Journal of Clinical Medicine

16 pages, 1436 KiB

Open AccessSystematic Review

Efficacy of Therapies for Solar Urticaria: A Systematic Review and Meta-Analysis

by Maya Engler Markowitz, Yehonatan Noyman, Israel Khanimov, Itay Zahavi, Batya Davidovici, Riad Kassem, Daniel Mimouni and Assi Levi

J. Clin. Med. 2025, 14(16), 5736; https://doi.org/10.3390/jcm14165736 - 13 Aug 2025

Abstract

Background: Solar urticaria is a rare and disabling photodermatosis. Due to its low prevalence, most available data regarding treatment are derived from observational studies and case series, and a systematic evaluation of treatment efficacy is lacking. This systematic review and meta-analysis aims [...] Read more.

Background: Solar urticaria is a rare and disabling photodermatosis. Due to its low prevalence, most available data regarding treatment are derived from observational studies and case series, and a systematic evaluation of treatment efficacy is lacking. This systematic review and meta-analysis aims to assess therapeutic outcomes across treatment modalities in order to guide clinical care. Methods: We conducted a systematic literature search across PubMed, ScienceDirect, the Cochrane Library, and ClinicalTrials.gov. Studies reporting treatment outcomes in patients with solar urticaria were included. Pooled response rates were calculated for each treatment modality. Results: Out of 508 studies initially identified, 38 met the inclusion criteria. Antihistamines were evaluated in 21 studies (376 patients), with a pooled response rate (partial or complete) of 83.0% (95% CI, 70.4–91.1%) and a complete response rate of 7.7% (95% CI, 1.7–28.3%). Phototherapy was assessed in 11 studies (145 patients), showing a similar overall response (89.8%; 95% CI, 77.9–95.3%) but a higher complete response rate (39.8%; 95% CI, 18.3–66.1%). Omalizumab, evaluated in nine studies (76 patients), demonstrated the highest efficacy, with 93.2% (95% CI, 73.8–98.5%) achieving response and 68.4% (95% CI, 48.5–83.2%) complete remission. Limited data on IVIG, cyclosporine, and plasmapheresis suggested partial efficacy in selected refractory cases. Conclusions: This meta-analysis may support clinical decision-making by clinicians. A stepwise approach is suggested: high-dose H₁ antihistamines as first-line therapy, phototherapy as an alternative option in patients with access to treatment centers, and omalizumab for those with insufficient response. In refractory cases, additional options might be considered. Full article

(This article belongs to the Special Issue Autoimmune Skin Diseases: Innovations, Challenges, and Opportunities)

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14 pages, 511 KiB

Open AccessArticle

Body Temperature, Metabolic, and Circulatory Changes After 8 Days of Water-Only Fasting in Healthy Middle-Aged Men

by Ilona Pokora, Piotr Wyderka, Wiesław Pilis and Karol Pilis

J. Clin. Med. 2025, 14(16), 5735; https://doi.org/10.3390/jcm14165735 - 13 Aug 2025

Abstract

Background: Maintaining thermal homeostasis is a basic function of the human body. This homeostasis depends largely on the body’s nutritional status and other conditions related to it. Aim: The present study investigated the impact of 8 days of water-only fasting (8DW-F) on selected [...] Read more.

Background: Maintaining thermal homeostasis is a basic function of the human body. This homeostasis depends largely on the body’s nutritional status and other conditions related to it. Aim: The present study investigated the impact of 8 days of water-only fasting (8DW-F) on selected features of thermal homeostasis, taking into account somatic, metabolic, and circulatory changes in middle-aged men. Methods: A total of 13 healthy men took part in the experiment. Volunteers were examined twice: after a mixed diet (C) and after using 8DW-F. At baseline, the following were recorded: body mass (BM), body fat (FM), fat-free mass (FFM), and total water (TBW), along with basal metabolic rate (BMR) and body surface area (BSA). Then, after 30 min of sitting under thermoneutral conditions, the following measurements were taken: eardrum temperature (Ti), skin temperatures (Tsk), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen uptake (VO₂), and respiratory exchange ratio (RER). The following were then calculated: average body (MTB) and skin temperature (MTsk), resting metabolic rate (RMR), body to skin temperature gradient (g), and whole-body thermal conductivity (C). Results: The results showed that 8DW-F cause a significant reduction in most somatic variables as well as SBP and BMR (p < 0.001), RMR (p < 0.05) with no changes in Ti, MTsk, MTB, or C and g (p = 0.09). There were also significant correlations between Δ MTB × Δ BMR (p < 0.05) and Δ RMR × Δ VO₂ (p < 0.001). Moreover, changes in the C range correlated with Δ RMR (p < 0.005) and Δ DBP (p < 0.05). Conclusions: 8DW-F reduced resting metabolic heat production in the studied men, but sufficient heat conservation ensured that thermal homeostasis was maintained under thermally neutral conditions. Full article

(This article belongs to the Section Sports Medicine)

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12 pages, 688 KiB

Open AccessArticle

Chlorhexidine vs. Povidone for Skin Antisepsis in Tissue Expander-Based Breast Reconstruction: A Propensity Score-Matched Analysis

by Agustin N. Posso, Audrey Mustoe, Manuela Neira, Micaela Tobin, Mohammed Yamin, Tricia Raquepo, Maria J. Escobar-Domingo, Sarah J. Karinja and Bernard T. Lee

J. Clin. Med. 2025, 14(16), 5734; https://doi.org/10.3390/jcm14165734 - 13 Aug 2025

Abstract

Background/Objectives: Tissue expander (TE)-based breast reconstruction is a common procedure, but postoperative infection rates can reach up to 30%. The optimal skin antiseptic solution for minimizing these infections remains uncertain. This retrospective cohort study aimed to compare the impact of chlorhexidine and [...] Read more.

Background/Objectives: Tissue expander (TE)-based breast reconstruction is a common procedure, but postoperative infection rates can reach up to 30%. The optimal skin antiseptic solution for minimizing these infections remains uncertain. This retrospective cohort study aimed to compare the impact of chlorhexidine and povidone-iodine for skin antisepsis in preventing surgical site infections in patients who underwent TE-based breast reconstruction. Methods: The TriNetX database was queried to identify patients who underwent TE-based breast reconstruction. Patients were classified into two cohorts: the chlorhexidine group and the povidone-iodine group. A propensity score matching analysis was performed to control infection risk factors. The primary outcome was the occurrence of surgical site infections, while secondary outcomes included wound dehiscence, emergency department visits, debridement, and TE removal. All outcomes were assessed at 30, 60, and 90 days following surgery. Results: After matching of both the chlorhexidine cohort and povidone-iodine cohort, each consisted of 1446 patients. Within 30 days post-surgery, no significant differences were observed between the chlorhexidine and povidone-iodine groups in terms of the risk of surgical site infections (RR 0.62, p = 0.168), wound dehiscence (RR 1.00, p = 1.000), emergency department visits (RR 0.95, p = 0.700), debridement (RR 0.71, p = 0.271), or TE removal (RR 0.84, p = 0.335). Similar results were seen at 60 and 90 days post-surgery. Conclusions: This study suggests that chlorhexidine and povidone-iodine may be equally effective for skin antisepsis in preventing surgical site infections and associated complications in patients undergoing TE-based breast reconstruction. Full article

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

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16 pages, 1310 KiB

Open AccessReview

Updates on Pulmonary Neuroendocrine Carcinoids: Progress and Perspectives

by Anna Scognamiglio, Arianna Zappi, Elisa Andrini, Adriana Di Odoardo, Davide Campana, Anna La Salvia and Giuseppe Lamberti

J. Clin. Med. 2025, 14(16), 5733; https://doi.org/10.3390/jcm14165733 - 13 Aug 2025

Abstract

Neuroendocrine neoplasms (NENs) of the lung are a biologically and clinically diverse group of tumors that includes well-differentiated typical and atypical carcinoids (LNETs), as well as poorly differentiated large-cell neuroendocrine carcinoma and small-cell lung cancer. Despite their relative rarity, the incidence of LNETs [...] Read more.

Neuroendocrine neoplasms (NENs) of the lung are a biologically and clinically diverse group of tumors that includes well-differentiated typical and atypical carcinoids (LNETs), as well as poorly differentiated large-cell neuroendocrine carcinoma and small-cell lung cancer. Despite their relative rarity, the incidence of LNETs is increasing, primarily due to advancements in diagnostic techniques and heightened clinical awareness. While the current World Health Organization (WHO) classification offers a morphological basis for diagnosis and prognosis, particularly for extrapulmonary neuroendocrine neoplasms (ep-NENs), it has limitations in predicting the clinical behavior of pulmonary carcinoids. Recent evidence highlights the inadequacy of traditional criteria in fully capturing the biological complexity and clinical heterogeneity of these tumors. This review explores the evolving landscape of LNETs, focusing on well-differentiated forms and analyzing current classification systems, clinicopathological features, and the emerging role of novel prognostic and predictive biomarkers. Advances in histopathology and molecular profiling have begun to elucidate distinct molecular subsets within carcinoids, offering potential avenues for improved risk stratification and therapeutic decision-making. Although there are limited treatment options for advanced disease, new insights into tumor biology could facilitate the development of personalized therapeutic strategies and pave the way for future innovations in LNET management. Full article

(This article belongs to the Section Oncology)

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13 pages, 514 KiB

Open AccessArticle

by Elena López-Mezquita Torres, Antonia García-Martín, María del Carmen Andreo-López, Victoria Contreras-Bolívar, Cristina García-Fontana, Beatriz García-Fontana and Manuel Muñoz-Torres

J. Clin. Med. 2025, 14(16), 5732; https://doi.org/10.3390/jcm14165732 - 13 Aug 2025

Abstract

Background/Objectives: Patients with chronic hypoparathyroidism are at increased risk of kidney complications. Also, chronic kidney disease is associated with increased cardiovascular risk. The aim was to analyze the factors that influence kidney function, including cardiovascular diseases (CVD), in a cohort of patients with [...] Read more.

Background/Objectives: Patients with chronic hypoparathyroidism are at increased risk of kidney complications. Also, chronic kidney disease is associated with increased cardiovascular risk. The aim was to analyze the factors that influence kidney function, including cardiovascular diseases (CVD), in a cohort of patients with chronic hypoparathyroidism. Methods: This was a retrospective longitudinal study that included 100 patients with chronic hypoparathyroidism. Results: The estimated glomerular filtration rate (eGFR) was associated with the duration of disease (p = 0.014). During follow-up, a significant decrease in eGFR was observed over time (p < 0.001), and changes in the eGFR were associated with the duration of disease (p < 0.001). We found that the eGFR was lower in patients with urolithiasis (p = 0.003), hypertension (p < 0.001), type 2 diabetes (p = 0.031) and dyslipidemia (p < 0.001). In total, 14% of patients had a chronic kidney disease (CKD), and these patients had a longer duration of disease (p < 0.001). The percentage of patients with urolithiasis (p = 0.003), nephrocalcinosis (p = 0.008), hypertension (p = 0.005), type 2 diabetes (p < 0.001), dyslipidemia (p < 0.001), coronary heart disease (p = 0.008), and arrhythmia (p < 0.001) was higher in patients with CKD. Logistic regression models showed that disease duration was associated with CKD (OR = 1.11; 95% CI [1.03–1.22]; p = 0.008). We used ROC curves to assess the usefulness of disease duration as a marker of CKD, and the AUC was 0.850 (95% CI 0.763–0.937, p < 0.001). A duration of disease > 15.5 years had a sensitivity of 85.7% and a specificity of 71.9% for a diagnosis of CKD. Conclusions: The duration of disease appears to be a predictor of the presence of renal dysfunction in patients with chronic hypoparathyroidism. In addition, the coexistence of CVD factors could result in greater renal damage. Full article

(This article belongs to the Special Issue Novel Aspects of Endocrine Care: From Patient-Centred Management of Endocrine Diseases to Guidelines Standards)

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17 pages, 2724 KiB

Open AccessSystematic Review

Management and Outcomes of Non-Missile Penetrating Brain Injury Involving the Anterior Skull Base: A Case Report and Systematic Review

by Wojciech Czyżewski, Michał Szymoniuk, Jakub Litak, Krzysztof Kura, Klaudia Kuś-Budzyńska, Aleksandra Dryla, Jacek Baj, Kamil Torres and Grzegorz Staśkiewicz

J. Clin. Med. 2025, 14(16), 5731; https://doi.org/10.3390/jcm14165731 - 13 Aug 2025

Abstract

Introduction: Non-missile penetrating brain injury (PBI) involving the anterior skull base constitutes a rare subclass of traumatic brain injury in civilians. Management of this type of trauma is poorly described in the literature, with only case series and reports available. Materials and Methods: [...] Read more.

Introduction: Non-missile penetrating brain injury (PBI) involving the anterior skull base constitutes a rare subclass of traumatic brain injury in civilians. Management of this type of trauma is poorly described in the literature, with only case series and reports available. Materials and Methods: A systematic search was conducted across PubMed, Scopus, and Web of Science databases. The study included reports of adult patients with non-missile PBI with foreign bodies crossing the anterior skull base, published between the years 2000 and 2024. The patients were divided into three groups based on the entry point of foreign bodies: transorbital, transmental, and transnasal injuries. The obtained data were analyzed through descriptive statistics. A case report of a 20-year-old male following PBI involving the anterior skull base caused by suicidal self-shooting with a crossbow is presented. Results: A total of 17 articles reporting 40 patients and the current case were included. The mean age of the patients was 37.4 ± 13.1 years, and 92.7% of them were male. Transorbital injury was the dominant type of PBI (29 cases), followed by transmental injury (7 cases) and transnasal injury (5 cases). A total of 37 patients (90.2%) were managed operatively due to retained foreign bodies after PBI. Antibiotic prophylaxis was implemented in 33 cases (80.5%), mostly in transorbital (93.1%) and transnasal (100%) PBI. In seven reported cases, antiepileptic drugs were preventively administered. At the last follow-up, 18 patients (47.4%) did not fully recover neurological functions, with vision loss as the most common deficit. Conclusions: Management of non-missile PBIs involving the anterior part of the skull base is complex, challenging, and often requires a multidisciplinary team including neurosurgeons, ENT surgeons, ophthalmologists, and maxillofacial surgeons. In this type of traumatic brain injury, following proper management may lead to favorable outcomes with minimal neurological deficits. Full article

(This article belongs to the Section Brain Injury)

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15 pages, 1382 KiB

Open AccessArticle

Predictive Value of Point-of-Care Proenkephalin for Worsening Renal Function and Mortality in Patients Presenting to Emergency Department with Acute Heart Failure

by Dionysis Matsiras, Effie Polyzogopoulou, Ioannis Ventoulis, Vasiliki Bistola, Christos Verras, Ignatios Ikonomidis and John Parissis

J. Clin. Med. 2025, 14(16), 5730; https://doi.org/10.3390/jcm14165730 - 13 Aug 2025

Abstract

Background: Enkephalins are endogenous opioid peptides that modulate cardiovascular and renal function and are overexpressed in patients with acute heart failure (AHF). Although biologically active enkephalins lack a favorable biomarker profile, their stable surrogate proenkephalin 119–159 (PENK) appears to display prognostic value in [...] Read more.

Background: Enkephalins are endogenous opioid peptides that modulate cardiovascular and renal function and are overexpressed in patients with acute heart failure (AHF). Although biologically active enkephalins lack a favorable biomarker profile, their stable surrogate proenkephalin 119–159 (PENK) appears to display prognostic value in AHF settings. The aim of the present study was to evaluate the role of point-of-care (POC) PENK in predicting mortality and worsening renal function (WRF) in patients presenting to the emergency department (ED) with AHF. Methods: In this single-center observational study, 107 patients presenting to the ED with AHF were prospectively enrolled. We measured PENK levels upon ED presentation with a commercially available POC immunoassay and investigated their association with WRF within 48 h and all-cause mortality during a 1-year follow-up. Results: The patients had a mean age of 72 ± 13 years, and 58% were men. Moreover, 62% had acutely decompensated chronic heart failure (HF), 24% had pulmonary edema, 9% had cardiogenic shock, and 5% had right HF. The median PENK levels were 111 [60–193] pmol/L. PENK was independently associated with WRF (adjusted OR, 95% CI: 15.4 [2.0–120.2]; p = 0.009), with levels of ≥90.5 pmol/L identified as the optimal cut-off for predicting WRF (AUC: 0.690; p < 0.001). PENK was also an independent predictor of short- and long-term all-cause mortality, with an optimal cut-off of ≥95.8 pmol/L (AUC for 30-day, 90-day, and 1-year mortality: 0.717, 0.723, and 0.724, respectively; all p < 0.001). Conclusions: In patients presenting to the ED with AHF, POC PENK may serve as an early prognostic marker of WRF and short- and long-term mortality. Full article

(This article belongs to the Special Issue Patient-Oriented Treatments for Heart Failure)

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13 pages, 608 KiB

Open AccessArticle

Medical Therapy in Patients with Heart Failure: A Delphi Consensus from Italian Cardiologists

by Valentina Tardivo, Emanuele Venturini, Gaetano M. Ruocco, Guido Pastorini, Elisa Bertone and Mauro Feola

J. Clin. Med. 2025, 14(16), 5729; https://doi.org/10.3390/jcm14165729 - 13 Aug 2025

Abstract

Background: Adherence to current clinical guidelines is crucial for ensuring optimal therapy in patients with heart failure (HF). This study aims to explore how cardiologists, as specialists in heart failure, approach the clinical scenarios encountered in the management of HF patients, in [...] Read more.

Background: Adherence to current clinical guidelines is crucial for ensuring optimal therapy in patients with heart failure (HF). This study aims to explore how cardiologists, as specialists in heart failure, approach the clinical scenarios encountered in the management of HF patients, in line with the recommended guidelines. A heart failure-focused meeting was organized, during which participating cardiologists engaged actively. During HF meetings in which cardiologists participated, 108 questionnaires were distributed electronically. In total, 57 men and 51 women expressed their opinions regarding the Delphi analysis. Results: A strong consensus on the benefits of beta-blockers in improving prognoses for, and reducing mortality in, patients with HF and reduced systolic function emerged. The majority of cardiologists continue to prefer intravenous therapy with continuous loop-diuretic administration in combination with thiazide diuretics. The use of metolazone elicits fewer preferences, probably due to concerns about side effects. Certainly, SGLT2i is useful in reducing hospitalizations and reducing congestion; however, there is no full consensus on whether MRAi should be discontinued in favor of SGLT2i alone. The majority of participants would discontinue MRAs in the presence of hyperkalemia and worsening renal function, maintaining sacubitril/valsartan, and indicating a priority for renal safety. There was near-unanimous agreement on the early initiation of sacubitril/valsartan after the stabilization of patients hospitalized for heart failure. Conclusions: A significant majority (97%) of cardiologists expressed a preference for utilizing all of the guideline-recommended drug classes in the management of heart failure, even if this meant not always reaching the maximum tolerated dose for each medication. This approach underscores the importance of comprehensive therapy, targeting multiple pathophysiological mechanisms in heart failure. Cardiologists emphasized that while achieving optimal dosing is ideal, flexibility in treatment regimens is often necessary to accommodate individual patient characteristics, tolerance, and clinical status. The findings highlight the need for personalized treatment strategies that align with current guidelines, while also recognizing the challenges and variability in patient responses to therapy. Full article

(This article belongs to the Section Pharmacology)

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12 pages, 1369 KiB

Open AccessArticle

Sex Differences in 24 H Blood Pressure in Night-Shift Workers

by Barbara Toffoli, Silvia Berti, Ilaria Pitteri, Matilde Contessa, Federica Tonon, Rebecca Defendi, Andrea Grillo, Bruno Fabris and Stella Bernardi

J. Clin. Med. 2025, 14(16), 5728; https://doi.org/10.3390/jcm14165728 - 13 Aug 2025

Abstract

Background/Objectives: Gender Medicine addresses how sex- and gender-based differences influence people’s health. Blood pressure (BP), which is the leading global risk factor for cardiovascular disease, shows a sexual dimorphism. This is seen also in case of shift work, as shift work is [...] Read more.

Background/Objectives: Gender Medicine addresses how sex- and gender-based differences influence people’s health. Blood pressure (BP), which is the leading global risk factor for cardiovascular disease, shows a sexual dimorphism. This is seen also in case of shift work, as shift work is associated with hypertension in the male sex. It is not clear if this may be extended also to night-shift work, as data for this are limited. Based on this background, the aim of this study was to evaluate whether there were sex differences in the 24 h BP profile during a day with a day shift and a day with a night shift. Methods: This study is a post hoc analysis of a previous study where we evaluated ambulatory blood pressure monitoring data for two days, in a day with a day shift (and night of rest) and in a day with a night shift. Results: Overall, 25 subjects (physicians) were included in the analysis, of whom 10 were (40%) males and 15 were (60%) females. No differences were recorded in terms of age, years of work, number of steps, admissions, and calls during the recordings between the two sexes. Subjects worked on average 1.2 night per month, indicating that this population had a low exposure to night-shift work. BP patterns did not differ between sexes, but BP levels were always higher in males than females. Nevertheless, only females showed a significant increase of SBP during the night shift as compared to the night of rest. Both males and females showed a significant reduction in BP dipping during the night shift, but only in females, the significant reduction in BP dipping was maintained after the night-shift work. Interestingly, BMAL1 gene expression, which is a gene of the circadian rhythm, increased significantly after the night shift only in females, suggesting that females display an earlier acrophase than males after night-shift work, which may be associated with tolerance to shiftwork. Conclusions: Our data are consistent with the concept that blood pressure display several sex/gender differences. Males had higher BP values, but females showed signs of lower tolerance to shift work. This might be due to sex differences in the circadian rhythm regulation, which, in turns, regulate physiological functions, such as blood pressure. Full article

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

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13 pages, 1072 KiB

Open AccessArticle

Real-World Clinical Practice Evaluation of Tralokinumab in Atopic Dermatitis: A 52-Week Multi-Center Retrospective Study in the Basque Country

by Rosa María Izu Belloso, Marc Juliá Manresa, Nekane Martínez Peña, Maider Pretel Irazabal, Vanesa Fatsini Blanch, Nerea Ormaechea Pérez, Manuel Pascual Ares and Juan Antonio Ratón Nieto

J. Clin. Med. 2025, 14(16), 5727; https://doi.org/10.3390/jcm14165727 - 13 Aug 2025

Abstract

Background: Tralokinumab is an anti-IL-13 monoclonal antibody approved for moderate-to-severe atopic dermatitis (AD). While pivotal trials have demonstrated its efficacy, real-world data remain limited. Methods: We conducted a retrospective, multi-center study in the Basque Country including 109 adults with moderate-to-severe AD [...] Read more.

Background: Tralokinumab is an anti-IL-13 monoclonal antibody approved for moderate-to-severe atopic dermatitis (AD). While pivotal trials have demonstrated its efficacy, real-world data remain limited. Methods: We conducted a retrospective, multi-center study in the Basque Country including 109 adults with moderate-to-severe AD treated with tralokinumab. Clinical outcomes (EASI, IGA, BSA, DLQI, and NRS-pruritus/sleep) were assessed at baseline, weeks 16, 24, and 52. Results: EASI-75/90/100 responses were 66%/44%/16% at week 16 and increased to 83%/70%/34% at week 52. Pruritus NRS decreased from 7.1 to 3.1 and DLQI from 17.8 to 9.0. Adverse events were uncommon, with only three cases of conjunctivitis (two discontinued). Conclusions: Our findings support tralokinumab as a safe and effective long-term therapy for AD in routine practice. Results were consistent with, or superior to, pivotal and other RWE studies. Full article

(This article belongs to the Special Issue Treatment of Atopic Dermatitis)

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13 pages, 7025 KiB

Open AccessArticle

Bilateral–Contralateral Endoscopic Decompression as a Fusion-Deferral Strategy in Upper Lumbar Stenosis: A Structural Rationale and Conditional Framework—A Technical Note with Cases Review

by Dong Hyun Lee, Sang Yeop Han, Seung Young Jeong and Il-Tae Jang

J. Clin. Med. 2025, 14(16), 5726; https://doi.org/10.3390/jcm14165726 - 13 Aug 2025

Abstract

Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a [...] Read more.

Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a novel, facet-preserving bilateral–contralateral decompression strategy using unilateral biportal endoscopy (UBE) for upper lumbar stenosis, aiming to defer unnecessary spinal fusion. Methods: This retrospective series of three cases involved patients with upper lumbar stenosis characterized by vertically oriented facets (>60°) and narrow laminae, including cases of adjacent segment stenosis (ASS) and stenosis with grade 1 spondylolisthesis. Patients were selected using the authors’ facet angle–based criteria (>60°) and laminar morphology to identify anatomically vulnerable segments. All patients exhibited vertical facet orientation and narrow laminae, without significant dynamic instability or severe foraminal compromise. Bilateral–contralateral decompression was performed using biportal endoscopy to preserve facet integrity and defer fusion where feasible. Results: This series demonstrated that bilateral–contralateral decompression provided effective neural decompression and symptom relief while preserving facet structures in the upper lumbar spine characterized by vertical facets and narrow laminae. No progression to instability or requirement for additional fusion was observed during the 6-month follow-up, even among patients with ASS and grade 1 spondylolisthesis. Conclusions: The authors propose that bilateral–contralateral decompression may serve as a facet-preserving and fusion-deferral strategy for upper lumbar stenosis with vertically oriented facets and narrow laminae. This approach is particularly applicable in cases such as ASS and spinal stenosis with grade 1 spondylolisthesis, where preserving structural reserve is critical. These preliminary findings highlight the need for prospective validation through carefully designed observational studies and larger case series. Full article

(This article belongs to the Special Issue Advances in Spine Surgery: Best Practices and Future Directions)

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10 pages, 1761 KiB

Open AccessSystematic Review

Relationship Between Simple Renal Cysts and Hypertension: A Systematic Review and Meta-Analysis

by Michael Kitlinski, Harshita Kaushik, Zbigniew Heleniak and Alicja Dębska-Ślizień

J. Clin. Med. 2025, 14(16), 5725; https://doi.org/10.3390/jcm14165725 - 13 Aug 2025

Abstract

Background: Simple renal cysts (SRCs) are the most common incidentally found cystic lesions in the kidney. While their association with hypertension (HT) has been explored in various studies, the findings remain inconclusive. Thus, our meta-analysis aimed to systematically evaluate the relationship between [...] Read more.

Background: Simple renal cysts (SRCs) are the most common incidentally found cystic lesions in the kidney. While their association with hypertension (HT) has been explored in various studies, the findings remain inconclusive. Thus, our meta-analysis aimed to systematically evaluate the relationship between SRCs and HT (PROSPERO ID: CRD42025580609). Methods: We conducted searches in PubMed, Web of Science Core Collection, and Scopus to identify observational studies that examined the association between SRCs and HT. All articles containing animal or pediatric (<18 years old) study populations or having <10 patients in total and/or lacking a control group that did not develop HT were excluded. Two reviewers independently screened the studies and extracted the data, and the quality of each included study was assessed using the Newcastle–Ottawa Scale. Statistical analyses were performed using Review Manager 5.4. Results: In total, 12 studies with 147,310 participants were included in this meta-analysis. Presence of SRCs was associated with a 2.04-fold higher likelihood of having HT (OR 2.04, 95%CI 1.70–2.45, p < 0.0001). Multivariate analysis further revealed that SRCs were independently associated with HT (aOR 1.36, 95%CI 1.24–1.49, p < 0.0001), with multiple SRCs (aOR 1.36, 95%CI 1.26–2.42, p = 0.0008) and bilateral SRCs (aOR 2.26, 95%CI 1.12–4.59, p = 0.02) showing a stronger association. Conclusions: This study provides the first in-depth review on the topic, showing an established link between SRCs and HT even after adjustment for major confounding factors such as age, sex, renal function, and other metabolic factors. Full article

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

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12 pages, 720 KiB

Open AccessArticle

Safety and Feasibility of Wedge Resection in Lung Cancer Patients with Pre-Existing Interstitial Lung Disease: Real-World Data from Multicenter, Shizuoka Registry

by Keigo Sekihara, Kensuke Takei, Koshi Homma, Motohisa Shibata and Kazuhito Funai

J. Clin. Med. 2025, 14(16), 5724; https://doi.org/10.3390/jcm14165724 - 13 Aug 2025

Abstract

Background/Objectives: Acute exacerbation of interstitial lung disease (AE-ILD) is a life-threatening complication in lung cancer patients with pre-existing ILD. Anatomical resection is recognized as a significant risk factor for AE-ILD. We investigated the safety and feasibility of wedge resection in lung cancer patients [...] Read more.

Background/Objectives: Acute exacerbation of interstitial lung disease (AE-ILD) is a life-threatening complication in lung cancer patients with pre-existing ILD. Anatomical resection is recognized as a significant risk factor for AE-ILD. We investigated the safety and feasibility of wedge resection in lung cancer patients with ILD. Methods: This retrospective study analyzed clinical stage IA–IIIA primary lung cancer patients with ILD, as recorded in the Shizuoka Registry across eight institutions from January 2019 to May 2023. Patients were categorized into a wedge resection group (WG) and an anatomical resection group (AG), which included segmentectomy, lobectomy, and bilobectomy. Perioperative outcomes were compared between the groups. Results: The WG comprised 36 patients, while the AG included 81. The WG had significantly older patients (77 vs. 72 years, p < 0.01) and smaller tumors (18 vs. 24 mm, p < 0.01). Wedge resection was associated with shorter operative time (100 vs. 205 min, p < 0.01) and less blood loss (5 vs. 30 mL, p = 0.02). The incidence of postoperative complications did not differ significantly (p = 0.84). AE-ILD occurred in three patients (8%) in the WG and four patients (4%) in the AG. Perioperative mortality was 0% in the WG and 2% in the AG; both deaths were due to AE-ILD. Marginal recurrence was observed in four patients (11%) in the WG. Conclusions: Although AE-ILD incidence was higher, no deaths due to IP-AE were observed in the WG. While wedge resection cannot completely prevent postoperative AE-ILD, it may reduce perioperative mortality in lung cancer patients with ILD. Full article

(This article belongs to the Section Respiratory Medicine)

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14 pages, 1704 KiB

Open AccessFeature PaperArticle

Retinal Thinning in Attention Deficit Hyperactivity Disorder (ADHD): Structural Changes Detected by Spectral-Domain OCT

by Carmen Miquel-Lopez, Jose Javier Garcia-Medina, A. Eusebio Lopez-Hernandez, Diego Garcia-Ayuso, Maravillas De-Paco-Matallana, Javier Hernandez-Olivares, Maria Dolores Pinazo-Duran and Monica Del-Rio-Vellosillo

J. Clin. Med. 2025, 14(16), 5723; https://doi.org/10.3390/jcm14165723 - 13 Aug 2025

Abstract

Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. As the retina is an extension of the central nervous system, retinal imaging may provide insights into the ADHD pathophysiology. The objective of this work was to evaluate structural retinal alterations [...] Read more.

Background/Objectives: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. As the retina is an extension of the central nervous system, retinal imaging may provide insights into the ADHD pathophysiology. The objective of this work was to evaluate structural retinal alterations using optical coherence tomography (OCT) in ADHD patients compared to neurotypical controls. Methods: A case–control study involving 200 eyes (100 from 50 patients with ADHD and 100 from 50 controls) was conducted by comparing the thicknesses of the macular region (total retina, inner and outer retinal layers, ganglion cell layer plus inner plexiform layer [GCIPL], and macular retinal nerve fiber layer [mRNFL]), the peripapillary region (pRNFL), and the optic nerve head (ONH) parameters. Areas under the curve (AUCs) were calculated to evaluate diagnostic performance. Right and left eyes were analyzed separately. Results: Patients with ADHD showed a significant reduction in total and outer retinal thickness across several macular sectors in both eyes. No significant differences were observed in mRNFL, GCIPL, inner retina, pRNFL, or ONH parameters between groups. AUC values derived from ROC analysis indicate moderate diagnostic performance for total and outer retinal thickness in the macular region. Conclusions: ADHD is associated with retinal thinning in the macula (total and outer retinal thickness) in both eyes, suggesting the potential of OCT-based biomarkers for this condition. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

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20 pages, 783 KiB

Open AccessReview

A Scoping Review of Clinical Features and Mechanisms of Orofacial Pain and Headache in Patients with Head and Neck Cancer

by Ernesto Anarte-Lazo and Carlos Bernal-Utrera

J. Clin. Med. 2025, 14(16), 5722; https://doi.org/10.3390/jcm14165722 - 13 Aug 2025

Abstract

Background: Orofacial pain (OFP) and headache are common and disabling conditions in people with head and neck cancer (HNC), although their clinical characteristics and underlying pain mechanisms remain poorly studied, leading to worse diagnosis and, thus, management. Therefore, this review aims to synthesize [...] Read more.

Background: Orofacial pain (OFP) and headache are common and disabling conditions in people with head and neck cancer (HNC), although their clinical characteristics and underlying pain mechanisms remain poorly studied, leading to worse diagnosis and, thus, management. Therefore, this review aims to synthesize the literature regarding clinical features, pain descriptors, mechanisms, and assessment tools of OFP and/or headache in adults with HNC. Methods: A scoping review was conducted following the Arksey and O’Malley framework and reported using PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, and Web of Science. Quantitative and qualitative original studies were included. Data were charted and summarized using narrative synthesis. Results: Of 3647 records initially retrieved, 32 studies met the inclusion criteria. Most studies were observational and heterogeneous in design, population, and pain assessment methods. OFP was highly prevalent, with neuropathic descriptors (e.g., burning, electric shocks, tingling) reported in 13.1% to 64.5% of patients, although heterogeneity in study design and tools used to assess this potential pain mechanism was high. Pain was frequently localized at the tumor site, although pain in other regions beyond the head and neck was also reported. Pain intensity was generally moderate, although varied across studies. OFP and headache in HNC patients were often neuropathic in nature and contributed significantly to disability and reduced quality of life. Most articles lacked mechanistic classifications of pain, although some suggested that central sensitization may be involved in some patients. Conclusions: Orofacial pain and headache are prevalent, under-characterized symptoms in HNC patients. There is an urgent need for standardized assessments using validated tools to improve phenotyping and inform targeted treatment strategies. Full article

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

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16 pages, 773 KiB

Open AccessArticle

Barriers to Timely Referral of Children Born with Myelomeningocele in Zambia

by Rya Muller, Kabelele Sipalo, Caitlyn Beals, Angela Chazura, Stephanie Chola, Roxanna Garcia, Brooks Jackson, Joseph Feinglass, Kirill V. Nourski, Marie-Renee Mala Wa Mpoyi, Humphrey Kunda and Rebecca Reynolds

J. Clin. Med. 2025, 14(16), 5721; https://doi.org/10.3390/jcm14165721 - 13 Aug 2025

Abstract

Background: Congenital anomalies impact 52 million infants worldwide with an estimated 94% living in low- and middle-income countries (LMICs). Approximately 200,000 children are born with a neural tube defect (NTD) in LMICs annually. Zambia is an LMIC with a high burden of [...] Read more.

Background: Congenital anomalies impact 52 million infants worldwide with an estimated 94% living in low- and middle-income countries (LMICs). Approximately 200,000 children are born with a neural tube defect (NTD) in LMICs annually. Zambia is an LMIC with a high burden of myelomeningocele (MMC; a severe form of NTD). This study sought to characterize the barriers influencing access to healthcare for children born with MMC in Zambia. Methods: Two cross-sectional surveys were administered to healthcare providers at referring public health facilities and mothers of infants born with MMC undergoing surgical closure. The survey among mothers was nested in a longitudinal study evaluating surgical closure in Lusaka, Zambia from 28 May 2024 to 21 January 2025. Results: Sixty-nine mother–MMC baby dyads and 123 providers from 21 facilities were enrolled in the study. The median age at presentation for MMC was 7.5 (range 0–244) days old. Most patients were referred from rural district hospitals (51%; n = 35) and travelled greater than 250 km to access care (80%; n = 55). Seventy-seven percent (n = 53) of mothers reported receiving at least one antenatal ultrasound, with 62% (n = 43) undergoing an ultrasound after 20 weeks estimated gestational age. Of these, only 3% (n = 2) received an MMC diagnosis prior to delivery. Referring patients with MMC for further care greater than six hours after birth was reported by 59% providers (n = 73). Hospitals further away from the tertiary center were more likely to report late referrals (p < 0.001). Conclusions: There is a delay in the diagnosis and referral of infants with MMC to specialized care in Zambia, which may be attributed to inadequate in utero diagnosis capabilities and distance from the tertiary facility. Improving the accuracy of prenatal diagnosis and strengthening referral pathways to facilitate access to care among infants with MMC in Zambia are important for improving incidence and outcomes. Full article

(This article belongs to the Special Issue Neurosurgery: Current Challenges and New Perspectives)

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14 pages, 693 KiB

Open AccessArticle

Short-Term Clinical and Biochemical Outcomes of Infants Born After 34 Weeks of Gestation with Mild-to-Moderate Cord Blood Acidosis—A Retrospective Study

by Ayala Gover, Arieh Riskin, Livnat Sharkansky, Rawan Hijazi, Ranin Ghannam and Hussein Zaitoon

J. Clin. Med. 2025, 14(16), 5720; https://doi.org/10.3390/jcm14165720 - 13 Aug 2025

Abstract

Background/Objectives: Umbilical cord pH is used as a predictor of risk for poor neurologic outcome in high-risk newborns. While data on neonates with severe acidemia show a strong association with birth asphyxia and long-term adverse outcomes, the significance of mild-to-moderate acidemia is [...] Read more.

Background/Objectives: Umbilical cord pH is used as a predictor of risk for poor neurologic outcome in high-risk newborns. While data on neonates with severe acidemia show a strong association with birth asphyxia and long-term adverse outcomes, the significance of mild-to-moderate acidemia is less clear. This study aimed to investigate short-term outcomes of late preterm and term infants born with mild-to-moderate cord blood acidosis and to compare the predictive ability of pH and base excess. Methods: This was a retrospective cohort study, including term and late preterm (≥34 weeks) neonates with mild–moderate umbilical cord blood acidosis, defined as pH 7.0–7.2 or base excess between −12 and −16. Data including demographic, clinical, and laboratory measures were extracted. The cohort population was stratified based on the level of acidosis, mild or moderate, with separate analyses performed by definitions of pH and BE. Mild acidosis was defined as cord blood pH 7.13–7.20 and base excess > −12 and moderate acidosis was defined as cord blood pH 7.00–7.12 or base excess between −12 and −16. Results: The study included 337 newborns. Most had mild acidosis, but 90 infants had BE of −12 to −16 and 86 infants had pH 7.00–7.12. Rate of NICU admission was 12.8% (43/337), rising up to 27% among newborns with moderate acidosis. The leading cause for admission was respiratory distress, and there were no cases of moderate–severe HIE. Renal and hepatic dysfunction were more common in moderate compared to mild acidosis; however, most lab abnormalities were mild and transient. Using ROC curves, BE ≤ −12 was found to be a better predictor for renal and liver involvement than pH ≤ 7.12. Conclusions: Moderate acidosis in cord blood was associated with an increased incidence of short-term neonatal morbidities, NICU admissions and renal or liver dysfunction compared to mild cord blood acidemia. BE correlated with abnormal values better than pH. Infants with cord gas BE levels ≤ −12 may benefit from closer clinical monitoring and assessment of renal and liver function. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management of Neonatal Diseases)

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11 pages, 1041 KiB

Open AccessArticle

Predictors of Suboptimal Response After Radiofrequency Ablation of Benign Thyroid Nodules

by Giacomo Di Filippo, Fabio Medas, Giulia Gobbo, Leonardo Rossi, Giovanni Lazzari, Dorin Serbusca, Eleonora Morelli, Federico Cappellacci, Marco Puccini, Gabriele Materazzi and Gian Luigi Canu

J. Clin. Med. 2025, 14(16), 5719; https://doi.org/10.3390/jcm14165719 - 12 Aug 2025

Abstract

Objective: Radiofrequency ablation (RFA) has gained recognition as a minimally invasive alternative to surgery for managing symptomatic benign thyroid nodules. However, predicting RFA efficacy remains challenging, especially in identifying patients who may require multiple treatment sessions. The aim of the present study [...] Read more.

Objective: Radiofrequency ablation (RFA) has gained recognition as a minimally invasive alternative to surgery for managing symptomatic benign thyroid nodules. However, predicting RFA efficacy remains challenging, especially in identifying patients who may require multiple treatment sessions. The aim of the present study is to identify predictors of suboptimal volume reduction (SVR), defined as failure to achieve a volume reduction greater than 5% between 6 and 12 months after procedure and persistence of symptoms. Methods: A retrospective single-center analysis of consecutive patients who underwent a single RFA procedure for benign thyroid at Verona University Hospital between 2020 and 2023 was conducted. Clinical data, including nodule volume and compressive symptoms, were collected preoperatively and at 1, 6, and 12 months post-RFA. Regression analysis was performed to identify predictors of SVR and persistence of symptoms. Results: A total of 50 patients were included. Baseline nodule volume, higher ACR-TIRADS score, and higher body mass index (BMI) were identified as independent predictors of SVR (p < 0.05). At 12 months, 18.4% of patients reported persistent compressive symptoms; however, no significant predictors of symptom persistence were identified. Conclusions: RFA is effective in reducing benign thyroid nodule volume, with a minority of patients experiencing persistent symptoms. Baseline nodule volume, ultrasonographic characteristics, and BMI significantly influence RFA outcomes, suggesting the need for additional procedures. Further studies are required to identify predictors of treatment response, enhancing patient selection and optimizing therapeutic efficacy. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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14 pages, 814 KiB

Open AccessReview

Applications of Forced Oscillatory Technique in Obstructive and Restrictive Pulmonary Diseases: A Concise State of the Art

by Claudio Tirelli, Sabrina Mira, Marta Italia, Sara Maggioni, Carmelo Intravaia, Martina Zava, Simone Contino, Elena Maria Parazzini and Michele Mondoni

J. Clin. Med. 2025, 14(16), 5718; https://doi.org/10.3390/jcm14165718 - 12 Aug 2025

Abstract

The FOT is a non-invasive method for assessing respiratory mechanics. It enables the measurement of respiratory system impedance by applying pressure oscillations through a loudspeaker at the subject mouth and then studying its deformation, which is commensurate to the resistance opposed by the [...] Read more.

The FOT is a non-invasive method for assessing respiratory mechanics. It enables the measurement of respiratory system impedance by applying pressure oscillations through a loudspeaker at the subject mouth and then studying its deformation, which is commensurate to the resistance opposed by the respiratory system. The main parameters which can be determined with the FOT are the impedance (Z) and the components of respiratory resistance (Rrs) and reactance (Xrs). The FOT has been predominantly applied to the study of respiratory mechanics for research purposes; however, preclinical experiments and subsequently observational clinical studies have demonstrated that FOT can effectively assess airway obstruction, bronchodilator response, bronchial hyperresponsiveness, and the presence of small airways disease. More recently, studies on the FOT in restrictive lung diseases have also been reported. Nonetheless, international guidelines on the precise applications of the FOT in lung diseases are still lacking. The aim of the review was to describe the technical aspects related to the FOT methodology in clinical practice and to provide a concise state of the art on the applications of the FOT in obstructive and restrictive lung diseases. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Pulmonology)

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