Journal of Clinical Medicine

26 pages, 760 KB

Open AccessEditor’s ChoiceReview

Male Infertility and Reduced Life Expectancy: Epidemiology, Mechanisms, and Clinical Implications

by Aris Kaltsas, Andreas Koumenis, Marios Stavropoulos, Zisis Kratiras, Dimitrios Deligiannis, Konstantinos Adamos and Michael Chrisofos

J. Clin. Med. 2025, 14(11), 3930; https://doi.org/10.3390/jcm14113930 - 3 Jun 2025

Cited by 9 | Viewed by 6653

Abstract

Male infertility is a prevalent condition affecting approximately 15% of couples worldwide. Recent evidence indicates that, beyond its immediate reproductive implications, male infertility may reflect broader health concerns. Large-scale cohort studies consistently show that men with poorer semen parameters have elevated all-cause mortality [...] Read more.

Male infertility is a prevalent condition affecting approximately 15% of couples worldwide. Recent evidence indicates that, beyond its immediate reproductive implications, male infertility may reflect broader health concerns. Large-scale cohort studies consistently show that men with poorer semen parameters have elevated all-cause mortality compared to fertile counterparts, with a dose-dependent pattern whereby more severe abnormalities correlate with a higher risk of early death. Proposed mechanisms linking infertility to reduced life expectancy encompass genetic, hormonal, and lifestyle factors. For instance, Klinefelter syndrome exemplifies a genetic cause of azoospermia that also predisposes to metabolic syndrome, diabetes, and certain malignancies. Low testosterone, a frequent finding in testicular dysfunction, is implicated in obesity, insulin resistance, and cardiovascular disease, all of which can shorten lifespan. Additionally, psychosocial stress and depression—commonly reported among infertile men—may contribute to health-compromising behaviors. Environmental exposures and socioeconomic factors further compound these risks. Collectively, these data underscore the importance of recognizing male infertility as an early indicator of potentially modifiable health vulnerabilities. A comprehensive evaluation of infertile men should therefore extend beyond fertility assessments to include screening for chronic diseases, hormonal imbalances, and mental health issues. Targeted surveillance for specific cancers (e.g., testicular and prostate) and early interventions—such as lifestyle modifications, appropriate hormonal therapies, and psychosocial support—can improve both reproductive outcomes and long-term well-being. Given these insights, male fertility assessment may serve as a valuable gateway to broader men’s healthcare, prompting proactive strategies that mitigate associated risks and potentially enhance longevity. Full article

(This article belongs to the Special Issue Male Fertility in the Modern Age: Challenges and Opportunities)

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14 pages, 268 KB

Open AccessEditor’s ChoiceReview

Sequential Fractional CO₂ and 1540/1570 nm Lasers: A Narrative Review of Preclinical and Clinical Evidence

by Alessandro Clementi, Giovanni Cannarozzo, Luca Guarino, Elena Zappia, Fortunato Cassalia, Antonio Alma, Mario Sannino, Caterina Longo and Steven Paul Nisticò

J. Clin. Med. 2025, 14(11), 3867; https://doi.org/10.3390/jcm14113867 - 30 May 2025

Cited by 9 | Viewed by 9949

Abstract

Ablative fractional CO₂ laser is an established tool for dermatologic and aesthetic indications. Non-ablative wavelengths, such as 1540 and 1570 nm, are increasingly being combined with CO₂ laser to optimise the results while reducing the recovery time. A narrative review of [...] Read more.

Ablative fractional CO₂ laser is an established tool for dermatologic and aesthetic indications. Non-ablative wavelengths, such as 1540 and 1570 nm, are increasingly being combined with CO₂ laser to optimise the results while reducing the recovery time. A narrative review of the literature was conducted, including ex vivo, in vivo, and in vitro studies, as well as human clinical trials that evaluated the efficacy, safety, and histological impact of dual-laser systems. Preclinical studies have shown that sequential application of fractional CO₂ followed by 1540/1570 nm expands the thermal coagulation zone without increasing the ablation depth. At the histological level, the dual protocol promotes collagen remodelling with greater thermal precision. On a clinical level, a combined treatment has shown efficacy in improving scars, striae distensae, skin laxity, and wrinkles, with reduced recovery times compared to CO₂ monotherapy. Preliminary data also suggest potential benefits in inflammatory conditions such as hidradenitis suppurativa. The sequential CO₂ + 1540/1570 nm combination represents an effective and well-tolerated approach in regenerative dermatology. Current evidence supports its use as a versatile, safe, and reproducible technique for skin rejuvenation and scar modulation; however, further comparative studies are needed to standardise protocols. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

18 pages, 613 KB

Open AccessEditor’s ChoiceReview

Managing Hypertension in Chronic Kidney Disease: The Role of Diet and Guideline Recommendations

by Emelina Stambolliu, Panagiotis Iliakis, Konstantinos Tsioufis and Aikaterini Damianaki

J. Clin. Med. 2025, 14(11), 3755; https://doi.org/10.3390/jcm14113755 - 27 May 2025

Cited by 3 | Viewed by 8763

Abstract

Lifestyle and dietary modifications are unanimously suggested as the initial step to treat hypertension in the general population and in patients with chronic kidney disease (CKD). Limiting sodium intake constitutes the cornerstone of dietary interventions, but augmenting dietary potassium intake has also been [...] Read more.

Lifestyle and dietary modifications are unanimously suggested as the initial step to treat hypertension in the general population and in patients with chronic kidney disease (CKD). Limiting sodium intake constitutes the cornerstone of dietary interventions, but augmenting dietary potassium intake has also been associated with a significant blood pressure (BP)-lowering effect. Although there may be a consensus about restraining the daily sodium intake to <2 g per day, the target for optimal potassium intake is vague. In hypertensive patients with CKD, the desired amount of potassium in the diet remains a controversial issue, as evidence from studies concerning the effect on CKD progression is contradictory. Hence, medical societies and food authorities worldwide do not share a joint recommendation. Other dietary components, including calcium, magnesium, protein, phosphorus, zinc, and alcohol intake may play a role in BP control, but the evidence in the CKD population so far is inconclusive. Further studies are needed to establish solid evidence about the safety and efficacy of dietary interventions, particularly in CKD patients, the majority of whom suffer from hypertension. The purpose of this review is to summarize the existing recommendations and evidence concerning dietary interventions in hypertensives with CKD, with a primary focus on sodium and potassium intake. Additionally, we briefly address other dietary components that may play a role in BP regulation or kidney function. Full article

(This article belongs to the Special Issue Hypertension in Adults: Current Updates on Diagnosis, Treatment and Management)

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21 pages, 315 KB

Open AccessEditor’s ChoiceReview

Safety and Risks of Antihypertensive Medications During Breastfeeding: A Review of Current Guidelines

by Emilia Piotrkowicz, Piotr Skrzypczyk, Aleksander Prejbisz, Piotr Dobrowolski, Maciej Gawlak and Przemysław Kosiński

J. Clin. Med. 2025, 14(11), 3722; https://doi.org/10.3390/jcm14113722 - 26 May 2025

Cited by 1 | Viewed by 12698

Abstract

Hypertension disorders of pregnancy affect almost 10% of pregnancies. Most hypertensive disorders associated with pregnancy, including chronic hypertension and gestational hypertension, often persist into the postpartum period. Thus, many breastfeeding mothers require ongoing antihypertensive treatment with antihypertensive medications while nursing. This highlights the [...] Read more.

Hypertension disorders of pregnancy affect almost 10% of pregnancies. Most hypertensive disorders associated with pregnancy, including chronic hypertension and gestational hypertension, often persist into the postpartum period. Thus, many breastfeeding mothers require ongoing antihypertensive treatment with antihypertensive medications while nursing. This highlights the importance of understanding the efficacy, safety, and potential adverse effects of antihypertensive therapy in breastfeeding mothers. Unfortunately, research in this area is limited, and references in clinical guidelines remain sparse. Our review aims to provide a comprehensive summary of the current knowledge on antihypertensive medications during breastfeeding, drawing from available research and evidence-based guidelines. This article discusses all groups of antihypertensive drugs, presenting societies’ recommendations and available clinical data. Based on the available literature, calcium channel blockers (extended-release nifedipine as the first choice) and beta-blockers (labetalol, metoprolol) appear to be the drugs of choice. Our review highlights the need for further research to evaluate the long-term safety of antihypertensive medications during breastfeeding, improve clinical guidelines, and ensure optimal treatment for nursing mothers. Full article

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Clinical Updates and Perspectives)

15 pages, 2682 KB

Open AccessEditor’s ChoiceArticle

Clinical Efficacy of Platelet-Rich Plasma and Hyaluronic Acid Versus Hyaluronic Acid for Knee Osteoarthritis with MRI Analysis: A Randomized Controlled Trial

by Mandy Zhang, Kelvin Chew, Patrick Goh, Mon Hnin Tun, Kenneth Sheah, Victor Tan, Baoying Lim, Chung Sien Ng and Benedict Tan

J. Clin. Med. 2025, 14(10), 3553; https://doi.org/10.3390/jcm14103553 - 19 May 2025

Cited by 1 | Viewed by 10346

Abstract

Background: Some evidence suggests that combining hyaluronic acid (HA) with platelet-rich-plasma (PRP) may offer synergistic benefits by enhancing the biological and mechanical properties of joints. However, data on the combination of HA+PRP vs. HA alone in the management of knee osteoarthritis (OA) remain [...] Read more.

Background: Some evidence suggests that combining hyaluronic acid (HA) with platelet-rich-plasma (PRP) may offer synergistic benefits by enhancing the biological and mechanical properties of joints. However, data on the combination of HA+PRP vs. HA alone in the management of knee osteoarthritis (OA) remain limited. Methods: A double-blinded randomized controlled trial was conducted at an outpatient clinic and enrolled 58 patients with Kellgren–Lawrence grade 2–3 knee OA. They were randomly allocated to receive either intra-articular PRP combined with HA (n = 29 knees) or HA alone (n = 29 knees). The primary outcome was pain, assessed using a visual analog scale (VAS). Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), health-related quality of life (EQ-5D-5L), and structural changes on MRI, measured by the Whole-Organ MRI Score (WORMS). The VAS, WOMAC, and EQ-5D-5L were evaluated at baseline and at months 1, 3, 6, and 12. MRI WORMS was assessed at baseline and 12 months. Results: The baseline characteristics were comparable between the HA+PRP and HA groups. Both interventions showed improvements in pain and function at 12 months. However, the between-group difference in VAS at 12 months—the primary outcome—was not statistically significant (p = 0.102) and did not exceed the minimal clinically important difference (MCID) of 20 mm. The HA group demonstrated significantly greater VAS score reductions at 1 month (−31.1 [95% CI: −38.9 to −23.2] vs. −14.3 [95% CI: −22.2 to −6.4], p = 0.003) and at 6 months (−32.1 [95% CI: −40.1 to −24.1] vs. −19.2 [95% CI: −27.1 to −11.3], p = 0.024), compared to the HA+PRP group, although these differences did not reach clinical significance. No significant between-group differences were observed in the WOMAC scores, EQ-5D-5L, or total WORMS scores at all time points (p > 0.05). At 12 months, MRI assessment revealed a significant decrease in bone marrow edema in the HA+PRP group (−0.7 [95% CI: −1.6 to 0.2]) compared to the HA group (0.7 [95% CI: −0.2 to 1.6], p = 0.030). Conclusions: Both HA+PRP and HA treatments were effective in reducing pain and improving function in patients with knee OA over 12 months. While HA demonstrated greater early pain relief, the addition of PRP was associated with a significant reduction in bone marrow edema at 12 months. These findings suggest potential structural benefits of HA+PRP, although clinical superiority over HA alone was not established. Full article

(This article belongs to the Section Orthopedics)

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16 pages, 295 KB

Open AccessEditor’s ChoiceReview

Updates and Current Knowledge on the Common Forms of Gastroenteritis: A Review

by Pranav Patel, Hareesha Rishab Bharadwaj, Omar Al Ta’ani, Shahryar Khan, Saqr Alsakarneh, Sheza Malik, Umar Hayat, Manesh Kumar Gangwani, Hassam Ali and Dushyant Singh Dahiya

J. Clin. Med. 2025, 14(10), 3465; https://doi.org/10.3390/jcm14103465 - 15 May 2025

Cited by 2 | Viewed by 12774

Abstract

Background/Objective: Acute gastroenteritis is a major cause of diarrheal illnesses throughout the United States. The purpose of this article is to review the current knowledge in diagnostic and therapeutic aspects. Methods: A comprehensive literature review was conducted using PubMed and Google Scholar, focusing [...] Read more.

Background/Objective: Acute gastroenteritis is a major cause of diarrheal illnesses throughout the United States. The purpose of this article is to review the current knowledge in diagnostic and therapeutic aspects. Methods: A comprehensive literature review was conducted using PubMed and Google Scholar, focusing on articles published within the last ten years. Results: There are multiple etiologies of gastroenteritis that affect the general population. Out of the many causes, norovirus continues to be a leading cause of acute diarrheal illness worldwide. Rotavirus was also a common form of diarrhea worldwide, but the development of routine vaccination has largely reduced its incidence. Bacterial gastroenteritis continues to be a significant burden on healthcare facilities worldwide. Supportive care remains the cornerstone of treatment, while using antibiotics remains crucial in severe bacterial forms of gastroenteritis. Conclusions: Acute gastroenteritis remains a significant global health concern requiring a multifaceted approach for effective management. Enhanced diagnostic techniques, vaccine development, and robust public health measures are essential in controlling the spread of gastroenteritis. Full article

(This article belongs to the Special Issue Gastroenteritis and Related Diseases: Current Knowledge and Therapeutic Prospects)

19 pages, 3870 KB

Open AccessEditor’s ChoiceSystematic Review

Efficacy of Ergonomic Interventions on Work-Related Musculoskeletal Pain: A Systematic Review and Meta-Analysis

by Weiner Santos, Carmen Rojas, Rui Isidoro, Alejandro Lorente, Ana Dias, Gonzalo Mariscal, María Benlloch and Rafael Lorente

J. Clin. Med. 2025, 14(9), 3034; https://doi.org/10.3390/jcm14093034 - 28 Apr 2025

Cited by 5 | Viewed by 20458

Abstract

Background: Among the leading causes of work-related disability, musculoskeletal diseases (MSDs) profoundly affect productivity and quality of life. Workplace changes, equipment adjustments, and training courses, among other ergonomic interventions, seek to lower the frequency and degree of MSDs. This systematic review and [...] Read more.

Background: Among the leading causes of work-related disability, musculoskeletal diseases (MSDs) profoundly affect productivity and quality of life. Workplace changes, equipment adjustments, and training courses, among other ergonomic interventions, seek to lower the frequency and degree of MSDs. This systematic review and meta-analysis evaluated whether ergonomic interventions help prevent and control MSDs in various workplace environments. Methods: A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library to identify relevant studies. Inclusion criteria included randomized controlled trials (RCTs) that evaluated ergonomic interventions against conventional conditions. Effect sizes were computed using mean differences and pooled using a random-effects model in case of heterogeneity. A uniform Excel sheet was used for data extraction. Revman software (Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. Results: This meta-analysis included 24 RCTs with 4086 workers with different occupations. A meta-analysis of 10 included studies demonstrated lower pain intensity with a mean difference in VAS score between ergonomic interventions and the control group of −0.28 (95%CI: −0.43, −0.14, p = 0.0001). Also, there was a significant reduction in reported MSD-related pain in the lower back with ergonomic interventions with an OR 0.53 (95%CI: 0.40–0.70, p < 0.00001). Moreover, there were statistically significant results for ergonomic interventions in the upper back, ankles, wrists, and neck. In contrast, there were no significant improvements in the thighs, arms, knees, shoulders, and elbows. Conclusions: Our findings support implementing ergonomic strategies as a practical approach to reducing work-related MSDs. However, further research is needed to improve intervention design and long-term effectiveness. Full article

(This article belongs to the Special Issue Musculoskeletal Disorders: Clinical Diagnosis, Treatment and Rehabilitation)

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14 pages, 1137 KB

Open AccessEditor’s ChoiceArticle

The Effects of Progressive Muscle Relaxation on Mental Health and Sleep Quality in Adults with Cystic Fibrosis: A Randomized Controlled Trial

by Adelina Maritescu, Camelia Corina Pescaru, Alexandru Florian Crisan, Emil Robert Stoicescu, Cristian Oancea and Daniela Iacob

J. Clin. Med. 2025, 14(8), 2807; https://doi.org/10.3390/jcm14082807 - 18 Apr 2025

Cited by 3 | Viewed by 11420

Abstract

Background/Objective: Cystic fibrosis (CF) is a chronic genetic disease affecting multiple body systems and having a significant impact on mental health and sleep. Patients with CF frequently suffer from anxiety, depression, and sleep disturbances, but non-pharmacological strategies are understudied. Although progressive muscle [...] Read more.

Background/Objective: Cystic fibrosis (CF) is a chronic genetic disease affecting multiple body systems and having a significant impact on mental health and sleep. Patients with CF frequently suffer from anxiety, depression, and sleep disturbances, but non-pharmacological strategies are understudied. Although progressive muscle relaxation (PMR) has recognized benefits, its impact on CF remains insufficiently explored. The study aimed to analyze the effect of integrating PMR into a standard pulmonary rehabilitation (PR) program on mental health, sleep quality, and quality of life in adults with CF. Methods: A total of 22 adult patients with CF were randomly assigned to either the intervention group (PR + PMR) or the control group (PR only). Assessments were performed at baseline, after 21 days of intervention, and at the 48-day follow-up. Outcome measures included the CFQ-R for quality of life, the HADS for mental health, and the PSQI for sleep. Results: Compared to the control group, participants who practiced PMR experienced significant reductions in anxiety (p = 0.05) and depression (p = 0.02) at the final assessment. A significant improvement in sleep quality was also observed (p < 0.01). No relevant differences were found in pulmonary function or performance on the six-minute walk test. Conclusions: Integrating PMR into pulmonary rehabilitation programs may be an effective strategy for improving mental health and sleep in patients with CF. Due to its accessibility and ease of implementation, PMR could be adopted as a complementary method in the holistic care of these patients. Full article

(This article belongs to the Section Mental Health)

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18 pages, 819 KB

Open AccessEditor’s ChoiceReview

Adolescent Pregnancies and Perinatal Mental Health—Needs and Complex Support Options: A Literature Review

by Sigita Lesinskienė, Justina Andruškevič and Agnė Butvilaitė

J. Clin. Med. 2025, 14(7), 2334; https://doi.org/10.3390/jcm14072334 - 28 Mar 2025

Cited by 2 | Viewed by 13887

Abstract

Adolescent pregnancy remains a global issue, demanding comprehensive, long-term solutions. Despite declining rates, early pregnancy leads to severe physical and mental health risks along with increased mortality. Therefore, adolescent pregnancy requires urgent global action. This literature review evaluates pregnant adolescents’ psychological health issues, [...] Read more.

Adolescent pregnancy remains a global issue, demanding comprehensive, long-term solutions. Despite declining rates, early pregnancy leads to severe physical and mental health risks along with increased mortality. Therefore, adolescent pregnancy requires urgent global action. This literature review evaluates pregnant adolescents’ psychological health issues, explores their needs, and investigates interdisciplinary approaches to enhance mental and physical health support. Studies show that adolescent pregnancy poses significant mental health risks and is associated with high rates of depression, suicidal ideation, low self-esteem, substance use, and anxiety. Co-occurring hardships further worsen psychological well-being. Found data indicated that the main needs of pregnant adolescents were adequate sexual and reproductive health; legal rights; high-quality, accessible healthcare; and socioeconomic support. The included references revealed several interventions and recommendations for supporting pregnant adolescents while highlighting challenges in the current framework. Pregnant adolescents face diverse gaps in current support systems. Further research is needed addressing social services, reproductive health consultations, and mental health support. Greater emphasis on multidisciplinary approaches and examples of effective support strategies is crucial to creating a nurturing environment and securing the well-being of pregnant adolescents. Full article

(This article belongs to the Special Issue Perinatal Mental Health Management)

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14 pages, 2291 KB

Open AccessEditor’s ChoiceSystematic Review

Hemoadsorption in the Management of Septic Shock: A Systematic Review and Meta-Analysis

by David Steindl, Tim Schroeder, Alexander Krannich and Jens Nee

J. Clin. Med. 2025, 14(7), 2285; https://doi.org/10.3390/jcm14072285 - 27 Mar 2025

Cited by 9 | Viewed by 4767

Abstract

Background/Objectives: Septic shock remains a significant clinical challenge with consistently high mortality rates. Recent investigations have focused on the efficacy of CytoSorb^® (CytoSorbents Corporation, Monmouth Junction, NJ, USA), an extracorporeal cytokine adsorber, and how it impacts outcomes in sepsis. The current [...] Read more.

Background/Objectives: Septic shock remains a significant clinical challenge with consistently high mortality rates. Recent investigations have focused on the efficacy of CytoSorb^® (CytoSorbents Corporation, Monmouth Junction, NJ, USA), an extracorporeal cytokine adsorber, and how it impacts outcomes in sepsis. The current meta-analysis reports on the impact of CytoSorb^® on survival, specifically in septic shock patients. Methods: We conducted a comprehensive systematic search across the PubMed and COCHRANE databases for studies published up to 10 June 2024. The analysis prioritized randomized controlled trials and observational studies with control groups involving septic shock patients while excluding case reports and case series. Nine studies were finally included in our meta-analysis following the initial screening of 115 articles after excluding duplicates and irrelevant entries. Results: The meta-analysis was performed on 744 critically ill patients with septic shock from one RCT and eight observational studies. Of these, 449 patients received treatment with CytoSorb^® in addition to standard care. Our data indicate that CytoSorb^® use is associated with reduced in-hospital mortality, evidenced by an odds ratio (OR) of 0.64 [0.42; 0.97] and a p-value of 0.036. For 28–30-day mortality, the findings were more pronounced with an OR of 0.46 [0.28; 0.78] and a p-value of 0.003. The analysis of the longest observed mortality showed a trend for improved survival within the CytoSorb group; however, it did not reach statistical significance. Additionally, there was a significant improvement in hemodynamic stability as a secondary endpoint, as evidenced by notable reductions in vasopressor requirements in the hemoadsorption group. Conclusions: The current meta-analysis suggests that the use of CytoSorb^® alongside standard of care management may be linked to improved short-term survival in patients with septic shock; however, these findings should be interpreted with caution in light of the heterogeneity and the modest quality of the studies included. Prospective studies are needed to better determine the impact of hemoadsorption on shock reversal and survival in these critically ill patients. Full article

(This article belongs to the Special Issue Sepsis: Current Updates and Perspectives)

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13 pages, 939 KB

Open AccessEditor’s ChoiceArticle

Remnant Cholesterol Levels at Diagnosis May Predict Acute Coronary Syndrome Occurrence During Follow-Up in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

by Hyunsue Do, Oh Chan Kwon, Jang Woo Ha, Jihye Chung, Yong-Beom Park, Ji Hye Huh and Sang-Won Lee

J. Clin. Med. 2025, 14(7), 2260; https://doi.org/10.3390/jcm14072260 - 26 Mar 2025

Viewed by 771

Abstract

Background/Objectives: Previous studies have revealed the predictive potential of remnant cholesterol (RC) for acute coronary syndrome (ACS) occurrence in the general population. However, whether this association applies to patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), in which a lipid paradox exists, remains [...] Read more.

Background/Objectives: Previous studies have revealed the predictive potential of remnant cholesterol (RC) for acute coronary syndrome (ACS) occurrence in the general population. However, whether this association applies to patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV), in which a lipid paradox exists, remains unclear. We investigated whether RC levels at diagnosis could predict ACS occurrence during follow-up in patients with AAV. Methods: This study included 139 patients with AAV. ACS was defined as ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina occurring after AAV diagnosis. RC levels were calculated as (total cholesterol)–(low-density lipoprotein cholesterol)–(high-density lipoprotein cholesterol). Patients were categorised into three groups by RC tertiles: highest (≥26.2 mg/dL), middle (19.1−26.1 mg/dL), and lowest (≤19.0 mg/dL) tertile groups. Results: The median age of the 139 patients (male, 31.7%) was 58.0 years. During follow-up, six, two, and one patients were diagnosed with ACS in the highest, middle, and lowest tertile groups, respectively. Patients in the highest tertile group exhibited a significantly lower ACS-free survival rate than those in the lowest tertile (p = 0.030). In the multivariable Cox hazards model, male sex (hazard ratio [HR] 9.054, 95% confidence interval [CI] 1.786−45.910), Birmingham vasculitis activity score (HR 1.147, 95% CI 1.033−1.274), and the highest tertile of RC levels (HR 10.818, 95% CI 1.867–62.689) were significantly and independently associated with ACS occurrence during follow-up in patients with AAV. Conclusions: Our findings indicate that RC levels at diagnosis may predict ACS occurrence during follow-up in patients with AAV, regardless of the traditional cardiovascular risk factors. Full article

(This article belongs to the Section Immunology & Rheumatology)

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16 pages, 5310 KB

Open AccessEditor’s ChoiceArticle

Acute Myocardial Infarction Mortality in the Older Population of the United States: An Analysis of Demographic and Regional Trends and Disparities from 1999 to 2022

by Ali Bin Abdul Jabbar, Mason Klisares, Kyle Gilkeson and Ahmed Aboeata

J. Clin. Med. 2025, 14(7), 2190; https://doi.org/10.3390/jcm14072190 - 23 Mar 2025

Cited by 6 | Viewed by 2897

Abstract

Background/Objectives: Acute myocardial infarction (AMI) has been a leading cause of mortality in the US. Though AMI mortality has been decreasing in the US, significant disparities have persisted. We aim to evaluate disparities in AMI-related deaths in the US from 1999 to [...] Read more.

Background/Objectives: Acute myocardial infarction (AMI) has been a leading cause of mortality in the US. Though AMI mortality has been decreasing in the US, significant disparities have persisted. We aim to evaluate disparities in AMI-related deaths in the US from 1999 to 2022. Methods: Data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) multiple causes of death database were used to analyze death certificates from 1999 to 2022 for AMI-related deaths among United States older adults (aged ≥ 65) for overall trend and disparities based on demographic (sex, race/ethnicity, and ten-year age groups) and regional (census regions, rural-urban status, and states) subgroups. Rural and urban status were distinguished using definitions set by the 2013 NCHS Urban-Rural Classification scheme for counties. These data come from the 2010 Census report and are updated from the 2006 NCHS Urban-Rural Classification scheme for counties. The crude mortality rate (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 people were used to calculate annual percentage changes (APCs) and average annual percentage changes (AAPCs) using Joinpoint regression analysis. Results: From 1999 to 2022, there were 3,249,542 deaths due to AMI. Overall, age-adjusted mortality rates (AAMRs) decreased by 62.78% from 563.2 * (95% CI 560.3–565.7) in 1999 to a nadir at 209.6 * (208.3–210.8) in 2019, with an AAPC of −4.96 * (95% CI −5.11 to −4.81). There were a total of 355,441 deaths from AMI from 2020 to 2022; 21,216 (5.97%) of those were from AMI with COVID-19 infection. An increase of 11.4% was observed from an AAMR of 209.6 * (95% CI 208.3–210.8) in 2019 to 233.5 * (95% CI 232.2–234.8) in 2021. From 2021 to 2022, the AAMR of AMI decreased from 233.5 * (95% CI 232.2–234.8) to 209.8 * (95% CI 208.6–211), recovering to the 2019 levels. The AAMR for AMI excluding associated COVID-19 infection was 217.2 at its peak in 2021, which correlates to only a 3.63% increase from 2019. Significant disparities in AMI mortality were observed, with higher mortality rates in men, African Americans, the oldest age group (age ≥ 85), and those living in southern states and rural areas. Conclusions: AMI mortality in the older adult population of the US has significantly decreased from 1999 to 2019, with a brief increase during the pandemic from 2019 to 2021, followed by recovery back to the 2019 level in 2022. The majority of the rise observed during the pandemic was associated with COVID-19 infection. Despite remarkable improvement in mortality, significant disparities have persisted, with men, African Americans, and those living in rural areas and the southern region of the US having disproportionately higher mortality. Full article

(This article belongs to the Special Issue Myocardial Infarction: Current Status and Future Challenges)

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27 pages, 721 KB

Open AccessEditor’s ChoiceReview

Lights and Shadows on Artificial Intelligence in Glaucoma: Transforming Screening, Monitoring, and Prognosis

by Alessio Martucci, Gabriele Gallo Afflitto, Giulio Pocobelli, Francesco Aiello, Raffaele Mancino and Carlo Nucci

J. Clin. Med. 2025, 14(7), 2139; https://doi.org/10.3390/jcm14072139 - 21 Mar 2025

Cited by 7 | Viewed by 2315

Abstract

Background/Objectives: Artificial intelligence (AI) is increasingly being integrated into medicine, including ophthalmology, owing to its strong capabilities in image recognition. Methods: This review focuses on the most recent key applications of AI in the diagnosis and management of, as well as [...] Read more.

Background/Objectives: Artificial intelligence (AI) is increasingly being integrated into medicine, including ophthalmology, owing to its strong capabilities in image recognition. Methods: This review focuses on the most recent key applications of AI in the diagnosis and management of, as well as research on, glaucoma by performing a systematic review of the latest papers in the literature. Results: In glaucoma, AI can help analyze large amounts of data from diagnostic tools, such as fundus images, optical coherence tomography scans, and visual field tests. Conclusions: AI technologies can enhance the accuracy of glaucoma diagnoses and could provide significant economic benefits by automating routine tasks, improving diagnostic accuracy, and enhancing access to care, especially in underserved areas. However, despite these promising results, challenges persist, including limited dataset size and diversity, class imbalance, the need to optimize models for early detection, and the integration of multimodal data into clinical practice. Currently, ophthalmologists are expected to continue playing a leading role in managing glaucomatous eyes and overseeing the development and validation of AI tools. Full article

(This article belongs to the Topic Machine Learning and Deep Learning in Medical Imaging)

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29 pages, 3183 KB

Open AccessEditor’s ChoiceReview

The Meniscus: Basic Science and Therapeutic Approaches

by Nikodem Kuczyński, Julia Boś, Kinga Białoskórska, Zuzanna Aleksandrowicz, Bartosz Turoń, Maria Zabrzyńska, Klaudia Bonowicz and Maciej Gagat

J. Clin. Med. 2025, 14(6), 2020; https://doi.org/10.3390/jcm14062020 - 16 Mar 2025

Cited by 9 | Viewed by 12512

Abstract

The proper function and longevity of the knee joint are ensured by the knee menisci. Their susceptibility to damage and injury is one of the main risk factors for rapid cartilage loss and the development of osteoarthritis. The vascularization pattern and nutritional status [...] Read more.

The proper function and longevity of the knee joint are ensured by the knee menisci. Their susceptibility to damage and injury is one of the main risk factors for rapid cartilage loss and the development of osteoarthritis. The vascularization pattern and nutritional status of a torn meniscus determine its potential for healing and the success of meniscus surgery. Blood supply is a crucial factor in assessing healing potential. Knee cartilage volume loss and its modification often result from meniscal damage or excision, leading to osteoarthritis. Modern methods for preserving meniscal tissue are currently the treatment of choice. Magnetic resonance imaging (MRI) is the gold standard for assessing meniscus lesions. It provides a comprehensive evaluation of tear stability and progression risk. Additionally, it offers high sensitivity and specificity. Arthrography combined with computed tomography (CT) can be used for patients who are unable to undergo MRI. Other methods, such as X-ray and ultrasound, are not useful for the typical diagnosis of meniscal lesions. Minimally invasive surgery has become the gold standard for both treatment and diagnosis. Modern techniques, such as all-inside compression sutures and other suturing techniques, are also considered. In contrast, in the past, open total meniscectomy was routinely performed as the gold standard, based on the mistaken belief that the menisci were functionless. Currently, new treatment methods for meniscal lesions are being explored, including mesenchymal stem cells, synthetic implants, and platelet-rich plasma (PRP). The crucial role of the menisci in knee biomechanics drives the development of modern solutions focused on preserving meniscal tissue. Full article

(This article belongs to the Special Issue Advances in Arthroscopic Surgery for Meniscus and Cartilage Repair)

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16 pages, 5278 KB

Open AccessEditor’s ChoiceArticle

From Grammont to a New 135° Short-Stem Design: Two-Hand Lever Test and Early Superior–Lateral Dislocations Reveal Critical Role of Liner Stability Ratio and Stem Alignment

by Stefan Bauer, Jaad Mahlouly, Luca Tolosano, Philipp Moroder, William G. Blakeney and Wei Shao

J. Clin. Med. 2025, 14(6), 1898; https://doi.org/10.3390/jcm14061898 - 11 Mar 2025

Cited by 1 | Viewed by 2018

Abstract

Background: In reverse shoulder arthroplasty (RSA), the neck–shaft angle (NSA) has trended downward from 155° to 135° to reduce scapular notching, but concerns about instability persist. To assess superior–lateral stability, we developed the intraoperative two-hand lever test (2HLT). The primary objective was [...] Read more.

Background: In reverse shoulder arthroplasty (RSA), the neck–shaft angle (NSA) has trended downward from 155° to 135° to reduce scapular notching, but concerns about instability persist. To assess superior–lateral stability, we developed the intraoperative two-hand lever test (2HLT). The primary objective was to evaluate the effectiveness of the 2HLT, analyze the learning curve in this first study reporting on the new Perform stem, and compare the liner characteristics of 155° and 135° systems. Methods: In a single-surgeon learning curve study, 81 RSA procedures with the new Perform stem (Stryker) were included. The outcomes included the 2HLT test applied in 65 cases, early dislocations, stem alignment, stem length, liner type/thickness, and complications. The early dislocation rate was compared to 167 prior Ascend Flex RSA procedures (Stryker). The liner characteristics of three 135° systems (Perform/Stryker, Univers/Arthrex, and Altivate/Enovis) were compared to traditional 155° Grammont systems (Delta Xtend/DePuy, Affinis Metal/Mathys, SMR 150/Lima, and Aequalis Reversed/Stryker), focusing on jump height (JH) and the liner stability ratio (LSR). Results: In 63% (31/49) of the cases, the 2HLT detected superior–lateral instability, necessitating a retentive 135° liner. The early dislocation rate in the Perform cohort was 4.9% (0% for retentive liners, 8% for standard liners) versus 0% in the Ascend Flex cohort. The mean effective NSA was 133° (127–144°) for short Perform stems and 135° (129–143°) for long stems. Long Perform stems significantly reduced varus outlier density below 132° and 130° (p = 0.006, 0.002). The 36 mm Perform 135° standard liner has a JH of 8.1 mm and an LSR of 152%, markedly lower than the Altivate (10.0 mm/202%) and Univers (9.7 mm/193%) and similar to traditional 155° Grammont liners (8.1–8.9 mm/147–152%). Perform retentive liners have LSR values of 185–219%, comparable to the established 135° design standard liners (195–202%). In the Perform cohort, early complications included four superior–lateral dislocations (all standard liners, LSR 147–152%) requiring four revisions. Conclusions: Perform standard liners have a lower LSR than the established 135° designs. Retentive Perform liners (LSR > 184%) are comparable to standard liners of established 135° designs and effectively mitigate instability. We recommend discontinuing non-retentive Perform standard liners (NSA 135°, LSR < 158%) due to the 63% superior–lateral instability rate detected with the novel 2HLT, necessitating retentive liners, the documented LSR-NSA implant mismatch, and an early clinical dislocation rate of up to 8%. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

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14 pages, 642 KB

Open AccessEditor’s ChoiceReview

Maintenance Immunosuppression in Kidney Transplantation: A Review of the Current Status and Future Directions

by Muhammad Ali Khan, Alessandra Hanna, Srilekha Sridhara, Harshad Chaudhari, Hay Me Me, Rose Mary Attieh and Bassam G. Abu Jawdeh

J. Clin. Med. 2025, 14(6), 1821; https://doi.org/10.3390/jcm14061821 - 8 Mar 2025

Cited by 7 | Viewed by 7839

Abstract

Kidney transplantation remains the gold standard for managing end-stage kidney disease, providing superior survival and quality-of-life outcomes compared to dialysis. Despite the ongoing gap between organ availability and demand, it is inevitable that kidney transplantation will continue to grow. This is owed to [...] Read more.

Kidney transplantation remains the gold standard for managing end-stage kidney disease, providing superior survival and quality-of-life outcomes compared to dialysis. Despite the ongoing gap between organ availability and demand, it is inevitable that kidney transplantation will continue to grow. This is owed to broader organ sharing, increased comfort of transplant programs with marginal kidney utilization, and the expansion of paired exchange among living donor kidneys. The evolution of kidney transplantation could not have been possible without the availability of effective immunosuppressive regimens that prevent rejection and maintain graft function. Mycophenolic acid and calcineurin inhibitors continue to serve as the foundation of modern maintenance immunosuppression. While these agents have markedly reduced acute rejection rates, their long-term efficacy in graft survival remains suboptimal. Alternative immunosuppressive therapies, including belatacept and mammalian target of rapamycin inhibitors, have demonstrated potential benefits. However, concerns regarding an increased risk of rejection have limited their widespread adoption as primary treatment options. In addition to ongoing efforts to refine steroid- and calcineurin inhibitor-sparing strategies, the identification of practical and quantifiable biomarkers for predicting long-term graft survival remains a critical objective. This review evaluates contemporary immunosuppressive protocols, highlights existing challenges, and explores future directions for optimizing long-term transplant outcomes. Full article

(This article belongs to the Special Issue New Insights into Kidney Transplantation)

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38 pages, 474 KB

Open AccessEditor’s ChoiceReview

Bone Regeneration: A Review of Current Treatment Strategies

by Raffaella De Pace, Silvia Molinari, Elisa Mazzoni and Giuseppe Perale

J. Clin. Med. 2025, 14(6), 1838; https://doi.org/10.3390/jcm14061838 - 8 Mar 2025

Cited by 44 | Viewed by 19306

Abstract

Bone regeneration has emerged as a critical research and clinical advancement field, fueled by the growing demand for effective treatments in orthopedics and oncology. Over the past two decades, significant progress in biomaterials and surgical techniques has led to the development of novel [...] Read more.

Bone regeneration has emerged as a critical research and clinical advancement field, fueled by the growing demand for effective treatments in orthopedics and oncology. Over the past two decades, significant progress in biomaterials and surgical techniques has led to the development of novel solutions for treating bone defects, surpassing the use of traditional autologous grafts. This review aims to assess the latest approaches in bone regeneration, including autologous, allogenic, and xenogenic grafts, naturally derived biomaterials, and innovative synthetic substitutes such as bioceramics, bioactive glasses, metals, polymers, composite materials, and other specialized applications. A comprehensive literature search was conducted on PubMed, focusing on studies published between 2019 and 2024, including meta-analyses, reviews, and systematic reviews. The review evaluated a range of bone regeneration strategies, examining the clinical outcomes, materials used, surgical techniques, and the effectiveness of various approaches in treating bone defects. The search identified numerous studies, with the inclusion criteria focused on those exploring innovative bone regeneration strategies. These studies provided valuable insights into the clinical and biological outcomes of different biomaterials and graft types. Results indicated that while advancements in synthetic and naturally derived biomaterials show promising potential, challenges remain in optimizing therapeutic strategies across diverse patient populations and clinical settings. The findings emphasize the need for an integrated approach that combines scientific research, clinical practice, and technological innovation to improve bone regeneration therapies. Further research is required to establish standardized protocols and determine the optimal application of various materials and techniques to enhance patient outcomes and the quality of care. Full article

(This article belongs to the Section Orthopedics)

14 pages, 261 KB

Open AccessEditor’s ChoiceReview

The Expanding Therapeutic Potential of Deucravacitinib Beyond Psoriasis: A Narrative Review

by Chul-Hwan Bang, Chul-Jong Park and Yoon-Seob Kim

J. Clin. Med. 2025, 14(5), 1745; https://doi.org/10.3390/jcm14051745 - 5 Mar 2025

Cited by 11 | Viewed by 5608

Abstract

Deucravacitinib is an allosteric, selective tyrosine kinase 2 (TYK2) inhibitor that has demonstrated significant efficacy in the treatment of psoriasis. TYK2, a member of the Janus kinase (JAK) family, plays a critical role in intracellular signaling pathways for pro-inflammatory cytokines. Unlike traditional JAK [...] Read more.

Deucravacitinib is an allosteric, selective tyrosine kinase 2 (TYK2) inhibitor that has demonstrated significant efficacy in the treatment of psoriasis. TYK2, a member of the Janus kinase (JAK) family, plays a critical role in intracellular signaling pathways for pro-inflammatory cytokines. Unlike traditional JAK inhibitors, which target active domains, deucravacitinib selectively binds to the pseudokinase domain of TYK2. This binding induces a conformational change that locks the enzyme in an inactive state, ensuring superior selectivity for TYK2 over JAK 1/2/3. This unique mechanism specifically inhibits key pro-inflammatory cytokines, including IL-12, IL-23, and type I interferons, critical in the pathogenesis of psoriasis and other immune-mediated diseases. As a result, deucravacitinib represents a promising option for targeted therapy in immune-mediated diseases and may reduce adverse events commonly associated with broader immunosuppressive treatments. Furthermore, its oral administration offers a convenient alternative to injectable biologics, potentially improving patient adherence and treatment satisfaction. This review highlights recent studies suggesting that deucravacitinib may also have therapeutic benefits in psoriatic arthritis, palmoplantar pustulosis, systemic lupus erythematosus, Sjogren’s disease, and inflammatory bowel disease. Given its expanding therapeutic potential, deucravacitinib may provide a safer and more effective alternative to current therapies, offering a tailored approach to treatment. Full article

(This article belongs to the Section Dermatology)

19 pages, 1239 KB

Open AccessFeature PaperEditor’s ChoiceArticle

The Interplay Between Stress and Eating Attitudes: A Cross-Sectional Study Among Romanian Physical Therapy Students

by Corina Sporea, Maria-Veronica Morcov, Claudiu Ionut Vasile, Ioana Elena Cioca, Oana Alina Apostol, Andrada Mirea and Antoaneta Punga

J. Clin. Med. 2025, 14(5), 1755; https://doi.org/10.3390/jcm14051755 - 5 Mar 2025

Cited by 5 | Viewed by 2001

Abstract

Background: University students often experience significant stress, which may contribute to disordered eating behaviors. Objectives: This study examines the relationship between perceived stress and eating attitudes among physical therapy students in Romania, exploring the impact on overall well-being and identifying predictors of maladaptive [...] Read more.

Background: University students often experience significant stress, which may contribute to disordered eating behaviors. Objectives: This study examines the relationship between perceived stress and eating attitudes among physical therapy students in Romania, exploring the impact on overall well-being and identifying predictors of maladaptive eating patterns. Methods: A cross-sectional survey was conducted with 192 students from the Faculty of Midwifery and Nursing, “Carol Davila” University of Medicine and Pharmacy. Two validated instruments were used: the Eating Attitudes Test (EAT-26) to assess eating behaviors and the Perceived Stress Scale (PSS-14) to measure stress levels. Statistical analyses included correlations, ANOVA, and regression models, with a significance threshold of p < 0.05. Results: Among respondents, 15.1% displayed disordered eating behaviors, with stress significantly correlating with EAT-26 subscales. Stress levels were predominantly moderate to high, with younger students reporting higher perceived stress. A significant positive correlation was found between perceived stress and disordered eating behaviors, particularly dieting and bulimia/food preoccupation. Female students reported higher stress levels than males; however, no significant gender differences were observed in disordered eating patterns. No significant associations were found between BMI, weight fluctuations, and EAT-26 scores, suggesting other factors may better explain disordered eating behaviors. Logistic regression identified perceived stress as a significant predictor of disordered eating risk, reinforcing its role in shaping maladaptive eating patterns. Conclusions: Stress significantly impacts eating attitudes, highlighting the need for targeted interventions to reduce stress and promote healthy coping mechanisms. Future research should investigate longitudinal patterns and the effectiveness of interventions aimed at improving student well-being. The limited sample size and the absence of sensitivity analyses are notable limitations that constrain the generalizability of the findings. Full article

(This article belongs to the Section Mental Health)

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16 pages, 413 KB

Open AccessEditor’s ChoiceSystematic Review

Effectiveness of Neuromuscular Training in Preventing Lower Limb Soccer Injuries: A Systematic Review and Meta-Analysis

by Maria Stergiou, Alberto Lorenzo Calvo and Florian Forelli

J. Clin. Med. 2025, 14(5), 1714; https://doi.org/10.3390/jcm14051714 - 4 Mar 2025

Cited by 9 | Viewed by 11616

Abstract

Background: Soccer is associated with a high risk of injuries, mainly affecting the lower limbs, leading to significant consequences for player performance and career longevity. Neuromuscular training (NMT) has been proposed as an effective preventive strategy, but its impact varies across different [...] Read more.

Background: Soccer is associated with a high risk of injuries, mainly affecting the lower limbs, leading to significant consequences for player performance and career longevity. Neuromuscular training (NMT) has been proposed as an effective preventive strategy, but its impact varies across different populations and implementation strategies. Methods: A systematic review was conducted following PRISMA guidelines. A comprehensive search of PubMed, MEDLINE, and SPORTDiscus identified randomized controlled trials, cohort studies, and systematic reviews examining the effects of NMT on lower limb injury prevention in soccer players. Study quality was assessed using the Downs and Black tool, and injury incidence rate ratios were analyzed. Results: Eleven studies, encompassing over 10,000 soccer players, were included. NMT interventions, particularly FIFA 11+, significantly reduced injury rates compared to standard warm-ups. Higher adherence and coach education enhanced program effectiveness. Female players benefited more, particularly in ACL injury prevention. No significant differences were observed between shorter (10 min) and standard (20 min) NMT protocols. Conclusions: NMT effectively reduces lower limb injuries in soccer, with adherence and proper coaching being key determinants of success. Future research should optimize program design and long-term adherence strategies to maximize benefits across all player demographics. Full article

(This article belongs to the Special Issue Sports Injury: Clinical Prevention and Treatment)

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22 pages, 6742 KB

Open AccessEditor’s ChoiceArticle

Comparative Evaluation of High-Speed Videoendoscopy and Laryngovideostroboscopy for Functional Laryngeal Assessment in Clinical Practice

by Joanna Hoffman, Magda Barańska, Ewa Niebudek-Bogusz and Wioletta Pietruszewska

J. Clin. Med. 2025, 14(5), 1723; https://doi.org/10.3390/jcm14051723 - 4 Mar 2025

Cited by 2 | Viewed by 2728

Abstract

Advancements in dynamic laryngeal imaging, particularly high-speed videoendoscopy (HSV), have addressed several limitations of laryngovideostroboscopy (LVS). This study aimed to compare the success rates of LVS and HSV in generating recordings suitable for objective functional assessment of vocal fold movements. Methods: This study [...] Read more.

Advancements in dynamic laryngeal imaging, particularly high-speed videoendoscopy (HSV), have addressed several limitations of laryngovideostroboscopy (LVS). This study aimed to compare the success rates of LVS and HSV in generating recordings suitable for objective functional assessment of vocal fold movements. Methods: This study included 200 patients with voice disorders (123 with benign glottal lesions, 56 with malignant lesions, and 21 with functional voice disorders) and 47 normophonic individuals. All participants underwent LVS followed by HSV. Kymographic analysis was performed to evaluate phonatory parameters, including amplitude, symmetry, and glottal dynamics. The success of both methods in generating analyzable kymograms was assessed, and statistical comparisons were made using the chi-square test (significance level set at p < 0.05). Results: The failure rate for LVS was significantly higher (43.32%) compared to HSV. HSV successfully generated kymograms in 68.22% of cases where LVS failed. The primary factors contributing to LVS failure included synchronization issues, inadequate recording brightness, unstable phonation, and hidden glottal opening. Failure rates related to structural obstacles were similar between the two methods. HSV demonstrated superior kymogram feasibility across all subgroups, with the highest success observed in cases of organic glottal pathologies (30.73%). A significant advantage of HSV was observed for both benign and malignant glottal lesions, especially in cases of asynchronous vocal fold oscillations. Conclusions. By overcoming the inherent limitations of LVS, HSV provides a more reliable and objective assessment of phonatory function. Its ability to generate suitable kymograms with greater precision makes HSV a valuable tool for routine clinical diagnostics, enabling the accurate identification of subtle laryngeal pathologies and enhancing diagnostic accuracy. Full article

(This article belongs to the Special Issue New Advances in the Management of Voice Disorders)

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31 pages, 867 KB

Open AccessEditor’s ChoiceReview

Precision Medicine in Rheumatology: The Role of Biomarkers in Diagnosis and Treatment Optimization

by Matteo Colina and Gabriele Campana

J. Clin. Med. 2025, 14(5), 1735; https://doi.org/10.3390/jcm14051735 - 4 Mar 2025

Cited by 7 | Viewed by 5986

Abstract

Rheumatic diseases encompass a wide range of autoimmune and inflammatory disorders, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and systemic sclerosis (SSc). These conditions often result in chronic pain, disability, and reduced quality of life, with unpredictable disease courses [...] Read more.

Rheumatic diseases encompass a wide range of autoimmune and inflammatory disorders, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and systemic sclerosis (SSc). These conditions often result in chronic pain, disability, and reduced quality of life, with unpredictable disease courses that may lead to joint destruction, organ damage, or systemic complications. Biomarkers, defined as measurable indicators of biological processes or conditions, have the potential to transform clinical practice by improving disease diagnosis, monitoring, prognosis, and treatment decisions. While significant strides have been made in identifying and validating biomarkers in rheumatic diseases, challenges remain in their standardization, clinical utility, and integration into routine practice. This review provides an overview of the current state of biomarkers in rheumatic diseases, their roles in clinical settings, and the emerging advancements in the field. Full article

(This article belongs to the Special Issue Advances in Rheumatology: From Bench to Bedside)

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18 pages, 617 KB

Open AccessEditor’s ChoiceReview

Anticoagulation Management: Current Landscape and Future Trends

by Andaleb Kholmukhamedov, David Subbotin, Anna Gorin and Ruslan Ilyassov

J. Clin. Med. 2025, 14(5), 1647; https://doi.org/10.3390/jcm14051647 - 28 Feb 2025

Cited by 14 | Viewed by 10518

Abstract

Blood transports nutrients and oxygen to the cells while removing the waste. It also possesses a hemostasis function to prevent excessive bleeding. However, abnormal clot formation (thrombosis) within healthy blood vessels can lead to life-threatening conditions like heart attacks, strokes, and pulmonary embolism. [...] Read more.

Blood transports nutrients and oxygen to the cells while removing the waste. It also possesses a hemostasis function to prevent excessive bleeding. However, abnormal clot formation (thrombosis) within healthy blood vessels can lead to life-threatening conditions like heart attacks, strokes, and pulmonary embolism. This review explores anticoagulants, their historical aspects, current clinical applications, and future trends. Anticoagulants play a critical role in preventing and treating thrombosis by interfering with different stages of blood clotting. The journey began with heparin, a rapidly acting injectable medication discovered in 1916. The introduction of warfarin in the 1950s revolutionized anticoagulation by offering long-term oral regimens. Today, anticoagulants are crucial for managing conditions like deep vein thrombosis and pulmonary embolism, especially in an aging population with a rising prevalence of thrombotic complications. Three main types of anticoagulants are used today: vitamin K antagonists (VKAs), injectable heparins, and direct oral anticoagulants (DOACs). Despite advancements, managing anticoagulant therapy remains complex due to individual patient variability, the need for regular monitoring, and the delicate balance between preventing thrombosis and bleeding risks. Emerging trends include the development of factor XIa inhibitors, which promise more targeted thrombosis prevention with potentially lower bleeding risks. This review highlights the ongoing innovation in anticoagulant development, the need for precise management, and potential future avenues like factor XIa inhibitors. Additionally, artificial intelligence holds promise for improving patient outcomes and addressing the complexities of thrombotic disease management by personalizing therapy and reducing bleeding risks. Full article

(This article belongs to the Special Issue Advances in Thrombosis and Haemostasis)

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28 pages, 1191 KB

Open AccessEditor’s ChoicePerspective

Shaping the Future of Healthcare: Ethical Clinical Challenges and Pathways to Trustworthy AI

by Polat Goktas and Andrzej Grzybowski

J. Clin. Med. 2025, 14(5), 1605; https://doi.org/10.3390/jcm14051605 - 27 Feb 2025

Cited by 90 | Viewed by 15235

Abstract

Background/Objectives: Artificial intelligence (AI) is transforming healthcare, enabling advances in diagnostics, treatment optimization, and patient care. Yet, its integration raises ethical, regulatory, and societal challenges. Key concerns include data privacy risks, algorithmic bias, and regulatory gaps that struggle to keep pace with [...] Read more.

Background/Objectives: Artificial intelligence (AI) is transforming healthcare, enabling advances in diagnostics, treatment optimization, and patient care. Yet, its integration raises ethical, regulatory, and societal challenges. Key concerns include data privacy risks, algorithmic bias, and regulatory gaps that struggle to keep pace with AI advancements. This study aims to synthesize a multidisciplinary framework for trustworthy AI in healthcare, focusing on transparency, accountability, fairness, sustainability, and global collaboration. It moves beyond high-level ethical discussions to provide actionable strategies for implementing trustworthy AI in clinical contexts. Methods: A structured literature review was conducted using PubMed, Scopus, and Web of Science. Studies were selected based on relevance to AI ethics, governance, and policy in healthcare, prioritizing peer-reviewed articles, policy analyses, case studies, and ethical guidelines from authoritative sources published within the last decade. The conceptual approach integrates perspectives from clinicians, ethicists, policymakers, and technologists, offering a holistic “ecosystem” view of AI. No clinical trials or patient-level interventions were conducted. Results: The analysis identifies key gaps in current AI governance and introduces the Regulatory Genome—an adaptive AI oversight framework aligned with global policy trends and Sustainable Development Goals. It introduces quantifiable trustworthiness metrics, a comparative analysis of AI categories for clinical applications, and bias mitigation strategies. Additionally, it presents interdisciplinary policy recommendations for aligning AI deployment with ethical, regulatory, and environmental sustainability goals. This study emphasizes measurable standards, multi-stakeholder engagement strategies, and global partnerships to ensure that future AI innovations meet ethical and practical healthcare needs. Conclusions: Trustworthy AI in healthcare requires more than technical advancements—it demands robust ethical safeguards, proactive regulation, and continuous collaboration. By adopting the recommended roadmap, stakeholders can foster responsible innovation, improve patient outcomes, and maintain public trust in AI-driven healthcare. Full article

(This article belongs to the Section Clinical Guidelines)

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12 pages, 1301 KB

Open AccessEditor’s ChoiceArticle

Clinical Significance of Antinuclear Antibodies in Patients with Rheumatoid Arthritis: From SETOUCHI-RA Registry

by Kazuhisa Nakano, Shunichi Fujita, Sumie Hiramatsu-Asano, Akiko Nagasu, Shoko Tsuji, Yuka Koide, Masatomo Yamada, Yo Mizuta, Masakatsu Ikeda, Hiroyasu Hirano and Yoshitaka Morita

J. Clin. Med. 2025, 14(5), 1553; https://doi.org/10.3390/jcm14051553 - 26 Feb 2025

Cited by 2 | Viewed by 3383

Abstract

Background/Objectives: Rheumatoid arthritis (RA) is a representative systemic autoimmune rheumatic disease (SARD) characterized by synovial inflammation. While antinuclear antibodies (ANAs) positivity in patients with RA varies widely, the relationship between ANA patterns and clinical features remains unclear. This study aimed to evaluate the [...] Read more.

Background/Objectives: Rheumatoid arthritis (RA) is a representative systemic autoimmune rheumatic disease (SARD) characterized by synovial inflammation. While antinuclear antibodies (ANAs) positivity in patients with RA varies widely, the relationship between ANA patterns and clinical features remains unclear. This study aimed to evaluate the clinical significance of ANA in patients with RA. Methods: This single-center RA registry study included 814 Japanese patients after excluding those with coexisting SARDs. ANA titers and staining patterns were assessed by indirect immunofluorescence assays on HEp-2 cells. Clinical and laboratory features were analyzed, and logistic regression was used to identify risk factors for pulmonary involvement. Hierarchical clustering and statistical analyses were performed to explore associations between ANA patterns and clinical features. Results: ANA positivity was observed in 41.5% of patients, with the speckled and homogeneous patterns being the most common. ANA-positive patients exhibited significantly higher rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody (ACPA) positivity rates and titers, along with elevated disease activity markers, including Evaluator’s Global Assessment and Swollen Joint Count. Nucleolar pattern positivity was independently associated with pulmonary complications, predominantly interstitial lung disease, and higher rates of JAK inhibitor use. Discrete-speckled pattern-positive patients exhibited high ANA titers but lower RF and ACPA levels, reflecting a distinct subset of RA. Conclusions: ANA staining patterns and titers are clinically relevant in RA, with nucleolar and discrete-speckled patterns indicating distinct clinical and pathophysiological profiles. ANA should be interpreted alongside other serological markers and clinical parameters rather than as a standalone tool. Further studies are needed to refine its clinical applicability and integration into RA management. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Clinical Updates on Diagnosis and Treatment)

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13 pages, 575 KB

Open AccessEditor’s ChoiceReview

Advances in Digital Technologies in Dental Medicine: Enhancing Precision in Virtual Articulators

by Sofia Lobo, Inês Argolinha, Vanessa Machado, João Botelho, João Rua, Junying Li and José João Mendes

J. Clin. Med. 2025, 14(5), 1495; https://doi.org/10.3390/jcm14051495 - 23 Feb 2025

Cited by 9 | Viewed by 6413

Abstract

Precision in diagnosis is essential for achieving optimal outcomes in prosthodontics, orthodontics, and orthognathic treatments. Virtual articulators provide a sophisticated digital alternative to conventional methods, integrating intraoral scans, facial scans, and cone beam computed tomography (CBCT) to enhance treatment predictability. This review examines [...] Read more.

Precision in diagnosis is essential for achieving optimal outcomes in prosthodontics, orthodontics, and orthognathic treatments. Virtual articulators provide a sophisticated digital alternative to conventional methods, integrating intraoral scans, facial scans, and cone beam computed tomography (CBCT) to enhance treatment predictability. This review examines advancements in virtual articulator technology, including digital workflows, virtual facebow transfer, and occlusal analysis, with a focus on Artificial Intelligence (AI)-driven methodologies such as machine learning and artificial neural networks. The clinical implications, particularly in condylar guidance and sagittal condylar inclination, are investigated. By streamlining the acquisition and articulation of digital dental models, virtual articulators minimize material handling errors and optimize workflow efficiency. Advanced imaging techniques enable precise alignment of digital maxillary models within computer-aided design and computer-aided manufacturing systems (CAD/CAM), facilitating accurate occlusal simulations. However, challenges include potential distortions during digital file integration and the necessity for robust algorithms to enhance data superimposition accuracy. The adoption of virtual articulators represents a transformative advancement in digital dentistry, with promising implications for diagnostic precision and treatment outcomes. Nevertheless, further clinical validation is essential to ensure the reliable transfer of maxillary casts and refine digital algorithms. Future developments should prioritize the integration of AI to enhance predictive modeling, positioning virtual articulators as a standard tool in routine dental practice, thereby revolutionizing treatment planning and interdisciplinary collaboration. This review explores advancements in virtual articulators, focusing on their role in enhancing diagnostic precision, occlusal analysis, and treatment predictability. It examines digital workflows, AI-driven methodologies, and clinical applications while addressing challenges in data integration and algorithm optimization. Full article

(This article belongs to the Special Issue Clinical Advances in Dental Medicine and Oral Health)

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11 pages, 521 KB

Open AccessEditor’s ChoiceReview

Narrative Review of the Use of Hydrocolloids in Dermatology: Applications and Benefits

by Nhi Nguyen, Ajay S. Dulai, Sarah Adnan, Zill-e-huma Khan and Raja K. Sivamani

J. Clin. Med. 2025, 14(4), 1345; https://doi.org/10.3390/jcm14041345 - 18 Feb 2025

Cited by 7 | Viewed by 12265

Abstract

Background/Objectives: Hydrocolloid dressings are commonly used in the treatment of chronic wounds by forming a gel-like protective layer upon the dispersion of water, absorbing exudate, and creating a moist environment that promotes healing. However, the use of hydrocolloids has expanded outside of wound [...] Read more.

Background/Objectives: Hydrocolloid dressings are commonly used in the treatment of chronic wounds by forming a gel-like protective layer upon the dispersion of water, absorbing exudate, and creating a moist environment that promotes healing. However, the use of hydrocolloids has expanded outside of wound care, and this review summarizes the evidence for their use within dermatology. Methods: To perform this narrative review, several databases were searched for manuscripts that described the use of hydrocolloid dressings within dermatology. Results: The hydrophilic and colloidal dispersion properties of hydrocolloid dressings facilitate the formation of an absorptive, hydrating, and protective layer. In addition, the viscous layer supports innate immunity by activating immune cells such as granulocytes and monocytes, making them effective in wound care. Hydrocolloid dressings appear to be an effective treatment in acute wounds, with the potential of reduced healing time and easier application compared to traditional dressings. The majority of the related research suggests that hydrocolloid dressings and standard dressings have similar efficacy in healing pressure ulcers, and the prevention of hypertrophic and keloid scars. Early reports suggest that hydrocolloid dressings have a role in the treatment of facial dermatitis and acne vulgaris. Conclusions: Hydrocolloid dressings have been studied most extensively for chronic wounds and then for use in acute wounds. There have been a few studies on their use for treating acne, facial atopic dermatitis, and hypertrophic scarring. While more clinical studies are needed, there appears to be early evidence of hydrocolloid dressing use within dermatology. Full article

(This article belongs to the Special Issue Tissue Scarring, Fibrosis and Regeneration)

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22 pages, 1010 KB

Open AccessEditor’s ChoiceReview

What Is New and What Is Next for SAPHO Syndrome Management: A Narrative Review

by Mario Ferraioli, Juela Levani, Riccardo De Luca, Caterina Matucci-Cerinic, Marco Gattorno, Serena Guiducci, Silvia Bellando Randone and Maria Sole Chimenti

J. Clin. Med. 2025, 14(4), 1366; https://doi.org/10.3390/jcm14041366 - 18 Feb 2025

Cited by 8 | Viewed by 6780

Abstract

Synovitis–acne–pustulosis–hyperostosis–osteitis (SAPHO) syndrome is a rare disease characterized by a sterile inflammatory osteitis and/or arthritis associated with a wide range of dermatological manifestations, such as acne, palmoplantar pustulosis, and psoriasis. This review, providing up-to-date knowledge on this disease, aims at informing researchers and [...] Read more.

Synovitis–acne–pustulosis–hyperostosis–osteitis (SAPHO) syndrome is a rare disease characterized by a sterile inflammatory osteitis and/or arthritis associated with a wide range of dermatological manifestations, such as acne, palmoplantar pustulosis, and psoriasis. This review, providing up-to-date knowledge on this disease, aims at informing researchers and clinicians to help them program future studies in order to improve patients’ care. Due to the vast clinical heterogeneity that characterizes this disease, SAPHO syndrome has received various names; among these, chronic recurrent multifocal osteomyelitis represents the most used one. The various nomenclatures in use also reflect different approaches to its management. Indeed, considering the world-wide distribution and the vast onset age (from children to late adulthood), in addition to the multiform clinical presentation, its diagnosis and treatment are often challenging for clinicians. In this review, we provide valuable insights on SAPHO syndrome, delving into its many aspects: epidemiology, pathogenesis, clinical presentation, diagnosis, and classification. Most importantly, this paper addresses the continuously changing treatment panorama of this disease, from established drugs to newly introduced ones. Furthermore, a peculiar focus regards nonpharmacologic approaches, including traditional Chinese medicine, the apheresis technique, and surgery. Similarly, this review also discusses patients’ lifestyle, including quality of life. To improve SAPHO syndrome’s management, different knowledge gaps should be filled, such as its current epidemiology and pathogenesis. In turn, perfected knowledge in these fields could also advance research in therapy. Full article

(This article belongs to the Section Immunology & Rheumatology)

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24 pages, 2785 KB

Open AccessEditor’s ChoiceArticle

Polypharmacy Prevalence Among Older Adults Based on the Survey of Health, Ageing and Retirement in Europe: An Update

by Elena Gatt Bonanno, Teodora Figueiredo, Inês Figueiroa Mimoso, Maria Inês Morgado, Joana Carrilho, Luís Midão and Elísio Costa

J. Clin. Med. 2025, 14(4), 1330; https://doi.org/10.3390/jcm14041330 - 17 Feb 2025

Cited by 10 | Viewed by 11438

Abstract

Polypharmacy, a common condition among the older population, is associated with adverse outcomes, including higher mortality, falls and hospitalization rates, adverse drug reactions, drug–drug interactions, medication nonadherence, and consequently increased healthcare costs. Background/Objectives: This study aims to explore the prevalence of polypharmacy [...] Read more.

Polypharmacy, a common condition among the older population, is associated with adverse outcomes, including higher mortality, falls and hospitalization rates, adverse drug reactions, drug–drug interactions, medication nonadherence, and consequently increased healthcare costs. Background/Objectives: This study aims to explore the prevalence of polypharmacy and its associated factors among older adults across 27 European countries and Israel. Methods: In this cross-sectional analysis, we used data from participants aged 65 years or older from Wave 9 of the Survey of Health, Aging, and Retirement in Europe (SHARE) database. The variables studied were classified into the following categories: sociodemographic, behavioral factors, physical functioning, physical health, mental health, and living conditions. Results: Our results showed an overall prevalence of polypharmacy of 36.2%, ranging from 25.0 to 51.8%. Slovenia, Greece, and Switzerland were the countries with the lowest prevalence, whereas Portugal, Israel, and Poland were the countries where the prevalence of polypharmacy was the highest. Polypharmacy was shown to be associated with variables from all categories. Conclusions: Polypharmacy is a highly prevalent condition in the older population. Identification of variables associated with polypharmacy, such as those identified in this study, is important to identify and monitor older groups, which are most vulnerable to polypharmacy. Interventions designed to reduce polypharmacy should consider these associations. Full article

(This article belongs to the Special Issue Geriatric Diseases: Management and Epidemiology)

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16 pages, 628 KB

Open AccessEditor’s ChoiceReview

Therapeutic Advancements in Psoriasis and Psoriatic Arthritis

by Robin C. Yi, Maya Akbik, Logan R. Smith, Yael Klionsky and Steven R. Feldman

J. Clin. Med. 2025, 14(4), 1312; https://doi.org/10.3390/jcm14041312 - 16 Feb 2025

Cited by 16 | Viewed by 10170

Abstract

Background: Within the past few years, many new therapies have emerged for psoriasis and psoriatic arthritis (PsA). Current topical therapies—including corticosteroids, vitamin D analogs, tapinarof, and roflumilast—remain the mainstay for mild disease, while oral systemic and biologic options are for moderate to severe [...] Read more.

Background: Within the past few years, many new therapies have emerged for psoriasis and psoriatic arthritis (PsA). Current topical therapies—including corticosteroids, vitamin D analogs, tapinarof, and roflumilast—remain the mainstay for mild disease, while oral systemic and biologic options are for moderate to severe cases. Biologics—such as Tumor necrosis factor-alpha (TNF-alpha), Interleukin 12/23 (IL-12/23), Interleukin-17 (IL-17), and Interleukin-23 (IL-23)—have revolutionized care by providing highly effective and safer alternatives. Oral small molecules, including Janus kinase (JAK) and tyrosine kinase 2 (TYK2) inhibitors, further expand the therapeutic options. Objectives: The goal for this review article was to examine current and latest treatments for psoriasis and PsA and discuss whether these emerging therapeutic options address the unmet needs of current treatments. Methods: The search for this review article included PubMed, Google Scholar, and ClinicalTrials.gov for relevant articles and current clinical trials using keywords. Results: A wide range of novel psoriatic and PsA therapies are currently undergoing clinical trials. These include selective JAK inhibitors, TYK2 inhibitors, retinoic acid-related orphan receptor (RORγT) inhibitors, oral IL-23 receptor inhibitors, oral IL-17A inhibitors, nanobody products, sphingosine-1-phosphate (S1P1R) antagonists, A3 adenosine receptor (A3AR) agonists, heat shock protein (HSP) 90 inhibitors, and rho-associated protein kinases (ROCK-2) inhibitors. Conclusions: These different mechanisms of action not only expand treatment options but may offer potential solutions for patients who do not achieve adequate response with existing therapies. However, the safety and contraindications of these newer agents remain an important consideration to ensure appropriate patient selection and minimize potential risks. Certain mechanisms may pose increased risks for infection, cardiovascular manifestations, malignancy, or other immune-related adverse events, necessitating careful monitoring and individualized treatment decisions. Ongoing clinical research aims to address unmet needs for patients who do not respond to previous agents to achieve sustained remission, monitor long-term safety outcomes, and assess patient preferences for delivery, including a preference for oral delivery. Oral IL-23 inhibitors hold potential due to their robust safety profiles. In contrast, oral IL-17 inhibitors and TYK-2 inhibitors are effective but may present side effects that could impact their acceptability. It is essential to balance efficacy, safety, and patient preferences to guide the selection of appropriate therapies. Full article

(This article belongs to the Special Issue Therapeutic Advancements in Psoriasis and Psoriatic Arthritis)

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15 pages, 1582 KB

Open AccessEditor’s ChoiceArticle

Tinnitus and Its Comorbidities: A Comprehensive Analysis of Their Relationships

by Stefani Maihoub, Panayiota Mavrogeni, Viktória Molnár and András Molnár

J. Clin. Med. 2025, 14(4), 1285; https://doi.org/10.3390/jcm14041285 - 15 Feb 2025

Cited by 14 | Viewed by 5368

Abstract

Objectives: This study aimed to explore the demographic and clinical features of tinnitus individuals and analyse its correlation with associated comorbidities. Methods: The study population comprised 147 participants (66 men, 81 women; median age: 52 years) who experienced persistent tinnitus. Comprehensive assessments were [...] Read more.

Objectives: This study aimed to explore the demographic and clinical features of tinnitus individuals and analyse its correlation with associated comorbidities. Methods: The study population comprised 147 participants (66 men, 81 women; median age: 52 years) who experienced persistent tinnitus. Comprehensive assessments were carried out, including audiological examinations, scoring using the Tinnitus Handicap Inventory, and thorough medical evaluations. Statistical analyses were applied to explore the correspondences between tinnitus, hearing loss, and various comorbidities, including cardiovascular conditions, metabolic disorders, gastroesophageal reflux disease, autoimmune diseases, pulmonary diseases, and allergic rhinitis. Results: The analysis indicated a slight predominance of females, comprising 55.1% of the participants, with a median onset of tinnitus around the age of 50. Chronic tinnitus was noted, lasting approximately 46 months. Hearing loss was noted in 52.4% of patients, with bilateral tinnitus being the most prevalent type, affecting 44.2% of individuals. Dyslipidaemia was found to significantly predict bilateral tinnitus (p = 0.003*) and left-sided tinnitus (p = 0.023*). Additionally, atherosclerosis was associated with hearing impairment (p = 0.006*) and right-sided tinnitus (p = 0.044*). Dyslipidaemia was also significantly correlated with elevated intensity values (p = 0.04*). Furthermore, atherosclerosis was significantly associated with higher levels of hearing loss (p < 0.00001*). Conclusions: The study emphasises the complex nature of tinnitus and its links to cardiovascular, metabolic, and other comorbidities, highlighting the necessity for comprehensive, interdisciplinary management. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

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16 pages, 2760 KB

Open AccessEditor’s ChoiceReview

Advancements in Diagnostic Methods and Imaging Technologies in Dentistry: A Literature Review of Emerging Approaches

by Ana Amélia de Magalhães and Ana Teresa Santos

J. Clin. Med. 2025, 14(4), 1277; https://doi.org/10.3390/jcm14041277 - 14 Feb 2025

Cited by 10 | Viewed by 5787

Abstract

Introduction: Recent advancements in diagnostic imaging technologies have significantly improved the field of dental medicine. This review examines these new imaging techniques and their impact on enhancing accuracy, enabling early detection, and facilitating effective treatment planning in dentistry. Methods: A bibliometric [...] Read more.

Introduction: Recent advancements in diagnostic imaging technologies have significantly improved the field of dental medicine. This review examines these new imaging techniques and their impact on enhancing accuracy, enabling early detection, and facilitating effective treatment planning in dentistry. Methods: A bibliometric and content analysis was conducted on 61 peer-reviewed articles retrieved from the Scopus database, published between 2019 and 2024. The selection criteria focused on studies exploring advances in dental diagnosis through innovative imaging methods and personalized techniques for identifying oral pathologies. The bibliometric approach analyzed publication trends, while content analysis categorized emerging technologies and their clinical applications. Results: Our findings indicate a notable shift towards integrating cutting-edge technologies, including Cone Beam Computed Tomography (CBCT), artificial intelligence (AI), and biosensors. These advancements have significantly improved diagnostic accuracy, particularly in complex cases such as periodontal diseases, dental fractures, and oral infections. Studies demonstrate that molecular diagnostics and AI-driven algorithms enhance the personalization of treatment plans, optimizing patient outcomes. Conclusions: Emerging diagnostic technologies have the potential to enhance both the quality and efficiency of dental care. However, their implementation is challenged by high costs, the need for specialized training, and disparities in access. Future research should focus on refining AI-driven diagnostic models, addressing regulatory considerations, and expanding the clinical validation of novel imaging tools. As these technologies evolve, they are expected to increase diagnostic specificity, leading to more precise, patient-centered treatment approaches. Ultimately, these advancements offer substantial opportunities to transform dental practice by providing faster, less invasive, and more reliable diagnoses. Full article

(This article belongs to the Special Issue Clinical Advances in Dental Medicine and Oral Health)

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15 pages, 664 KB

Open AccessEditor’s ChoiceReview

Review of Recent Treatment Strategies for Lumbar Disc Herniation (LDH) Focusing on Nonsurgical and Regenerative Therapies

by Jae Sun Lee, Soo-Bin Lee, Kyung-Yil Kang, Seong Ho Oh and Dong-Sik Chae

J. Clin. Med. 2025, 14(4), 1196; https://doi.org/10.3390/jcm14041196 - 12 Feb 2025

Cited by 8 | Viewed by 25728

Abstract

Conservative treatment is primarily performed for the treatment of patients with lumbar disc herniation (LDH), but if it does not respond, surgical treatment can be performed. Surgical intervention has a positive effect on the rapid improvement of LDH symptoms. However, the effectiveness of [...] Read more.

Conservative treatment is primarily performed for the treatment of patients with lumbar disc herniation (LDH), but if it does not respond, surgical treatment can be performed. Surgical intervention has a positive effect on the rapid improvement of LDH symptoms. However, the effectiveness of surgical versus conservative treatment for LDH is controversial, especially regarding long-term effects. Recently, a treatment using platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), low-intensity pulsed ultrasound (LIPUS), etc., has been actively conducted as a treatment to avoid side effects of surgery and promote tissue regeneration. In this paper, the literature evaluating the effectiveness of non-surgical treatment options is reviewed with an emphasis on the effectiveness of clinical application. Several clinical studies have shown that PRP, biomaterials, BMAC, and LIPUS treatment promote tissue regeneration and alleviate symptoms. Although PRP-applied studies have suggested disc height changes, cell therapy and LIPUS treatment have many shortcomings in clinical aspects of tissue regeneration. Therefore, it is necessary to establish a unified, safe protocol and standardize the method of presenting results to confirm the clinical effect of the treatment for impaired intervertebral regeneration in patients with intervertebral disc degeneration (IDD), including LDH. Full article

(This article belongs to the Section Orthopedics)

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23 pages, 347 KB

Open AccessEditor’s ChoiceReview

Advancements in Melanoma Treatment: A Review of PD-1 Inhibitors, T-VEC, mRNA Vaccines, and Tumor-Infiltrating Lymphocyte Therapy in an Evolving Landscape of Immunotherapy

by Apoorva Mehta, Mateen Motavaf, Ikenna Nebo, Sophia Luyten, Kofi D. Osei-Opare and Alejandro A. Gru

J. Clin. Med. 2025, 14(4), 1200; https://doi.org/10.3390/jcm14041200 - 12 Feb 2025

Cited by 13 | Viewed by 9123

Abstract

Melanoma, an aggressive skin cancer, presents significant therapeutic challenges. Consequently, innovative treatment strategies beyond conventional chemotherapy, radiation, and surgery are actively explored. This review discusses the evolution of immunotherapy in advanced melanoma, highlighting PD-1/PD-L1 inhibitors, mRNA vaccines, Talimogene Laherparepvec (T-VEC), and tumor-infiltrating lymphocyte [...] Read more.

Melanoma, an aggressive skin cancer, presents significant therapeutic challenges. Consequently, innovative treatment strategies beyond conventional chemotherapy, radiation, and surgery are actively explored. This review discusses the evolution of immunotherapy in advanced melanoma, highlighting PD-1/PD-L1 inhibitors, mRNA vaccines, Talimogene Laherparepvec (T-VEC), and tumor-infiltrating lymphocyte (TIL) therapies. PD-1/PD-L1 inhibitors such as pembrolizumab and nivolumab block immune checkpoints, promoting T-cell cytotoxic activity and improving overall survival in patients with advanced melanoma. T-VEC, a modified oncolytic herpes virus, promotes a systemic anti-tumor response while simultaneously lysing malignant cells. mRNA vaccines, such as Moderna’s mRNA-4157/V940, take advantage of malignant-cell-specific neoantigens to amplify the adaptive immune response while protecting healthy tissue. TIL therapy is a form of therapy involving ex vivo expansion and reinfusion of the patient’s tumor-specific lymphocytes and has been shown to provide durable tumor control. While these therapies have demonstrated promising clinical outcomes, challenges such as tumor resistance, high financial burden, and limited accessibility pose challenges to their widespread use. This review explores combination therapies such as PD-L1 inhibitors with mRNA vaccines, or TIL therapy, which aim to enhance treatment through synergistic approaches. Further research is required to optimize these combinations, address barriers preventing their use, and control adverse events. Full article

(This article belongs to the Section Dermatology)

20 pages, 1124 KB

Open AccessEditor’s ChoiceReview

Osteoporosis and Rheumatoid Arthritis: Mechanisms Underlying Osteoclast Differentiation and Activation or Factors Associated with Hip Fractures

by Takeshi Miyamoto

J. Clin. Med. 2025, 14(4), 1138; https://doi.org/10.3390/jcm14041138 - 10 Feb 2025

Cited by 7 | Viewed by 3327

Abstract

Osteoporosis is defined as a condition of increased risk of fracture due to decreased bone strength. In developed countries, the number of patients with osteoporosis and fragility fractures has been increasing in recent years due to the growing elderly population, posing a social [...] Read more.

Osteoporosis is defined as a condition of increased risk of fracture due to decreased bone strength. In developed countries, the number of patients with osteoporosis and fragility fractures has been increasing in recent years due to the growing elderly population, posing a social challenge not only to fracture patients and their families but also to the social healthcare economy. Osteoporosis can be divided into two categories: primary osteoporosis caused by aging or menopause and secondary osteoporosis caused by metabolic or inflammatory diseases or drugs such as glucocorticoids. The majority of patients have primary osteoporosis, and the pathogenesis of postmenopausal osteoporosis and factors associated with fragility fractures in the elderly have been elucidated. On the other hand, rheumatoid arthritis (RA) is one of the causes of secondary osteoporosis. RA is a chronic inflammatory disease characterized by joint swelling and destruction. Most often, treatment focuses on suppressing these symptoms. However, physicians should be aware of the risk of osteoporosis in RA patients, because (1) RA is a chronic inflammatory disease, which itself can be a risk factor for osteoporosis; (2) glucocorticoids, which are sometimes administered to treat RA, can be a risk factor for osteoporosis; and (3) patients with RA are becoming older, and aging is an osteoporosis risk factor. A comprehensive understanding of the pathogenesis of osteoporosis and its fragility fractures requires elucidating the mechanisms underlying osteoclast activation, which drives their development. Furthermore, identifying the factors associated with fragility fractures is essential. This review summarizes the pathogenesis of osteoporosis, the factors associated with fragility fractures, and the associations between RA and osteoporosis development. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Clinical Updates on Diagnosis and Treatment)

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14 pages, 2982 KB

Open AccessEditor’s ChoiceReview

Role of Mirikizumab in the Treatment of Inflammatory Bowel Disease—From Bench to Bedside

by Michael Colwill, Samantha Baillie, Jennifer Clough, Richard Pollok, Andrew Poullis, Kamal Patel and Sailish Honap

J. Clin. Med. 2025, 14(3), 1001; https://doi.org/10.3390/jcm14031001 - 5 Feb 2025

Cited by 8 | Viewed by 7149

Abstract

Mirikizumab is a monoclonal antibody directed against the p19 subunit of interleukin (IL)-23 to inhibit its interaction with the IL-23 receptor. IL-23 is a key cytokine involved in initiating and perpetuating the inflammatory cascade in inflammatory bowel disease (IBD). Mirikizumab is the first [...] Read more.

Mirikizumab is a monoclonal antibody directed against the p19 subunit of interleukin (IL)-23 to inhibit its interaction with the IL-23 receptor. IL-23 is a key cytokine involved in initiating and perpetuating the inflammatory cascade in inflammatory bowel disease (IBD). Mirikizumab is the first agent from the novel anti-IL-23p19 drug class to be licensed for ulcerative colitis and the first to present long-term endoscopic, histologic, symptomatic, and quality-of-life outcomes. More recently, the VIVID trial programme has led to the approval of mirikizumab in moderate to severe Crohn’s disease. This review explores the history of its development, discusses key immunopharmacological properties unique to the drug, and details the available clinical trials and real-world evidence supporting its use in IBD. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease (IBD): Clinical Diagnosis and Treatment)

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15 pages, 484 KB

Open AccessEditor’s ChoiceArticle

Exploring the Utility of ChatGPT in Cleft Lip Repair Education

by Monali Mahedia, Rachel N. Rohrich, Kaiser O’Sahil Sadiq, Lauren Bailey, Lucas M. Harrison and Rami R. Hallac

J. Clin. Med. 2025, 14(3), 993; https://doi.org/10.3390/jcm14030993 - 4 Feb 2025

Cited by 9 | Viewed by 2406

Abstract

Background/Objectives: The evolving capabilities of large language models, such as generative pre-trained transformers (ChatGPT), offer new avenues for disseminating health information online. These models, trained on extensive datasets, are designed to deliver customized responses to user queries. However, as these outputs are [...] Read more.

Background/Objectives: The evolving capabilities of large language models, such as generative pre-trained transformers (ChatGPT), offer new avenues for disseminating health information online. These models, trained on extensive datasets, are designed to deliver customized responses to user queries. However, as these outputs are unsupervised, understanding their quality and accuracy is essential to gauge their reliability for potential applications in healthcare. This study evaluates responses generated by ChatGPT addressing common patient concerns and questions about cleft lip repair. Methods: Ten commonly asked questions about cleft lip repair procedures were selected from the American Society of Plastic Surgeons’ patient information resources. These questions were input as ChatGPT prompts and five board-certified plastic surgeons assessed the generated responses on quality of content, clarity, relevance, and trustworthiness, using a 4-point Likert scale. Readability was evaluated using the Flesch reading ease score (FRES) and the Flesch–Kincaid grade level (FKGL). Results: ChatGPT responses scored an aggregated mean rating of 2.9 out of 4 across all evaluation criteria. Clarity and content quality received the highest ratings (3.1 ± 0.6), while trustworthiness had the lowest rating (2.7 ± 0.6). Readability metrics revealed a mean FRES of 44.35 and a FKGL of 10.87, corresponding to approximately a 10th-grade literacy standard. None of the responses contained grossly inaccurate or potentially harmful medical information but lacked citations. Conclusions: ChatGPT demonstrates potential as a supplementary tool for patient education in cleft lip management by delivering generally accurate, relevant, and understandable information. Despite the value that AI-powered tools can provide to clinicians and patients, the lack of human oversight underscores the importance of user awareness regarding its limitations. Full article

(This article belongs to the Special Issue Plastic Surgery: Innovations and Future Directions)

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26 pages, 1237 KB

Open AccessFeature PaperEditor’s ChoiceReview

Therapeutic Management of Locally Advanced Rectal Cancer: Existing and Prospective Approaches

by Horia-Dan Lișcu, Nicolae Verga, Dimitrie-Ionuț Atasiei, Andreea-Teodora Ilie, Maria Vrabie, Laura Roșu, Alexandra Poștaru, Stefania Glăvan, Adriana Lucaș, Maria Dinulescu, Andreea Delea and Andreea-Iuliana Ionescu

J. Clin. Med. 2025, 14(3), 912; https://doi.org/10.3390/jcm14030912 - 30 Jan 2025

Cited by 7 | Viewed by 6147

Abstract

Rectal cancer (RC) presents significant challenges in diagnosis and treatment, with increasing incidence among younger populations. Treatment approaches, particularly for locally advanced rectal cancer (LARC), have evolved, notably with the introduction of total neoadjuvant therapy (TNT). TNT combines neoadjuvant chemotherapy and chemoradiotherapy before [...] Read more.

Rectal cancer (RC) presents significant challenges in diagnosis and treatment, with increasing incidence among younger populations. Treatment approaches, particularly for locally advanced rectal cancer (LARC), have evolved, notably with the introduction of total neoadjuvant therapy (TNT). TNT combines neoadjuvant chemotherapy and chemoradiotherapy before surgery, improving overall survival and reducing both metastasis and local recurrence rates compared to traditional methods, while enabling more patients to complete the full oncological treatment. Clinical trials, such as RAPIDO, OPRA, and PRODIGE 23, have demonstrated the effectiveness of TNT in tumor downstaging and complete pathological responses, offering better outcomes for patients; however, debates persist regarding the role of neoadjuvant radiotherapy, with novel strategies exploring its omission in specific cases to reduce toxicity and enhance quality of life. In addition, organ preservation strategies, such as the watch-and-wait (WW) approach, have emerged as viable options for patients with a complete response to neoadjuvant therapy. Future directions point towards personalized treatment plans incorporating radiogenomics and the integration of artificial intelligence into diagnostics to optimize patient outcomes. This review aims to synthesize current treatment strategies and ongoing advancements in rectal cancer management, providing insights into potential future innovations. Full article

(This article belongs to the Special Issue Comprehensive Treatment of Rectal Cancer)

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19 pages, 835 KB

Open AccessFeature PaperEditor’s ChoiceReview

Advancing Cardiovascular Diagnostics: The Expanding Role of CMR in Heart Failure and Cardiomyopathies

by Antonio Luca Maria Parlati, Ermanno Nardi, Federica Marzano, Cristina Madaudo, Mariafrancesca Di Santo, Ciro Cotticelli, Simone Agizza, Giuseppe Maria Abbellito, Fabrizio Perrone Filardi, Mario Del Giudice, Francesco Ruggiero Annunziata, Isabel Martone, Maria Prastaro, Stefania Paolillo, Pasquale Perrone Filardi and Paola Gargiulo

J. Clin. Med. 2025, 14(3), 865; https://doi.org/10.3390/jcm14030865 - 28 Jan 2025

Cited by 7 | Viewed by 3665

Abstract

Cardiovascular magnetic resonance (CMR) imaging has become a cornerstone in the diagnosis, risk stratification, and management of cardiovascular disease (CVD), particularly heart failure (HF) and cardiomyopathies. Renowned as the gold standard for non-invasive quantification of ventricular volumes and ejection fraction, CMR delivers superior [...] Read more.

Cardiovascular magnetic resonance (CMR) imaging has become a cornerstone in the diagnosis, risk stratification, and management of cardiovascular disease (CVD), particularly heart failure (HF) and cardiomyopathies. Renowned as the gold standard for non-invasive quantification of ventricular volumes and ejection fraction, CMR delivers superior spatial and temporal resolution with excellent tissue–blood contrast. Recent advancements, including T1, T2, and T2* mapping, extracellular volume quantification, and late gadolinium enhancement, enable precise tissue characterization, allowing early detection of myocardial changes such as fibrosis, edema, and infiltration. These features provide critical insights into the pathophysiological mechanisms underlying HF phenotypes and diverse cardiomyopathies, enhancing diagnostic accuracy and guiding therapeutic decisions. This review explores the expanding role of CMR in CV disease, highlighting its diagnostic value in HF and in several cardiomyopathies, as well as its contribution to improving patient outcomes through detailed tissue characterization and prognosis. Full article

(This article belongs to the Special Issue Technological Advancements and Clinical Innovations in Diagnostic and Interventional Radiology)

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12 pages, 2235 KB

Open AccessEditor’s ChoiceArticle

Functional Alignment Achieved a More Balanced Knee After Robotic Arm-Assisted Total Knee Arthroplasty than Modified Kinematic Alignment

by Hong-Yeol Yang, Jong-Keun Seon, Ji-Hyeon Yim, Dong-Hyun Lee and Eun-Kyoo Song

J. Clin. Med. 2025, 14(3), 820; https://doi.org/10.3390/jcm14030820 - 26 Jan 2025

Cited by 8 | Viewed by 2347

Abstract

Background: The aim of this study was to evaluate the balance in extension and flexion achievable after total knee arthroplasty (TKA) using a modified kinematic alignment (KA) plan and the subsequent balance achievable after adjusting the component based on the functional alignment [...] Read more.

Background: The aim of this study was to evaluate the balance in extension and flexion achievable after total knee arthroplasty (TKA) using a modified kinematic alignment (KA) plan and the subsequent balance achievable after adjusting the component based on the functional alignment (FA) principle. Methods: This retrospective cohort study included 100 consecutive patients who underwent primary TKA for knee osteoarthritis through an image-based robotic system in a single center between October 2021 and February 2022. Whether modified KA or FA could achieve a balanced knee was evaluated by assessing the ligament balance in the medial and lateral compartments using a robotic system at extension and 90° flexion. Balance was defined as a difference of ≤2 mm between the compartments. Component positioning was adjusted within limits based on the functional positioning principles to achieve balance. Implant positioning and balance in extension and 90° flexion were compared between the modified KA plan (n = 100) and after FA adjustments (n = 100). Results: FA achieved significantly better balance in extension (FA, 99.0% vs. modified KA, 86.0%; p = 0.001) and flexion (98.0% vs. 43.0%; p < 0.001) than the modified KA plan. The mean difference in gap balance in extension (FA, 0.1 mm vs. modified KA, 0.6 mm; p = 0.001) and flexion (0.1 mm vs. 2.3 mm; p < 0.001) was also significant between the two techniques. The femoral component was positioned more externally rotated relative to the transepicondylar axis (FA, 2.5° vs. modified KA, 0.0°; p < 0.001) to obtain balanced targets. There were significant improvements in the patient-reported outcome measures between preoperative and postoperative assessments two years after TKA (all p < 0.05). Conclusions: FA consistently achieved superior balance in both extension and flexion following TKA compared with modified KA without altering the soft tissue envelope, leading to significant improvements in clinical outcomes at the two-year follow-up. Full article

(This article belongs to the Special Issue Advances in Surgical Management of Orthopedics—Artificial Intelligence (AI) Applications and Robotic Surgery Techniques)

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17 pages, 10340 KB

Open AccessEditor’s ChoiceArticle

Five-Year Comparative Study of Zygomatic and Subperiosteal Implants: Clinical Outcomes, Complications, and Treatment Strategies for Severe Maxillary Atrophy

by Rafal Zielinski, Jakub Okulski, Martyna Piechaczek, Jan Łoś, Jerzy Sowiński, Monika Sadowska-Sowińska, Agata Kołkowska, Wojciech Simka and Marcin Kozakiewicz

J. Clin. Med. 2025, 14(3), 661; https://doi.org/10.3390/jcm14030661 - 21 Jan 2025

Cited by 16 | Viewed by 8721

Abstract

Background/Objectives: Severe maxillary atrophy presents challenges in maxillofacial rehabilitation. This study compares the clinical outcomes of zygomatic and subperiosteal implants, focusing on implant survival, soft tissue management, and postoperative complications over a five-year follow-up. Methods: A retrospective cohort study analyzed 150 [...] Read more.

Background/Objectives: Severe maxillary atrophy presents challenges in maxillofacial rehabilitation. This study compares the clinical outcomes of zygomatic and subperiosteal implants, focusing on implant survival, soft tissue management, and postoperative complications over a five-year follow-up. Methods: A retrospective cohort study analyzed 150 patients divided into two groups based on the type of implant. Zygomatic implants were assessed for immediate functional loading, procedural efficiency, and complications such as sinus-related issues and orbital damage. Subperiosteal implants were evaluated for their customized design, keratinized mucosa integration, and adaptation to severe anatomical limitations. Statistical analyses, including Chi-square tests, were used to determine significant differences (p < 0.05). Results: This study demonstrated differences in complication rates (sinus-related complications: 12.4% for zygomatic implants; peri-implantitis: 5.6% for subperiosteal implants). Implant survival rates were comparable (zygomatic: 96.3%, subperiosteal: 97.1%, p = 0.278). Zygomatic implants demonstrated higher incidences of sinus-related complications (12.4%) and risks of orbital damage. Subperiosteal implants exhibited superior soft tissue stability with fewer cases of peri-implantitis (5.6%, p < 0.05). Procedural duration was shorter for zygomatic implants (177 min vs. 123 min); however, subperiosteal implants allowed for re-implantation after failure, providing flexibility that was unavailable with zygomatic implants. Conclusions: Zygomatic implants excel in immediate functional loading and reduced procedural time but require advanced surgical expertise to mitigate anatomical risks. Subperiosteal implants offer a safer, customizable solution, particularly in anatomically complex cases. These findings emphasize the importance of individualized treatment planning and technological advancements in implant design to optimize clinical outcomes for patients with severe maxillary atrophy. Full article

(This article belongs to the Special Issue Clinical Updates and Perspectives of Implant Dentistry)

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16 pages, 292 KB

Open AccessEditor’s ChoiceReview

The Cell-Specific Effects of JAK1 Inhibitors in Ulcerative Colitis

by Suzanne H. C. Veltkamp and Philip W. Voorneveld

J. Clin. Med. 2025, 14(2), 608; https://doi.org/10.3390/jcm14020608 - 18 Jan 2025

Cited by 7 | Viewed by 3980

Abstract

JAK1 inhibitors have become an important addition to the therapeutic options for ulcerative colitis (UC), targeting key inflammatory pathways mediated by cytokines such as the IL-6 family, interferons, IL-2 family, IL-10 family, and G-CSF. However, not all patients respond equally, and chronic inflammation [...] Read more.

JAK1 inhibitors have become an important addition to the therapeutic options for ulcerative colitis (UC), targeting key inflammatory pathways mediated by cytokines such as the IL-6 family, interferons, IL-2 family, IL-10 family, and G-CSF. However, not all patients respond equally, and chronic inflammation persists in a subset of individuals. The variability in treatment response may reflect the heterogeneity of UC. Immune cells, epithelial cells, and stromal cells may have distinct contributions to disease pathogenesis. While JAK inhibitors were originally designed to target immune cells, their impact on non-immune cell types, such as epithelial and stromal cells, remains poorly understood. Investigating the mechanisms through which JAK1 inhibitors affect these diverse cellular populations and identifying the factors underlying differential responses is crucial to optimizing outcomes. This review explores the roles of immune, epithelial, and stromal cells in response to JAK1 inhibition and discusses potential strategies to improve treatment precision, such as predicting responders and identifying complementary therapeutic targets. Full article

(This article belongs to the Special Issue New Directions for Treatment and Assessment of Ulcerative Colitis)

12 pages, 264 KB

Open AccessFeature PaperEditor’s ChoiceReview

The Clinical Use of Myo-Inositol in IVF-ET: A Position Statement from the Experts Group on Inositol in Basic and Clinical Research and on PCOS (EGOI-PCOS), the Polish Society of Andrology, and the International Scientific Association for the Support and Development of Medical Technologies

by Artur Wdowiak, Szymon Bakalczuk, Michał Filip, Antonio Simone Laganà and Vittorio Unfer

J. Clin. Med. 2025, 14(2), 558; https://doi.org/10.3390/jcm14020558 - 16 Jan 2025

Cited by 2 | Viewed by 14897

Abstract

Background: Myo-inositol plays a vital role in human health, functioning as a second messenger of FSH and facilitating the transport of glucose into the cell. Consequently, myo-inositol is regularly utilized in the treatment of polycystic ovary syndrome (PCOS), wherein it acts upon metabolic [...] Read more.

Background: Myo-inositol plays a vital role in human health, functioning as a second messenger of FSH and facilitating the transport of glucose into the cell. Consequently, myo-inositol is regularly utilized in the treatment of polycystic ovary syndrome (PCOS), wherein it acts upon metabolic factors, improving insulin sensitivity and reducing total androgen levels. Patients with PCOS frequently suffer from infertility; thus, the use of myo-inositol has been explored in improving assistive reproductive technique (ART) procedures. This is by no means limited to patients with PCOS, as inositol has found applications in non-PCOS patient groups in addition to in male factor infertility. This joint statement from the Experts Group on Inositol in Basic and Clinical Research and on PCOS (EGOI-PCOS), the Polish Society of Andrology, and the International Scientific Association for the Support and Development of Medical Technologies discusses the latest evidence on this topic, with the aim of interrogating whether myo-inositol could be implemented in everyday ART patient care. Methods: The authors conducted a narrative review performed via an independent literature search between July and August 2024, using the search platforms PubMed, Web of Science, and Google Scholar. Results: In both non-PCOS and PCOS populations seeking IVF care, MI supplementation prior to ovarian stimulation may positively affect gonadotropin use and duration, oocyte and embryo quality, fertilization, and clinical pregnancy rates. Conclusions: This position statement recommends that myo-inositol be considered as a potential pretreatment strategy prior to ovarian hyperstimulation with gonadotropins. Full article

(This article belongs to the Section Reproductive Medicine & Andrology)

19 pages, 1530 KB

Open AccessEditor’s ChoiceReview

Periocular Aging Across Populations and Esthetic Considerations: A Narrative Review

by Brendan K. Tao, Fahad R. Butt, Thanansayan Dhivagaran, Michael Balas, Navdeep Nijhawan, Georges Nassrallah, Ahsen Hussain and Edsel B. Ing

J. Clin. Med. 2025, 14(2), 535; https://doi.org/10.3390/jcm14020535 - 16 Jan 2025

Cited by 6 | Viewed by 8169

Abstract

As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial [...] Read more.

As the face ages, the skin, fat, muscle, and fascia descend, and the underlying bone, cartilage, and teeth may lose mass. Oculofacial aging is a multifactorial process that is influenced by genetic, environmental, and lifestyle factors. This review summarizes the patterns of oculofacial aging that are observed across populations, including variations in periorbital hollowing, eyelid ptosis, and skin elasticity. Evidence indicates significant variability in aging patterns between sex- and race-based subgroups. Nonetheless, there remains a paucity of research on the progression of aging in some under-studied demographic groups. Signs of oculofacial aging often become apparent to patients well before these changes reach full maturity in later years, leading many to seek early esthetic interventions. Others may present with more advanced signs of aging, motivating a diverse range of therapeutic options. We discuss minimally invasive esthetic interventions to mitigate the signs of aging, which may include botulinum toxin injections, dermal fillers, applied energy-based treatments (e.g., lasers), and emerging techniques such as micro-focused ultrasound and platelet-rich plasma therapies. We review evidence on outcomes related to patient satisfaction and quality of life following esthetic interventions for oculofacial aging. Finally, we outline ethical considerations and challenges faced with the delivery of esthetic surgery, including treatment complications and the influence of social media. This review provides a comprehensive overview of oculofacial aging patterns, its management, and important considerations for the provision of esthetic oculofacial treatment. Full article

(This article belongs to the Special Issue Advances in Ophthalmic Plastic and Reconstructive Surgery)

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14 pages, 283 KB

Open AccessEditor’s ChoiceReview

Early Identification of Exacerbations in Patients with Chronic Obstructive Pulmonary Disease (COPD)

by Ilektra Voulgareli, Elvira-Markela Antonogiannaki, Konstantinos Bartziokas, Stavrina Zaneli, Petros Bakakos, Stelios Loukides and Andriana I. Papaioannou

J. Clin. Med. 2025, 14(2), 397; https://doi.org/10.3390/jcm14020397 - 10 Jan 2025

Cited by 6 | Viewed by 9444

Abstract

Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) have a substantial effect on overall disease management, health system costs, and patient outcomes. However, exacerbations are often underdiagnosed or recognized with great delay due to several factors such as patients’ inability to differentiate between acute [...] Read more.

Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) have a substantial effect on overall disease management, health system costs, and patient outcomes. However, exacerbations are often underdiagnosed or recognized with great delay due to several factors such as patients’ inability to differentiate between acute episodes and symptom fluctuations, delays in seeking medical assistance, and disparities in dyspnea perception. Self-management intervention plans, telehealth and smartphone-based programs provide educational material, counseling, virtual hospitals and telerehabilitation, and help COPD patients to identify exacerbations early. Moreover, biomarkers such as blood eosinophil count, fibrinogen, CRP, Serum amyloid A(SAA),together with imaging parameters such as the pulmonary artery-to-aorta diameter ratio, have emerged as potential predictors of exacerbations, yet their clinical utility is limited by variability and lack of specificity. In this review, we provide information regarding the importance of the early identification of exacerbation events in COPD patients and the available methods which can be used for this purpose. Full article

(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Diseases in the Era of Precision Medicine)

11 pages, 208 KB

Open AccessEditor’s ChoiceArticle

Utility of Artificial Intelligence for Decision Making in Thoracic Multidisciplinary Tumor Boards

by Jon Zabaleta, Borja Aguinagalde, Iker Lopez, Arantza Fernandez-Monge, Jon A. Lizarbe, Maria Mainer, Juan A. Ferrer-Bonsoms and Mateo de Assas

J. Clin. Med. 2025, 14(2), 399; https://doi.org/10.3390/jcm14020399 - 10 Jan 2025

Cited by 7 | Viewed by 2563

Abstract

Background/Objectives: The aim of this study was to analyze whether the implementation of artificial intelligence (AI), specifically the Natural Language Processing (NLP) branch developed by OpenAI, could help a thoracic multidisciplinary tumor board (MTB) make decisions if provided with all of the [...] Read more.

Background/Objectives: The aim of this study was to analyze whether the implementation of artificial intelligence (AI), specifically the Natural Language Processing (NLP) branch developed by OpenAI, could help a thoracic multidisciplinary tumor board (MTB) make decisions if provided with all of the patient data presented to the committee and supported by accepted clinical practice guidelines. Methods: This is a retrospective comparative study. The inclusion criteria were defined as all patients who presented at the thoracic MTB with a suspicious or first diagnosis of non-small-cell lung cancer between January 2023 and June 2023. Intervention: GPT 3.5 turbo chat was used, providing the clinical case summary presented in committee proceedings and the latest SEPAR lung cancer treatment guidelines. The application was asked to issue one of the following recommendations: follow-up, surgery, chemotherapy, radiotherapy, or chemoradiotherapy. Statistical analysis: A concordance analysis was performed by measuring the Kappa coefficient to evaluate the consistency between the results of the AI and the committee’s decision. Results: Fifty-two patients were included in the study. The AI had an overall concordance of 76%, with a Kappa index of 0.59 and a consistency and replicability of 92.3% for the patients in whom it recommended surgery (after repeating the cases four times). Conclusions: AI is an interesting tool which could help in decision making in MTBs. Full article

(This article belongs to the Special Issue Thoracic Surgery: Current Challenges and Future Perspectives)

31 pages, 369 KB

Open AccessFeature PaperEditor’s ChoiceArticle

An Update on Deaths in the United Kingdom from ‘Poppers’ (Alkyl Nitrites), with a Particular Focus on ‘Swallowing’ Fatalities

by John Martin Corkery, Caroline S. Copeland, Stephen Ream, Peter Streete and Fabrizio Schifano

J. Clin. Med. 2025, 14(2), 427; https://doi.org/10.3390/jcm14020427 - 10 Jan 2025

Cited by 6 | Viewed by 11231

Abstract

Background/Objectives: Alkyl nitrites are a class of inhalant, commonly known as ‘poppers’. Although having medical uses, some other effects include a ‘rush’, ‘high’, ‘euphoria’, or feeling of excitement. This has led to their recreational use, in different scenarios, since the mid-1960s. Adverse effects [...] Read more.

Background/Objectives: Alkyl nitrites are a class of inhalant, commonly known as ‘poppers’. Although having medical uses, some other effects include a ‘rush’, ‘high’, ‘euphoria’, or feeling of excitement. This has led to their recreational use, in different scenarios, since the mid-1960s. Adverse effects include tachycardia, migraine headaches, fainting and dizziness, and ventricular fibrillation. Death can occur from the inhalation or ingestion of nitrites. As part of its updated advice to the United Kingdom (UK) Government, the Advisory Council on the Misuse of Drugs considered popper-related mortality, seeking an accurate estimate of deaths. Methods: Data from a range of sources, including specialist mortality databases, were collated and analysed in terms of the key characteristics of decedents and fatal incidents, including the use mode. The chemical names of the nitrites were used in searches. Results: At least forty-two deaths occurred during 1987–2018; two were female. The mean age at death was 44 (range of 20–75) years. Most were White. Most fatalities occurred in England. The specific nitrites mentioned (N = thirty-two) were isobutyl (fourteen); amyl (seven); isopropyl (six); alkyl (three); and butyl (two). The mode of use was only known in 23/42 cases. The product was definitely swallowed in five cases, and very likely in a further one. Four additional cases were identified from the literature and media searches. Conclusions: The lack of a current systematic identification of relevant deaths and shortcomings in historical specialist mortality databases have severely limited what could be established with certainty about these cases. The same criticisms also apply to inhalant mortality data more generally. Nevertheless, the information presented here allows for some conclusions to be drawn and inform UK policy development. Full article

(This article belongs to the Section Pharmacology)

37 pages, 1241 KB

Open AccessEditor’s ChoiceReview

The Triad of Risk: Linking MASLD, Cardiovascular Disease and Type 2 Diabetes; From Pathophysiology to Treatment

by Eleni Michalopoulou, John Thymis, Stamatios Lampsas, George Pavlidis, Konstantinos Katogiannis, Dimitrios Vlachomitros, Eleni Katsanaki, Gavriella Kostelli, Sotirios Pililis, Loukia Pliouta, Aikaterini Kountouri, Ioannis S. Papanikolaou, Vaia Lambadiari and Ignatios Ikonomidis

J. Clin. Med. 2025, 14(2), 428; https://doi.org/10.3390/jcm14020428 - 10 Jan 2025

Cited by 17 | Viewed by 5321

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health concern, and it is not only the keystone precursor of eventual liver-related morbidity, but it also places patients at considerably higher cardiovascular risk, which is still a leading cause of death in [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging global health concern, and it is not only the keystone precursor of eventual liver-related morbidity, but it also places patients at considerably higher cardiovascular risk, which is still a leading cause of death in these patients. The most important common underlying pathophysiological mechanisms in these diseases are primarily related to insulin resistance, chronic inflammation and oxidative stress. The presence of MASLD with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) elevates the risk for poor outcomes, thus this review highlights a method to the therapeutic approaches. Given the intertwined nature of MASLD, T2DM, and CVD, there is an urgent need for therapeutic strategies that address all three conditions. Although lifestyle changes are important as treatment, medication plays a crucial role in managing hyperglycemia, enhancing liver function and lowering cardiovascular risk. The onset and progression of MASLD should be addressed through a multifaceted therapeutic approach, targeting inflammatory, immune, metabolic, oxidative stress, hormonal and gutaxis pathways, alongside the treatment strategies for T2DM. In this review, we discuss the effects of antidiabetic drugs with an impact on both liver outcomes and cardiovascular risk in patients affected by MASLD, T2DM and CDV. Full article

(This article belongs to the Section Cardiology)

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38 pages, 3670 KB

Open AccessEditor’s ChoiceReview

All You Need to Know About TACE: A Comprehensive Review of Indications, Techniques, Efficacy, Limits, and Technical Advancement

by Carolina Lanza, Velio Ascenti, Gaetano Valerio Amato, Giuseppe Pellegrino, Sonia Triggiani, Jacopo Tintori, Cristina Intrieri, Salvatore Alessio Angileri, Pierpaolo Biondetti, Serena Carriero, Pierluca Torcia, Anna Maria Ierardi and Gianpaolo Carrafiello

J. Clin. Med. 2025, 14(2), 314; https://doi.org/10.3390/jcm14020314 - 7 Jan 2025

Cited by 14 | Viewed by 15615

Abstract

Transcatheter arterial chemoembolization (TACE) is a proven and widely accepted treatment option for hepatocellular carcinoma and it is recommended as first-line non-curative therapy for BCLC B/intermediate HCC (preserved liver function, multifocal, no cancer-related symptoms) in patients without vascular involvement. Different types of TACE [...] Read more.

Transcatheter arterial chemoembolization (TACE) is a proven and widely accepted treatment option for hepatocellular carcinoma and it is recommended as first-line non-curative therapy for BCLC B/intermediate HCC (preserved liver function, multifocal, no cancer-related symptoms) in patients without vascular involvement. Different types of TACE are available nowadays, including TAE, c-TACE, DEB-TACE, and DSM-TACE, but at present there is insufficient evidence to recommend one TACE technique over another and the choice is left to the operator. This review then aims to provide a comprehensive overview of the current literature on indications, types of procedures, safety, and efficacy of different TACE treatments. Full article

(This article belongs to the Special Issue Technological Advancements and Clinical Innovations in Diagnostic and Interventional Radiology)

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17 pages, 3371 KB

Open AccessEditor’s ChoiceReview

Optimizing Mechanical Ventilation: A Clinical and Practical Bedside Method for the Identification and Management of Patient–Ventilator Asynchronies in Critical Care

by Vasco Costa, José Pedro Cidade, Inês Medeiros and Pedro Póvoa

J. Clin. Med. 2025, 14(1), 214; https://doi.org/10.3390/jcm14010214 - 2 Jan 2025

Cited by 1 | Viewed by 11128

Abstract

The prompt identification and correction of patient–ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact [...] Read more.

The prompt identification and correction of patient–ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact not only on the respiratory mechanics and the mortality associated with mechanical ventilation but also on the patient’s cardiac output and hemodynamic profile. Strong evidence has demonstrated that these frequently occurring and often underdiagnosed events have significant prognostic value for mechanical ventilation outcomes and are strongly associated with prolonged ICU stays and hospital mortality. Halting the consequences of PVA relies on the correct identification and approach of its underlying causes. However, this often requires advanced knowledge of respiratory physiology and the evaluation of complex ventilator waveforms in patient–ventilator interactions, posing a challenge to intensive care practitioners, in particular, those less experienced. This review aims to outline the most frequent types of PVA and propose a clinical algorithm to provide physicians with a structured approach to assess, accurately diagnose, and correct PVA. Full article

(This article belongs to the Special Issue Acute Respiratory Failure: Innovations and Clinical Insights)

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