test sets with a 7:3 ratio. Random forest and logistic regression models were developed to predict low Psychomotor Development Index (PDI < 85) and low Mental Development Index (MDI < 85), respectively. Performance metrics, including the area under the receiver operating curve (AUROC), accuracy, sensitivity, precision, and F1 score, were evaluated in the test set. Results: A total of 150 patient data were analyzed. For predicting low PDI, the random forest classifier was employed. The AUROC values for models using clinical variables, MR volumetry, and both clinical variables and MR volumetry were 0.8435, 0.7281, and 0.9297, respectively. To predict low MDI, a logistic regression model was chosen. The AUROC values for models using clinical variables, MR volumetry, and both clinical variables and MR volumetry were 0.7483, 0.7052, and 0.7755, respectively. The model incorporating both clinical variables and MR volumetry exhibited the highest AUROC values for both PDI and MDI prediction. Conclusions: This study presents a promising new prediction model utilizing an automated volumetry algorithm to distinguish long-term psychomotor developmental outcomes in preterm infants. Further research and validation are required for its clinical application. Full article

(This article belongs to the Section Clinical Pediatrics)

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15 pages, 1033 KiB

Open AccessArticle

Heart Rate and Prognosis of Heart Failure with Reduced Ejection Fraction in Women and Men in Sinus Rhythm

by Antonio de Padua Mansur, Maria Eduarda Bergamo, Geovana Braga do Nascimento, Giovanna Silva Machado, Carlos Henrique Del Carlo, Solange Desirée Avakian, Antonio Carlos Pereira-Barretto and Edimar Alcides Bocchi

J. Clin. Med. 2025, 14(6), 1995; https://doi.org/10.3390/jcm14061995 (registering DOI) - 15 Mar 2025

Abstract

Background: A resting heart rate (RHR) is a guideline-recommended therapeutic target for all patients with heart failure with reduced ejection fraction (HFrEF), with reductions to 60 bpm linked to improved outcomes. Conversely, elevated RHR is associated with increased mortality in HFrEF. However, [...] Read more.

Background: A resting heart rate (RHR) is a guideline-recommended therapeutic target for all patients with heart failure with reduced ejection fraction (HFrEF), with reductions to 60 bpm linked to improved outcomes. Conversely, elevated RHR is associated with increased mortality in HFrEF. However, sex-specific differences in mortality, particularly for women in sinus rhythm, remain unclear. We evaluated mortality rates at RHR thresholds of ≤60 bpm and ≤70 bpm in women and men with HFrEF. Methods: From February 2017 to January 2022, we assessed 2984 patients (61 ± 13.8 years, 64.4% men) with HFrEF in sinus rhythm. Clinical and echocardiographic data were analyzed to examine RHR’s influence on mortality. Results: Over a mean follow-up of 3.7 ± 1.6 years, left ventricular ejection fraction improved in men (29.5 ± 6.7% to 36.7 ± 12.9%; p < 0.001) and women (29.9 ± 6.4% to 38.0 ± 13.4%; p < 0.001). Men had higher mortality (43.7% vs. 36.7%; p < 0.001), with cumulative death incidence greater at an RHR > 60 bpm (p < 0.001) and >70 bpm (p = 0.011). Cox regression identified an RHR as an independent predictor of mortality for men (HR = 1.008; p = 0.008) but not women. Conclusions: An elevated RHR increases mortality risk in men, suggesting a target near 60 bpm and closer to 70 bpm in women, supporting individualized RHR management. Full article

(This article belongs to the Section Cardiology)

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9 pages, 1202 KiB

Open AccessCase Report

Mature Teratoma of the Cerebellum with Formed Extracranial Component

by Agnieszka Nowacka, Ewa Ziółkowska, Wojciech Smuczyński, Dominika Bożiłow and Maciej Śniegocki

J. Clin. Med. 2025, 14(6), 1994; https://doi.org/10.3390/jcm14061994 (registering DOI) - 15 Mar 2025

Abstract

Background: Intracranial teratomas are very rare in adults, representing only 0.3–0.5% of all primary brain tumors. They originate from all three germ layers, and are classified as mature, immature, or malignant. Mature teratomas constitute the most prevalent type in the adult population, commonly [...] Read more.

Background: Intracranial teratomas are very rare in adults, representing only 0.3–0.5% of all primary brain tumors. They originate from all three germ layers, and are classified as mature, immature, or malignant. Mature teratomas constitute the most prevalent type in the adult population, commonly originating from midline structures such as the pineal and suprasellar regions. However, the localization of these tumors within the cerebellum is exceedingly rare, with only a limited number of cases reported globally. In this manuscript, we describe, to the best of our knowledge, the first documented case of a young adult patient presenting with a mature teratoma situated between the cerebellar hemispheres. Notably, this tumor was accompanied by occipital bone loss, through which a tumor pedicle extended, forming an extracranial component. Methods: After analyzing the clinical picture and additional examinations, the patient was classified for surgery. The intracranial part of the tumor contained numerous cysts with yellow fluid, a tooth, and fat tissue. The tumor was removed radically, with its extracranial part. Results: On the fourth day after surgery, the patient was discharged from the clinic in a good general condition, walking, with marked cerebellar symptoms. In a follow-up at 6 months postoperatively, the neurological examination was normal, with no headaches. MRI at the 6 months follow-up did not show any residual or recurrent tumor. Conclusions: Histopathological examination confirmed the diagnosis of mature teratoma. Full article

(This article belongs to the Section Oncology)

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Graphical abstract

11 pages, 218 KiB

Open AccessArticle

From Itch to Access: Psychodermatological Care Challenges and the Promise of Telehealth

by Julia Rümmelein, Christiane Brockes and Christian Greis

J. Clin. Med. 2025, 14(6), 1993; https://doi.org/10.3390/jcm14061993 (registering DOI) - 15 Mar 2025

Abstract

Background/Objectives: Pruritus is a prominent symptom of chronic inflammatory skin diseases and significantly affects quality of life. Psychological stress can exacerbate pruritus and worsen skin conditions, yet psychological aspects are often insufficiently addressed in clinical routine. While psychodermatological treatments are becoming more available [...] Read more.

Background/Objectives: Pruritus is a prominent symptom of chronic inflammatory skin diseases and significantly affects quality of life. Psychological stress can exacerbate pruritus and worsen skin conditions, yet psychological aspects are often insufficiently addressed in clinical routine. While psychodermatological treatments are becoming more available in German-speaking countries, they are mostly confined to specialized clinics, limiting access for many patients. This study aims to explore the unmet needs of patients with chronic inflammatory skin diseases in German-speaking regions and assess the potential role of telemedicine in bridging existing psychodermatological care gaps. Methods: Patients with chronic inflammatory skin diseases were invited via the Network of People with Autoimmune Diseases to participate in free video consultations with a licensed psychotherapist. Quantitative data on disease, pruritus, and distress were analyzed alongside qualitative feedback from consultations and surveys. Results: Of 174 individuals who received the newsletter, 124 opened it, and 16 engaged with the scheduling link. Over one month, five patients (mean age 40.4 years, all female) participated in psychodermatological video consultations. All had chronic inflammatory skin diseases and were under dermatological care but felt insufficiently treated by dermatological approaches alone. Barriers to multimodal care included lack of awareness, distance to specialized clinics, and long waiting times. Three participants reported pruritus with an average intensity of 75/100 on a Visual Analog Scale (VAS). Psychological factors were identified as significant contributors to pruritus by all participants. Post-consultation, 4/5 of participants completed a survey, reporting high levels of distress (average 74/100 VAS) and favoring online or hybrid treatment options. Conclusions: Dermatological treatment alone often fails to address psychological aspects in patients with chronic inflammatory skin diseases. These findings emphasize the need for integrated dermatological and psychological treatment, with telemedicine offering a valuable avenue to improve access and foster interdisciplinary collaboration. Full article

(This article belongs to the Special Issue Pruritus and Psyche: An Update on Clinical Management)

10 pages, 215 KiB

Open AccessArticle

Effect of Perioperative Immunonutrition on Early-Postoperative Complications in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Case Series

by Francesco Cianflone, Alice Tartara, Lucia Aretano, Valentina Da Prat, Andrea Ringressi, Carlo Marchetti, Chiara Lonati, Giulia Gambini, Riccardo Caccialanza and Richard Naspro

J. Clin. Med. 2025, 14(6), 1992; https://doi.org/10.3390/jcm14061992 (registering DOI) - 15 Mar 2025

Abstract

Objective: The objective was to evaluate the impact of perioperative immunonutrition (IN) on postoperative complications in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Methods: A prospective case series of 19 patients treated with perioperative IN between October 2022 and July 2023 [...] Read more.

Objective: The objective was to evaluate the impact of perioperative immunonutrition (IN) on postoperative complications in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Methods: A prospective case series of 19 patients treated with perioperative IN between October 2022 and July 2023 was conducted. Patients received preoperative IN based on nutritional risk and postoperative IN with gradual recovery of normal feeding. The inclusion criteria encompassed clinically node-negative patients without metastatic disease. The outcomes were assessed using Clavien–Dindo classification and included infectious complications, wound healing disorders, ileus, anemia, genitourinary issues, recovery time, and compliance with the nutritional regimen. Results: Sixteen patients (84.2%) experienced complications. Most were low-grade (CD 1–2), with no CD > 3a. Wound disorders affected 10.5% and anemia requiring transfusion occurred in 47.4% of patients, infectious complications were reported in 26.3%, and ileus in 36.8%. The median time to first flatus was 2 days (IQR 2–3), while resumption of oral feeding occurred after 4 days (IQR 2–5), like mobilization (IQR 2–5). The median hospital stay was 14 days (IQR 11–18). Compliance with IN was 78.9%, with gastrointestinal intolerance being the primary cause of discontinuation. Conclusions: Patients with RC undergoing perioperative IN showed low rates of high-grade complications and promising results in bowel function recovery and infection rates. Further randomized controlled trials are required to validate these results. Full article

(This article belongs to the Section Nephrology & Urology)

11 pages, 604 KiB

Open AccessSystematic Review

Impact of Oral Health Interventions on Sarcopenia and Frailty in Older Adults: A Systematic Review

by Andrés Celis, Benjamín Cáceres, Bárbara Escobar, Pilar Barahona, Erik Dreyer and Fanny Petermann-Rocha

J. Clin. Med. 2025, 14(6), 1991; https://doi.org/10.3390/jcm14061991 (registering DOI) - 15 Mar 2025

Abstract

Background/Objectives: Frailty and sarcopenia are geriatric syndromes associated with increased vulnerability to adverse health outcomes, including functional decline, disability, and mortality. Emerging evidence suggests that oral health interventions may play a role in mitigating these conditions. This systematic review aims to evaluate the [...] Read more.

Background/Objectives: Frailty and sarcopenia are geriatric syndromes associated with increased vulnerability to adverse health outcomes, including functional decline, disability, and mortality. Emerging evidence suggests that oral health interventions may play a role in mitigating these conditions. This systematic review aims to evaluate the impact of oral health interventions on frailty and sarcopenia in older adults. Methods: A systematic search was conducted in PubMed, Scopus, and SciELO databases for studies published up to December 2023. Inclusion criteria comprised experimental and quasi-experimental studies assessing dental interventions and their effects on frailty and sarcopenia in individuals aged 60 years and older. The primary outcomes included frailty index, grip strength, walking speed, and functional dentition. Study quality was assessed using GRADEpro. Results: Eight studies were included. Preventive oral hygiene interventions improved oral health but did not significantly impact frailty scores. Oral exercises significantly improved muscle strength and weight, leading to frailty score reductions (−1.1 points, 95% CI: −1.5 to −0.7, p < 0.01). Swallowing therapies were linked to increased grip strength (+1.8 kg, p = 0.03) and walking speed (+0.2 m/s, p = 0.04), with corresponding frailty index reductions (−0.8 points, 95% CI: −1.2 to −0.4, p = 0.01). The certainty of evidence ranged from very low to moderate. Conclusions: Oral health interventions, particularly oral exercises and swallowing therapies, show potential in reducing frailty and sarcopenia-related outcomes in older adults. However, methodological heterogeneity and low-certainty evidence highlight the need for high-quality, large-scale trials with standardized assessment measures to establish definitive clinical recommendations. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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8 pages, 215 KiB

Open AccessArticle

Evaluation of Reliability of Formulas for Intraocular Lens Power Calculation After Hyperopic Refractive Surgery

by Rosa Boccia, Michele Lanza, Giuseppe Luciano, Italo Fattore, Luigi Serra, Salvatore Ambrosio, Francesco Abbate and Francesca Simonelli

J. Clin. Med. 2025, 14(6), 1990; https://doi.org/10.3390/jcm14061990 (registering DOI) - 15 Mar 2025

Abstract

Background: We evaluate the accuracy of intraocular lens (IOL) power calculation in the following formulas—Barrett True-K No History (BTKNH), EVO 2.0 Post-Hyperopic LASIK/PRK (EVO 2.0), Haigis-L, Pearl-DGS, and Shammas (SF)—with patients who have undergone cataract surgery at the Eye Unit of University of [...] Read more.

Background: We evaluate the accuracy of intraocular lens (IOL) power calculation in the following formulas—Barrett True-K No History (BTKNH), EVO 2.0 Post-Hyperopic LASIK/PRK (EVO 2.0), Haigis-L, Pearl-DGS, and Shammas (SF)—with patients who have undergone cataract surgery at the Eye Unit of University of Campania Luigi Vanvitelli, Naples, Italy, and had prior hyperopic laser refractive surgery. Methods: A monocentric, retrospective, comparative study, including the charts of patients who had undergone cataract surgery and previous hyperopic laser refractive surgery, was retrospectively reviewed. Patients with no other ocular or systemic disease which might interfere with visual acuity results and no operative complications or combined surgery were enrolled. The mean absolute prediction error (MAE) was calculated for each formula and compared. Subgroup analysis based on the axial length and mean keratometry was performed. Results: A total of 107 patients (107 eyes) were included. The MAE calculated with SF provided less accurate (p < 0.05) results when compared to both BTKNH and EVO 2.0 formulas. The MAE obtained using Haigis-L, EVO 2.0, Pearl-DGS, and BTKNH showed no significant differences. Conclusions: The analysis of the accuracy of the selected formulas shows no clear advantage in using one specific formula in standard cases, but in eyes where it is mandatory to reach the target refraction, SF should be avoided. Full article

(This article belongs to the Special Issue Presbyopia, Laser, Cataract and Refractive Surgery: State-of-the-Art Research)

22 pages, 3953 KiB

Open AccessCase Report

A New Histology-Based Prognostic Index for Acute Myeloid Leukemia: Preliminary Results for the “AML Urayasu Classification”

by Toru Mitsumori, Hideaki Nitta, Haruko Takizawa, Hiroko Iizuka-Honma, Chiho Furuya, Maki Fujishiro, Shigeki Tomita, Akane Hashizume, Tomohiro Sawada, Kazunori Miyake, Mitsuo Okubo, Yasunobu Sekiguchi, Miki Ando and Masaaki Noguchi

J. Clin. Med. 2025, 14(6), 1989; https://doi.org/10.3390/jcm14061989 (registering DOI) - 15 Mar 2025

Abstract

Background: This study was aimed at elucidating the mechanisms underlying the development of treatment resistance in patients with acute myeloid leukemia (AML) other than M3 myeloid leukemia in order to devise ways to overcome treatment resistance and improve the treatment outcomes in these [...] Read more.

Background: This study was aimed at elucidating the mechanisms underlying the development of treatment resistance in patients with acute myeloid leukemia (AML) other than M3 myeloid leukemia in order to devise ways to overcome treatment resistance and improve the treatment outcomes in these patients. Methods: For this study, we randomly selected 35 patients with AML who had received combined cytarabine plus idarubicin treatment for new-onset AML at our hospital. We performed immunohistochemical analysis of biopsy specimens obtained from the patients to investigate the expressions of 23 treatment-resistance-related proteins, and retrospectively analyzed the correlations between the expression profiles of the resistance proteins and the patient survival. Results: The following four proteins were identified as being particularly significant in relation to treatment resistance and patient prognosis: (1) p53; (2) multidrug resistance-associated protein 1 (MRP1; idarubicin extracellular efflux pump); (3) aldo-keto reductase family 1 member B10 (AKR1B10; idarubicin-inactivating enzyme); and (4) AKR1B1 (competitive inhibitor of AKR1B10). Based on our findings, we propose the following Urayasu classification for AML, which we believe would be very useful for accurately stratifying patients with AML according to the predicted prognosis: Group 1 (n = 22, 63%): p53(-)/MRP1(-) associated with AKR1B10(+)/AKR1B1(+) or AKR1B10(-)/AKR1B1(-); 5-year overall survival (OS), 82%–100%; Group 2 (n = 9, 26%): p53(-)/MRP1(-) associated with AKR1B10(+)/AKR1B1(-); 5-year OS, 68%; Group 3 (n = 4, 11%): p53(+) or MRP1(+); median survival, 12–14 months; 2-year OS, 0%. Conclusions: The Urayasu classification for AML is useful for predicting the prognosis of patients with AML. Group 1 in this classification included twice as many patients as that included in the Favorable prognosis group in the AML prognostic classification proposed by the European Leukemia Net. As the Urayasu classification for AML is based on the mechanisms of resistance to chemotherapy, it is not only useful for prognostic stratification of the patients, but also provides insights for developing more effective treatments for AML. Full article

(This article belongs to the Section Hematology)

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13 pages, 1183 KiB

Open AccessArticle

The Italian Version of the New General Self-Efficacy Scale (NGSES): Structural Validity, Psychometric Properties, and Measurement Invariance

by Alessandro Alberto Rossi, Stefania Mannarini, Federica Taccini, Gianluca Castelnuovo and Giada Pietrabissa

J. Clin. Med. 2025, 14(6), 1988; https://doi.org/10.3390/jcm14061988 (registering DOI) - 14 Mar 2025

Abstract

Background/Objectives: General Self-Efficacy (GSE) refers to an individual’s belief in their overall ability to perform effectively across various situations. Research shows that GSE is a key predictor of multiple outcomes, including psychological resilience, better health, and improved overall well-being across different populations and [...] Read more.

Background/Objectives: General Self-Efficacy (GSE) refers to an individual’s belief in their overall ability to perform effectively across various situations. Research shows that GSE is a key predictor of multiple outcomes, including psychological resilience, better health, and improved overall well-being across different populations and environments. Numerous tools have been developed to measure GSE, enhancing our understanding of self-efficacy and its broader implications. This study aimed to evaluate the psychometric properties of the Italian version of the New General Self-Efficacy Scale (NGSES) in a community sample of adults recruited through social media platforms. Methods: The NGSES was adapted into Italian following the back-translation procedure. A total of 811 participants (mean = 43.18; 68.8% females) completed the scale. A confirmatory factor analysis (CFA) was used to examine the factorial structure of the questionnaire. Adjusted item-total correlations and internal consistency were assessed using McDonald’s omega. Additionally, multi-group CFA was used to test factorial invariance across gender. Results: The trimmed model exhibited a strong fit to the data: RMSEA = 0.068, CFI = 0.994, SRMR = 0.043. An omega coefficient of 0.872 confirmed the scale’s strong reliability. Convergent validity was established by a moderate and significant correlation with the NGSES. Configural, metric, scalar, and latent means invariance across genders were all confirmed. Conclusions: The NGSES was found to be a valid and reliable tool, suitable for both clinical and research applications in the Italian context. It can also inform the development of educational and therapeutic interventions aimed at enhancing GSE in the general population. Full article

(This article belongs to the Section Mental Health)

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20 pages, 1169 KiB

Open AccessReview

Peripheral Arterial Disease in Diabetic Foot: One Disease with Multiple Patterns

by Marco Meloni and Prashanth R. J. Vas

J. Clin. Med. 2025, 14(6), 1987; https://doi.org/10.3390/jcm14061987 - 14 Mar 2025

Abstract

Peripheral arterial disease (PAD) is a major complication in individuals with diabetes and is increasingly prevalent in those with diabetic foot ulcers (DFUs). Despite this, the characterisation of PAD in diabetic patients remains insufficiently refined, leading to suboptimal management and outcomes. This review [...] Read more.

Peripheral arterial disease (PAD) is a major complication in individuals with diabetes and is increasingly prevalent in those with diabetic foot ulcers (DFUs). Despite this, the characterisation of PAD in diabetic patients remains insufficiently refined, leading to suboptimal management and outcomes. This review underscores the necessity for a more nuanced understanding of PAD’s anatomical and biological aspects in diabetic patients. The distribution of atherosclerotic plaques varies significantly among individuals, influencing prognosis and treatment efficacy. We describe three key patterns of PAD in diabetes: pattern 1 PAD—below-the-knee (BTK) disease (with infrageniculate disease where present); pattern 2—below-the-ankle (BTA) disease; and pattern 3—small artery disease (SAD), each presenting unique challenges and require tailored therapeutic approaches. BTK PAD, characterised by occlusions in the anterior tibial, posterior tibial, and peroneal arteries, necessitates targeted revascularisation to improve foot perfusion. BTA PAD, involving the pedal and plantar arteries, is associated with higher risks of amputation and requires advanced revascularisation techniques. SAD, affecting the small arteries of the foot, remains an enigma and is challenging to treat with the current mechanical methods, highlighting the potential of autologous cell therapy as a promising alternative. A refined characterisation of PAD in diabetes is crucial for developing effective, individualised treatment strategies, ultimately improving patient outcomes, and reducing the burden of diabetic foot complications. In light of these complexities, it is incredulous that we often use a single term, “peripheral arterial disease”, to describe such a diverse array of disease patterns. This oversimplification can be perilous, as it may lead to inadequate therapeutic approaches and suboptimal patient care. Full article

(This article belongs to the Special Issue New Insights into Diabetic Foot)

18 pages, 577 KiB

Open AccessSystematic Review

The Comparison Between the Different Types of Storage Mediums on the Viability of Periodontal Cells Prior to the Replantation of Avulsed Teeth: A Systematic Review & Meta-Analysis

by Charlotte Anne Blackledge, Marcela Ferrer Molina, Tawfiq Hijazi Alsadi and Susana Muwaquet Rodriguez

J. Clin. Med. 2025, 14(6), 1986; https://doi.org/10.3390/jcm14061986 - 14 Mar 2025

Abstract

Background/Objectives: Dental avulsion involves the complete displacement of the tooth from its socket and falls into the most severe categories of the various types of traumatic dental injuries. Successful replantation of the tooth depends on various factors such as the time between [...] Read more.

Background/Objectives: Dental avulsion involves the complete displacement of the tooth from its socket and falls into the most severe categories of the various types of traumatic dental injuries. Successful replantation of the tooth depends on various factors such as the time between the event and replantation, as well as the extra-alveolar storage medium and duration. The adoption of the correct handling measures and use of an appropriate storage medium are key factors that affect the long-term prognosis of the avulsed tooth following replantation. This systematic review and meta-analysis aim to determine if Hank’s Balanced Salt Solution (HBSS) is the most effective storage medium to preserve periodontal (PDL) cell viability following avulsion. Methods: A comprehensive review of the literature available was conducted on the 18th of November 2024 across three databases, namely EBSCO (including PubMed-Medline), Scopus, and Web of Science. The review was written according to and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement created in 2009 and updated in 2020. The following PICO question was constructed for the systematic review: “In patients with avulsed permanent teeth, is Hank’s balanced salt solution more effective in preserving periodontal cell viability to increase the likelihood of a more successful replantation than any other storage media technique available?” A meta-analysis was also conducted with the selected studies, and the software used for this was R 4.3.1 (R Core Team (2018)). Results: A total number of 443 articles were found in the initial search. Of these 443, 9 articles were included in the final systematic review and meta-analysis. 6 out of the 9 articles conclude HBSS to be the most superior storage medium for the preservation of the PDL cells, whilst the other three concluded PDL cell preservation was higher in Morinda citrifolia juice, propolis, and coconut water, suggesting a suitable alternative to HBSS. Nonetheless, the meta-analysis indicated that PDL cell viability was significantly higher using HBSS compared to all other storage media. Conclusions: The systematic review and meta-analysis have provided adequate data in favor of the alternative hypothesis, indicating that Hank’s balanced salt solution is the most effective storage medium in the preservation of periodontal cell viability following the avulsion of permanent teeth. Full article

(This article belongs to the Special Issue Oral Health and Clinical Dentistry: Advances and Challenges)

11 pages, 1109 KiB

Open AccessReview

The Correlation Between Infant Head Shape in Craniometric Studies and Psychomotor Development Disorders

by Natalia Zielińska, Maria Górska, Anna Skrzek and Agnieszka Dębiec-Bąk

J. Clin. Med. 2025, 14(6), 1985; https://doi.org/10.3390/jcm14061985 - 14 Mar 2025

Abstract

Objectives: The objective of this study was to analyze the correlation between muscle tone distribution disorders and asymmetry, with specific postnatal positional cranial deformities in infants. The study focused on assessing the level of unilateral occipital flattening and the extent of symmetrical [...] Read more.

Objectives: The objective of this study was to analyze the correlation between muscle tone distribution disorders and asymmetry, with specific postnatal positional cranial deformities in infants. The study focused on assessing the level of unilateral occipital flattening and the extent of symmetrical occipital flattening. Methods: The study involved 60 infants aged between 1 and 5 months. Each infant was neurologically diagnosed and assigned to one of three groups: asymmetry, reduced muscle tone, or increased muscle tone. Each group consisted of 20 infants (10 girls and 10 boys). A MIMOS craniometer was used to measure the infants’ head shapes, calculating the cranial vault asymmetry (mm) and cranial index (%). The data were analyzed and processed using Statistica software and appropriate statistical tests. Results: The results revealed a correlation between asymmetry and reduced muscle tone, increased muscle tone, and specific positional head deformities in infants up to the age of 5 months. Full article

(This article belongs to the Section Clinical Rehabilitation)

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