Journal of Clinical Medicine

14 pages, 684 KiB

Open AccessArticle

Prevalence and Risk Factors of Oral Lesions in a Portuguese Subpopulation: A Retrospective Study

by Carolina Doroteia, Gonçalo Martins Pereira, Luís Proença, José João Mendes and Maria Alzira Cavacas

J. Clin. Med. 2025, 14(10), 3294; https://doi.org/10.3390/jcm14103294 (registering DOI) - 9 May 2025

Abstract

Background/Objectives: Oral cancer is a significant global public health concern. Understanding the prevalence and associated risk factors of oral lesions is essential for developing effective preventive strategies. This study aimed to assess the prevalence and risk factors of oral lesions submitted for biopsy [...] Read more.

Background/Objectives: Oral cancer is a significant global public health concern. Understanding the prevalence and associated risk factors of oral lesions is essential for developing effective preventive strategies. This study aimed to assess the prevalence and risk factors of oral lesions submitted for biopsy in a Portuguese subpopulation. A retrospective cross-sectional analysis was conducted using data from patients who sought dental care at the Egas Moniz Dental Clinic (EMDC) in the Lisbon metropolitan area. Methods: Data analysis was performed on a sample of 264 patients who attended the EMDC between October 2016 and December 2019 to ascertain the presence of oral lesions, their different types, and their correlation with potential risk factors. The analysis included all patients who underwent biopsy, and their pathology reports were reviewed. Results: The prevalence of oral lesions was 10.3%, affecting 58.7% females and 41.3% males, with a mean age of 55 years. The most frequently biopsied site was the buccal mucosa (23.5%). Non-neoplastic lesions accounted for 75.0% of cases, while mesenchymal lesions were the most common neoplastic category (58.5%). The most prevalent diagnosis was fibroepithelial hyperplasia (36.7%). A statistically significant association was observed between neoplastic lesions and statin use, as well as between both neoplastic and non-neoplastic lesions and the use of antidiabetic medications. Conclusions: Oral lesions are prevalent, with non-neoplastic lesions being the most frequent. Understanding their nature, prevalence, and associated risk factors is crucial for early and accurate diagnosis, aiding in disease prevention and management. Full article

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

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14 pages, 2334 KiB

Open AccessArticle

Balance or Strength? Reconsidering Muscle Metrics in Sagittal Malalignment in Adult Sagittal Deformity Patients

by Donghua Huang, Zhan Wang, Mihir Dekhne, Atahan Durbas, Tejas Subramanian, Gabrielle Dykhouse, Robert N. Uzzo, Luis Felipe Colón, Stephane Owusu-Sarpong, Han Jo Kim and Francis Lovecchio

J. Clin. Med. 2025, 14(10), 3293; https://doi.org/10.3390/jcm14103293 (registering DOI) - 9 May 2025

Abstract

Background/Objectives: Atrophy of the paraspinal and psoas major muscles is closely linked to sagittal malalignment in adult spinal deformity (ASD). However, most studies overlook the balance between these muscle groups. This study investigates the relationship between trunk muscle balance and sagittal alignment [...] Read more.

Background/Objectives: Atrophy of the paraspinal and psoas major muscles is closely linked to sagittal malalignment in adult spinal deformity (ASD). However, most studies overlook the balance between these muscle groups. This study investigates the relationship between trunk muscle balance and sagittal alignment in ASD patients. Methods: A single-institution database was reviewed for patients with sagittal malalignment (PT > 20° and PI–LL > 10°). Standard sagittal parameters were measured based on standing X-rays. The cross-section area (CSA) of trunk posterior muscles (CSA^P: erector spinae and multifidus) and anterior muscles (CSA^A: psoas) at L4 were measured based on a T2-weighted MRI. Patients with prior lateral fusions were excluded. Muscle balance was evaluated by the CSA ratio of trunk posterior to anterior muscles (CSA^P/A). The relationship between sagittal alignment parameters and CSA^P, CSA^A, as well as CSA^P/A were analyzed using linear and quadratic regressions. Akaike information criteria (AIC) compared model fit. Subgroup analyses examined the relationship between sagittal alignment changes and different CSA^P/A levels. Results: A total of 112 patients met inclusion and exclusion criteria. CSA^P correlated linearly with SS (r² = 0.057, p = 0.011), PT (r² = 0.043, p = 0.028), and T4–L1PA mismatch (r² = 0.044, p = 0.027). CSA^A showed no significant linear or quadratic relationships with sagittal spinal alignment parameters. In contrast, CSA^P/A was quadratically associated with LL (r² = 0.056, p = 0.044), SS (r² = 0.134, p < 0.001), PI (r² = 0.096, p = 0.004), L1PA (r² = 0.114, p = 0.001), and T4–L1PA mismatch (r² = 0.094, p = 0.005). Quadratic models of CSA^P/A consistently had higher r² and lower AIC values compared to the linear models of CSA^P for most sagittal alignment parameters, especially in SS, PI, L1PA, and T4–L1PA mismatch (AIC difference ≥4). Higher CSA^P/A is correlated to larger PI (and consequently, larger LL, SS, and L1PA). Conclusions: Trunk posterior–anterior muscle balance (CSA^P/A) demonstrates a stronger relationship with sagittal alignment than individual muscle metrics. Quantitative MRI-based definitions of sarcopenia may need to be adjusted for PI. Full article

(This article belongs to the Special Issue Optimizing Outcomes in Scoliosis and Complex Spinal Surgery)

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9 pages, 9435 KiB

Open AccessBrief Report

The Efficiency of FLAIR Images for Hemodynamic Change After STA-MCA Bypass with Moyamoya Disease and Symptomatic Steno-Occlusive Disorder

by Hyun Dong Yoo, Seung Young Chung, Seong Min Kim, Ki Seok Park, Seung Jun Ryu and Jae Guk Kim

J. Clin. Med. 2025, 14(10), 3292; https://doi.org/10.3390/jcm14103292 (registering DOI) - 8 May 2025

Abstract

Background: Hyperintense vessels (HVs) visualized on FLAIR MRI are believed to reflect sluggish antegrade or retrograde flow in leptomeningeal collaterals that develop in response to major intracranial artery stenosis or occlusion. HV is frequently observed in conditions such as Moyamoya disease and [...] Read more.

Background: Hyperintense vessels (HVs) visualized on FLAIR MRI are believed to reflect sluggish antegrade or retrograde flow in leptomeningeal collaterals that develop in response to major intracranial artery stenosis or occlusion. HV is frequently observed in conditions such as Moyamoya disease and symptomatic ICA/MCA steno-occlusion. However, the relationship between HV and cerebral hemodynamics—and the effect of STA-MCA bypass on HV—remains inadequately characterized. This study aimed to investigate the relationship between HV on FLAIR and cerebral vascular hemodynamic status, as measured by SPECT, in patients with Moyamoya disease and symptomatic ICA/MCA occlusion. The secondary goal was to assess the impact of recanalization through STA-MCA bypass surgery on the presence of HV. Methods: We retrospectively analyzed 49 patients with symptomatic ICA or MCA steno-occlusion who underwent STA-MCA bypass between 2015 and 2020. Pre- and postoperative FLAIR MRIs were evaluated, and HV presence was graded as negative (0), minimal (1), or positive (2). SPECT was utilized to assess cerebrovascular reserve (CVR) in regions exhibiting various HV intensities. Follow-up FLAIR imaging was performed 3–14 months postoperatively to correlate HV changes with hemodynamic improvements observed via SPECT. Result: HV was present in 74% (36/49) of affected hemispheres. Regions exhibiting minimal or positive HV demonstrated a significantly lower CVR compared to HV-negative areas, indicating compromised perfusion. Following bypass surgery, HV was reduced or resolved in 65% (32/49) of patients, and this regression corresponded with improved CVR as confirmed by both SPECT and perfusion MRI. Conclusions: HV presence on FLAIR imaging is associated with impaired cerebrovascular hemodynamics in patients with Moyamoya disease or symptomatic large-vessel steno-occlusion. HV-positive territories exhibit reduced CVR, while surgical revascularization via STA-MCA bypass leads to hemodynamic improvement and concurrent HV reduction. These findings support HV as a potential surrogate marker for treatment response. Full article

(This article belongs to the Section Clinical Neurology)

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17 pages, 5112 KiB

Open AccessArticle

Biomechanical Impact of Cementation Technique Variations on Femoral Stem Stability: An In Vitro Polyurethane Model Study

by Roland Fazakas, Laura Ioana Bondar, Csongor Toth, Brigitte Osser, Iosif Ilia, Caius Calin Miuta, Dan Fruja, Diana Carina Iovanovici, Liviu Gavrila-Ardelean and Alexandru Pop

J. Clin. Med. 2025, 14(10), 3291; https://doi.org/10.3390/jcm14103291 - 8 May 2025

Abstract

Background/Objectives: Achieving optimal primary stability in cemented total hip arthroplasty remains a critical factor influencing long-term implant success. Variability in cementation techniques can significantly affect biomechanical performance, yet consensus on best practices is lacking. This study investigates the influence of cementation parameters on [...] Read more.

Background/Objectives: Achieving optimal primary stability in cemented total hip arthroplasty remains a critical factor influencing long-term implant success. Variability in cementation techniques can significantly affect biomechanical performance, yet consensus on best practices is lacking. This study investigates the influence of cementation parameters on femoral stem fixation. Methods: This in vitro comparative study evaluated four cementation techniques—Classic (line-to-line), Press-Fit (undersized reaming), Overreaming (oversized reaming), and Valgus Malpositioning (15° deviation). An experimental model using standardized Polyurethane (PU) bone surrogates was developed. Mechanical testing assessed axial deformation and ultimate load capacity to failure. Results: The Press-Fit technique demonstrated significantly greater deformation (17.10 ± 0.89 mm) but a reduced load capacity (6317.47 ± 518.34 N) compared to the Classic approach. Overreaming and Valgus techniques both showed reduced mechanical performance, with Overreaming yielding the lowest structural integrity. Conclusions: Cement mantle thickness emerged as the primary determinant of biomechanical stability, surpassing the impact of implant positioning. While increased mantle thickness improves energy absorption, it may compromise ultimate strength. These findings underscore the importance of optimizing the cementation technique to balance flexibility and mechanical resistance, guiding surgical protocols toward improved implant longevity. This study introduces a novel integrative approach combining fluoroscopic assessment of cement mantle morphology with mechanical testing in a standardized model, providing new evidence on the relative influence of mantle thickness and implant malposition on femoral stem stability. Full article

(This article belongs to the Section Orthopedics)

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22 pages, 3412 KiB

Open AccessArticle

Seasonal Mortality Patterns Analyzing Epidemiological Impact of COVID-19 on Overall Mortality Rates in Belgrade, Serbia Over Three-Year Period (2020–2023): Mental Health Consequences and Public Health Implications

by Jelena Milic, Zoran Kokic, Predrag Kon, Milica Vucurovic, Sonja Novak, Nadezda Popovic and Vuk Marusic

J. Clin. Med. 2025, 14(10), 3290; https://doi.org/10.3390/jcm14103290 - 8 May 2025

Abstract

Background/Objectives: Seasonal variations in mortality rates are well-documented, particularly during the winter months when mortality typically increases. This rise in mortality, ranging from 5% to 25%, is often associated with chronic cardiovascular and respiratory diseases. Understanding these seasonal fluctuations is essential for [...] Read more.

Background/Objectives: Seasonal variations in mortality rates are well-documented, particularly during the winter months when mortality typically increases. This rise in mortality, ranging from 5% to 25%, is often associated with chronic cardiovascular and respiratory diseases. Understanding these seasonal fluctuations is essential for guiding public health interventions. This study analyzes mortality rates and excess mortality in Belgrade from March 2020 to May 2023, focusing on the impact of the COVID-19 pandemic on overall mortality trends. The primary objective of this study is to assess the impact of the COVID-19 pandemic on mortality rates in Belgrade during the study period. The first secondary objective is to evaluate seasonal variations in mortality, with a focus on the 10.57% overall increase in mortality, and to highlight the 34.23% rise in winter mortality recorded in 2020. The second secondary objective is to assess the effectiveness of public health measures in mitigating excess mortality during this period. Methods: A descriptive epidemiological approach was used to analyze monthly mortality data from the City Bureau of Statistics. Mortality rates were standardized using direct standardization and compared winter (December-February) and non-winter (March-November) periods. Trends, percentage increases, and age-specific mortality were analyzed based on the 2011 census methodology. Results: Mortality rates in Belgrade ranged from 1115.67 to 1267.19 deaths per 100,000 inhabitants, with an average of 1205.62. Standardized mortality rates ranged from 936.49 to 1111.67, averaging 1021.64. The winter months showed higher mortality, averaging 1716 deaths per 100,000, compared to 1558 in the non-winter months. Conclusions: The winter months exhibited significantly higher mortality rates, likely exacerbated by the COVID-19 pandemic. Targeted public health policies and interventions are necessary to reduce seasonal mortality risks during future public health crises. Full article

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

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22 pages, 714 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Lung Function and Treatment Decisions in Children with Asthma: A Retrospective Study

by Jaqueline Abdul-Razzak, Mihaela Ionescu, Radu Diaconu, Alexandru Dan Popescu, Elena Carmen Niculescu, Ileana Octavia Petrescu, Cristina Elena Singer, Carmen Simona Coșoveanu, Liliana Anghelina and Cristian Gheonea

J. Clin. Med. 2025, 14(10), 3289; https://doi.org/10.3390/jcm14103289 - 8 May 2025

Abstract

Background/Objectives: Asthma outcomes in children and adolescents largely depend on parental adherence to prescribed treatment plans. This study investigates how the COVID-19 pandemic influenced parental decision-making in managing their children’s asthma, regardless of whether the children were infected with SARS-CoV-2. Material and [...] Read more.

Background/Objectives: Asthma outcomes in children and adolescents largely depend on parental adherence to prescribed treatment plans. This study investigates how the COVID-19 pandemic influenced parental decision-making in managing their children’s asthma, regardless of whether the children were infected with SARS-CoV-2. Material and method: In this research, 146 children with asthma were analyzed based on the following data: demographic parameters (gender, age group, and residence), before and after measurements of FeNO and pulmonary function test parameters were performed to assess the evolution of asthma for infected and non-infected children, exacerbations, parents’ compliance with the treatment, changes in treatment steps performed by physicians, and the GINA asthma control levels. Results: The effect of parent self-management of doses was evident in the variation of FeNO and pulmonary function test parameters before and after COVID-19 disease, including children with asthma who did not contract the virus, in the decrease in well-controlled asthma cases, as well as in the number of exacerbations per year. A step-down in treatment doses was statistically associated with increased FeNO values (p < 0.0005), and decreased FEV1 values (p = 0.025). Higher values of FeNO were statistically significantly associated with a higher number of exacerbations per year (p < 0.0005). There was a statistically significant moderately strong association between the treatment steps evolution (decided by the attending physician) and parents’ self-management of doses in the attempt to assess the control of the disease of children with asthma (p = 0.019). Also, 80.95% of children for whom the parents performed a step-down in dose no longer presented well-controlled asthma, leading to a statistically significant association relative to the level of asthma control and doses adjustments (p < 0.0005). Conclusions: During epidemiological circumstances, a strong collaboration between the parents/caregivers/pediatric patients with asthma and attending physicians is essential to correctly assess the symptoms and to comply the asthma treatment with ICS and a bronchodilator in order to control the disease. Full article

(This article belongs to the Section Clinical Pediatrics)

17 pages, 1101 KiB

Open AccessArticle

Proximal Landing Zone’s Impact on Outcomes of Branched and Fenestrated Aortic Arch Repair

by Petroula Nana, Konstantinos Spanos, Giuseppe Panuccio, José I. Torrealba, Fiona Rohlffs, Christian Detter, Yskert von Kodolitsch and Tilo Kölbel

J. Clin. Med. 2025, 14(10), 3288; https://doi.org/10.3390/jcm14103288 (registering DOI) - 8 May 2025

Abstract

Background/Objectives: The impact of the proximal landing zone has not been investigated in fenestrated and branched endovascular aortic arch repair (f/bTEVAR). This study aimed to analyze the f/bTEVAR outcomes in patients with non-native (nNPAL) vs. native proximal aortic landing (NPAL). Methods: The [...] Read more.

Background/Objectives: The impact of the proximal landing zone has not been investigated in fenestrated and branched endovascular aortic arch repair (f/bTEVAR). This study aimed to analyze the f/bTEVAR outcomes in patients with non-native (nNPAL) vs. native proximal aortic landing (NPAL). Methods: The STROBE statement was followed in order to conduct a single-center retrospective analysis of patients with nNPAL vs. NPAL managed, from 1 September 2011 to 30 June 2022, with f/bTEVAR. The primary outcomes were technical success, 30-day mortality and stroke. Results: A total of 83 patients with nNPAL vs. 126 patients with NPAL were included. Among the nNPAL group, 34 (39.7%) underwent previous aortic arch replacement and the remaining underwent an ascending aortic replacement. The nNPAL patients were more commonly treated for chronic dissections (nNPAL: 70.6% vs. NPAL: 21.6%, p < 0.001), presented a more proximal disease (zone 0: nNPAL: 27.7% vs. NPAL: 7.1%, p < 0.001; zone 1: nNPAL: 50.6% vs. NPAL: 10.2%, p < 0.001) and received more triple-branch devices (nNPAL: 16.9% vs. NPAL: 3.2%, p < 0.001), with a higher rate of Ishimaru zone 0 landing (nNPAL: 86.8% vs. NPAL: 51.6%, p < 0.001). Technical success (nNPAL: 98.8% vs. NPAL: 94.4%, p = 0.07) and 30-day mortality (nNPAL: 6.0%, vs. NPAL: 11.9%, p = 0.16) were similar. Stroke was lower among nNPAL patients (nNPAL: 4.8% vs. NPAL: 13.5%, p = 0.04). A multivariate regression analysis confirmed nNPAL as an independent protector for stroke (p = 0.002). Survival (log rank: p = 0.02) was higher within the nNPAL group at 24 months. Conclusions: f/bTEVAR in patients with nNPAL zone showed encouraging outcomes. Despite more proximal landing in zone 0, stroke was significantly lower when compared to NPAL patients. Full article

(This article belongs to the Special Issue Advances in Aortic Surgery)

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17 pages, 861 KiB

Open AccessArticle

Effects of Whole-Body and Lower-Body Cold-Water Immersion on Exercise-Induced Pain Score, Muscle Damage Indices, and Maximal Voluntary Isometric Contractions

by Jinseok Lee, Jeheon Moon and Namsu Kim

J. Clin. Med. 2025, 14(10), 3287; https://doi.org/10.3390/jcm14103287 - 8 May 2025

Abstract

Background/Objectives: The aim of this study was to assess the effects of cold-water immersion (CWI) post-eccentric muscle contraction exercise on skin temperature, pain score, maximum voluntary isometric contraction (MVIC), muscle damage, and muscle mechanical properties. Methods: Twenty-seven male participants (age 20.6 [...] Read more.

Background/Objectives: The aim of this study was to assess the effects of cold-water immersion (CWI) post-eccentric muscle contraction exercise on skin temperature, pain score, maximum voluntary isometric contraction (MVIC), muscle damage, and muscle mechanical properties. Methods: Twenty-seven male participants (age 20.6 ± 0.6; body mass 69.4 ± 8.1; body fat % 13.7 ± 4.3) were divided into three treatments: whole-body CWI treatment group (n = 9), lower-body CWI treatment group (n = 9), and control treatment group (n = 9). Results: MVIC did not show a significant interaction effect between group and time but demonstrated a significant main effect for time (p = 0.001). The pain scale demonstrated a significant interaction effect between group and treatment (p = 0.049), in addition to significant main effects for both time and treatment (both p = 0.001). While blood creatine kinase (CK) concentration revealed no significant interaction effect between group and time, a significant main effect was observed for time (p = 0.001). Blood lactate dehydrogenase (LDH) concentration showed both a significant interaction effect between group and time (p = 0.02) and a significant main effect for time (p = 0.001). The tensiomyography (TMG) results for Dm showed a significant interaction effect between group and treatment (p = 0.047), as well as a significant main effect for time (p = 0.001). Conclusions: Lower-body CWI is effective in reducing pain indices and blood LDH levels, a marker of muscle damage. It may serve as an effective method for preventing and minimizing pain and muscle damage, comparable to whole-body CWI. Full article

(This article belongs to the Section Sports Medicine)

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17 pages, 296 KiB

Open AccessReview

Interventional Endoscopic Ultrasonography: Advances in Application

by Haidar Khan, Sharon Slomovich, Neal C. Shah and Frank Gress

J. Clin. Med. 2025, 14(10), 3286; https://doi.org/10.3390/jcm14103286 - 8 May 2025

Abstract

Technological advances have greatly expanded the diagnostic and therapeutic capabilities of endoscopic ultrasound (EUS). The integration of cutting-edge imaging techniques, including tissue harmonic echo, contrast-enhanced harmonic EUS, elastography, and needle-based confocal laser endomicroscopy, have significantly enhanced lesion characterization and diagnostic accuracy. Additionally, developments [...] Read more.

Technological advances have greatly expanded the diagnostic and therapeutic capabilities of endoscopic ultrasound (EUS). The integration of cutting-edge imaging techniques, including tissue harmonic echo, contrast-enhanced harmonic EUS, elastography, and needle-based confocal laser endomicroscopy, have significantly enhanced lesion characterization and diagnostic accuracy. Additionally, developments in stent design and the introduction of new accessories have broadened the therapeutic applications of EUS. Ongoing innovations in clinical practice have transformed procedures such as drainage, tumor ablation, EUS-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), the placement of fiducial markers, advancements in endohepatology, lesion characterization, and treatment. These developments continue to expand the role of EUS in delivering precise and effective therapeutic interventions. Full article

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

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Graphical abstract

15 pages, 1398 KiB

Open AccessReview

Large Language Models in Cancer Imaging: Applications and Future Perspectives

by Mickael Tordjman, Ian Bolger, Murat Yuce, Francisco Restrepo, Zelong Liu, Laurent Dercle, Jeremy McGale, Anis L. Meribout, Mira M. Liu, Arnaud Beddok, Hao-Chih Lee, Scott Rohren, Ryan Yu, Xueyan Mei and Bachir Taouli

J. Clin. Med. 2025, 14(10), 3285; https://doi.org/10.3390/jcm14103285 - 8 May 2025

Abstract

Recently, there has been tremendous interest on the use of large language models (LLMs) in radiology. LLMs have been employed for various applications in cancer imaging, including improving reporting speed and accuracy via generation of standardized reports, automating the classification and staging of [...] Read more.

Recently, there has been tremendous interest on the use of large language models (LLMs) in radiology. LLMs have been employed for various applications in cancer imaging, including improving reporting speed and accuracy via generation of standardized reports, automating the classification and staging of abnormal findings in reports, incorporating appropriate guidelines, and calculating individualized risk scores. Another use of LLMs is their ability to improve patient comprehension of imaging reports with simplification of the medical terms and possible translations to multiple languages. Additional future applications of LLMs include multidisciplinary tumor board standardizations, aiding patient management, and preventing and predicting adverse events (contrast allergies, MRI contraindications) and cancer imaging research. However, limitations such as hallucinations and variable performances could present obstacles to widespread clinical implementation. Herein, we present a review of the current and future applications of LLMs in cancer imaging, as well as pitfalls and limitations. Full article

(This article belongs to the Section Oncology)

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15 pages, 268 KiB

Open AccessReview

Kisspeptins Regulating Fertility: Potential Future Therapeutic Approach in Infertility Treatment

by Sonia Kotanidou, Nikos Nikolettos, Nektaria Kritsotaki, Panagiotis Tsikouras, Angeliki Tiptiri-Kourpeti and Konstantinos Nikolettos

J. Clin. Med. 2025, 14(10), 3284; https://doi.org/10.3390/jcm14103284 - 8 May 2025

Abstract

Kisspeptins play a crucial role in the normal functioning of the reproductive axis in both humans and animals by stimulating the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Recent studies have investigated the association of kisspeptins to infertility of diverse causes and [...] Read more.

Kisspeptins play a crucial role in the normal functioning of the reproductive axis in both humans and animals by stimulating the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Recent studies have investigated the association of kisspeptins to infertility of diverse causes and the therapeutic potential of kisspeptins in infertility. Exogenous administration of kisspeptins appears to hold significant promise in restoring fertility, with ongoing studies in their application in ovarian stimulation protocols and as cryoprotectants during vitrification. This review provides a comprehensive analysis of the role of kisspeptins in reproductive physiology and their potential as therapeutic agents for infertility, highlighting their advantages over conventional treatments and their future prospects in clinical practice. Full article

(This article belongs to the Special Issue Assisted Reproductive Technology and Infertility Treatment: Current Updates and Perspectives)

19 pages, 1582 KiB

Open AccessArticle

Diagnostic and Psychometric Properties of the Arabic Sensory Processing Measure—Second Edition, Adult Version

by Hind M. Alotaibi, Ahmed Alduais, Fawaz Qasem and Muhammad Alasmari

J. Clin. Med. 2025, 14(10), 3283; https://doi.org/10.3390/jcm14103283 (registering DOI) - 8 May 2025

Abstract

Background: Sensory processing difficulties can interfere with daily functioning and participation across adulthood. While standardized assessment tools exist, culturally validated instruments for Arabic-speaking adults remain limited. Objectives: This study aimed to validate the Arabic version of the Sensory Processing Measure—Second Edition (SPM-2) [...] Read more.

Background: Sensory processing difficulties can interfere with daily functioning and participation across adulthood. While standardized assessment tools exist, culturally validated instruments for Arabic-speaking adults remain limited. Objectives: This study aimed to validate the Arabic version of the Sensory Processing Measure—Second Edition (SPM-2) Adult Self-Report form in a Saudi population and evaluate its utility for the early detection of sensory processing challenges in at-risk individuals. Methods: A total of 399 Saudi adults (205 females and 194 males), aged 21 to 87 years (M = 44.1; SD = 16.2), completed the Arabic SPM-2 online. The scale consists of eight subscales, six of which form the Sensory Total score—Vision, Hearing, Touch, Taste and Smell, Body Awareness, and Balance and Motion—representing core sensory processing abilities (i.e., Sensory Total (ST)). The remaining two—Planning and Ideas and Social Participation—capture higher-order integrative functions and do not contribute to the ST. Results: The overall scale demonstrated strong internal consistency (α = 0.89), with subscale alphas ranging from 0.43 (Hearing) to 0.70 (Body Awareness). Confirmatory factor analysis (CFA) (χ² [3052] = 4147.4; p < 0.001) showed good absolute fit (RMSEA = 0.030) and moderate incremental fit (CFI = 0.74; TLI = 0.73), values that are typical for large-df models. Descriptive and cluster analyses identified distinct participant subgroups with elevated frequency ratings (scores of 2 or 3) suggestive of sensory risk. Significant age-related differences were observed across multiple sensory domains, while no significant sex-related effects were found. Conclusions: Although Social Participation and Hearing showed lower reliability, the Arabic SPM-2 exhibits sound internal structure and therefore shows promise for future clinical application once criterion validity is established. The findings support its application in culturally responsive screening, early risk identification, and intervention planning in Arabic-speaking contexts. Full article

(This article belongs to the Section Mental Health)

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28 pages, 3777 KiB

Open AccessArticle

Comparative Evaluation of Large Language and Multimodal Models in Detecting Spinal Stabilization Systems on X-Ray Images

by Bartosz Polis, Agnieszka Zawadzka-Fabijan, Robert Fabijan, Róża Kosińska, Emilia Nowosławska and Artur Fabijan

J. Clin. Med. 2025, 14(10), 3282; https://doi.org/10.3390/jcm14103282 - 8 May 2025

Abstract

Background/Objectives: Open-source AI models are increasingly applied in medical imaging, yet their effectiveness in detecting and classifying spinal stabilization systems remains underexplored. This study compares ChatGPT-4o (a large language model) and BiomedCLIP (a multimodal model) in their analysis of posturographic X-ray images (AP [...] Read more.

Background/Objectives: Open-source AI models are increasingly applied in medical imaging, yet their effectiveness in detecting and classifying spinal stabilization systems remains underexplored. This study compares ChatGPT-4o (a large language model) and BiomedCLIP (a multimodal model) in their analysis of posturographic X-ray images (AP projection) to assess their accuracy in identifying the presence, type (growing vs. non-growing), and specific system (MCGR vs. PSF). Methods: A dataset of 270 X-ray images (93 without stabilization, 80 with MCGR, and 97 with PSF) was analyzed manually by neurosurgeons and evaluated using a three-stage AI-based questioning approach. Performance was assessed via classification accuracy, Gwet’s Agreement Coefficient (AC1) for inter-rater reliability, and a two-tailed z-test for statistical significance (p < 0.05). Results: The results indicate that GPT-4o demonstrates high accuracy in detecting spinal stabilization systems, achieving near-perfect recognition (97–100%) for the presence or absence of stabilization. However, its consistency is reduced when distinguishing complex growing-rod (MCGR) configurations, with agreement scores dropping significantly (AC1 = 0.32–0.50). In contrast, BiomedCLIP displays greater response consistency (AC1 = 1.00) but struggles with detailed classification, particularly in recognizing PSF (11% accuracy) and MCGR (4.16% accuracy). Sensitivity analysis revealed GPT-4o’s superior stability in hierarchical classification tasks, while BiomedCLIP excelled in binary detection but showed performance deterioration as the classification complexity increased. Conclusions: These findings highlight GPT-4o’s robustness in clinical AI-assisted diagnostics, particularly for detailed differentiation of spinal stabilization systems, whereas BiomedCLIP’s precision may require further optimization to enhance its applicability in complex radiographic evaluations. Full article

(This article belongs to the Special Issue Current Progress and Future Directions of Spine Surgery)

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12 pages, 1277 KiB

Open AccessArticle

Development and Validation of Comorbidity Severity Adjustment Methods in Mortality Models for Acute Cerebrovascular Disease Using Survival and Machine Learning Analyses

by Yeaeun Kim and Jongho Park

J. Clin. Med. 2025, 14(10), 3281; https://doi.org/10.3390/jcm14103281 - 8 May 2025

Abstract

Background/Objectives: This study aimed to develop and validate comorbidity-based severity adjustment methods for acute cerebrovascular disease by recalibrating the Charlson Comorbidity Index (CCI) and constructing a CCS-based comorbidity index to improve mortality risk prediction. Methods: Using the Korea Disease Control Agency’s [...] Read more.

Background/Objectives: This study aimed to develop and validate comorbidity-based severity adjustment methods for acute cerebrovascular disease by recalibrating the Charlson Comorbidity Index (CCI) and constructing a CCS-based comorbidity index to improve mortality risk prediction. Methods: Using the Korea Disease Control Agency’s Discharge Injury In-depth Survey Dataset (2013–2022), we applied Cox proportional hazards regression and machine learning techniques, including LASSO, CART, Random Forests, GBM, and ANN, to recalibrate the CCI and develop a CCS-based comorbidity index. Results: The recalibrated Charlson Comorbidity Index (m-CCI) and the newly developed CCS-based comorbidity index (m-CCS) demonstrated improved predictive performance for in-hospital mortality. Among the machine learning models, GBM (AUC = 0.835) and ANN (AUC = 0.830) demonstrated the highest predictive accuracy, with m-CCS consistently outperforming other indices. Conclusions: The recalibrated m-CCI and newly developed m-CCS comorbidity indices enhance mortality risk adjustment for acute cerebrovascular disease patients in Korea. The superior performance of machine learning models underscores their potential for enhancing severity adjustment in hospital benchmarking and quality assessment. Full article

(This article belongs to the Section Vascular Medicine)

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20 pages, 1011 KiB

Open AccessSystematic Review

Minimally Invasive Percutaneous Techniques for the Treatment of Cervical Disc Herniation: A Systematic Review and Meta-Analysis

by Magdalena Rybaczek, Zenon Mariak, Paweł Grabala and Tomasz Łysoń

J. Clin. Med. 2025, 14(10), 3280; https://doi.org/10.3390/jcm14103280 - 8 May 2025

Abstract

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to [...] Read more.

Background: In recent decades, the adoption of minimally invasive (non-endoscopic) cervical techniques has grown significantly. Advancements in surgical instrumentation have broadened the spectrum of available percutaneous interventions, thus providing viable alternative treatment options for patients with prolonged, conservative treatment-resistant ailments due to contained cervical disc herniation. The aim of this study was to perform a systematic review and meta-analysis in order to evaluate the effectiveness and safety of minimally invasive percutaneous (non-endoscopic) cervical techniques. Methods: A comprehensive literature search was conducted using the PubMed, Cochrane Library, and SCOPUS databases up to July 2024, in accordance with the PRISMA guidelines. Outcomes measured included Visual Analogue Scale (VAS) scores, the Neck Disability Index (NDI), and MacNab scores, assessing pain relief and functional recovery. The risk of bias was evaluated using the Cochrane risk of bias tool (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool, with statistical analyses conducted in R software (version 4.3.1). Results: Out of 847 records, 21 studies (covering 1580 patients) were included in the final analysis. Five different percutaneous minimally invasive cervical procedures were incorporated into this review: nucleoplasty (n = 973), discectomy (n = 311), a combination of nucleoplasty and discectomy (n = 98), annuloplasty (n = 33), and pulsed radiofrequency (n = 17). The mean patient age was 49.5, with a gender distribution of 47.7% male and 52.3% female. A meta-analysis of six studies on cervical nucleoplasty (400 patients) demonstrated a significant reduction in pain scores, with a standardized mean difference (SMD) of −4.68 (95% CI: −8.77; −0.59, p = 0.032). However, a high heterogeneity (I² = 98.8%, Q = 407.31, p < 0.001) was observed, indicating significant variability across studies. The reoperation rate among patients was 3.4%, with discitis and device-related complications being the most frequently reported adverse events. Conclusions: Minimally invasive percutaneous cervical interventions provide effective pain relief and functional improvement for patients with cervical disc herniation, as evidenced by reductions in VAS scores and positive MacNab outcomes. The choice of the most appropriate technique should be based on individual clinical scenarios, surgeon expertise, and patient preferences, as no single method demonstrates clear superiority according to clinical outcomes or complication rates. Full article

(This article belongs to the Special Issue Spine Surgery and Rehabilitation: Current Advances and Future Options)

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24 pages, 768 KiB

Open AccessArticle

Public Perception of Clinical Trials and Its Predictors Among Polish Adults

by Alicja Kozakiewicz, Joanna Mazur, Monika Szkultecka-Dębek, Maciej Białorudzki and Zbigniew Izdebski

J. Clin. Med. 2025, 14(10), 3279; https://doi.org/10.3390/jcm14103279 - 8 May 2025

Abstract

Background/Objectives: Public perception of clinical trials (CT) in Poland remains underexplored. This study aims to assess attitudes towards clinical trials, to identify key sociodemographic and health-related predictors of participation willingness, and to evaluate the perceived health impact (CT-PHI) associated with participants’ involvement [...] Read more.

Background/Objectives: Public perception of clinical trials (CT) in Poland remains underexplored. This study aims to assess attitudes towards clinical trials, to identify key sociodemographic and health-related predictors of participation willingness, and to evaluate the perceived health impact (CT-PHI) associated with participants’ involvement in trials. Methods: A cross-sectional online survey was conducted (2–20 March 2022) among 2050 Polish adults who had benefited from medical care in the past 24 months. This study examined sociodemographic factors, health-related factors (self-perceived health, EQ-5D-5L, the level of awareness of patient rights, use of public vs. private healthcare, adherence), and motivations for participation in trials (health-related, financial, and altruistic). Multivariate logistic and generalized linear models identified predictors of participation willingness and CT-PHI variability. Results: Overall, 56.3% of the respondents expressed a willingness to participate in clinical trials. The main motivation was health improvement (45.8%), followed by financial incentives (23.2%) and altruism (22.7%). Those driven by health reasons showed the highest sensitivity to demographic and health-related factors. In this group, higher CT-PHI scores were associated with older age (66+: B = 1.24, p < 0.001), female gender (B = 0.41, p = 0.034), rural residence (B = 0.41, p = 0.033), dual use of public/private healthcare (B = 0.64, p = 0.001), adherence (B = 2.50, p < 0.001), and greater pain severity (moderate: B = 1.36, p < 0.001; severe: B = 0.91, p = 0.023). Socioeconomic factors played a greater role for financially motivated individuals, while altruistic participants showed the least variability in influencing factors. Conclusions: Willingness to participate in clinical trials in Poland is influenced by the motivation type. A patient-centered approach to recruitment strategies, considering diverse motivations and sociodemographic factors, is essential for optimizing participation in clinical trials. Full article

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

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20 pages, 2790 KiB

Open AccessSystematic Review

Advancing Maxillary Reconstruction: A Systematic Review and Meta-Analysis of the Evolving Role of the Scapular Free Flap

by Giovanni Salzano, Veronica Scocca, Stefania Troise, Vincenzo Abbate, Paola Bonavolontà, Luigi Angelo Vaira, Alfonso Scarpa, Jerome R. Lechien, Gianluca De Fazio, Emanuele Carraturo and Giovanni Dell’Aversana Orabona

J. Clin. Med. 2025, 14(10), 3278; https://doi.org/10.3390/jcm14103278 - 8 May 2025

Abstract

Background/Objectives: This systematic review and meta-analysis evaluates the surgical, functional, and aesthetic outcomes of scapular free flaps in maxillary reconstruction. The primary objective is to assess early surgical complications, fistula formation, donor site morbidity, dental restoration, normal dietary intake, aesthetic compromise, and eye-related [...] Read more.

Background/Objectives: This systematic review and meta-analysis evaluates the surgical, functional, and aesthetic outcomes of scapular free flaps in maxillary reconstruction. The primary objective is to assess early surgical complications, fistula formation, donor site morbidity, dental restoration, normal dietary intake, aesthetic compromise, and eye-related issues. Secondary objectives include total free flap necrosis, the need for revision procedures, and functional performance of the upper limb. Methods: A systematic review was conducted following the PRISMA guidelines. Eligible studies were identified by searching PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar, with the last search conducted on 10th February 2025. Inclusion criteria were studies reporting on patients undergoing maxillary reconstruction with scapular free flaps, and which provided data on at least one of the primary or secondary outcomes. A single-arm meta-analysis was performed to assess the outcomes of scapular free flap reconstruction. The risk of bias was assessed using the Newcastle–Ottawa Quality Assessment Scale, with two independent reviewers performing the assessment. Results: From an initial search of 310 articles, 6 studies were included in the qualitative and quantitative synthesis, encompassing 231 patients with a mean age of 52.9 years (95% CI 44.9–60.8). Early general surgical complications occurred in 24% (95% CI 13–40) of patients, while 12% (95% CI 4–31) experienced fistula formation. Donor site morbidity was reported in 10% (95% CI 6–17) of cases, with a mean DASH score of 10.49, indicating low upper limb impairment. Dental rehabilitation was achieved in 56% (95% CI 42–70), and 52% (95% CI 31–72) of patients resumed a normal diet. Aesthetic compromise was observed in 27% (95% CI 9–58), and 36% (95% CI 28–44) reported eye-related issues. Conclusions: Scapular free flap is a reliable option for maxillary reconstruction with favourable outcomes, particularly in complex composite defects requiring both bone and soft tissue reconstruction. However, the evidence is limited by risk of bias, significant heterogeneity, and imprecision due to the small number of studies and participants. Larger, more robust trials are needed to confirm these findings. Full article

(This article belongs to the Topic Current Challenges and Advances in Skin Repair and Regeneration)

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13 pages, 1768 KiB

Open AccessArticle

The Predictive Value of Preoperative Histological Risk Factors in Early Cervical Cancer

by Jana Adams, Amelie Wingels, Constanze Amir-Kabirian, Janice Katharina Jeschke, Lara Gesemann, Büsra Eser, Caroline Lenz, Bernd Morgenstern and Fabinshy Thangarajah

J. Clin. Med. 2025, 14(10), 3277; https://doi.org/10.3390/jcm14103277 - 8 May 2025

Abstract

Background: Cervical cancer is a leading cause of morbidity and mortality among women globally. Currently, treatment is primarily based on tumor staging; however, discrepancies between preoperative and postoperative tumor staging remain a significant challenge and may impact treatment decisions and outcomes. This [...] Read more.

Background: Cervical cancer is a leading cause of morbidity and mortality among women globally. Currently, treatment is primarily based on tumor staging; however, discrepancies between preoperative and postoperative tumor staging remain a significant challenge and may impact treatment decisions and outcomes. This study aims to investigate the disparity between preoperative and postoperative risk factors in early-stage cervical cancer, with a particular focus on the histopathological parameters and the correlation with preclinical risk factors. Methods: Patients who underwent surgical treatment for an initial diagnosis of primary cervical carcinoma at the University Hospital Cologne in the Department of Gynecology and Obstetrics between 2015 and 2021 were included. A retrospective analysis was conducted to examine variations in histological parameters and their relationships with preclinical risk factors, such as age, BMI, smoking status, and HPV status, along with pretherapeutic diagnostic results. Results: In 85.7% of cases, preoperative grading showed concordance with postoperative grading. Postoperative upgrading was observed in 14.3% of cases with no instances of downgrading. Inconsistent findings were noted for venous invasion (3.6% of cases) and lymphovascular space invasion (6.7% of cases). No significant correlations were found between pre- and postoperative discrepancies and preclinical risk factors or pretherapeutic diagnostics. Kaplan–Meier analyses revealed no impact of discordance in grading (p = 0.559) or lymphatic vessel invasion (p = 0.752) on recurrence-free survival. Conclusions: The analyzed discrepancies were not influenced by preclinical risk factors or pretherapeutic interventions and showed no significant prognostic relevance for the patients’ recurrence-free survival. More robust conclusions would require further studies with larger sample sizes. Full article

(This article belongs to the Section Oncology)

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11 pages, 588 KiB

Open AccessArticle

Routine Removal of Syndesmotic Screws After Tibiofibular Syndesmosis Fixation Does Not Affect Patient Function and Is Associated with a Higher Risk of Postoperative Complications

by Błażej Grzegorz Wójtowicz, Katarzyna Chawrylak, Jędrzej Lesman, Hubert Makowski, Kacper Kuczyński, Michał Maciejowski, Antoni Raciborski-Król and Marcin Domżalski

J. Clin. Med. 2025, 14(10), 3276; https://doi.org/10.3390/jcm14103276 - 8 May 2025

Abstract

Background: Syndesmotic fixation is a standard treatment for tibiofibular syndesmosis injury, especially in ankle fractures, but the necessity of routine screw removal remains debated. This study evaluates the impact of routine removal on functional outcomes, complication rates, and recovery, aiming to clarify its [...] Read more.

Background: Syndesmotic fixation is a standard treatment for tibiofibular syndesmosis injury, especially in ankle fractures, but the necessity of routine screw removal remains debated. This study evaluates the impact of routine removal on functional outcomes, complication rates, and recovery, aiming to clarify its clinical relevance. Methods: This retrospective observational study included 330 patients treated surgically for tibiofibular syndesmosis injuries at a single institution from 2016 to 2024. Patients were categorized into three groups: no removal, routine removal, and removal for clinical indications. Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS), and complications, including infections and prolonged pain, were recorded. Statistical analyses evaluated differences between groups. Results: Of the 170 patients who completed follow-up, no significant differences in OMASs were found between the groups (p = 0.646). Complications were more frequent in reoperated patients (9% vs. 2% for non-reoperated), but routine removal did not improve functional outcomes. Younger patients showed better OMASs, highlighting age as a key factor in recovery. Fixation and fracture types had no significant impact on outcomes. Conclusions: Routine syndesmosis screw removal offers no significant functional benefits, as demonstrated by comparable OMASs across groups (median OMAS: 85 for non-reoperated, 80 for routinely reoperated, and 80 for indication-based reoperated patients). However, routine removal is associated with a higher complication rate. A selective approach focusing on clinical indications is recommended to minimize unnecessary surgeries and optimize patient outcomes. Future research should focus on redefining evidence-based management strategies for syndesmotic fixation. Full article

(This article belongs to the Special Issue Orthopedic Trauma and Fracture Care: Patient Expectations and Fulfillment in Clinical Practice)

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