Journal of Clinical Medicine

17 pages, 2307 KB

Open AccessReview

Superficial Fungal Infections in Children—What Do We Know?

by Katarzyna Rychlik, Julia Sternicka-Rohde, Roman J. Nowicki, Leszek Bieniaszewski and Dorota Purzycka-Bohdan

J. Clin. Med. 2025, 14(20), 7380; https://doi.org/10.3390/jcm14207380 (registering DOI) - 18 Oct 2025

Abstract

Superficial fungal infections are common conditions affecting the skin, hair, and nails, primarily caused by dermatophytes, yeasts, and less frequently, molds. Humid climates, prolonged summer seasons, immunodeficiencies, diabetes and socioeconomic factors such as poor hygiene and overcrowding promote them. Children are particularly susceptible [...] Read more.

Superficial fungal infections are common conditions affecting the skin, hair, and nails, primarily caused by dermatophytes, yeasts, and less frequently, molds. Humid climates, prolonged summer seasons, immunodeficiencies, diabetes and socioeconomic factors such as poor hygiene and overcrowding promote them. Children are particularly susceptible due to their immature immune systems and other contributing factors. The infections are classified based on the site involved and include, among others, scalp infections, athlete’s foot, or nail infections (onychomycosis). Scalp mycoses are primarily caused by dermatophytes of the genera Trichophyton and Microsporum, which may originate from human or animal sources. Onychomycosis is rare in young children, with Trichophyton rubrum and Trichophyton mentagrophytes being the most frequently isolated pathogens. The increasing incidence in pediatric populations is linked to atopy, immune disorders, and immunosuppressive therapies. Treatment involves topical and systemic medications, depending on the location and severity of the infection. Maintaining proper hygiene, addressing risk factors, and monitoring therapy are essential to prevent recurrence. Focusing on children, this review explores current epidemiological trends, diagnostic practices, and treatment options related to superficial fungal infections. Full article

(This article belongs to the Special Issue New Insights into Infectious Skin and Mucosal Diseases)

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14 pages, 827 KB

Open AccessArticle

LDH-to-Albumin Ratio (LAR) in Solid Tumor Patients with Cytopenia: A Simple Biomarker to Predict Bone Marrow Metastasis

by Tugba Cetintepe, Lutfi Cetintepe, Zeynep Guc, Ibrahim Ertekin, Onur Karaalp and Ahmet Alacacioglu

J. Clin. Med. 2025, 14(20), 7379; https://doi.org/10.3390/jcm14207379 (registering DOI) - 18 Oct 2025

Abstract

Objectives: This study evaluated the frequency of bone marrow metastasis (BMM), its associated clinical and laboratory parameters, and its effects on survival in patients with solid tumors who underwent bone marrow biopsy due to cytopenia. Furthermore, the diagnostic power of inflammatory biomarkers [...] Read more.

Objectives: This study evaluated the frequency of bone marrow metastasis (BMM), its associated clinical and laboratory parameters, and its effects on survival in patients with solid tumors who underwent bone marrow biopsy due to cytopenia. Furthermore, the diagnostic power of inflammatory biomarkers (LAR, NLR, PLR, HALP, and SII) in predicting BMM was systematically analyzed for the first time in a large sample. Methods: Data from 233 patients with solid tumors were retrospectively reviewed. Fifteen patients with therapy-related high-risk myelodysplastic syndrome and acute myeloid leukemia were excluded, leaving 218 patients included in the study. Cytopenia was categorized according to CTCAE5.0. ROC analyses were performed for the inflammatory biomarkers LAR, NLR, PLR, SII, and HALP score. Results: BMM was detected in 39.9% (n = 87) of all patients. Prostate cancer exhibited the highest incidence of BMM, while bone represented the most common site of concurrent metastasis (p < 0.01). Hematologic and biochemical abnormalities—including low hemoglobin, platelet, and albumin levels, along with elevated LDH—were significantly associated with BMM (p < 0.01 for all). Elevated inflammatory indices (LAR, PLR, and SII) also correlated with higher risk. A multivariate analysis demonstrated that LAR provided the strongest predictive value (AUC: 0.939; 95% CI: 0.901–0.955; p < 0.01), with an optimal cutoff of 9.21. Conclusions: BMM is an important condition that negatively affects survival in solid tumor patients with cytopenia. The risk of BMM especially increases in male patients and in those with high LDH and low levels of albumin, hemoglobin, and platelets. Among the evaluated inflammatory biomarkers, LAR showed the highest diagnostic performance in predicting BMM. Full article

(This article belongs to the Section Oncology)

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18 pages, 8055 KB

Open AccessArticle

Assessment of Occlusal Contacts Recorded with the Medit Intraoral Scanner vs. Exocad Software

by Diana-Elena Vlăduțu, Răzvan Mercuț, Marius Ciprian Văruț, Alexandru Stefârță, Veronica Mercuț, Alexandra Maria Rădoi, Mihaela Roxana Brătoiu, Angelica Diana Popa, Adrian Marcel Popescu, Ștefana Dică, Răzvan Sabin Stan and Daniel Adrian Târtea

J. Clin. Med. 2025, 14(20), 7378; https://doi.org/10.3390/jcm14207378 (registering DOI) - 18 Oct 2025

Abstract

Background/Objectives: Occlusal analysis is an important component of oral rehabilitation with a determining role in the prognosis of restorations. Over time, several qualitative and quantitative occlusal analysis methods have been proposed, starting with occlusion wax up to the most advanced digital systems. [...] Read more.

Background/Objectives: Occlusal analysis is an important component of oral rehabilitation with a determining role in the prognosis of restorations. Over time, several qualitative and quantitative occlusal analysis methods have been proposed, starting with occlusion wax up to the most advanced digital systems. The objective of the present study was to evaluate and compare the data obtained through dental occlusion analysis using the Medit i700 and Exocad Elefsina v3.2 in a group of subjects, in order to establish the reliability or compatibility between the two occlusal analysis systems. Methods: The study was conducted on 20 subjects, aged between 24 and 53 years, who presented in the Dental Prosthetics Clinic of the University of Medicine and Pharmacy of Craiova. Digital impressions were acquired using the Medit Link v.3.3.6 intraoral scanner, and the digital files were subsequently uploaded from the Medit i700 into the Medit Occlusion Analyzer application and the Dental CAD Exocad software. For the analysis of occlusion in dynamics, mandibular movements and data acquisition, positions of edge-to-edge in protrusion, edge-to-edge in right laterotrusion and edge-to-edge in left laterotrusion were recorded, using the corresponding print screens. The 2D occlusal contact images generated by the two software programs were converted into .jpeg format and subsequently imported into Adobe Photoshop CS6 (2021) for comparative analysis. The data were statistically processed for each software used and the obtained data were subsequently compared. Results: The occlusal surfaces recorded with the Medit Occlusion Analyzer application represent 94% of the occlusal surfaces recorded with the Exocad software for the maxilla and 90% of the occlusal surfaces recorded for the mandible. In maximum intercuspation, the highest values were recorded by the Medit i700 software, whereas in edge-to-edge protrusion and both right and left edge-to-edge laterotrusion positions, the highest values were reported by the Exocad software. The discrepancy between maxillary and mandibular values arises from the conversion of the data from a three-dimensional to a two-dimensional format during image processing. Conclusions: The occlusal areas recorded by the DentalCAD Exocad software show higher values than those provided by the Medit Link software with the Medit Occlusion Analyzer application. The differences in recorded values, in the case of the digital flow of prosthetic restorations, require the intervention of the dentist to perform clinical adjustments to optimize occlusal relationships after the fabrication and cementation of restorations. Full article

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

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10 pages, 236 KB

Open AccessArticle

The Impact of an Adolescent-Friendly Approach on Metabolic Control in Adolescents with Type 1 Diabetes in Türkiye

by Ayşegül Şahiner, Ayşe Gül Güven, Zeynep Şıklar, Merih Berberoğlu, Elif Özsu and Zehra Aycan

J. Clin. Med. 2025, 14(20), 7377; https://doi.org/10.3390/jcm14207377 (registering DOI) - 18 Oct 2025

Abstract

Background/Objectives: Metabolic control worsens in adolescents with Type 1 Diabetes. In this study, adolescent-friendly structured adolescent interviews were conducted to identify psychosocial problems. The effect of providing the necessary support for these problems on metabolic control was evaluated. Methods: In this [...] Read more.

Background/Objectives: Metabolic control worsens in adolescents with Type 1 Diabetes. In this study, adolescent-friendly structured adolescent interviews were conducted to identify psychosocial problems. The effect of providing the necessary support for these problems on metabolic control was evaluated. Methods: In this study, a survey asking about personal, family, school, and diabetes-related information was administered face-to-face to 21 adolescents with Type 1 diabetes and poor metabolic control. At each visit, the structured adolescent interview was conducted under the headings of HEEADSSS (home/education/eating/activity/addiction/depression/safety). Patients who required it were seen by the adolescent health department’s dietitian and psychologist using a transdisciplinary approach. The patients’ HbA1c levels were compared before and after the study, with a minimum follow-up period of 6 months. Results: Of the 21 patients with a calendar age of 13.6 ± 1.7 years and a diabetes duration of 6.4 ± 3.6 years, 14 (66.7%) were female. The mean pre-study HbA1c level was 10.9 ± 1.9%, while the post-study level was 9.3 ± 1.9% (p = 0.002). While 100% of patients had poor metabolic control before the study, this rate decreased to 47.6% with the adolescent-friendly approach. No significant difference was found between the two groups (those with improved metabolic control and those without) in terms of relationship with mother, relationship with father, family relationships, mother and father education level, school success, and screen time. Conclusions: The adolescent-friendly approach has a highly positive effect on the metabolic control of adolescents with Type 1 diabetes, and this approach should be adopted by physicians who follow this patient group. Full article

(This article belongs to the Section Clinical Pediatrics)

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18 pages, 616 KB

Open AccessArticle

Efficacy of Subsequent Therapy in Patients with Hormone-Positive Advanced Breast Cancer with Disease Progression After CDK4/6 Inhibitor Therapy: Multicenter Real-Life Data

by Buket Şahin Çelik, Aslı Geçgel, Oğuzcan Özkan, Nargiz Majidova, Buket Erkan Özmarasalı, Gözde Ağdaş, İsmail Bayrakçı, Türkkan Evrensel and Erhan Gökmen

J. Clin. Med. 2025, 14(20), 7376; https://doi.org/10.3390/jcm14207376 (registering DOI) - 18 Oct 2025

Abstract

Objectives: The aim of this study was to evaluate the effect of different systemic therapies after CDK4/6 inhibitor therapy on survival outcomes in HR+/HER2− metastatic breast cancer (MBC) patients. Methods: In this retrospective multicenter study, patients who continued chemotherapy (CT), everolimus [...] Read more.

Objectives: The aim of this study was to evaluate the effect of different systemic therapies after CDK4/6 inhibitor therapy on survival outcomes in HR+/HER2− metastatic breast cancer (MBC) patients. Methods: In this retrospective multicenter study, patients who continued chemotherapy (CT), everolimus + endocrine therapy (HT), and other hormonotherapy after treatment with a CDK4/6 inhibitor were compared. Clinicopathological data and survival outcomes were analyzed. Statistical analyses were performed using the SPSS v25 program, survival analyses were performed using the Kaplan–Meier method, and comparisons were made using the log-rank test. Results: A total of 145 patients were included in the study. The groups were similar in terms of baseline characteristics such as age, menopausal status, histology, stage, adjuvant treatment status, and metastatic spread pattern. The rate of recurrent disease was significantly higher in the CT and Everolimus + HT groups compared to the “Other” group (p = 0.027). However, there was no significant difference between the groups in terms of PFS and OS in the general population (p > 0.05). In subgroup analyses, OS was significantly longer in the everolimus + HT group compared to the CT group in those with recurrence duration ≥ 1 year and stable disease course > 6 months during CDK4/6 inhibitor treatment (p = 0.010 and p = 0.039). Conclusions: Although there was no significant difference in overall survival regarding the choice of treatment after a CDK4/6 inhibitor, everolimus + endocrine therapy was observed to have a positive effect on survival in some subgroups. This finding supports individualized treatment. Full article

(This article belongs to the Section Oncology)

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18 pages, 3836 KB

Open AccessArticle

Dementia Prevalence in the CARhES Cohort: Importance of Socioeconomic Level

by Elena Lobo, Sara Malo, Isabel Aguilar-Palacio, Sara Castel-Feced, Lina Maldonado, Concepción De la Cámara and María José Rabanaque

J. Clin. Med. 2025, 14(20), 7375; https://doi.org/10.3390/jcm14207375 (registering DOI) - 18 Oct 2025

Abstract

Objectives: Dementia preventive strategies might benefit from a comprehensive approach that considers the interplay of biological and social factors. The aim of this study was to examine the prevalence of dementia by sex and age in a cohort of individuals with cardiovascular [...] Read more.

Objectives: Dementia preventive strategies might benefit from a comprehensive approach that considers the interplay of biological and social factors. The aim of this study was to examine the prevalence of dementia by sex and age in a cohort of individuals with cardiovascular risk factors, and to assess how sociodemographic and clinical factors are associated with this disease. Methods: Cross-sectional study was conducted on ≥55-year-old individuals from the CARhES (CArdiovascular Risk factors for HEalth Services research) Spanish cohort. Real-world data on sociodemographic, clinical, and drug information was obtained. Dementia cases were identified by diagnoses and pharmacological treatment. Age- and sex-stratified logistic regression models and sex-stratified CTree analyses were used. Results: The prevalence of dementia among the 323,973 individuals in the cohort was 5.2%, 3.4% in men and 6.6% in women, and it increased with age. In both sex groups, stroke and depression were associated with a higher prevalence of dementia for all the age groups, while sex differences were found in the association of the rest of the sociodemographic and clinical variables with dementia. Being older and with lower socioeconomic status were the most predictive factors of dementia prevalence. Stroke was a stronger indicator in men than in women, while hypertension was nearly twice as significant in women. Conclusions: The prevalence of dementia in people with cardiovascular risk factors was 5.2%, similar to that of the general population. Besides age, having a lower socioeconomic level was the most important indicator of dementia, which may justify more resources and care for these populations. Full article

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

11 pages, 2902 KB

Open AccessArticle

Reduced Native T1 Values of Wrist Tissues in Transthyretin Cardiac Amyloidosis

by Jean-François Deux, Pierre Brugières, Mounira Kharoubi, Amira Zaroui, Silvia Oghina, Thibaud Damy and Ruxandra Cosson

J. Clin. Med. 2025, 14(20), 7374; https://doi.org/10.3390/jcm14207374 (registering DOI) - 18 Oct 2025

Abstract

Background/Objectives: Carpal tunnel syndrome (CTS) may signal extracardiac amyloid deposition years before transthyretin cardiac amyloidosis (ATTR-CA). This study investigated potential alterations of wrist tissue T1 values in ATTR-CA patients. Methods: Patients with ATTR-CA and healthy volunteers underwent 1.5T wrist MRI using a gradient [...] Read more.

Background/Objectives: Carpal tunnel syndrome (CTS) may signal extracardiac amyloid deposition years before transthyretin cardiac amyloidosis (ATTR-CA). This study investigated potential alterations of wrist tissue T1 values in ATTR-CA patients. Methods: Patients with ATTR-CA and healthy volunteers underwent 1.5T wrist MRI using a gradient echo sequence. Manual contouring of the transverse carpal ligament (TCL), median nerve (MN), sheaths of the flexor carpi tendons (SFCT), subcutaneous fat (SCF), muscle of the thenar eminence (MTE), and global wrist (GCW) was performed by two readers. Native T1 values were compared between groups. Results: Thirty-six patients with ATTR-CA (mean age, 78 ± 9 years; 32 men) and 69 volunteers (43 ± 14 years; 24 men) were evaluated. Mean native T1 values of TCL, MN, SFCT, SCF, and GCW were significantly lower in patients than in volunteers (p < 0.005 for all). Multivariable regression adjusted for age and sex confirmed these associations. SCF T1 was significantly lower in patients with CTS symptoms (885 [762–1080] ms) than in asymptomatic patients (1041 [949–1267] ms, p = 0.04). The highest area under the curve (AUC) for detecting CA was obtained for SFCT (AUC = 0.85; 95% CI 0.77–0.93). Conclusions: Patients with transthyretin cardiac amyloidosis show a significant reduction in the native T1 of wrist tissues compared with controls. These preliminary findings suggest that wrist T1 mapping may serve as a non-invasive marker of peripheral amyloid involvement, but require further validation in larger, age-matched, histologically validated studies. Full article

(This article belongs to the Section Cardiology)

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14 pages, 416 KB

Open AccessArticle

Joint Hypermobility: An Under-Recognised Cause of Palpitations, Dizziness, and Syncope in Young Females

by Zeina Abu Orabi, Sophie E. Thompson, Jan van Vliet, Kate Gee, Ashwin Roy and Jonathan N. Townend

J. Clin. Med. 2025, 14(20), 7373; https://doi.org/10.3390/jcm14207373 (registering DOI) - 18 Oct 2025

Abstract

Background: Symptoms of dizziness, syncope, and palpitations are common presentations in outpatient and emergency care, frequently attributed to stress and anxiety when conventional neurological and cardiac evaluations are normal. Joint hypermobility (JH) syndromes including hypermobile Ehlers–Danlos syndrome (hEDS), and hypermobility spectrum disorders (HSD) [...] Read more.

Background: Symptoms of dizziness, syncope, and palpitations are common presentations in outpatient and emergency care, frequently attributed to stress and anxiety when conventional neurological and cardiac evaluations are normal. Joint hypermobility (JH) syndromes including hypermobile Ehlers–Danlos syndrome (hEDS), and hypermobility spectrum disorders (HSD) are under-recognised as potential causes. Methods: Our retrospective cohort study examined the clinical features, diagnostic findings, and responses to treatment in patients with JH syndromes, who are referred to a specialised syncope clinic within a UK teaching hospital. It involved 218 patients with joint hypermobility, predominantly young females (median Beighton score: 6), reporting chronic orthostatic intolerance, dizziness, and palpitations. Common comorbidities included joint pain, chronic fatigue, gastrointestinal dysmotility, and psychiatric conditions. Prevalence of symptoms, cardiovascular abnormalities on investigation (ECG, echocardiography, and tilt-table testing), and treatment responses were analysed. Results: History and examination were often diagnostic. Standard cardiac tests rarely provided diagnostic value except to exclude alternate conditions. Tilt-table testing was abnormal in 82.0% of cases, revealing orthostatic hypotension, reflex syncope, or postural tachycardia syndrome (POTS). Conservative measures (hydration, salt intake, and exercise) were effective in over half of the cases; pharmacological treatments (ivabradine, fludrocortisone) were considered for refractory cases. Conclusions: This study emphasises that JH syndromes are a common cause of palpitations, dizziness, and syncope in young females. They are multi-system conditions affecting both physical and mental health, which remain under-recognised and are often dismissed as ‘functional’, particularly in women—highlighting gender bias in diagnosis. A structured diagnostic approach with routine joint assessments for JH and increased awareness can facilitate early recognition and management in general medical settings, reducing reliance on emergency services and improving patient outcomes. Full article

(This article belongs to the Section Cardiology)

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9 pages, 218 KB

Open AccessArticle

Tooth Eruption and Microbial Correlation in Pediatric Appendicitis: An Exploratory Case–Control Study

by Wieland Elger, Carlotta Blod, Sara Schülin, Christian Hirsch, Martin Lacher and Steffi Mayer

J. Clin. Med. 2025, 14(20), 7372; https://doi.org/10.3390/jcm14207372 (registering DOI) - 18 Oct 2025

Abstract

Background/Objectives: The oral cavity has been discussed as a possible reservoir for pathogens involved in pediatric appendicitis. In a previous study, microbial similarities between oral and appendix samples were observed, but clinical dental findings showed no significant associations. The present study aimed [...] Read more.

Background/Objectives: The oral cavity has been discussed as a possible reservoir for pathogens involved in pediatric appendicitis. In a previous study, microbial similarities between oral and appendix samples were observed, but clinical dental findings showed no significant associations. The present study aimed to (1) perform a more detailed analysis of dental variables—such as eruption status, caries indices, oral hygiene behavior, and the Periodontal Screening Index (PSI)—to identify potential overlooked associations with appendicitis, and (2) compare two oral sampling sites (buccal mucosa and dental sulcus) in terms of their correlation with appendix microbiota. Methods: This secondary analysis used previously collected clinical and microbiological data from 36 children who had undergone appendectomy or elective surgery. Quantitative PCR (qPCR) was used to assess bacterial mRNA levels in appendix, buccal mucosa, and sulcus samples. Dental variables were derived from standardized clinical examinations performed at the time of surgery. Results: No significant group differences were observed in caries indices, PSI, or oral hygiene behavior. However, patients with appendicitis had a significantly higher number of erupting teeth compared to controls (3.82 vs. 1.68; p = 0.021). Bacterial mRNA levels did not differ notably between oral sites, and neither showed stronger correspondence with appendix samples; notably, sulcus swabs were not obtained from erupting teeth, limiting the ability to test a site-specific eruption mechanism. Conclusions: Tooth eruption may be associated with appendicitis, although this remains speculative and requires confirmation in larger studies. Full article

(This article belongs to the Special Issue Novel Research in Pediatric Dentistry: 2nd Edition)

11 pages, 384 KB

Open AccessArticle

Percutaneous Coronary Interventions in Nonagenarians: Single-Centre Insights

by Gwidon Polak

J. Clin. Med. 2025, 14(20), 7371; https://doi.org/10.3390/jcm14207371 (registering DOI) - 18 Oct 2025

Abstract

Background/Objectives: Despite the common use of invasive diagnostics and treatment of coronary artery disease (CAD), there are still doubts concerning the disease management method of choice in the population of very old patients. Our goal was to assess the patient profile, feasibility [...] Read more.

Background/Objectives: Despite the common use of invasive diagnostics and treatment of coronary artery disease (CAD), there are still doubts concerning the disease management method of choice in the population of very old patients. Our goal was to assess the patient profile, feasibility of coronary angiography (CAG), effectiveness (successful relieving of the coronary artery’s narrowing or occlusion) of percutaneous coronary intervention (PCI) and safety (mortality and other complications) of both procedures in nonagenarians. Methods: The database of the Dr. E. Warmiński Clinical Hospital of the Bydgoszcz University of Technology was searched for patients aged 90 years and older who underwent CAG and PCI between 2013 and 2023. We retrospectively analysed the case reports of these patients, including reason for hospital admission, course of hospitalisation, procedure data, and complications. Results: A total of 150 nonagenarians meeting the criteria were found, with a mean age of 92 years and 63% being female. A total of 110 patients (73%) were admitted on the basis of acute coronary syndrome (ACS). Upon CAG, 108 patients had obstructive coronary artery disease confirmed, 90% of whom had multivessel disease. In 96 out of 108 of these patients (that is, 89%), PCI was performed successfully in 89 (93%) procedures. Transradial access was used in 112 patients (75%). According to the diagnosis, PCI was performed in all cases (100%) of STEMI patients, in 80% cases of non-ST elevation acute coronary syndrome (NSTE-ACS) patients, and in 27% cases of stable CAD patients. Median time of hospitalisation was 6.5 days (IQR 4–10). In the course of hospitalisation, mortality was 8.7% (13 out of 150), although two cases were non-cardiological in nature. In the PCI group, mortality was 11.5% (11 out of 96); all 11 were treated due to ACS (no deaths in patients with stable ACS). In the STEMI subgroup, mortality was much higher at 33% (4 out of 12, with all 4 admitted with cardiogenic shock). Accordingly, in the NSTEMI group, mortality was 8.97%. Other complications in the PCI group were perforation of coronary artery in 1 case, access site complications in the case of transfemoral access in 10 patients, bleeding requiring transfusion in 2 patients, and contrast-induced nephropathy (CIN) in 4 patients. Conclusions: This analysis demonstrates that the CAG and PCI procedures are feasible and effective in nonagenarians, and the risk of complications is not as great as it was heretofore believed. Full article

(This article belongs to the Section Cardiovascular Medicine)

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15 pages, 2697 KB

Open AccessArticle

Optical Coherence Tomography Angiography Is Associated with Disease Activity Expressed by NEDA-3 Status in Patients with Relapsing Multiple Sclerosis

by Jozef Szilasi, Marianna Vitková, Zuzana Gdovinová, Miriam Fedičová, Pavol Mikula, Lýdia Frigová and Jarmila Szilasiová

J. Clin. Med. 2025, 14(20), 7370; https://doi.org/10.3390/jcm14207370 (registering DOI) - 18 Oct 2025

Abstract

Background: Retinal microvascular changes may serve as biomarkers for disease activity in multiple sclerosis (MS). This study evaluated macular and peripapillary vascular plexus densities using optical coherence tomography angiography (OCTA) in patients with relapsing MS (RMS) and healthy controls (HCs), exploring their association [...] Read more.

Background: Retinal microvascular changes may serve as biomarkers for disease activity in multiple sclerosis (MS). This study evaluated macular and peripapillary vascular plexus densities using optical coherence tomography angiography (OCTA) in patients with relapsing MS (RMS) and healthy controls (HCs), exploring their association with disease activity based on the NEDA-3 concept. Methods: In a cross-sectional study, 117 RMS patients and 37 HCs underwent OCTA imaging. Parameters analyzed included superficial vascular plexus (SVP), deep vascular plexus (DVP), foveal avascular zone (FAZ), and radial peripapillary capillary (RPC) density. Images with artifacts were excluded. Associations between OCTA metrics and demographic, clinical, and MRI volumetrics, as well as NEDA-3 status, were evaluated using multivariate generalized estimating equations. Receiver operating characteristic (ROC) curves assessed predictive capacity. Results: Compared to HCs, MS eyes with prior optic neuritis showed significantly lower SVP density (p < 0.05). DVP and FAZ parameters did not differ between groups. SVP and DVP densities correlated with age, disease duration, relapse history, and MRI volumetrics, including gray matter and whole brain volume. SVP density predicted NEDA-3 status (AUC = 0.82), while DVP also showed predictive value (AUC = 0.64). FAZ FD (Foveal density) was associated with gray matter and whole brain atrophy (AUC = 0.62–0.61). Conclusions: Retinal vascular alterations correlate with clinical and MRI measures in MS. Reduced SVP and DVP densities may serve as markers of recent disease activity, and FAZ metrics reflect neurodegeneration. OCTA may be a valuable non-invasive tool for monitoring MS progression. Full article

(This article belongs to the Section Clinical Neurology)

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9 pages, 236 KB

Open AccessArticle

Clinical Characteristics and Correlation of Hearing Outcomes Following Varying Courses of Repetitive Transcranial Magnetic Stimulation for Idiopathic Sudden Sensorineural Hearing Loss: A Prospective Clinical Study

by Chao Huang, Junming Li, Ge Tan and Ling Liu

J. Clin. Med. 2025, 14(20), 7369; https://doi.org/10.3390/jcm14207369 (registering DOI) - 18 Oct 2025

Abstract

Objective: We aimed to explore the efficacy of repetitive transcranial magnetic stimulation (rTMS) for idiopathic sudden sensorineural hearing loss (ISSNHL) and evaluate the correlation between treatment courses of rTMS and hearing outcomes. Methods: A prospective observational study was conducted at West [...] Read more.

Objective: We aimed to explore the efficacy of repetitive transcranial magnetic stimulation (rTMS) for idiopathic sudden sensorineural hearing loss (ISSNHL) and evaluate the correlation between treatment courses of rTMS and hearing outcomes. Methods: A prospective observational study was conducted at West China Fourth Hospital, Sichuan University, from January 2018 to January 2025. The study enrolled 339 patients (342 affected ears) diagnosed with ISSNHL. Among them, 67 patients (group A) received standard therapy combined with rTMS, while the control group (group B) received conventional therapy only. To verify the correlation between different treatment courses of rTMS and hearing outcomes, patients in Group A were divided into Group A1 (treatment courses ≤ 10) and Group A2 (treatment courses > 10). Hearing thresholds and clinical characteristics were evaluated at admission, discharge day and 6 months post-treatment. The SDRG’s criteria were used for the grading of hearing recovery. Results: Tinnitus (79.89% vs. 75.32%, p = 0.361) and sleep disorders (33.70% vs. 41.14%, p = 0.178) were highly prevalent among patients in group A and group B. 1 Hz rTMS significantly improved these symptoms (PSQI: 52.32% vs. 44.44%, p = 0.032; THI: 16.67 ± 19.41 vs. 8.22 ± 12.77, p = 0.002). Compared to high-tone hearing loss patients, those with low-tone loss in groupA2 showed a more rapid improvement (250 Hz: 17.66 ± 16.59 vs. 14.09 ± 15.58, p = 0.041; 500 Hz: 21.20 ± 18.03 vs. 17.31 ± 16.24, p = 0.036) than grouA1, with benefits sustained at 6-month follow-up (250 Hz: 27.79 ± 18.74 vs. 22.71 ± 18.31, p = 0.012; 500 Hz: 31.89 ± 19.73 vs. 26.49 ± 20.08, p = 0.013). Conclusions: rTMS at 1 Hz, administered in courses > 10 sessions, demonstrated both short-term and long-term beneficial effects in the ISSNHL. Those with low-tone hearing loss exhibit better recovery but a higher chance of relapse than high-tone loss patients. As a non-invasive approach with minimal side effects, rTMS is suitable for routine ISSNHL treatment. Full article

(This article belongs to the Section Otolaryngology)

13 pages, 540 KB

Open AccessReview

The Role of IOS in Identification of Specific Treatable Traits in Pediatric Asthma: Current Limitations and Future Perspectives—Narrative Review

by Joanna Połomska, Hanna Sikorska-Szaflik and Barbara Sozańska

J. Clin. Med. 2025, 14(20), 7368; https://doi.org/10.3390/jcm14207368 (registering DOI) - 18 Oct 2025

Abstract

Asthma management in children aims to prevent ongoing symptoms, preserve lung function and support normal daily activities. Impulse oscillometry (IOS) represents a modern approach to evaluating lung function that is also suitable for performing in the pediatric asthma population. Further research is warranted [...] Read more.

Asthma management in children aims to prevent ongoing symptoms, preserve lung function and support normal daily activities. Impulse oscillometry (IOS) represents a modern approach to evaluating lung function that is also suitable for performing in the pediatric asthma population. Further research is warranted to clarify the role of IOS in the early identification of small airway disease (SAD) as a potential treatable asthma trait and to understand its implications for personalized treatment strategies. Before the integration of IOS into routine clinical protocols, it is necessary to establish population-specific reference values. Further studies in the pediatric population are needed to evaluate the added value of IOS in combination with conventional spirometry and fractional exhaled nitric oxide (FeNO). Future pediatric asthma management guidelines may consider incorporating the assessment of SAD with IOS as a possible tool for its evaluation. Full article

(This article belongs to the Special Issue New Clinical Advances in Pediatric Asthma)

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18 pages, 2595 KB

Open AccessArticle

Clinical Characteristics, Treatment Approaches, and Survival Predictors in Adult Acute Myeloid Leukemia: Interim Results from the Turkish Society of Hematology AML Registry

by Volkan Karakus, Ibrahim Ethem Pinar, Utku Iltar, Emel Merve Yenihayat, Merve Gokcen Polat, Serhat Celik, Umit Yavuz Malkan, Guldane Cengiz Seval, Ali Dogan, Aydan Akdeniz, Demircan Ozbalci, Idris Ince, Ramazan Erdem, Ozgur Mehtap, Hakki Onur Kirkizlar, Murat Kacmaz, Burak Deveci, Fatma Aykas, Gulten Korkmaz, Sureyya Yigit Kaya, Hacer Berna Afacan Ozturk, Omur Gokmen Sevindik, Ferda Can, Demet Cekdemir, Ceyda Aslan, Hale Bulbul, Zeynep Tugba Karabulut, Senem Maral, Salih Sertac Durusoy, Fatih Demirkan, Hakan Goker, Fahir Ozkalemkas, Muzaffer Keklik, Selami Kocak Toprak, Aylin Fatma Karatas, Unal Atas and Inci Alacacioglu Show full author list Hide full author list

J. Clin. Med. 2025, 14(20), 7367; https://doi.org/10.3390/jcm14207367 (registering DOI) - 18 Oct 2025

Abstract

Background: Acute myeloid leukemia (AML) is an aggressive and biologically diverse hematologic cancer that disproportionately affects older individuals. Despite advances in molecular profiling and therapy, long-term outcomes remain unsatisfactory. This nationwide registry was established to provide real-world insights into clinical characteristics, treatment [...] Read more.

Background: Acute myeloid leukemia (AML) is an aggressive and biologically diverse hematologic cancer that disproportionately affects older individuals. Despite advances in molecular profiling and therapy, long-term outcomes remain unsatisfactory. This nationwide registry was established to provide real-world insights into clinical characteristics, treatment strategies, and survival among adult AML patients in Turkey. Methods: The Turkish AML Registry Project (ClinicalTrials.gov Identifier: NCT05979675) combines retrospective and prospective data from 23 tertiary hematology centers. Adult patients diagnosed between January 2008 and July 2023 were included. Baseline demographics, European LeukemiaNet (ELN) 2017 risk groups, Eastern Cooperative Oncology Group (ECOG) performance status, treatment intensity, and targeted therapy use were analyzed. Response and survival outcomes were assessed using Kaplan–Meier methods. Results: The interim dataset included 891 patients (median age 58 years, 45.5% ≥60). Intensive chemotherapy, most commonly 7 + 3, was applied in 74.1%, while 25.9% received lower-intensity regimens. Targeted agents, mainly venetoclax, were incorporated more frequently into low-intensity therapies (19.1% vs. 3.4%, p < 0.001). Complete remission occurred in 70.2% after intensive and 35.9% after low-intensity therapy, improving to 51.4% with targeted agents. Median overall survival (OS) was 27.2 months, with 1-year OS rates of 54.1%, 28.9%, and 17.6% for favorable, intermediate, and adverse ELN groups (p < 0.001). ECOG 0–1 predicted superior survival (1-year OS 70.3% vs. 47.0%). Conclusions: Nationwide real-world evidence underscores the prognostic relevance of ELN risk and functional status in AML. While intensive chemotherapy remains central, combining targeted agents with low-intensity regimens improves outcomes in less fit patients and supports personalized treatment approaches. Full article

(This article belongs to the Special Issue Acute Myeloid Leukemia: Latest Advances in Diagnostics, Therapeutic Strategies and Clinical Management: 2nd Edition)

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12 pages, 347 KB

Open AccessArticle

The Impact of Ursodeoxycholic Acid on Fetal Cardiac Function in Women with Gestational Diabetes Mellitus: A Randomized Controlled Study (GUARDS Trial)

by Ana Maria Company Calabuig, Jose Eliseo Blanco Carnero, Christos Chatzakis, Catherine Williamson, Kypros H. Nicolaides, Marietta Charakida and Catalina De Paco Matallana

J. Clin. Med. 2025, 14(20), 7366; https://doi.org/10.3390/jcm14207366 - 17 Oct 2025

Abstract

Background: Gestational diabetes mellitus (GDM) is associated with subclinical alterations in fetal cardiac morphology and function. Ursodeoxycholic acid (UDCA), widely used in pregnancy for intrahepatic cholestasis, has demonstrated cardioprotective properties in experimental fetal models, preventing conduction abnormalities and improving myocardial function. Whether UDCA [...] Read more.

Background: Gestational diabetes mellitus (GDM) is associated with subclinical alterations in fetal cardiac morphology and function. Ursodeoxycholic acid (UDCA), widely used in pregnancy for intrahepatic cholestasis, has demonstrated cardioprotective properties in experimental fetal models, preventing conduction abnormalities and improving myocardial function. Whether UDCA modifies fetal or neonatal cardiac adaptation in GDM pregnancies has not been previously investigated. The objective was to evaluate the effect of ursodeoxycholic acid (UDCA) on fetal and neonatal cardiac function in pregnancies complicated by gestational diabetes mellitus (GDM). Methods: In this randomized, placebo-controlled study, 113 women with GDM were enrolled, of whom 56 received UDCA and 57 the placebo. After measurement of maternal blood UDCA concentrations, 43 participants in the treatment group had levels ≥0.5 µmol/L and were included in the per-protocol analysis. Echocardiographic and Doppler-derived cardiac indices were assessed at baseline, 36 weeks’ gestation, and postpartum. Comparisons were performed using univariable tests and mixed-effects multivariable models accounting for time and treatment. Results: In the treatment group, compared to the placebo group, there were no significant differences in cardiac indices at 36 weeks’ gestation or postpartum when assessed individually. However, in the mixed-effects longitudinal analysis, a significant treatment-by-time interaction was observed. Specifically, in the postpartum period, mitral A-wave velocity (MV-A) was higher in the treatment group compared to that under the placebo (9.58, 95% CI 2.29–16.87; p = 0.010), reflecting a more pronounced increase in the atrial contribution to left ventricular filling over time. Similarly, aortic peak velocity (Ao_Vmáx) was significantly higher in the treatment group compared to that under the placebo in the postpartum period (7.97, 95% CI 0.19–15.75; p = 0.045), indicating a greater augmentation in left ventricular outflow dynamics. Conclusions: In pregnancies complicated by GDM, UDCA did not lead to significant cross-sectional differences in fetal or neonatal cardiac indices at 36 weeks or postpartum. However, longitudinal modeling indicated that UDCA was associated with a greater increase in the atrial contribution to ventricular filling (MV-A) and aortic peak velocity (Ao_Vmáx) in the postpartum period compared to that under the placebo. These findings suggest that while UDCA does not broadly alter cardiac function, it may modulate specific aspects of diastolic filling and systolic outflow dynamics during late gestation and early neonatal adaptation. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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16 pages, 610 KB

Open AccessReview

Zilebesiran—Small Interfering RNAs as Prospective New Drug in the Treatment of Hypertension

by Sylwia Dudzicz-Gojowy and Marcin Adamczak

J. Clin. Med. 2025, 14(20), 7365; https://doi.org/10.3390/jcm14207365 - 17 Oct 2025

Abstract

The inhibition of renin–angiotensin–aldosterone system (RAAS) activity is one of the key mechanisms in the treatment of arterial hypertension. Non-adherence to therapeutic recommendations is considered to be the main cause of failure to achieve therapeutic goals in patients with arterial hypertension. Zilebesiran is [...] Read more.

The inhibition of renin–angiotensin–aldosterone system (RAAS) activity is one of the key mechanisms in the treatment of arterial hypertension. Non-adherence to therapeutic recommendations is considered to be the main cause of failure to achieve therapeutic goals in patients with arterial hypertension. Zilebesiran is the first antihypertensive drug using expression genes modified by siRNA action. The mechanism of action is based on silencing the angiotensinogen gene by activating the RNA-induced silencing complex (RISC). The decreased production of angiotensinogen and storage of siRNA in hepatocyte endosomes makes the drug’s effect prolonged; it may last up to several months after drug administration. In hypertensive patients, a long-term reduction in blood pressure by more than 10 mmHg compared to placebo has been observed after a single dose of zilebesiran. Despite the promising results of the previous studies, further observations are still necessary regarding side effects and long-term effectiveness, as well as the possibility of developing resistance to treatment. Full article

(This article belongs to the Section Nephrology & Urology)

13 pages, 948 KB

Open AccessArticle

Effects of Strength Training on Neck Muscle Function and Tenderness in Patients with Chronic Headache: A Secondary Analysis of a Clinical Trial

by Jordi Padrós-Augé, Gemma Victoria Espí-López, Henrik Winther Schytz, Karen Søgaard, Rafel Donat-Roca, Henrik Baare Olsen and Bjarne Kjeldgaard Madsen

J. Clin. Med. 2025, 14(20), 7364; https://doi.org/10.3390/jcm14207364 - 17 Oct 2025

Abstract

Background/Objectives: This study presents a secondary analysis from a previously published trial on strength training and postural correction in chronic headache patients. Here, we investigate changes in neck muscle function and tenderness, and their relationship with headache symptoms. Methods: A total [...] Read more.

Background/Objectives: This study presents a secondary analysis from a previously published trial on strength training and postural correction in chronic headache patients. Here, we investigate changes in neck muscle function and tenderness, and their relationship with headache symptoms. Methods: A total of 22 headache patients from a single-arm open-label trial were included in this study to assess muscle function and tenderness. The maximum voluntary contraction of neck flexion and extension, shoulder elevation, and craniocervical flexion test were performed at baseline, week eight, and week 14. The extension/flexion ratio of the neck, the rate of force development, and the early rate of force development for shoulder elevation were calculated. Muscle tenderness was analyzed using the total tenderness score (TTS) and correlations between these outcomes and headache changes were explored. Results: After the intervention muscle tenderness significantly decreased (−5.6 ± 6.4; p < 0.001) and significant improvements in muscle function were observed. Correlations of muscle function showed a significant and moderate correlation between TTS and extension/flexion ratio (Spearman rho: 0.567, p = 0.014). Conclusions: The results indicate that strength training and postural correction improve muscle function and reduce pericranial tenderness in patients with chronic headaches. These findings suggest that muscle tenderness and extension/flexion ratio may be useful for monitoring exercise interventions focused on improving the strength and balance of the neck in patients with chronic headaches. Full article

(This article belongs to the Special Issue Headache: Updates on the Assessment, Diagnosis and Treatment)

10 pages, 1615 KB

Open AccessArticle

Virtual Clinics in Cardiology: Do They Provide Equivalent Care and Reduce Travel?

by Matthew Farrier, Brian Wood, Zoubaida Yahia and Martin Farrier

J. Clin. Med. 2025, 14(20), 7363; https://doi.org/10.3390/jcm14207363 - 17 Oct 2025

Abstract

Objective: To evaluate whether virtual clinic appointments in cardiology are equivalent to face-to-face appointments in terms of investigations as a consequence of the appointment and a reduction in travel for the whole care episode. Design: Retrospective observational cohort study of 9445 patients. Setting: [...] Read more.

Objective: To evaluate whether virtual clinic appointments in cardiology are equivalent to face-to-face appointments in terms of investigations as a consequence of the appointment and a reduction in travel for the whole care episode. Design: Retrospective observational cohort study of 9445 patients. Setting: Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized NHS trust in the north-west of England. Participants: 9445 patients referred for new cardiology appointments between 2023 and 2025. Methods: Data were extracted from electronic records and test ordering systems and appointments with corresponding investigations were retrieved. The data was validated using random samples, and the extraction was modified until accuracy was achieved. Principle component analysis was used to compare groups, and Welch t-test was used to statistically analyse the results. Distance travelled was calculated using postcodes and the number of visits was calculated using investigations conducted on separate days. Results: Patients who had virtual appointments showed no statistical difference in the number of investigations or visits for investigations. The care provided via virtual and face-to-face appointments was found to be comparable in terms of clinical effectiveness and quality of care. The distance travelled for both types of appointment is therefore not different, but if the initial appointment is taken into consideration where there was no travel for the virtual appointment patients, then the reduction in miles travelled is 5002 km, resulting in a carbon saving of 784 kgCO₂eq. Conclusions: Virtual Clinics in Cardiology offer an equitable service but only a small reduction in travel. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 514 KB

Open AccessArticle

Neoadjuvant Chemotherapy for Early Breast Cancer: A Study on Response Rate and Toxicity

by Matt Galloway, Paula Barlow, Jody Jordan and Edward Lo

J. Clin. Med. 2025, 14(20), 7362; https://doi.org/10.3390/jcm14207362 - 17 Oct 2025

Abstract

Background: Neoadjuvant chemotherapy (NACT) is widely used in patients with high-risk HER2-amplified (HER2+) or triple negative early breast cancer (TNBC). Advantages of NACT include allowing less extensive surgery, assessing response to treatment and guiding adjuvant therapy. NACT-related toxicities are common and can [...] Read more.

Background: Neoadjuvant chemotherapy (NACT) is widely used in patients with high-risk HER2-amplified (HER2+) or triple negative early breast cancer (TNBC). Advantages of NACT include allowing less extensive surgery, assessing response to treatment and guiding adjuvant therapy. NACT-related toxicities are common and can result in treatment alterations and hospitalisation, which may adversely impact outcomes. Aim: To assess NACT treatment in Hawke’s Bay (HB), New Zealand, by evaluating pathologic complete response (pCR) rates and toxicities of different regimens. Method: Data were retrospectively obtained from medical records of NACT patients. pCR rates were compared to results from the previous literature. Toxicity was assessed by recording severe (grade 3 or above) toxicities, treatment-limiting toxicities (those leading to dose reductions, dose delays or early cessation) and hospitalisations for different NACT regimens. Results: A total of 71 NACT patients were included. pCR rates for HER2+ disease and TNBC were 19/45 (42%) and 8/24 (33%), respectively. The most common severe toxicities were diarrhoea, anaemia and febrile neutropaenia (all 16%) in FEC-D (5-fluorouracil/epirubicin/cyclophosphamide + docetaxel +/− carboplatin +/− immunotherapy) patients, neutropaenia (50%) in FEC-DH (FEC-D + trastuzumab +/− pertuzumab) patients and diarrhoea (38%) in TCH (docetaxel/carboplatin/trastuzumab +/− pertuzumab) patients. Comparing treatment-limiting toxicity in FEC-DH vs. TCH, 9/16 (56%) vs. 13/21 (62%) had dose reduction, 2/16 (13%) vs. 8/21 (38%) had dose delay, 1/16 (6%) vs. 5/21(24%) had early cessation and 6/16 (38%) vs. 13/21 (62%) were hospitalised, respectively. Conclusions: NACT was associated with high rates of severe and treatment-limiting toxicity. Despite this, pCR rates were consistent with the previous literature. With the caveat of small patient numbers, FEC-DH-based therapy was associated with fewer dosing delays, early cessations and hospitalisations compared with TCH-based therapy. Full article

(This article belongs to the Special Issue Breast Cancer: Advances in Clinical and Personalized Practices)

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