Journal of Clinical Medicine

9 pages, 220 KB

Open AccessArticle

The VincerEmo Pilot Study: Prospective Analysis of Controlled Physical Activity in People with Severe Hemophilia

by Federica Valeri, Cristina Dainese, Piera Merli, Mariella Galizia, Samuel Agostino, Nicolas Cunsolo, Carola Sella, Alessandra Valpreda, Mariagiulia Bailon, Marco Miniotti, Annamaria Porreca, Giuseppe Massazza, Benedetto Bruno and Alessandra Borchiellini

J. Clin. Med. 2025, 14(18), 6652; https://doi.org/10.3390/jcm14186652 (registering DOI) - 21 Sep 2025

Abstract

Background/Objectives: The approach to physical activity in people with hemophilia (PwH) is still conditioned by many difficulties. Thus, a prospective observational pilot study has been carried out aiming to evaluate how an adequate and controlled training program can slow down the onset [...] Read more.

Background/Objectives: The approach to physical activity in people with hemophilia (PwH) is still conditioned by many difficulties. Thus, a prospective observational pilot study has been carried out aiming to evaluate how an adequate and controlled training program can slow down the onset or evolution of arthropathy and improve musculoskeletal health and quality of life. Methods: Performed from April 2022 to April 2023, this study involved nine severe hemophilic A and B patients, aged > 18 years old, on regular prophylaxis with replacement products. Participants, without changing the usual prophylaxis schedule and maintaining a trough level of at least 20% FVIII/FIX before training, were involved in physical activity twice a week. Results: After 12 months, no increase in annual bleeding ratio (ABR) was observed, and baseline joint status (as assessable by HEAD US score, HJHS, and NRS) was maintained. Even if not statistically significant, a trend toward improvement in mean HEAD US score (15.55 vs. 13.11) and HJHS (14.4 vs. 11) from baseline was observed. Some of the physical tests performed showed a significant improvement at 6 months and 12 months from baseline (5 Rep Sit to Stand, Sit and Reach, and 6-minute Walking Test), meaning an improvement in leg strength, dorsal flexibility, and aerobic resistance. Conclusions: This is the first pilot study evaluating at 360 degrees the safety and impact of a controlled physical activity in PwH. No participant experienced bleedings or a worsening in joint status, but they experienced an improvement in articular functionality. Without changing the usual prophylaxis, scheduling training sessions according to individual pharmacokinetics turned out to be a safe and a cost-effective approach. Full article

(This article belongs to the Special Issue Hemophilia: Current Trends and Future Directions)

14 pages, 798 KB

Open AccessArticle

Assessment of Biomechanics Following Calcaneal Fracture Treatment with Internal Plate Fixation or Ilizarov External Fixation: A Retrospective, Two-Center Study

by Igor Kowal, Marcin Pelc, Daniele Pili, Łukasz Tomczyk, Radosław Operacz and Piotr Morasiewicz

J. Clin. Med. 2025, 14(18), 6651; https://doi.org/10.3390/jcm14186651 (registering DOI) - 21 Sep 2025

Abstract

Background: There is no consensus on the best treatment method for calcaneal fractures. The topic of lower limb biomechanics following calcaneal fracture treatment with various fixation methods has not been fully explored. The aim of the study was to assess the balance and [...] Read more.

Background: There is no consensus on the best treatment method for calcaneal fractures. The topic of lower limb biomechanics following calcaneal fracture treatment with various fixation methods has not been fully explored. The aim of the study was to assess the balance and load distribution of the lower limbs in patients after various methods of stabilization of calcaneal fractures. Methods: In this two-center study, we retrospectively collected data from 19 patients treated with internal plate fixation at a mean age of 46 years and 27 patients treated with Ilizarov external fixation at a mean age of 50 years. Using the Zebris Medical pedobarophragmatic platform, we assessed the percentage distribution of lower limb loads and balance. Results: There were no significant differences in total load distribution for both the operated (p = 0.489) and non-operated limb (p = 0.46), between the Ilizarov method group and the internal plate group. In the Ilizarov fixation group, total load distribution was 46.89% on the treated limb, and 53.11% on the uninjured limb, p = 0.077. In the internal plate fixation group, the mean total load distribution was 41.57% in the treated limb, and 57.89% in the uninjured limb, p = 0.008. The median CoG (center or gravity) sway path length was 132.41 cm and 170.21 cm in the Ilizarov and internal plate group, respectively, p = 0.023. The median CoG sway areas were 0.84 cm² and 7.57 cm² in the Ilizarov method group and internal plate fixation group, respectively, p < 0.001. Conclusions: The Ilizarov method was associated with more symmetrical load distribution and improved balance performance compared to internal plate fixation. Static biomechanical parameters of calcaneal fracture treatment were better in the Ilizarov group compared to patients with internal plate fixation. Full article

(This article belongs to the Special Issue Advancements in Total Joint Arthroplasty: Innovations, Outcomes and Challenges)

19 pages, 11761 KB

Open AccessArticle

Metastatic Head and Neck Non-Melanoma Skin Cancer: A Retrospective Analysis of Clinico-Pathologic Features and Reconstructive Approach

by Victor Vlad Costan, Otilia Boișteanu, Delia Gabriela Ciobanu Apostol, Ștefan Vasile Toader, Cristina Colac Boțoc, Alin Gabriel Colac, Mihai-Liviu Ciofu and Mihaela Paula Toader

J. Clin. Med. 2025, 14(18), 6650; https://doi.org/10.3390/jcm14186650 (registering DOI) - 21 Sep 2025

Abstract

Background/Objectives: Non-melanoma skin cancer (NMSC) is the most common malignancy globally, with cutaneous squamous cell carcinoma (cSCC) posing a significant risk of regional metastasis, especially in high-risk anatomical areas such as the head and neck. While general risk factors for metastasis are well [...] Read more.

Background/Objectives: Non-melanoma skin cancer (NMSC) is the most common malignancy globally, with cutaneous squamous cell carcinoma (cSCC) posing a significant risk of regional metastasis, especially in high-risk anatomical areas such as the head and neck. While general risk factors for metastasis are well known, few studies have directly compared the clinical and pathological features of synchronous versus metachronous metastatic behavior. This study aimed to evaluate the clinicopathological characteristics and reconstructive implications associated with these two metastatic patterns in head and neck NMSC. Methods: We conducted a retrospective observational study of 46 patients with histologically confirmed metastatic NMSC of the head and neck, treated between January 2022 and May 2024 at a tertiary care center. Patients were stratified into synchronous or metachronous metastasis groups. Clinical data, histopathological features, metastatic sites, and surgical approaches were analyzed. Comparative statistics were applied using chi-square and t-tests, with significance set at p < 0.05. Results: Of the 46 patients, 50% had synchronous and 50% had metachronous metastases. The lower lip was the most common primary tumor site in both groups. Perineural and lymphovascular invasion were more frequent in synchronous metastases. Metachronous cases often required more complex reconstructive procedures, including free flap reconstructions and mandibular resections. Patients with metachronous metastases were significantly older (p = 0.024), and approximately one-third developed metastases more than four years after initial treatment. Conclusions: Head and neck NMSC, particularly involving the lower lip, may exhibit late-onset metastatic potential. Risk-adapted surveillance extending beyond current guidelines is warranted to improve long-term outcomes in high-risk patients. Full article

(This article belongs to the Special Issue Clinical Advances in Skin Cancer: A Closer Look at Non-Melanoma Types)

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26 pages, 2809 KB

Open AccessFeature PaperReview

Role of Extracellular Vesicles as Mediators of Cell Communication and Novel Biomarkers in Sepsis

by Alberto Repici, Giovanna Piraino, Vivian Wolfe, Jennifer Kaplan, Takahisa Nakamura and Basilia Zingarelli

J. Clin. Med. 2025, 14(18), 6649; https://doi.org/10.3390/jcm14186649 (registering DOI) - 21 Sep 2025

Abstract

Small extracellular vesicles (sEVs), typically <200 nm in diameter, have emerged as key mediators of intercellular communication, transferring bioactive molecules such as proteins, lipids, and nucleic acids between cells. This review focuses on the growing significance of sEVs in the context of sepsis, [...] Read more.

Small extracellular vesicles (sEVs), typically <200 nm in diameter, have emerged as key mediators of intercellular communication, transferring bioactive molecules such as proteins, lipids, and nucleic acids between cells. This review focuses on the growing significance of sEVs in the context of sepsis, a life-threatening syndrome caused by a dysregulated immune response to infection. Sepsis remains a major global health challenge due to its complex pathophysiology, rapid progression, and the limitations of current diagnostic tools, which often fail to detect the condition early or accurately assess the host’s immune status. As interest grows in precision diagnostics, sEVs have gained attention for their potential as biomarkers in liquid biopsy—a minimally invasive approach that analyzes circulating vesicles to monitor disease. Small EVs reflect the physiological state of their cells of origin and can provide real-time insights into immune activation, inflammation, and pathogen presence. This review explores the mechanisms by which sEVs contribute to immune modulation in sepsis, recent advances in understanding their biogenesis and uptake, and their diagnostic and prognostic potential. By highlighting the role of sEVs in sepsis, we aim to underscore their promise in improving early detection, guiding therapeutic decisions, and advancing personalized medicine. Full article

(This article belongs to the Special Issue New Diagnostic and Therapeutic Trends in Sepsis and Septic Shock)

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13 pages, 1199 KB

Open AccessArticle

Evaluation of the Effectiveness of TECAR and Vibration Therapy as Methods Supporting Muscle Recovery After Strenuous Eccentric Exercise

by Łukasz Oleksy, Anna Mika, Maciej Daszkiewicz, Martyna Sopa, Miłosz Szczudło, Maciej Kuchciak, Artur Stolarczyk, Olga Adamska, Paweł Reichert, Zofia Dzięcioł-Anikiej and Renata Kielnar

J. Clin. Med. 2025, 14(18), 6648; https://doi.org/10.3390/jcm14186648 (registering DOI) - 21 Sep 2025

Abstract

Background/Objectives. Despite growing interest in capacitive-resistive electric transfer TECAR) and Vibration therapy (VT), their comparative effectiveness in sports recovery remains unclear. This study aimed to evaluate and contrast the short-term effects of TECAR and VT on neuromuscular recovery following eccentric muscle fatigue, [...] Read more.

Background/Objectives. Despite growing interest in capacitive-resistive electric transfer TECAR) and Vibration therapy (VT), their comparative effectiveness in sports recovery remains unclear. This study aimed to evaluate and contrast the short-term effects of TECAR and VT on neuromuscular recovery following eccentric muscle fatigue, relative to passive rest, in active young adults. We hypothesized that both interventions would accelerate recovery and potentially reduce injury risk. Methods. Forty-one participants were randomized into two groups: TECAR therapy (Group 1) and VT (Group 2). Neuromuscular function was assessed at baseline, post-exercise, and post-intervention using tensiomyography (TMG) and electromyography (EMG). Results. Both groups showed a significant increase in EMG MDF intercept after exercise. Post-intervention, VT induced a further rise in this parameter, whereas TECAR stabilized values without significant change. In the contralateral resting limb, increases persisted after exercise and passive recovery. Between-limb differences were significant only in the TECAR group. TMG analysis revealed a non-significant but large-effect increase in contraction delay (Td) post-exercise, followed by significant reductions after both interventions. In the left limb, Td changes were not significant. For maximal displacement (Dm), both VMO and VLO muscles demonstrated a significant decrease post-exercise and a marked recovery after both therapies. Other TMG parameters (Ts, Tc, Tr) showed no significant changes. Conclusions. Both TECAR and VT effectively enhanced neuromuscular recovery after eccentric exercise. TECAR demonstrated a modest but consistent advantage, particularly in normalizing muscle recruitment and restoring mechanical properties, making it suitable in contexts requiring rapid recovery. VT, however, remains a more accessible and cost-effective modality. These findings support the application of both techniques in sports recovery, while highlighting the need for further research in professional athletes and diverse exercise settings to optimize regeneration strategies and reduce injury risk. Full article

(This article belongs to the Special Issue Clinical Aspects of Return to Sport After Injuries)

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12 pages, 783 KB

Open AccessFeature PaperArticle

Value of Continuous Hemofiltration in Patients with Severe Acute Pancreatitis at Onset: Single Centre Experience on 48 Patients

by Paolina Saullo, Roberto Caronna, Alberto Maria Angelici, Valerio Rinaldi, Giovanni Liberatori, Andrea Mingoli and Piero Chirletti

J. Clin. Med. 2025, 14(18), 6647; https://doi.org/10.3390/jcm14186647 (registering DOI) - 21 Sep 2025

Abstract

Background: Severe acute pancreatitis (SAP) presents with Multiple Organ Dysfunction Syndrome (MODS) in ~15% of cases, accounting for ~35% of early deaths within 48 h. Major complications—shock, renal failure, and respiratory insufficiency—arise from an overwhelming systemic inflammatory response driven by markedly elevated [...] Read more.

Background: Severe acute pancreatitis (SAP) presents with Multiple Organ Dysfunction Syndrome (MODS) in ~15% of cases, accounting for ~35% of early deaths within 48 h. Major complications—shock, renal failure, and respiratory insufficiency—arise from an overwhelming systemic inflammatory response driven by markedly elevated pro-inflammatory cytokines. Massive release of IL-2, IL-6, and TNF-α underlies the systemic inflammatory response syndrome (SIRS). Continuous veno-venous hemofiltration (CVVH) with the oXiris filter, adsorbing endotoxins and cytokines, has been used in sepsis and applied early in SAP to reduce cytokine load and organ injury. Aims: To evaluate the efficacy and safety of early CVVH with the oXiris filter in modulating the systemic inflammatory response by removing toxic cytokines from the bloodstream in patients with SAP complicated by organ dysfunction and refractory sepsis. Methods: This single-centre, retrospective, observational study was conducted at a tertiary university hospital between 2000 and 2022. Forty-eight consecutive patients with SAP at onset, defined according to the 2012 Atlanta Classification, with an APACHE II score ≥ 19 and persistent organ dysfunction (>48 h), were included. All patients were unresponsive to initial intensive care within the first 24 h and underwent urgent laparotomy with extensive peritoneal lavage, pancreatic necrosectomy, and placement of multiple abdominal drains, followed by transfer to the intensive care unit. CVVH (Prismax system) with the oXiris filter was initiated within 12 h post-surgery. IL-6 and TNF-α were selected as inflammatory markers and measured in both serum and ultrafiltrate at baseline (0 h) and at 24, 48, 72, and 96 h. These measurements were correlated with clinical parameters and prognostic scores (APACHE II, SOFA). Results: Treatment was well tolerated in all patients. The 28-day survival rate was 97.9%. There was a significant time-dependent decrease in IL-6 (p = 0.019) and TNF-α (p = 0.008) concentrations in the ultrafiltrate, consistent with high early adsorption followed by a reduced cytokine burden, whereas serum levels showed a non-significant downward trend (IL-6 p = 0.08; TNF-α p = 0.310). The APACHE II score decreased from 23 postoperatively to 8 by the second week (−65.2%; p = 0.013), with a statistically significant correlation between cytokine reduction and clinical improvement. Adverse events were rare and manageable. Conclusions: Early CVVH with the oXiris filter in SAP, complicated by MODS and refractory sepsis, proved safe, well-tolerated, and potentially effective in reducing cytokine burden and improving prognostic indices. These findings support the hypothesis of a relevant immunomodulatory effect, warranting prospective controlled trials to confirm its true impact on survival and organ recovery. Full article

(This article belongs to the Special Issue Interventional and Surgical Treatment of Acute and Chronic Pancreatitis)

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13 pages, 1180 KB

Open AccessArticle

Battery Life of Pulse Generators in Spinal Cord Stimulation: Analysis and Comparison Between Surgical and Percutaneous Leads in Energy Efficiency

by Marta Antonia Gómez González, Nicolás Cordero Tous, Carlos Sánchez Corral, Beatriz Lechuga Carrasco, Manuel Alejandro Sánchez García, Rafael Gálvez Mateos and Gonzalo Olivares Granados

J. Clin. Med. 2025, 14(18), 6646; https://doi.org/10.3390/jcm14186646 (registering DOI) - 21 Sep 2025

Abstract

Background: Spinal cord stimulation (SCS) is an established therapy for chronic neuropathic pain. Although rechargeable and non-rechargeable pulse generators (PGs) are widely used, their real-world battery life and the influence of lead type on energy efficiency remain underexplored. Objective: To evaluate PG battery [...] Read more.

Background: Spinal cord stimulation (SCS) is an established therapy for chronic neuropathic pain. Although rechargeable and non-rechargeable pulse generators (PGs) are widely used, their real-world battery life and the influence of lead type on energy efficiency remain underexplored. Objective: To evaluate PG battery longevity and compare the performance of surgical versus percutaneous leads in terms of energy efficiency. Methods: We conducted a retrospective study of 283 PGs implanted at Hospital Virgen de las Nieves (Granada, Spain) from 1996 to 2023. Data on patient demographics, pain etiology, lead type and placement, stimulation modality, and PG status were extracted. A competing risks analysis was used to assess PG shutdown and early explantation over time. Results: Of the PGs analyzed, 43.5% were non-rechargeable and 56.5% rechargeable. Rechargeable PGs showed significantly longer battery life (mean: 82.7 vs. 38.9 months, p < 0.05), with a lower probability of shutdown at 50, 100, and 150 months. No significant differences in battery longevity were observed regarding lead location, stimulation type, or pain etiology. A trend toward longer battery life was observed with percutaneous leads, although not statistically significant. Conclusions: Rechargeable PGs demonstrated superior longevity compared to non-rechargeable models and should be considered the preferred option in most cases. While both surgical and percutaneous leads are effective, percutaneous systems may offer improved battery efficiency. Further prospective studies are warranted to confirm these findings and assess cost-effectiveness. Full article

(This article belongs to the Special Issue Clinical Advances in Pain Management)

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16 pages, 1628 KB

Open AccessArticle

Association of Scene Time Interval and Field Arrival to Epinephrine Administration Time with Outcomes in Cardiac Arrest

by Yohei Okada, Ki Jeong Hong, Marcus Eng Hock Ong, Sang Do Shin, Kyoung Jun Song, Jeong Ho Park, Young Sun Ro, Nur Shahidah, Shir Lynn Lim and Fahad Javaid Siddiqui

J. Clin. Med. 2025, 14(18), 6645; https://doi.org/10.3390/jcm14186645 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: The association of scene time interval (STI) and field arrival to epinephrine administration time (FET) with outcomes in out-of-hospital cardiac arrest (OHCA) is unknown. The goal of this investigation is to assess the association of STI and FET with outcomes in OHCA. [...] Read more.

Background/Objectives: The association of scene time interval (STI) and field arrival to epinephrine administration time (FET) with outcomes in out-of-hospital cardiac arrest (OHCA) is unknown. The goal of this investigation is to assess the association of STI and FET with outcomes in OHCA. Methods: All adult OHCA cases with prehospital epinephrine administration in South Korea and Singapore were included. STI was divided into short and long stay based on the median value of each country. FET was categorized into early (<10 min) and late groups. We performed multivariable logistic regression for survival to discharge and good neurological recovery. Cases were grouped into short stay early epinephrine (SS-EE), short stay late epinephrine (SS-LE), long stay early epinephrine (LS-EE), and long stay late epinephrine (LS-LE) (reference). Interaction analysis with STI and FET for outcomes was conducted. Results: A total of 18,867 cases from South Korea and 4184 cases from Singapore were included. Adjusted odds ratio (AOR) for survival to discharge was 2.14 (95% CI: 1.18–2.25) in SS-EE, 1.15 (0.94–1.40) in SS-LE, and 1.82 (1.45–2.28) in LS-EE compared to LS-LE in South Korea with similar results for Singapore. SS-EE and LS-EE were also associated with good neurologic recovery. Interaction analysis showed that early epinephrine injection in short stay and long stay was associated with better outcomes. But short STI was not associated with better outcomes in early and late epinephrine groups. Conclusions: Early epinephrine administration was associated with higher survival to discharge irrespective of the scene time interval. Full article

(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest: 2nd Edition)

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21 pages, 1542 KB

Open AccessArticle

Building a Machine Learning Model to Predict Postpartum Depression from Electronic Health Records in a Tertiary Care Setting

by Zhitu Ma, Michael Horvath, David Michael Stamilio, Kobby Sekyere and Metin Nafi Gurcan

J. Clin. Med. 2025, 14(18), 6644; https://doi.org/10.3390/jcm14186644 (registering DOI) - 20 Sep 2025

Abstract

Background: Postpartum depression is a common mental health condition that can occur up to one year after childbirth. Recent studies have increasingly used machine learning techniques to predict its occurrence; however, few have comprehensively explored the use of electronic health record data, [...] Read more.

Background: Postpartum depression is a common mental health condition that can occur up to one year after childbirth. Recent studies have increasingly used machine learning techniques to predict its occurrence; however, few have comprehensively explored the use of electronic health record data, particularly in tertiary care settings where such data can be fragmented. Methods: We analyzed electronic health record data from 12,284 women who delivered at The Birth Center at Atrium Health Wake Forest Baptist Medical Center, excluding those with missing data or no prenatal or postpartum visits. To define the target variable, we examined different combinations of depression screening tools (Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9), along with diagnosis codes specific to postpartum depression. We then trained a random forest classification model to predict postpartum depression. Results: The model achieved an area under the receiver operating characteristic curve of 0.733 ± 0.008, which is comparable to previous studies. Adding socioeconomic features from census tract data did not improve predictive performance, underscoring the importance of individual-level data. Incorporating national survey data, such as the Pregnancy Risk Assessment Monitoring System, also did not improve performance due to limited overlap in data features. Interestingly, model performance was slightly lower among Hispanic patients (area under the curve = 0.713 ± 0.040), although this difference was not statistically significant (p = 0.17), likely due to the small sample size. A similar, but statistically significant trend was observed in the larger national survey dataset (area under the curve = 0.699 ± 0.019 for Hispanic patients versus 0.735 ± 0.010 for White patients, p < 0.01). Conclusions: While our model demonstrates moderate predictive capability, further validation and prospective testing are needed before clinical implementation. This work also identified an optimal approach for digital phenotyping postpartum depression in electronic health record data and highlighted key gaps in data quality and completeness. These findings emphasize the importance of robust data when developing predictive models for real-world clinical use. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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13 pages, 1470 KB

Open AccessArticle

Comparative Analysis of Root Canal Microbiota in Patients with Diabetes and Systemically Healthy Individuals: A Pilot Next-Generation Sequencing Study

by Nazife Maide Dayıcan and Sevinç Aktemur Türker

J. Clin. Med. 2025, 14(18), 6643; https://doi.org/10.3390/jcm14186643 (registering DOI) - 20 Sep 2025

Abstract

Objectives: The aim of this study is to assess the influence of diabetes mellitus on the microbial flora involved in root canal infections through a comparative analysis with that of systemically healthy individuals. Methods: A total of 39 participants, including 21 patients with [...] Read more.

Objectives: The aim of this study is to assess the influence of diabetes mellitus on the microbial flora involved in root canal infections through a comparative analysis with that of systemically healthy individuals. Methods: A total of 39 participants, including 21 patients with diabetes mellitus and 18 systemically healthy individuals (controls), were enrolled in the study. In the diabetic group, 12 teeth were diagnosed with secondary/persistent endodontic infections (SEIs) and 9 with primary endodontic infections (PEIs). In the healthy group, 12 teeth presented with SEIs and 6 with PEIs. Root canal samples were obtained using sterile paper points. The V3–V4 hypervariable regions of 16S rDNA from both sample types were amplified and sequenced using the Illumina MiSeq platform. Microbial richness and diversity were assessed using alpha diversity indices and beta diversity metrics. Results: Faith’s Phylogenetic Diversity showed a significant difference between diabetic patients with SEIs and healthy individuals with PEIs (p = 0.02). Both weighted and unweighted UniFrac beta diversity analyses indicated significant differences in microbial composition and phylogenetic structure between diabetic patients with SEIs and healthy individuals with PEIs (p = 0.01 and p = 0.02, respectively). Within the diabetic patient group, significant differences were observed between SEI and PEI groups based on alpha (Fisher’s alpha, p = 0.04) and beta diversity analyses (Bray–Curtis and Weighted UniFrac p = 0.02 and p = 0.01, respectively). Conclusions: Diabetic patients showed different microbial profiles compared to healthy individuals. Full article

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

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17 pages, 288 KB

Open AccessArticle

Sociodemographic and Health Determinants of Adipose Tissue Distribution in a Local Community from Eastern Poland: A Cross-Sectional Study

by Maciej Polak, Grzegorz Józef Nowicki, Magdalena Kozela, Maciej Matyja and Barbara Ślusarska

J. Clin. Med. 2025, 14(18), 6642; https://doi.org/10.3390/jcm14186642 (registering DOI) - 20 Sep 2025

Abstract

Objectives: The aim of this study was to assess the distribution of abdominal volume index (AVI) conicity index (C-Index) and weight adjusted waist index (WWI) attributes by sociodemographic and health characteristics in apparently healthy individuals (residents of the Janów Lubelski district in the [...] Read more.

Objectives: The aim of this study was to assess the distribution of abdominal volume index (AVI) conicity index (C-Index) and weight adjusted waist index (WWI) attributes by sociodemographic and health characteristics in apparently healthy individuals (residents of the Janów Lubelski district in the eastern Poland). Additionally, the study examined whether sociodemographic and health characteristics differentiate the distribution of adipose tissue indicators in individuals with a normal body weight, defined as a BMI of less than 25 kg/m². Methods: A total of 3752 apparently healthy respondents participated in the cross-sectional study. In order to determine the participants’ adipose tissue distribution, professionally trained nurses measured their anthropometric indices and interviewed them to assess the sociodemographic and health variables. Results: The study group’s mean values for anthropometric indices related to central adipose tissue distribution were as follows: C-Index 1.26 ± 0.088, AVI 18.28 ± 4.96 and WWI 10.63 ± 0.73. The three indices examined in multivariable analyses showed a significant relationship with age, gender, place of residence, education, living alone, smoking status, alcohol consumption and comorbidities (diabetes, hypertension and hypercholesterolemia). Conclusions: The study findings demonstrate a significant relationship between the level of specific anthropometric indices related to central adipose tissue distribution and sociodemographic and health-related variables. The employment of certain anthropometric indices related to central adipose tissue distribution, which are derived from waist circumference, can be beneficial in primary healthcare by potentially facilitating early prevention of cardiometabolic diseases. Full article

(This article belongs to the Special Issue Obesity-Related Metabolic and Cardiovascular Disorders)

15 pages, 876 KB

Open AccessArticle

Dinutuximab Beta for the Treatment of High-Risk Neuroblastoma: Data from the Hungarian Pediatric Oncology Network

by Márk Hernádfői, Márton Szabados, Edit Brückner, Ágnes Varga, Péter Hauser, Gábor Ottóffy, Ágnes Vojcek, Krisztina Csanádi, Gabriella Kertész, Zsuzsanna Jakab, Gergely Agócs and Miklós Garami

J. Clin. Med. 2025, 14(18), 6641; https://doi.org/10.3390/jcm14186641 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: The anti-GD2 monoclonal antibody dinutuximab beta has become standard of care maintenance therapy for high-risk neuroblastoma (HR-NB) in the first-line setting and is also approved in the relapsed/refractory setting. We present a retrospective review of 37 children with HR-NB included in the [...] Read more.

Background/Objectives: The anti-GD2 monoclonal antibody dinutuximab beta has become standard of care maintenance therapy for high-risk neuroblastoma (HR-NB) in the first-line setting and is also approved in the relapsed/refractory setting. We present a retrospective review of 37 children with HR-NB included in the Hungarian Childhood Cancer Registry who received dinutuximab beta (first-line maintenance therapy, n = 31; relapsed/refractory, n = 6). Methods: All patients received dinutuximab beta continuously over the first 10 days of each 35-day cycle, with dosing based on body surface area/weight. Five cycles were planned, with further cycles administered at the treating physician’s discretion. Results: At data cutoff, the overall disease control rate was 54.1% (20/37) (complete response, 51.4% (19/37); partial response, 0.0% (0/37), stable disease, 2.7% [1/37]); two patients (5.4%) had progressive disease, and 15 patients (40.5%) had died. The 5-year overall survival (OS) and event-free survival (EFS) rates in the overall population were 63.3% (95% confidence interval, 49.1−81.7) and 56.2% (95% confidence interval, 42.1−75.0), respectively. Grade 3 or 4 adverse events (including blood and lymphatic system disorders, hypoxia, hypotension, and capillary leak syndrome) were generally consistent with dinutuximab beta’s known safety profile. Conclusions: Dinutuximab beta was an effective immunotherapy for patients with HR-NB in routine clinical practice, with a generally manageable side effect profile. Full article

(This article belongs to the Section Oncology)

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25 pages, 686 KB

Open AccessSystematic Review

Autogenous Injections in Temporomandibular Disorders: A Systematic Review

by Sylwia Orzeszek, Andrzej Malysa, Andrej Jenca, Jr., Magdalena Gebska, Katarzyna Sluzalec-Wieckiewicz, Marek Zietek and Piotr Seweryn

J. Clin. Med. 2025, 14(18), 6640; https://doi.org/10.3390/jcm14186640 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal conditions affecting the temporomandibular joints and masticatory muscles. In recent years, autogenous injections have been investigated as minimally invasive therapeutic options to alleviate pain and improve function. However, the clinical effectiveness of such [...] Read more.

Background/Objectives: Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal conditions affecting the temporomandibular joints and masticatory muscles. In recent years, autogenous injections have been investigated as minimally invasive therapeutic options to alleviate pain and improve function. However, the clinical effectiveness of such therapies across different TMD phenotypes remains uncertain. Methods: Electronic searches were performed in MEDLINE, Embase, and Web of Science for articles published between January 2015 and May 2025. Studies involving intra-articular or intra-muscular autogenous injections in TMD patients were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Thirteen studies met the inclusion criteria. Six were randomized controlled trials (RCTs) and seven were non-randomized clinical studies. Ten studies evaluated intra-articular conditions such as disc displacement or Temporomandibular Joint (TMJ) osteoarthritis, while three focused on myofascial pain. Platelet-Rich Plasma (PRP) was the most frequently investigated agent. Most studies reported statistically significant reductions in pain and improvements in mandibular mobility following autogenous injections, with PRP generally outperforming comparators such as hyaluronic acid, corticosteroids, or saline. No serious adverse events were reported. Conclusions: All PRP and Platelet-Rich Fibrin (PRF) injection protocols reviewed were effective in reducing pain and improving mobility in patients with TMD. However, differences in protocols and follow-up times prevented a meta-analysis from being conducted. More standardized RCTs are needed to determine clear clinical guidelines. Full article

(This article belongs to the Special Issue Bruxism and Temporomandibular Disorders: Current Advances and Future Challenges)

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13 pages, 967 KB

Open AccessFeature PaperArticle

Sarcopenia and Myosteatosis as a Predictor of Post-Operative Outcomes in Patients Undergoing Laparotomy for Abdominal Emergencies

by Simone Giudici, Ezio Lanza, Ludovica Lofino, Alberto Barison, Angela Ammirabile, Giulia Mauri, Davide Zulian, Martina Ceolin, Andrea Brocchi and Daniele Del Fabbro

J. Clin. Med. 2025, 14(18), 6639; https://doi.org/10.3390/jcm14186639 (registering DOI) - 20 Sep 2025

Abstract

Background: Emergency laparotomy (EL) is related to a high risk of morbidity and mortality. Sarcopenia (low skeletal muscle mass) and myosteatosis (poor muscle quality) have emerged as prognostic indicators in various clinical contexts. This study evaluated the impact of these conditions on [...] Read more.

Background: Emergency laparotomy (EL) is related to a high risk of morbidity and mortality. Sarcopenia (low skeletal muscle mass) and myosteatosis (poor muscle quality) have emerged as prognostic indicators in various clinical contexts. This study evaluated the impact of these conditions on postoperative outcomes in patients undergoing EL for abdominal emergencies. Methods: A retrospective analysis was conducted on 242 patients who underwent EL between January 2016 and December 2023. Skeletal muscle index (SMI) and muscle radiation attenuation (MRA) were measured using CT imaging at the L3 level. Sarcopenia was defined as SMI ≤ 41.6 cm²/m² for men and ≤ 32 cm²/m² for women. Myosteatosis was defined as MRA ≤ 29.3 HU for men and ≤ 22 HU for women. Outcomes included 30-day mortality, hospital length of stay (h-LOS), severe complications (Clavien-Dindo ≥ 3), and Intensive Care Unit (ICU) admission. Results: Of the 242 patients (median age: 70; 51.2% men), 42.6% were sarcopenic and 78.1% had myosteatosis. Sarcopenia was not significantly associated with any postoperative outcomes. Conversely, myosteatosis was significantly associated with longer h-LOS (17 vs. 8 days; p < 0.001), higher rates of severe complications (37.1% vs. 22.7%; p = 0.048), and ICU admission (48.2% vs. 28.3%; p = 0.010), but not with 30-day mortality. Multivariate analysis confirmed myosteatosis as an independent predictor of prolonged hospital stay (HR 0.59, 95% CI: 0.42–0.84 p = 0.003). Conclusions: Myosteatosis, rather than sarcopenia, is associated with worse postoperative outcomes following EL for abdominal emergencies. Including myosteatosis in preoperative risk assessments may improve the identification of high-risk patients and guide perioperative management. Full article

(This article belongs to the Special Issue New Insights into Abdominal Surgery)

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16 pages, 903 KB

Open AccessSystematic Review

Impact of Guided Implant Dentistry on Patient Quality of Life, Satisfaction, and Psychological Well-Being: A Systematic Review

by Daniela García-Valdez, Eugenio Velasco-Ortega, Iván Ortiz-Garcia, Loreto Monsalve-Guil, José López-López, Enrique Núñez-Márquez, Nuno Matos-Garrido, Álvaro Jiménez-Guerra, Jesús Moreno-Muñoz and José Luis Rondón-Romero

J. Clin. Med. 2025, 14(18), 6638; https://doi.org/10.3390/jcm14186638 (registering DOI) - 20 Sep 2025

Abstract

Introduction: Oral implantology, a modern approach to rehabilitating edentulous patients, has advanced significantly with digital technologies, notably computer-guided surgery. This technique is considered precise and predictable. However, it is essential to assess this technique from the patient’s perspective, focusing on its impact on [...] Read more.

Introduction: Oral implantology, a modern approach to rehabilitating edentulous patients, has advanced significantly with digital technologies, notably computer-guided surgery. This technique is considered precise and predictable. However, it is essential to assess this technique from the patient’s perspective, focusing on its impact on quality of life and satisfaction. Methods: A literature search was conducted in PubMed, Embase, and CINAHL up to January 2025. Clinical trials and case series studies were included. Studies conducted on partially or fully edentulous patients were selected for inclusion. The studies included static or dynamic guided oral implant treatments, as well as conventional treatments, and evaluated patient-reported outcomes, specifically perceived satisfaction and quality of life. A qualitative synthesis of the findings was performed, and the quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). Results: A total of twelve studies were included. The most commonly used questionnaires for evaluation were the Visual Analog Scale (VAS), Oral Health-Related Quality of Life (OHQoL), and Oral Health Impact Profile (OHIP). Computer-guided implantology appears to be a valid and predictable technique for dental implant placement. It is associated with a reduced intraoperative and postoperative pain. Some studies, however, did not identify significant differences compared with conventional implant surgery. Conclusions: Guided oral implantology is a viable option for oral rehabilitation in edentulous patients, offering benefits in surgical precision, pain reduction, and patient experience. Its effects on surgical time and overall patient satisfaction, however, warrant further investigation. Full article

(This article belongs to the Special Issue Implant Dentistry: New Challenges and Complication Management)

13 pages, 1177 KB

Open AccessArticle

Impact of Punctate Hyperfluorescence Status on Treatment Outcomes of Faricimab Versus Aflibercept in Neovascular Age-Related Macular Degeneration

by Hiroyuki Kamao, Katsutoshi Goto, Kenichi Mizukawa, Ryutaro Hiraki, Atsushi Miki and Shuhei Kimura

J. Clin. Med. 2025, 14(18), 6637; https://doi.org/10.3390/jcm14186637 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: To compare the treatment outcomes of intravitreal faricimab (IVF) and intravitreal aflibercept (IVA) in treatment-naïve patients with neovascular age-related macular degeneration (nAMD), stratified by the presence or absence of punctate hyperfluorescence (PH). Methods: This retrospective study included 301 treatment-naïve patients [...] Read more.

Background/Objectives: To compare the treatment outcomes of intravitreal faricimab (IVF) and intravitreal aflibercept (IVA) in treatment-naïve patients with neovascular age-related macular degeneration (nAMD), stratified by the presence or absence of punctate hyperfluorescence (PH). Methods: This retrospective study included 301 treatment-naïve patients with nAMD who underwent either IVF or IVA. After 1:1 propensity score matching based on baseline best-corrected visual acuity (BCVA), age, and PH status, 56 eyes (28 per group) were analyzed within each PH subgroup. Outcome measures included BCVA, central retinal thickness (CRT), subfoveal choroidal thickness (SFCT), and no retinal fluid rate during the loading dose regimen, and the retreatment rate after the loading dose regimen. The prespecified primary endpoint was the 1-year retreatment rate after completion of the loading dose regimen, analyzed by Kaplan–Meier curves with log-rank tests. Comparisons were performed separately between the PH and non-PH groups. Results: In the PH group, no significant differences were observed between IVF and IVA groups in terms of BCVA, CRT, SFCT, no retinal fluid rate, or retreatment rate at any time point. In the non-PH group, IVF and IVA groups showed no significant differences in BCVA, CRT, or SFCT at any time point; however, the IVF group achieved a significantly higher no retinal fluid rate (100.0% vs. 64.3%, p < 0.001) and a lower retreatment rate at 1 year (71.4% vs. 92.9%, p = 0.004) than the IVA group. Conclusions: IVF and IVA showed comparable efficacy in nAMD with PH. In contrast, IVF demonstrated superior anatomical outcomes in nAMD without PH. These retrospective findings suggest distinct pathophysiological mechanisms between PH and non-PH subtypes. Full article

(This article belongs to the Special Issue An Update on Retinal Diseases: From Diagnosis to Treatment)

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42 pages, 1139 KB

Open AccessReview

Fibrosis in Immune-Mediated and Autoimmune Disorders

by Magdalena Żurawek, Iwona Ziółkowska-Suchanek and Katarzyna Iżykowska

J. Clin. Med. 2025, 14(18), 6636; https://doi.org/10.3390/jcm14186636 (registering DOI) - 20 Sep 2025

Abstract

Fibrosis is a pathological process characterized by the excessive accumulation of extracellular matrix (ECM), particularly collagen, leading to tissue scarring, architectural distortion, and organ dysfunction. While fibrosis is a physiological component of wound healing, its persistence and dysregulation can drive chronic tissue damage [...] Read more.

Fibrosis is a pathological process characterized by the excessive accumulation of extracellular matrix (ECM), particularly collagen, leading to tissue scarring, architectural distortion, and organ dysfunction. While fibrosis is a physiological component of wound healing, its persistence and dysregulation can drive chronic tissue damage and organ dysfunction. In autoimmune diseases, fibrosis arises from prolonged inflammation and immune system dysregulation, creating a vicious cycle that exacerbates tissue injury and promotes disease progression. This review provides a comprehensive overview of the fibrotic processes across a range of immune-mediated and autoimmune conditions, including systemic sclerosis (SSc), morphea, autoimmune hepatitis (AIH), systemic lupus erythematosus (SLE), Sjögren’s syndrome (SS), inflammatory bowel disease (IBD), and rheumatoid arthritis (RA), Finally, we discuss current and emerging antifibrotic strategies aimed at interrupting pathological ECM remodeling and restoring tissue homeostasis. Full article

(This article belongs to the Section Immunology & Rheumatology)

18 pages, 1069 KB

Open AccessArticle

Spontaneous Multiple Cervical Artery Dissections Detected with High-Resolution MRI: A Prospective, Case-Series Study

by Aikaterini Foska, Aikaterini Theodorou, Maria Chondrogianni, Georgios Velonakis, Stefanos Lachanis, Eleni Bakola, Georgia Papagiannopoulou, Alexandra Akrivaki, Stella Fanouraki, Christos Moschovos, Panagiota-Eleni Tsalouchidou, Ermioni Papageorgiou, Athina Andrikopoulou, Klearchos Psychogios, Odysseas Kargiotis, Apostolοs Safouris, Effrosyni Koutsouraki, Georgios Magoufis, Dimos-Dimitrios Mitsikostas, Sotirios Giannopoulos, Lina Palaiodimou and Georgios Tsivgoulis Show full author list Hide full author list

J. Clin. Med. 2025, 14(18), 6635; https://doi.org/10.3390/jcm14186635 (registering DOI) - 20 Sep 2025

Abstract

Background: Cervical artery dissection (CAD) is a leading cause of acute ischemic stroke among young and middle-aged patients. Currently, the growing availability of high-resolution magnetic resonance imaging (MRI), particularly fat-saturated T1-weighted black-blood SPACE sequences, allows the non-invasive, rapid, and reliable diagnosis of [...] Read more.

Background: Cervical artery dissection (CAD) is a leading cause of acute ischemic stroke among young and middle-aged patients. Currently, the growing availability of high-resolution magnetic resonance imaging (MRI), particularly fat-saturated T1-weighted black-blood SPACE sequences, allows the non-invasive, rapid, and reliable diagnosis of multiple arterial dissections. Methods: We reported our experience from two tertiary stroke centers of patients diagnosed with spontaneous multiple cervical artery dissections, detected with high-resolution MRI, during a three-year period (2022–2025). Results: Among 95 consecutive patients with CAD, 11 patients (mean age: 48 ± 9 years, 6 (55%) females) were diagnosed with multiple symptomatic or asymptomatic CADs, whereas in 84 patients (mean age: 49 ± 11 years, 32 (38%) females) a single CAD was detected. In all patients, high-resolution MRI and MR-angiography were performed, whereas digital subtraction angiography (DSA) with simultaneous evaluation of renal arteries was conducted in nine patients. A history of trauma or chiropractic manipulations, intense physical exercise prior to symptom onset, recent influenza-like illness, and recent childbirth in a young female patient were reported as predisposing risk factors. Cervicocranial pain, cerebral infarctions leading to focal neurological signs, and Horner’s syndrome were among the most commonly documented symptoms. Characteristic findings in the high-resolution 3D T1 SPACE sequence were detected in all patients. Fibromuscular dysplasia and Eagle syndrome were detected in four patients and one patient, respectively. Eight patients were treated with antiplatelets, whereas three patients received anticoagulation with low-molecular-weight heparin. There was only one case of stroke recurrence during a mean follow-up period of 9 ± 4 months. Conclusions: This case series highlights the utility of specific high-resolution MRI sequences as a very promising method for detecting multiple CADs in young patients. The systematic use of these sequences could enhance the sensitivity of detecting multiple cervical CADs, affecting also the thorough investigation for underlying connective tissue vasculopathies, stratifying the risk for first-ever or recurrent ischemic stroke, and influencing acute reperfusion and secondary prevention therapeutic strategies. Full article

(This article belongs to the Special Issue Ischemic Stroke: Diagnosis and Treatment)

10 pages, 655 KB

Open AccessArticle

Framing Surgical Decisions in Elderly Patients: Minimally Invasive Partial Versus Radical Nephrectomy for Stage I Renal Cell Carcinoma at Mid-Term Follow-Up

by Umberto Anceschi, Antonio Tufano, Rocco Simone Flammia, Eugenio Bologna, Riccardo Mastroianni, Leslie Claire Licari, Aldo Brassetti, Maria Consiglia Ferriero, Alfredo Maria Bove, Gabriele Tuderti, Simone D’Annunzio, Maddalena Iori, Silvia Cartolano, Marco Pula, Costantino Leonardo and Giuseppe Simone

J. Clin. Med. 2025, 14(18), 6634; https://doi.org/10.3390/jcm14186634 (registering DOI) - 20 Sep 2025

Abstract

Background/Objectives: The optimal surgical approach for stage I renal cell carcinoma (RCC) in ultra-octogenarians remains debated, especially when balancing oncologic control, renal preservation, and procedural safety. While ablative techniques and active surveillance are often favored in frail patients, robust comparative evidence supporting [...] Read more.

Background/Objectives: The optimal surgical approach for stage I renal cell carcinoma (RCC) in ultra-octogenarians remains debated, especially when balancing oncologic control, renal preservation, and procedural safety. While ablative techniques and active surveillance are often favored in frail patients, robust comparative evidence supporting nephron-sparing surgery in this age group is limited. Methods: We retrospectively reviewed consecutive patients aged ≥80 years who underwent minimally invasive surgery for cT1 clear cell RCC at a high-volume tertiary-care center between July 2001 and August 2025. Patients were stratified into two cohorts: minimally invasive partial nephrectomy (MIPN, n = 51) and radical nephrectomy (MIRN, n = 26). All MIPNs were performed using an off-clamp approach. Baseline, perioperative, functional, and oncologic outcomes were compared. Kaplan–Meier analysis estimated overall survival (OS), cancer-specific survival (CSS), and progression to significant chronic kidney disease (sCKD, defined as CKD stage ≥ 3b). Results: Groups were comparable in age, comorbidities, and ASA score. MIRN patients exhibited higher tumor complexity (RENAL score: 9 vs. 7, p = 0.01) and a greater proportion of pT1b lesions (77% vs. 37.3%, p = 0.01). Perioperative transfusions occurred exclusively in the MIRN group (p = 0.01), whereas complication rates were low and similar between groups. MIPN was associated with significantly higher eGFR at follow-up (48 vs. 30.9 mL/min/1.73 m², p = 0.01) and a delayed progression to sCKD (p = 0.01), with no differences in OS or CSS at a median follow-up of 30.5 months. Conclusions: In this real-world series of ultra-octogenarians with cT1 clear cell RCC, off-clamp minimally invasive partial nephrectomy ensured superior renal function preservation and delayed progression to sCKD, without compromising oncologic control at mid-term follow-up. Beyond statistical outcomes, these results underscore the importance of tailoring surgical strategies to protect long-term functional autonomy and preserve physiological resilience in elderly patients. Full article

(This article belongs to the Section Nephrology & Urology)

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