Journal of Clinical Medicine

16 pages, 594 KB

Open AccessArticle

Refractory Thrombectomy: Incidence and Related Factors in a Third-Level Stroke Treatment Center

by Laura Restrepo-Carvajal, Francisco Hernández-Fernández, Angela Fernández-López, Laura Rojas-Bartolomé, Miguel de la Fuente, Cristian Alcahut, Blanca Serrano-Serrano, María Payá, Juan David Molina-Nuevo, Jorge García-García, Oscar Ayo-Martín, Rosa Angélica Barbella-Aponte, Gemma Serrano-Heras and Tomás Segura

J. Clin. Med. 2025, 14(23), 8514; https://doi.org/10.3390/jcm14238514 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: The efficacy of mechanical thrombectomy in large vessel occlusion has been established in multiple clinical trials as the standard of care for acute ischemic stroke. However, the incidence of refractory thrombectomy (RT), as well as related factors, remains unclear. Methods: We [...] Read more.

Background/Objectives: The efficacy of mechanical thrombectomy in large vessel occlusion has been established in multiple clinical trials as the standard of care for acute ischemic stroke. However, the incidence of refractory thrombectomy (RT), as well as related factors, remains unclear. Methods: We designed a retrospective study based on our prospective database from December 2014 to December 2023, collecting together the data on patients with large/medium vessel occlusion and reperfusion technique failure. We analyzed clinical, laboratory, histopathological, and radiological markers, as well as predictive variables of RT, mRS at three months, and symptomatic intracranial hemorrhage (sICH). Results: Among 733 patients, the incidence of refractory thrombectomy was 7.4% (n = 54). The most relevant causes were technical difficulties in passing through the occlusion (33.3%), clot resistance to extraction despite correct device placement (31.5%), and underlying intracranial stenosis (13%). A total of 20 recalcitrant thrombi were analyzed. Both atherotrombotic cause (OR 4.22, CI 95% 1.1–16.25; p = 0.04) and the absence of hyperdense artery sign (HAS) on CT (OR 0.26, 95% CI 0.09–0.79; p = 0.02) were independent predictors of RT outcome. For sICH, independent predictors were NIHSS at admission (OR 1.1; 95% CI 1.02–1.18; p = 0.008), protective effect in M1 occlusions (OR 0.28; 95% CI 0.09–0.88; p = 0.03), and prior IV thrombolysis (OR 0.38; 95% CI 0.16–0.93; p = 0.03). Finally, for favorable clinical outcome (mRS 0-2), a correlation was found with the NIHSS score at admission (OR 1.11; 95% CI 1.08–1.14; p = 0.0001), a history of diabetes (OR 0.53, 95% CI 1.02–1.18; p= 0.004), and RT status (OR 0.06, 95% CI 0.01–0.31; p = 0.001). No direct relationship was found between the clot composition and prognostic variables or first-line recanalization strategy. Conclusions: In our cohort, the incidence of refractory thrombectomies was low and associated with a worse clinical outcome. Absence of the hyperdense artery sign and the atherothrombotic stroke subtype were found to be independent predictors of refractory recanalization. Full article

(This article belongs to the Topic Diagnosis and Management of Acute Ischemic Stroke)

11 pages, 541 KB

Open AccessArticle

Randomized Prospective Comparison of the Singularity^TM Air Laryngeal Mask and Two Second-Generation Laryngeal Masks in Adult Patients

by Danijel Novina, Nadja Ettlin, Norbert Nickel, Norbert Aeppli, JoEllen Welter and Alexander Dullenkopf

J. Clin. Med. 2025, 14(23), 8513; https://doi.org/10.3390/jcm14238513 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: Supraglottic airway devices are commonly used airway management tools, with various second-generation laryngeal masks available for patients undergoing general anesthesia. These devices offer improved sealing, gastric suction capabilities, and the potential for tracheal intubation. This study compared the recently introduced Singularity^TM [...] Read more.

Background/Objectives: Supraglottic airway devices are commonly used airway management tools, with various second-generation laryngeal masks available for patients undergoing general anesthesia. These devices offer improved sealing, gastric suction capabilities, and the potential for tracheal intubation. This study compared the recently introduced Singularity^TM Air laryngeal mask with two well-established devices, Ambu^® AuraGain^TM and i-GEL^®, under clinical conditions. Methods: We prospectively included 98 adult patients scheduled for elective surgery requiring general anesthesia. Patients were randomized to one of three laryngeal mask groups, and data on insertion success, ventilation efficiency, and postoperative complications, such as sore throat and dysesthesia, were collected. The primary endpoint was oropharyngeal sealing pressure, with additional assessments of insertion ease and bronchoscopic glottic visibility. Results: Median initial oropharyngeal leak pressure was lowest with i-GEL^® (22 cm H₂O) as opposed to Ambu^® AuraGain^TM (25 cm H₂O) and Singularity^TM Air (25 cm H₂O) [p = 0.0138], but this difference equalized after 15–30 min. I-GEL^® showed higher insertion success (88%, p = 0.001) and shorter time-to-first ventilation (29 s, p = 0.0106). Conversely, the gastric tube insertion rate was lower (70% versus >90% in the other masks). The Ambu^® AuraGain^TM and Singularity^TM Air performed similarly for most parameters. No significant differences were observed in tracheal intubation potential or postoperative adverse events among the three groups. Conclusions: The Singularity^TM Air performed comparably to Ambu^® AuraGain^TM and i-Gel laryngeal masks in oropharyngeal sealing pressure. I-Gel^® had the highest successful insertion rate. Most of the differences detected were not statistically significant, with all three masks providing effective airway management. Full article

(This article belongs to the Section Anesthesiology)

11 pages, 751 KB

Open AccessReview

Factors Influencing Fertility Distress in Reproductive-Aged Gynecologic Cancer Patients: A Narrative Overview

by Jing Deng, Jing Chen, Xiujing Guo and Chuan Xie

J. Clin. Med. 2025, 14(23), 8512; https://doi.org/10.3390/jcm14238512 (registering DOI) - 30 Nov 2025

Abstract

Objective: To synthesize the multifactorial determinants of fertility distress among reproductive-aged women with gynecological cancers, elucidating complex interactions among biological, psychological, and sociocultural dimensions. Methods: Comprehensive literature searches were performed in PubMed, Embase, and PsycINFO to identify relevant studies on factors [...] Read more.

Objective: To synthesize the multifactorial determinants of fertility distress among reproductive-aged women with gynecological cancers, elucidating complex interactions among biological, psychological, and sociocultural dimensions. Methods: Comprehensive literature searches were performed in PubMed, Embase, and PsycINFO to identify relevant studies on factors influencing fertility distress in gynecologic cancer patients. Results: Gynecological cancers pose significant threats to women’s health, particularly in terms of fertility protection, which is a key priority for patients of childbearing age. Individuals diagnosed with these malignancies frequently experience fertility-related distress stemming from physiological alterations and exacerbated by psychological factors. Moreover, sociocultural support systems, familial expectations, and cultural norms significantly influence reproductive decision-making and psychological adjustment in this population. Fertility distress is determined by complex interactions among these dimensions. Conclusions: By integrating biological, psychological, and sociocultural perspectives, we provide clinical guidance for developing targeted interventions that address patients’ comprehensive needs, ultimately advancing patient-centered oncological care. Full article

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

11 pages, 1017 KB

Open AccessTechnical Note

The Sacral Frame Technique: A Novel Trans/Extrasacral Approach for Giant Sacral Schwannomas Resection with Sacropelvic Biomechanics Preservation

by Carlo Brembilla, Pietro Paolo Cotrufo, Ali Baram, Mario De Robertis, Laura Samà, Gabriele Capo, Donato Creatura, Maurizio Fornari, Federico Pessina and Ferdinando Carlo Maria Cananzi

J. Clin. Med. 2025, 14(23), 8511; https://doi.org/10.3390/jcm14238511 (registering DOI) - 30 Nov 2025

Abstract

Background: Giant sacral schwannomas present a significant surgical challenge, often requiring extensive resections that compromise neurological function and sacropelvic biomechanics. Conventional approaches frequently necessitate sacral bone sacrifice, resulting in the deafferentation of key pelvic stabilizers and subsequent long-term functional deficits. This study introduces [...] Read more.

Background: Giant sacral schwannomas present a significant surgical challenge, often requiring extensive resections that compromise neurological function and sacropelvic biomechanics. Conventional approaches frequently necessitate sacral bone sacrifice, resulting in the deafferentation of key pelvic stabilizers and subsequent long-term functional deficits. This study introduces the novel single-posterior “Sacral Frame Technique,” designed to preserve the lateral sacral bone margin and optimize functional reconstruction. Methods: We describe the surgical technique and report on a case of a 55-year-old female with a giant sacral schwannoma extending into the spinal canal and presacral space. The resection was performed via a combined trans-sacral and extrasacral approach, employing an intralesional piecemeal strategy to maintain the lateral sacral bone margin. The gluteus maximus muscles, along with the sacrotuberous and sacrospinous ligaments, were meticulously reattached to their natural insertion sites on the preserved bone. Clinical and radiological outcomes were evaluated at six months post-operatively. Results: Complete tumor resection was achieved without post-operative neurological deficits or sphincter dysfunction. The patient achieved early mobilization, returned to pre-operative activity levels, and showed no evidence of sacropelvic instability at the six-month follow-up. Post-operative imaging confirmed complete tumor clearance and the structural integrity of the preserved sacral bone margin. Conclusions: The “Sacral Frame Technique” offers a potential strategy for the safe and effective resection of giant sacral schwannomas. By prioritizing the preservation of the lateral sacral bone margin, the technique facilitates the anatomical reattachment of pelvic stabilizers, potentially mitigating long-term biomechanical deficits. Further studies with larger cohorts are warranted to fully validate these findings and establish the broader applicability of this bone-preserving approach. Full article

(This article belongs to the Special Issue Advancements in Spinal Oncology: The Current Landscape)

14 pages, 357 KB

Open AccessArticle

Exploring the Effects of Virtual Reality on Pain Relief and Physical Mobility in Spa-Based Treatment

by Alina Huseynli, Vojtěch Špet, Alena Lochmannová, Konstantin Novikov, Ladislav Špišák and Aleš Příhoda

J. Clin. Med. 2025, 14(23), 8510; https://doi.org/10.3390/jcm14238510 (registering DOI) - 30 Nov 2025

Abstract

Objectives: The objective of this prospective, controlled observational study embedded in routine spa care was to evaluate the effectiveness of integrating immersive virtual reality (VR) into a three-week spa-based rehabilitation program to reduce pain and improve physical mobility in adults with chronic [...] Read more.

Objectives: The objective of this prospective, controlled observational study embedded in routine spa care was to evaluate the effectiveness of integrating immersive virtual reality (VR) into a three-week spa-based rehabilitation program to reduce pain and improve physical mobility in adults with chronic musculoskeletal or neurogenic disorders. Methods: In this study, fifty-five adults with chronic musculoskeletal or neurogenic disorders completed a three-week spa regimen combining natural therapies, physiotherapy and rehabilitation. Participants were allocated in a preference- and availability-based manner either to the VR-enhanced group (n = 37), which completed interactive 25 min VR sessions three times per week, or to the control group (n = 18) receiving standard care. Pain was assessed using a 100 mm Visual Analog Scale (VAS) and shoulder-related joint mobility by goniometry before and after the intervention. Wilcoxon signed-rank and Mann–Whitney U tests evaluated within- and between-group differences, with subgroup analyses according to disease duration (≤5 vs. >5 years). Results: Both groups achieved significant post-treatment reductions in VAS pain scores (p < 0.001). The VR group exhibited a greater median decrease in pain compared to controls (p = 0.048), with the largest effect among patients with disease duration ≤ 5 years (p = 0.024). Goniometric measurements demonstrated significant mobility improvements across all tested angles in the VR group (p < 0.001), while improvements in the control group were smaller. Conclusions: VR integrated into spa-based rehabilitation was associated with greater pain reduction and mobility gains than standard care. These preliminary, hypothesis-generating findings require confirmation in larger randomized trials with standardized protocols and long-term follow-up. Full article

(This article belongs to the Section Clinical Rehabilitation)

22 pages, 738 KB

Open AccessReview

When Blood Disorders Meet Cancer: Uncovering the Oncogenic Landscape of Sickle Cell Disease

by Elise Casadessus, Manon Saby, Stéphanie Forté, Yves Pastore, Vincent-Philippe Lavallée and Thomas Pincez

J. Clin. Med. 2025, 14(23), 8509; https://doi.org/10.3390/jcm14238509 (registering DOI) - 30 Nov 2025

Abstract

Sickle cell disease (SCD) is a hemoglobinopathy characterized by hemolysis, vaso-occlusion, and systemic inflammation. Epidemiological studies identified an increased risk of leukemia, especially acute myeloid leukemia (AML), in individuals with SCD, whereas data regarding other tumors are conflicting. SCD-associated AMLs frequently display high-risk [...] Read more.

Sickle cell disease (SCD) is a hemoglobinopathy characterized by hemolysis, vaso-occlusion, and systemic inflammation. Epidemiological studies identified an increased risk of leukemia, especially acute myeloid leukemia (AML), in individuals with SCD, whereas data regarding other tumors are conflicting. SCD-associated AMLs frequently display high-risk features with unfavorable karyotypes and a dismal prognosis. SCD is associated with multiple phenomena linked to carcinogenesis in other contexts, including chronic inflammation, oxidative stress, ineffective erythropoiesis, accelerated hematopoietic aging, impaired tumor immunosurveillance, and increased clonal hematopoiesis. The role and respective contribution of these disease-intrinsic mechanisms in SCD remain to be studied. Although therapies used in SCD could theoretically modulate the risk of malignancies, no data exist to support an increased or reduced risk associated with their use. The most notable exception is hematopoietic stem cell transplantation and, to a lesser extent, gene therapy, for which the conditioning and/or procedure itself is known to increase the risk of leukemia. In sum, the effect of SCD on carcinogenesis is an emerging area of investigation with data supporting specificities in SCD-associated AML. Future research is required to determine the role of treatments to mitigate the increased risk and improve the outcome of SCD-associated AML. Full article

(This article belongs to the Section Hematology)

11 pages, 635 KB

Open AccessArticle

Clinical Features and Outcomes of Patients with Heart Failure and Advanced Chronic Kidney Disease

by María Anguita-Gámez, Javier Herrera-Flores, Juan L. Bonilla-Palomas, Alejandro Recio-Mayoral, Rafael González-Manzanares, Juan C Castillo Domínguez, José López-Aguilera, Javier Muñiz and Manuel Anguita-Sánchez

J. Clin. Med. 2025, 14(23), 8508; https://doi.org/10.3390/jcm14238508 (registering DOI) - 30 Nov 2025

Abstract

Objectives: The aim was to evaluate the clinical features, management and 1-year outcomes in patients with heart failure (HF) and advanced chronic kidney disease (CKD) who were followed in specialized HF units in Spain. Methods: Data from the registry of the [...] Read more.

Objectives: The aim was to evaluate the clinical features, management and 1-year outcomes in patients with heart failure (HF) and advanced chronic kidney disease (CKD) who were followed in specialized HF units in Spain. Methods: Data from the registry of the SEC-Excellent-HF quality program of the Spanish Society of Cardiology were analyzed. This registry included 1567 patients between 2019 and 2022 followed by 45 specialized HF units. Clinical features, treatment and 1-year rate of events (death and HF hospitalizations) were compared between the groups of advanced CKD (glomerular filtration rate <30 mL/minute/m²) and GFR ≥ 30 mL/min/m². Results: 11.1% of patients had a GFR < 30 and 88.9% ≥ 30 mL/min/m². The median LVEF was similar in groups with GFR < 30 and ≥ 30 mL/min/m²: 42% (IQR 30–58) versus 38% (IQR 29–54). Advanced CKD patients were older, had more severe HF (previous HF admissions in the last year, worse NYHA functional class and longer evolution time) and had higher prevalence of ischemic heart disease, diabetes mellitus, systemic hypertension, iron deficiency, anemia and hyponatremia. All drugs for HF, except for diuretics and potassium binders, were used in a lower proportion in patients with GFR < 30 mL/min/m² (p < 0.001). One-year overall mortality (49.2 versus 13.7/100 patients-year; p < 0.001) and one-year HF hospitalizations rate (83.2 versus 30.7/100 patients-year; p < 0.001) were higher in the group of advanced CKD. Conclusions: In our study, patients with advanced CKD had different clinical characteristics, received indicated treatment in a lower proportion and had higher 1-year rates of death and HF admissions. Full article

(This article belongs to the Section Nephrology & Urology)

10 pages, 467 KB

Open AccessArticle

Intraoperative Diagnostic Methods for Superior Mesenteric Artery Stenting in Chronic Mesenteric Ischemia

by Alexandra A. Brandtzäg, Jonas P. Eiberg, Mikkel Taudorf, Lars Lonn and Timothy A. Resch

J. Clin. Med. 2025, 14(23), 8507; https://doi.org/10.3390/jcm14238507 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: Chronic mesenteric ischemia (CMI) due to superior mesenteric artery (SMA) stenosis can be effectively treated with endovascular therapy (EVT). Appropriate intraoperative assessment is crucial for ensuring technical success and long-term patency. This study assesses intra-arterial pressure measurement (IAPM), and cone beam computed [...] Read more.

Background/Objectives: Chronic mesenteric ischemia (CMI) due to superior mesenteric artery (SMA) stenosis can be effectively treated with endovascular therapy (EVT). Appropriate intraoperative assessment is crucial for ensuring technical success and long-term patency. This study assesses intra-arterial pressure measurement (IAPM), and cone beam computed tomography (CBCT) for detecting residual stenosis during SMA stenting in CMI. Methods: This prospective study included 50 consecutive elective patients with symptomatic, significant SMA stenosis scheduled for EVT. The patients in this study were a subset of an ongoing randomized trial with a different primary objective. Intraoperative diagnostic tools—digital subtraction angiography (DSA), IAPM and CBCT were performed after stent placement. Technical success was defined as <30% residual stenosis on DSA, a residual pressure gradient of <10 mmHg with IAPM and full stent expansion on CBCT. Results: Although there was a fair agreement between DSA and CBCT (Kappa 0.294, p = 0.024), the Odds ratio suggests that DSA detected fewer positive cases compared to CBCT (Odds ratio 0.176; 95% CI: 0.004–1.37; p = 0.13). DSA also differed significantly from IAPM (Kappa = 0.016, p = 0.882), (Odds ratio = 0.167; 95% CI: 0.018–0.749; p = 0.013), suggesting DSA under-detects residual stenosis (>10 mmHg). No significant difference was found between CBCT and IAPM (Kappa = 0.201, p = 0.161) (Odds ratio: 2.25, 95% CI: 0.628–10.0%; p = 0.27) indicating comparable results. Conclusions: DSA overlooks clinically important residual stenosis that could be treated during the primary procedure. CBCT aids structural assessment of the stent and allows for on-table optimizing of the procedural outcomes. Full article

(This article belongs to the Section Vascular Medicine)

21 pages, 916 KB

Open AccessReview

Spectrum of Cervical Insufficiency: Management Strategies from Asymptomatic Shortening to Emergent Membrane Prolapse

by Dimitris Baroutis, Eleni Katsianou, Ioannis Fragiskos, Maria-Eleni Papakonstantinou, Konstantinos Koukoumpanis, Aikaterini-Gavriela Giannakaki, Alexander A. Tzanis, Vasilios Pergialiotis, Michael Sindos and George Daskalakis

J. Clin. Med. 2025, 14(23), 8506; https://doi.org/10.3390/jcm14238506 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: Cervical insufficiency affects 1–2% of pregnancies and represents a significant cause of second-trimester loss and spontaneous preterm birth. This review synthesizes current evidence across the clinical spectrum of cervical insufficiency, providing evidence-based management guidance and identifying areas requiring further investigation. Methods: We [...] Read more.

Background/Objectives: Cervical insufficiency affects 1–2% of pregnancies and represents a significant cause of second-trimester loss and spontaneous preterm birth. This review synthesizes current evidence across the clinical spectrum of cervical insufficiency, providing evidence-based management guidance and identifying areas requiring further investigation. Methods: We conducted a comprehensive review of the current literature, evidence-based clinical guidelines, and landmark randomized controlled trials examining diagnostic frameworks, therapeutic interventions, and clinical outcomes across different presentations of cervical insufficiency. Our analysis incorporated data from major obstetric databases, professional society recommendations, and recent comparative effectiveness research. Results: Cervical insufficiency diagnosis encompasses three primary categories: history-based, ultrasound-based, and physical examination-based. Vaginal progesterone achieves a 31% reduction in preterm birth before 33 weeks (RR 0.69, 95% CI 0.55–0.88; NNT= 14). Ultrasound-indicated cerclage achieves a 30% relative risk reduction for delivery <35 weeks. The landmark SuPPoRT trial (n = 386) demonstrated no statistically significant differences among cerclage, pessary, and progesterone (p = 0.4), though formal equivalence trials have not been conducted. Multiple gestations show no benefit from singleton-derived interventions (RR 0.99–1.04). Conclusions: Optimal cervical insufficiency management emphasizes individualized approaches based on comprehensive risk stratification and objective cervical assessment, with vaginal progesterone and cervical cerclage serving as cornerstone therapies supported by robust clinical evidence. Full article

(This article belongs to the Special Issue Clinical Challenges in High-Risk Pregnancy and Delivery)

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15 pages, 292 KB

Open AccessArticle

Precipitating Factors, Complications, and Outcomes of Diabetic Ketoacidosis (DKA) in Adults and Pediatrics: A Descriptive Study from Two Tertiary Centers in Riyadh, Saudi Arabia

by Osamah M. Alfayez, Ghazwaa G. Almutairi, Shahad B. Alqudhibi, Mayyadah A. Alnefaie, Sadeem D. Alshehri, Ruba K. Alzaidi, Dona M. Alassiri, Lama R. Alkhathran, Dalal A. Alabdulkarim, Majed S. Al Yami, Sultan M. Alghadeer and Omar A. Almohammed

J. Clin. Med. 2025, 14(23), 8505; https://doi.org/10.3390/jcm14238505 (registering DOI) - 30 Nov 2025

Abstract

Background: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus (DM) associated with significant morbidity, mortality, and healthcare burden worldwide. This study aimed to investigate population descriptors and clinical outcomes among adult and pediatric patients admitted with DKA at two tertiary [...] Read more.

Background: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus (DM) associated with significant morbidity, mortality, and healthcare burden worldwide. This study aimed to investigate population descriptors and clinical outcomes among adult and pediatric patients admitted with DKA at two tertiary medical centers in Riyadh, Saudi Arabia. Methods: We conducted a retrospective observational study that included adult and pediatric (≤15 years) patients admitted to emergency departments (EDs) and received care for DKA between 2018 and 2021. DKA severity was defined according to the American Diabetes Association (ADA) criteria, which rely on arterial/venous pH and serum bicarbonate (with anion gap supportive), as follows: mild (pH 7.25–7.30; HCO₃⁻ 15–18 mmol/L), moderate (pH 7.00–7.24; HCO₃⁻ 10–15 mmol/L), and severe (pH < 7.00; HCO₃⁻ < 10 mmol/L). Data were extracted from electronic medical records and analyzed descriptively. Results: A total of 373 patients were admitted to the EDs and received treatment for DKA throughout the study period. Adults constituted 71.6% (267/373), while children represented 28.4% (106/373) of the patients; the majority of adults (74.2%) had Type 1 DM (T1DM), while all pediatric patients had T1DM. More than half of the adult presentations met the criteria for severe DKA (55.8%; 149/267), whereas pediatric cases were most commonly moderate in severity (41.5%; 44/106). The most common precipitating factors across both age groups of patients with diabetes before the index DKA event were non-compliance with therapy and infection. Both groups demonstrated typical biochemical features of DKA, although pediatric patients presented with slightly lower bicarbonate and higher anion gaps (slightly greater metabolic acidosis) but with similar hydration status. Regarding patients’ outcomes, hyperkalemia was identified in 23.6% of adults and 24.5% of pediatric patients, while hypokalemia was documented in 20.2% of adults and 24.5% of pediatric patients, and adult patients experienced more acute kidney injuries than the other cohort (5.2% vs. 1.9%). In-hospital mortality was 0.8% (3/373) among all adults. Although pediatric patients experienced faster DKA resolution (median = 16.5 h; IQR, 11.7–25.8) compared to adult patients (23.7 h; 16.2–36.9), they had a longer hospital stay compared to adult patients, and a significant majority required ICU care (50.9%) at some point during their care. Conclusions: The increasing prevalence of DM in Saudi Arabia, especially among the youth, would lead to an increase in DKA burden unless effective preventive measures are taken. This study demonstrated that preventable causes, such as non-compliance with therapy and infection, were responsible for the high admission rates. Thus, comprehensive outpatient care can help strengthen care continuity and help decrease the burden on emergency and inpatient services. Full article

(This article belongs to the Section Endocrinology & Metabolism)

11 pages, 750 KB

Open AccessArticle

Etoricoxib-Induced Fixed Erythema

by Corina Porr, Dana M. Harris, Anca Vidrighin, Alina Catana, Cosmina Diaconu, Emi M. Preda, Mirela L. Popa and Elena C. Berghea

J. Clin. Med. 2025, 14(23), 8504; https://doi.org/10.3390/jcm14238504 (registering DOI) - 30 Nov 2025

Abstract

Background: Fixed drug eruption (FDE) is a non-immediate, CD8+ T cell–mediated hypersensitivity reaction characterized by well-demarcated erythematous–violaceous plaques that recur at the same site after re-exposure to the causative drug. Although NSAIDs and antibiotics are the most common triggers, various other medications may [...] Read more.

Background: Fixed drug eruption (FDE) is a non-immediate, CD8+ T cell–mediated hypersensitivity reaction characterized by well-demarcated erythematous–violaceous plaques that recur at the same site after re-exposure to the causative drug. Although NSAIDs and antibiotics are the most common triggers, various other medications may induce FDE, and genetic susceptibility has been linked to specific HLA alleles. Methods: We conducted a clinical evaluation supported by patch testing, oral drug provocation, and assessment of therapeutic alternatives to identify the causative agent and confirm delayed-type hypersensitivity. Results: We report the case of a 53-year-old woman with essential hypertension, autoimmune thyroiditis, and renal lithiasis who developed well-demarcated erythematous plaques with central vesiculation and moderate pruritus on the dorsal hand and posterior calf approximately 8 hours after ingestion of a 60 mg etoricoxib tablet. Patch testing was negative, while oral challenge confirmed etoricoxib-induced FDE; celecoxib was subsequently evaluated as a potential safe alternative. Conclusions: This case underscores the importance of an integrated diagnostic approach—including careful history, clinical examination, and confirmatory testing—to accurately diagnose delayed cutaneous drug reactions and to identify safe therapeutic options for patients. Full article

(This article belongs to the Special Issue Skin Wound Healing: Clinical Updates and Perspectives)

23 pages, 1141 KB

Open AccessReview

Autoantibodies in Primary Biliary Cholangitis: From Classical Markers to Emerging Targets

by Shima Mimura, Asahiro Morishita, Kyoko Oura, Rie Yano, Mai Nakahara, Tomoko Tadokoro, Koji Fujita, Joji Tani, Miwa Tatsuta, Takashi Himoto and Hideki Kobara

J. Clin. Med. 2025, 14(23), 8503; https://doi.org/10.3390/jcm14238503 (registering DOI) - 30 Nov 2025

Abstract

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive destruction of intrahepatic bile ducts. PBC encompasses several clinical subtypes, including classical AMA-positive PBC (90–95% of cases), AMA-negative PBC (5–10%), and overlap syndromes such as AIH-PBC. These subtypes exhibit distinct [...] Read more.

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive destruction of intrahepatic bile ducts. PBC encompasses several clinical subtypes, including classical AMA-positive PBC (90–95% of cases), AMA-negative PBC (5–10%), and overlap syndromes such as AIH-PBC. These subtypes exhibit distinct serological profiles, with AMA-negative cases often presenting PBC-specific antinuclear antibodies (anti-gp210, anti-sp100) and overlap syndromes demonstrating combined autoantibody patterns characteristic of both conditions. Autoantibodies serve as central biomarkers for diagnosis, prognosis, and understanding disease pathogenesis. This review provides a comprehensive overview of classical and emerging autoantibodies associated with PBC, including AMA-M2, anti-gp210, anti-sp100, anti-KLHL12, and anti-RPL30. We discuss their diagnostic significance across PBC subtypes, pathogenic implications, and potential utility in patient stratification and therapeutic monitoring. Recent evidence suggests that bile acid-induced neoantigen formation, rather than classical loss of immune tolerance, may drive AMA production. Advances in autoantibody profiling, including subclass-specific analysis and multi-marker panels, may pave the way for personalized medicine and improved outcomes in PBC. Full article

(This article belongs to the Special Issue Current Trends and Future Prospects in Autoantibodies in Liver Diseases)

11 pages, 1288 KB

Open AccessArticle

Outcomes of MagLev LVAD Support in Patients Requiring Preoperative Continuous Renal Replacement Therapy

by Christopher L. He, Clayton J. Rust, Ian M. Kusher, Sally El Sammak, Ailin Tang, Joshua D. Preston, Supreet S. Randhawa, Michael E. Halkos, Muath M. Bishawi, Mani A. Daneshmand and Joshua L. Chan

J. Clin. Med. 2025, 14(23), 8502; https://doi.org/10.3390/jcm14238502 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: Acute Kidney Injury (AKI) requiring continuous renal replacement therapy (CRRT) has historically been a contraindication for left ventricular assist device (LVAD) implantation. However, advancements in magnetically levitated (MagLev) LVADs warrant reevaluation. Methods: A retrospective review of adult LVAD recipients at [...] Read more.

Background/Objectives: Acute Kidney Injury (AKI) requiring continuous renal replacement therapy (CRRT) has historically been a contraindication for left ventricular assist device (LVAD) implantation. However, advancements in magnetically levitated (MagLev) LVADs warrant reevaluation. Methods: A retrospective review of adult LVAD recipients at a tertiary center (2009–2024) was performed. Patients were stratified by preoperative CRRT status and LVAD type. Baseline characteristics and perioperative morbidity, Kaplan–Meier survival estimates, restrictive mean survival time (RMST), and Cox proportional hazards models were assessed. Results: Among 312 MagLev LVAD recipients, 22 (7.1%) required preoperative CRRT. Compared to non-CRRT patients, the CRRT group had higher illness severity (INTERMACS 1 or 2: 95% vs. 71%, p = 0.019). Despite this, preoperative CRRT was not associated with worse mortality within the MagLev cohort at 30 days (9.1% vs. 7.9%), 1 year (18.2% vs. 17.9%), or 2 years (31.8% vs. 20.7%; p = 0.31). RMST at 1 year was also similar (305 vs. 311 days; p = 0.85). In contrast, patients on CRRT receiving non-MagLev devices had significantly worse outcomes, with 30-day, 1-year, and 2-year mortality rates of 57.1%, 71.4%, and 78.6%, respectively. RMST analysis showed a 170-day survival advantage at 1 year for MagLev vs. non-MagLev CRRT patients (p < 0.01). Conclusions: In this single-center cohort, preoperative CRRT was not associated with higher mortality among MagLev LVAD recipients and may challenge traditional contraindications against LVAD therapy. Further investigations using larger cohorts are necessary to further evaluate these findings and delineate patient subgroups that may derive the greatest clinical benefit. Full article

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

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9 pages, 443 KB

Open AccessArticle

Comparative Analysis of Sepsis Outcomes Across Body Mass Index Groups: A Retrospective Cohort Study

by Abdulmajeed M. Alshehri, Lama Alfehaid, Saad Alhamdan and Mohammad S. Shawaqfeh

J. Clin. Med. 2025, 14(23), 8501; https://doi.org/10.3390/jcm14238501 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: The relationship between body mass index (BMI) and clinical outcomes in sepsis patients remains controversial, with some studies suggesting an “obesity paradox” and others indicating increased risks for underweight individuals. This study aims to further explore the impact of BMI on [...] Read more.

Background/Objectives: The relationship between body mass index (BMI) and clinical outcomes in sepsis patients remains controversial, with some studies suggesting an “obesity paradox” and others indicating increased risks for underweight individuals. This study aims to further explore the impact of BMI on mortality and other specific sepsis outcomes. Methods: This was a retrospective cohort study of adult patients with sepsis admitted to the intensive care unit (ICU) from 1 January 2021 to 31 December 2023. Patients were divided into four groups according to BMI category. The primary outcome of this study was ICU mortality. Secondary outcomes included the development of septic shock, acute respiratory distress syndrome, 30- and 90-day mortality, ICU and hospital length of stay, and vasopressor- and/or ventilation-free days. Results: A total of 559 patients were included in the study. Among these, 51 were in the underweight group, 206 were in the normal weight group, 158 were in the overweight group, and 184 were in the obese group. The primary outcome of ICU mortality was not significantly different among all BMI groups (p-value > 0.05). Similarly, all secondary outcomes were not significantly different between the groups. Conclusions: Our findings demonstrate that BMI in sepsis patients is not associated with worse clinical outcomes. Further prospective research is warranted to confirm these findings on a larger scale. Full article

(This article belongs to the Special Issue Sepsis and Organ Dysfunction: New Insights into Diagnosis and Treatment)

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41 pages, 926 KB

Open AccessReview

Artificial Intelligence Enabled Lung Sound Auscultation in the Early Diagnosis and Subtyping of Interstitial Lung Disease

by Avneet Kaur, Swathi Priya Cherukuri, Megha Shashidhar Handral, Hanisha Reddy Kukunoor, Rikesh KC, Swathi Godugu, Jieun Lee, Gayathri Yerrapragada, Poonguzhali Elangovan, Mohammed Naveed Shariff, Thangeswaran Natarajan, Jayarajasekaran Janarthanan, Jayavinamika Jayapradhaban Kala, Sancia Mary Jerold Wilson, Samuel Richard, Shiva Sankari Karrupiah, Dipankar Mitra, Vivek N. Iyer, Scott A. Helgeson and Shivaram P. Arunachalam

J. Clin. Med. 2025, 14(23), 8500; https://doi.org/10.3390/jcm14238500 (registering DOI) - 30 Nov 2025

Abstract

Background: Interstitial lung disease (ILD) involves numerous chronic pulmonary conditions that damage the lung parenchyma and alveolar interstitium. ILD has overlapping clinical and radiological features with other commonly seen cardiac and respiratory conditions. If not identified and treated in a timely manner, it [...] Read more.

Background: Interstitial lung disease (ILD) involves numerous chronic pulmonary conditions that damage the lung parenchyma and alveolar interstitium. ILD has overlapping clinical and radiological features with other commonly seen cardiac and respiratory conditions. If not identified and treated in a timely manner, it may lead to irreversible fibrosis and a poor prognosis in the patient. The current diagnostic methods are either invasive or reliant on imaging or specialist interpretation, which can lead to diagnostic delay, increased radiation exposure, and healthcare costs. Lung crackles, often under-recognized as a non-specific feature of ILD, may serve as an important diagnostic clue in identifying not only the early stages of ILD but also its subtypes. This review explores the potential of analyzing the lung sounds in ILD through AI-based auscultation. Objective: To provide a comprehensive analysis of the pathophysiological stages of lung injury in ILD, the specific acoustic features, and the location associated with each ILD subtype and to evaluate the current state-of-the-art non-AI and AI methodologies that are used to diagnose ILD. This review aims to analyze the limitations associated with the current modalities and to envision AI-integrated auscultation as a powerful, cost-effective, non-invasive, radiation-free screening tool for early detection of ILD and its subtypes. Content Overview: The review begins with a detailed analysis of the lung sound pathophysiology, exploring the two-stage mechanism of alveolar epithelial injury and fibrosis formation. Existing hypotheses explaining the mechanism behind crackle production and the role of structural anatomy and surface tension in the generation of pathological lung sounds are examined. A tabulated summary of common ILD subtypes is provided, including their inciting events, pathogenesis, anatomical auscultation locations, and prognostic implications. Current diagnostic modalities for ILD, both non-AI and AI-based, are summarized along with their limitations, emphasizing the need for improved diagnostic tools. Discussion: Existing studies suggest that AI-based auscultation can match or exceed the current modalities in its sensitivity and specificity for detecting ILD-related crackles. Clinicians can identify the specific sound pattern and then correlate it with the ILD subtype and understand the prognosis in real time, thereby providing timely intervention to the patient. Additionally, AI-based auscultation can be used in resource-limited settings and can potentially reduce dependence on pulmonology expertise and radiation-based imaging for monitoring the condition. Conclusions: This literature review highlights the clinical potential of AI-based auscultation for early and accurate diagnoses of ILD. Understanding the associated pathological sounds, biomarkers, and genetic mutations linked to different subtypes opens avenues for future development of non-invasive diagnostic panels for ILD in clinical practice. Full article

(This article belongs to the Special Issue Interstitial Lung Diseases: New Treatments and Future Directions)

22 pages, 1044 KB

Open AccessSystematic Review

Does Adding LEAP to ACL Reconstruction Reduce Graft Failure? A Systematic Review and Meta-Analysis of Comparative Studies with Minimum Two-Year Follow-Up

by Simone Giusti, Angelo Matteucci, Simone Pavone, Ciro Mignano and Ezio Adriani

J. Clin. Med. 2025, 14(23), 8499; https://doi.org/10.3390/jcm14238499 (registering DOI) - 30 Nov 2025

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is the gold-standard treatment for ACL rupture; however, graft failure remains a significant concern, particularly in young, active, or high-risk patients. The addition of a Lateral Extra-Articular Procedure (LEAP) has been proposed to enhance rotational stability [...] Read more.

Background: Anterior cruciate ligament (ACL) reconstruction (ACLR) is the gold-standard treatment for ACL rupture; however, graft failure remains a significant concern, particularly in young, active, or high-risk patients. The addition of a Lateral Extra-Articular Procedure (LEAP) has been proposed to enhance rotational stability and reduce the risk of graft rupture. This systematic review and meta-analysis aimed to determine whether adding LEAP to primary ACLR reduces graft failure rates compared to isolated ACLR, with a minimum follow-up of two years. Methods: A comprehensive literature search was conducted across PubMed, Scopus, Embase and Cochrane Library databases in accordance with PRISMA guidelines. Eighteen comparative studies with a minimum 24-month follow-up were included, encompassing 7336 patients (3857 undergoing isolated ACLR and 3479 undergoing ACLR with LEAP). The primary outcome was graft failure rate. Data were analyzed using the Mantel–Haenszel method with a fixed-effects model to calculate pooled risk ratios (RR) and 95% confidence intervals (CI). Results: Pooled analysis demonstrated a significant increase in graft rupture risk in the ACLR-alone group compared to ACLR + LEAP (RR 2.72; 95% CI: 2.23–3.32; p < 0.00001), with negligible heterogeneity (I² = 0%). LEAP was particularly beneficial in high-risk populations such as young athletes and individuals with high-grade pivot shift or ligamentous laxity. Secondary outcomes showed improved rotational stability and comparable patient-reported outcomes and complication rates between groups. Conclusions: ACLR alone presents a higher risk of graft failure in comparison with the ALCR + LEAP technique. Furthermore, the addition of LEAP to ACLR improves rotational stability without increasing complications. LEAP should be selectively considered in patients with high-risk profiles or persistent intraoperative instability. These findings support the incorporation of LEAP as a valuable adjunct in modern ACL reconstruction strategies. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injuries: Clinical Treatment and Rehabilitation)

17 pages, 3735 KB

Open AccessArticle

Italian Systemic Lupus Erythematosus (SLE) Patients: Overview of Their Quality of Life and Unmet Needs

by Luca Moroni, Ginevra De Marchi, Rosa Pelissero, Mercedes Callori, Italia Agresta, Antonella Celano, Elisa Cosentino, Silvia Tamanini, Alessia Delli Carri, Giuseppe Alvise Ramirez, Alessia Nano, Luca Quartuccio and Lorenzo Dagna

J. Clin. Med. 2025, 14(23), 8498; https://doi.org/10.3390/jcm14238498 (registering DOI) - 30 Nov 2025

Abstract

Background/Objectives: Systemic Lupus Erythematosus (SLE) is a multifactorial disease that significantly affects patients’ quality of life (QoL) and poses management challenges. This project combined a nationwide patient listening initiative with an Advisory Board (AB) to identify unmet needs and perceptions, aiming to [...] Read more.

Background/Objectives: Systemic Lupus Erythematosus (SLE) is a multifactorial disease that significantly affects patients’ quality of life (QoL) and poses management challenges. This project combined a nationwide patient listening initiative with an Advisory Board (AB) to identify unmet needs and perceptions, aiming to integrate patient perspectives into decision-making and enhance SLE care. Methods: The “PaLESiamoci!” project, conducted by IQVIA with two patient organizations (Gruppo LES Italiano and APMARR), included both qualitative and quantitative phases. Ten patients completed disease diaries and one-hour interviews, while 151 others voluntarily filled a PO-administered survey including the validated 12-item Medical Outcome Short Form (SF-12) and items on physical, emotional, and daily life impact. Insights from these phases informed the AB discussion involving clinicians and patient representatives on six key topics. Results: Patients with SLE showed lower Physical (−13.4) and Mental (−14.0) Component Summary scores than the Italian population, indicating reduced social and work functioning. Despite EULAR recommendations to minimize corticosteroid use, 64% of patients remained on corticosteroids. The AB discussions revealed key unmet needs, including differing awareness of organ damage risks, corticosteroid-related adverse events, and adherence challenges, as well as the need for non-pharmacological and multidisciplinary support. Conclusions: The project highlighted major gaps and opportunities in SLE management. Patient organizations and rheumatologists emphasized developing tailored educational materials, strengthening rheumatologist–patient communication, and promoting multidisciplinary, patient-centered approaches to improve overall care. Full article

(This article belongs to the Section Immunology & Rheumatology)

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19 pages, 1052 KB

Open AccessReview

Automatic Segmentation of Intraluminal Thrombus in Abdominal Aortic Aneurysms Based on CT Images: A Comprehensive Review of Deep Learning-Based Methods

by Jia Guo, Fabien Lareyre, Sébastien Goffart, Andrea Chierici, Hervé Delingette and Juliette Raffort

J. Clin. Med. 2025, 14(23), 8497; https://doi.org/10.3390/jcm14238497 (registering DOI) - 30 Nov 2025

Abstract

Objectives: This review aims to review the application of deep learning (DL) techniques in the imaging analysis of abdominal aortic aneurysm (AAA), with a specific focus on the segmentation of intraluminal thrombus (ILT). Methods: A comprehensive literature review was conducted through [...] Read more.

Objectives: This review aims to review the application of deep learning (DL) techniques in the imaging analysis of abdominal aortic aneurysm (AAA), with a specific focus on the segmentation of intraluminal thrombus (ILT). Methods: A comprehensive literature review was conducted through searches of PUBMED and Web of Science up to September 2025. Only English-language studies applying DL-based networks for ILT segmentation in patients with AAA on computed tomography angiography were included. After screening 664 articles, 22 met the eligibility criteria and were included. The reported methodological frameworks and segmentation performance metrics were extracted for comparison and analysis. Results: Among the studies included, the reported Dice similarity coefficients ranged from 0.81 to 0.93 for 2D networks and from 0.804 to 0.9868 for 3D networks. Notably, 2D Multiview fusion models outperform other 2D approaches, while 3D U-Net remains a strong baseline. Methods using preoperative images demonstrated great applicability for surgical planning, while postoperative segmentation faced challenges related to imaging artifacts caused by stent. Conclusions: This review provides a comprehensive overview of recent DL-based ILT segmentation methods for AAA patients on CTA, offering perspectives for applications in advanced preoperative planning and postoperative surveillance. Despite the promising results, the lack of standardized datasets limits model development and external validation. Future research should address these limitations by focusing on multicenter standardized datasets and seamless integration into clinical workflows. Full article

(This article belongs to the Special Issue State of the Art in Management of Aortic Aneurysm in Vascular Surgery)

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16 pages, 925 KB

Open AccessSystematic Review

Chair-Based Magnetic Pelvic Floor Stimulation and Female Sexual Function in Women with Urinary Incontinence: A Systematic Review

by Geanina Sacarin, Marius Craina, Bogdan Sorop, Mihai Calin Bica, Lavinia Stelea, Mihaela Prodan, Madalina Sorop, Alina Simona Abu-Awwad, Maria Sorop-Florea, Adina Ruta and Razvan Nitu

J. Clin. Med. 2025, 14(23), 8496; https://doi.org/10.3390/jcm14238496 (registering DOI) - 30 Nov 2025

Abstract

Background and objectives: Urinary incontinence (UI) frequently coexists with female sexual dysfunction (FSD). Magnetic chair therapies—high-intensity focused electromagnetic stimulation (HIFEM) and extracorporeal magnetic innervation (ExMI)—are increasingly used for UI, but sexual outcomes are less well synthesized. We reviewed open-access clinical studies reporting [...] Read more.

Background and objectives: Urinary incontinence (UI) frequently coexists with female sexual dysfunction (FSD). Magnetic chair therapies—high-intensity focused electromagnetic stimulation (HIFEM) and extracorporeal magnetic innervation (ExMI)—are increasingly used for UI, but sexual outcomes are less well synthesized. We reviewed open-access clinical studies reporting Female Sexual Function Index (FSFI) and/or Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ) outcomes. Methods: Following PRISMA 2020 and an OSF-registered protocol, we searched PubMed, Scopus, and Web of Science to 25 October 2025. Eligible studies enrolled adult women with UI, used chair-based magnetic stimulation, and reported FSFI and/or PISQ before and after treatment. Data were narratively synthesized. Results: Five studies (n ≈ 219; FSFI n ≈ 170; PISQ n = 49) met the criteria. Randomized and controlled data showed clinically relevant advantages for active therapy: FSFI between-group gains were +6.3 at 8 weeks for HIFEM+PFMT vs. PFMT and +5.63 at 14 weeks for pulsed magnetic stimulation vs. sham. Single-arm cohorts reported FSFI increases of +8.1 at 3 months and +9.4 to +10.0 by ~6–12 months. PISQ-12 improved by +3.86 at 12 weeks when magnetic stimulation was combined with optimized PFMT. UI severity also decreased (ICIQ-UI SF −9.85; 74.4% at 12 weeks; ~71–72% reduction at 9–12 months). Adverse events were uncommon and mild where reported. Conclusions: Across heterogeneous designs, chair-based magnetic stimulation is associated with meaningful improvements in sexual function and continence in women with UI, with signals that combining stimulation with PFMT may enhance benefits. Standardized, longer-term trials centered on FSFI/PISQ are warranted. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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