Journal of Clinical Medicine

17 pages, 516 KiB

Open AccessArticle

Incidence and Predictive Factors of Acute Kidney Injury After Major Hepatectomy: Implications for Patient Management in Era of Enhanced Recovery After Surgery (ERAS) Protocols

by Henri Mingaud, Jean Manuel de Guibert, Jonathan Garnier, Laurent Chow-Chine, Frederic Gonzalez, Magali Bisbal, Jurgita Alisauskaite, Antoine Sannini, Marc Léone, Marie Tezier, Maxime Tourret, Sylvie Cambon, Jacques Ewald, Camille Pouliquen, Lam Nguyen Duong, Florence Ettori, Olivier Turrini, Marion Faucher and Djamel Mokart

J. Clin. Med. 2025, 14(15), 5452; https://doi.org/10.3390/jcm14155452 (registering DOI) - 2 Aug 2025

Abstract

Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop [...] Read more.

Background: Acute kidney injury (AKI) frequently occurs following major liver resection, adversely affecting both short- and long-term outcomes. This study aimed to determine the incidence of AKI post-hepatectomy and identify relevant pre- and intraoperative risk factors. Our secondary objectives were to develop a predictive score for postoperative AKI and assess the associations between AKI, chronic kidney disease (CKD), and 1-year mortality. Methods: This was a retrospective study in a cancer referral center in Marseille, France, from 2018 to 2022. Results: Among 169 patients, 55 (32.5%) experienced AKI. Multivariate analysis revealed several independent risk factors for postoperative AKI, including age, body mass index, the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, time to liver resection, intraoperative shock, and bile duct reconstruction. Neoadjuvant chemotherapy was protective. The AKIMEBO score was developed, with a threshold of ≥15.6, demonstrating a sensitivity of 89.5%, specificity of 76.4%, positive predictive value of 61.8%, and negative predictive value of 94.4%. AKI was associated with increased postoperative morbidity and one-year mortality following major hepatectomy. Conclusion: AKI is a common complication post-hepatectomy. Factors such as time to liver resection and intraoperative shock management present potential clinical intervention points. The AKIMEBO score can provide a valuable tool for postoperative risk stratification. Full article

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

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23 pages, 1693 KiB

Open AccessReview

From Vision to Illumination: The Promethean Journey of Optical Coherence Tomography in Cardiology

by Angela Buonpane, Giancarlo Trimarchi, Francesca Maria Di Muro, Giulia Nardi, Marco Ciardetti, Michele Alessandro Coceani, Luigi Emilio Pastormerlo, Umberto Paradossi, Sergio Berti, Carlo Trani, Giovanna Liuzzo, Italo Porto, Antonio Maria Leone, Filippo Crea, Francesco Burzotta, Rocco Vergallo and Alberto Ranieri De Caterina

J. Clin. Med. 2025, 14(15), 5451; https://doi.org/10.3390/jcm14155451 (registering DOI) - 2 Aug 2025

Abstract

Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize [...] Read more.

Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize atherosclerotic plaques was demonstrated in an in vitro study, and the following year marked the acquisition of the first in vivo OCT image of a human coronary artery. A major milestone followed in 2000, with the first intracoronary imaging in a living patient using time-domain OCT. However, the real inflection point came in 2006 with the advent of frequency-domain OCT, which dramatically improved acquisition speed and image quality, enabling safe and routine imaging in the catheterization lab. With the advent of high-resolution, second-generation frequency-domain systems, OCT has become clinically practical and widely adopted in catheterization laboratories. OCT progressively entered interventional cardiology, first proving its safety and feasibility, then demonstrating superiority over angiography alone in guiding percutaneous coronary interventions and improving outcomes. Today, it plays a central role not only in clinical practice but also in cardiovascular research, enabling precise assessment of plaque biology and response to therapy. With the advent of artificial intelligence and hybrid imaging systems, OCT is now evolving into a true precision-medicine tool—one that not only guides today’s therapies but also opens new frontiers for discovery, with vast potential still waiting to be explored. Tracing its historical evolution from ophthalmology to cardiology, this narrative review highlights the key technological milestones, clinical insights, and future perspectives that position OCT as an indispensable modality in contemporary interventional cardiology. As a guiding thread, the myth of Prometheus is used to symbolize the evolution of OCT—from its illuminating beginnings in ophthalmology to its transformative role in cardiology—as a metaphor for how light, innovation, and knowledge can reveal what was once hidden and redefine clinical practice. Full article

(This article belongs to the Section Cardiology)

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11 pages, 690 KiB

Open AccessArticle

Leadless Pacemaker Implantation During Extraction in Patients with Active Infection: A Comprehensive Analysis of Safety, Patient Benefits and Costs

by Aviv Solomon, Maor Tzuberi, Anat Berkovitch, Eran Hoch, Roy Beinart and Eyal Nof

J. Clin. Med. 2025, 14(15), 5450; https://doi.org/10.3390/jcm14155450 (registering DOI) - 2 Aug 2025

Abstract

Background: Cardiac implantable electronic device (CIED) infections necessitate extraction and subsequent pacing interventions. Conventional methods after removing the infected CIED system involve temporary or semi-permanent pacing followed by delayed permanent pacemaker (PPM) implantation. Leadless pacemakers (LPs) may offer an alternative, allowing immediate PPM [...] Read more.

Background: Cardiac implantable electronic device (CIED) infections necessitate extraction and subsequent pacing interventions. Conventional methods after removing the infected CIED system involve temporary or semi-permanent pacing followed by delayed permanent pacemaker (PPM) implantation. Leadless pacemakers (LPs) may offer an alternative, allowing immediate PPM implantation without increasing infection risks. Our objective is to evaluate the safety and cost-effectiveness of LP implantation during the same procedure of CIED extraction, compared to conventional two-stage approaches. Methods: Pacemaker-dependent patients with systemic or pocket infection undergoing device extraction and LP implantation during the same procedure at Sheba Medical Center, Israel, were compared to a historical group of patients undergoing a semi-permanent (SP) pacemaker implantation during the procedure, followed by a permanent pacemaker implantation. Results: The cohort included 87 patients, 45 undergoing LP implantation and 42 SP implantation during the extraction procedure. The LP group demonstrated shorter intensive care unit stay (1 ± 3 days vs. 7 ± 12 days, p < 0.001) and overall hospital days (11 ± 24 days vs. 17 ± 17 days, p < 0.001). Rates of infection relapse and one-year mortality were comparable between groups. Economic analysis revealed comparable total costs, despite the higher initial expense of LPs. Conclusions: LP implantation during CIED extraction offers significant clinical and logistical advantages, including reduced hospital stays and streamlined treatment, with comparable safety and cost-effectiveness to conventional approaches. Full article

(This article belongs to the Section Cardiology)

11 pages, 623 KiB

Open AccessArticle

A TAVI Programme Without an On-Site Cardiac Surgery Department: A Single-Center Retrospective Study

by Rami Barashi, Mustafa Gabarin, Ziad Arow, Ranin Hilu, Ilya Losin, Ivan Novikov, Karam Abd El Hai, Yoav Arnson, Yoram Neuman, Koby Pesis, Ziyad Jebara, David Pereg, Edward Koifman, Abid Assali and Hana Vaknin-Assa

J. Clin. Med. 2025, 14(15), 5449; https://doi.org/10.3390/jcm14155449 (registering DOI) - 2 Aug 2025

Abstract

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications [...] Read more.

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Implantation: Recent Advances and Future Directions)

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14 pages, 310 KiB

Open AccessArticle

Clinical Outcomes of Patients with Achalasia Following Pneumatic Dilation Treatment: A Single Center Experience

by Viktorija Sabljić, Dorotea Božić, Damir Aličić, Žarko Ardalić, Ivna Olić, Damir Bonacin and Ivan Žaja

J. Clin. Med. 2025, 14(15), 5448; https://doi.org/10.3390/jcm14155448 (registering DOI) - 2 Aug 2025

Abstract

Background/Objectives: Pneumatic dilation (PD) is a widely used treatment modality in the management of achalasia. It is particularly relevant in regions where many centers lack access to advanced therapeutic modalities. Therefore, we aimed to assess the effectiveness and safety of PD in [...] Read more.

Background/Objectives: Pneumatic dilation (PD) is a widely used treatment modality in the management of achalasia. It is particularly relevant in regions where many centers lack access to advanced therapeutic modalities. Therefore, we aimed to assess the effectiveness and safety of PD in our local region. Methods: This study retrospectively analyzed patients with achalasia that underwent PD from 1/2013 to 12/2019. The diagnosis of achalasia was established on the grounds of clinical symptoms, radiological and endoscopic findings, and esophageal manometry. Data on patient’s clinical characteristics, dilation technique and postprocedural follow-up were collected and statistically analyzed. Procedure effectiveness was defined as the postprocedural Eckardt score ≤ 3. Results: PD significantly reduced frequency of dysphagia, regurgitation, and retrosternal pain (p < 0.001). Body-weight increased significantly one month and one year after the procedure (p < 0.001). The procedural success rate was 100%. No severe complications were reported. Conclusions: PD is an effective and safe treatment modality in the management of achalasia. The study limitations include a single center design with the small number of participants, not all of whom underwent manometry, gender disproportion, absence of non-responders, and a short follow-up. Full article

(This article belongs to the Special Issue Clinical Advances in Gastrointestinal Endoscopy)

12 pages, 976 KiB

Open AccessCase Report

Familial MEN1 Syndrome with Atypical Renal Features and a Coexisting CLDN16 Variant: A Case Series

by Ioannis Petrakis, Eleni Drosataki, Dimitra Lygerou, Andreas Antonakis, Konstantina Kydonaki, Marinos Mitrakos, Christos Pleros, Maria Sfakiotaki, Paraskevi Xekouki and Kostas Stylianou

J. Clin. Med. 2025, 14(15), 5447; https://doi.org/10.3390/jcm14155447 (registering DOI) - 2 Aug 2025

Abstract

Background and Clinical Significance: Multiple Endocrine Neoplasia type 1 (MEN1) is a rare autosomal dominant disorder caused by mutations in the MEN1 gene. Although primarily characterized by endocrine tumors, renal manifestations remain underreported. Case Presentation: We report a three-generation family carrying a pathogenic [...] Read more.

Background and Clinical Significance: Multiple Endocrine Neoplasia type 1 (MEN1) is a rare autosomal dominant disorder caused by mutations in the MEN1 gene. Although primarily characterized by endocrine tumors, renal manifestations remain underreported. Case Presentation: We report a three-generation family carrying a pathogenic MEN1 mutation (c.1351-3_1359del) with a co-occurring Claudin 16 (CLDN16) variant (c.324+13C>G). Genetic testing included MLPA and whole-exome sequencing (WES), with bioinformatics analysis validating variant pathogenicity. All three patients exhibited primary hyperparathyroidism, hypercalcemia, hypercalciuria, early nephrocalcinosis, and renal hypomagnesemia. The CLDN16 variant, previously considered benign, co-segregated with hypomagnesemia and renal involvement, suggesting a potential modifying role. Conclusions: These findings support the need for comprehensive genetic screening in MEN1 patients with atypical renal presentations. Concomitant genetic variations can alter the principal phenotype. Full article

(This article belongs to the Section Nephrology & Urology)

11 pages, 398 KiB

Open AccessPerspective

Implications of Metabolic Bariatric Surgery on Reproductive Health

by Amihai Rottenstreich and Yitka Graham

J. Clin. Med. 2025, 14(15), 5446; https://doi.org/10.3390/jcm14155446 (registering DOI) - 2 Aug 2025

Abstract

In the last two decades, metabolic and bariatric surgery (MBS) has become the mainstay of treatment for severe and complex obesity. The majority of patients undergoing MBS are women of childbearing age. Coupled with the dramatic increase in the utilization of MBS, caregivers [...] Read more.

In the last two decades, metabolic and bariatric surgery (MBS) has become the mainstay of treatment for severe and complex obesity. The majority of patients undergoing MBS are women of childbearing age. Coupled with the dramatic increase in the utilization of MBS, caregivers are likely to encounter patients who have undergone MBS in routine practice. From this perspective, we highlight the different reproductive health challenges and issues encountered throughout the pre-operative, peri-operative, and postoperative phases. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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19 pages, 487 KiB

Open AccessReview

Recent Trends in the Management of Varicocele

by Tamás Takács, Anett Szabó and Zsolt Kopa

J. Clin. Med. 2025, 14(15), 5445; https://doi.org/10.3390/jcm14155445 (registering DOI) - 2 Aug 2025

Abstract

Varicocele is a common, potentially correctable condition associated with impaired male fertility. Despite being frequently encountered in clinical andrology, its pathophysiological mechanisms, diagnostic criteria, and therapeutic approaches remain areas of active investigation and debate. The authors conducted a comprehensive literature search, using the [...] Read more.

Varicocele is a common, potentially correctable condition associated with impaired male fertility. Despite being frequently encountered in clinical andrology, its pathophysiological mechanisms, diagnostic criteria, and therapeutic approaches remain areas of active investigation and debate. The authors conducted a comprehensive literature search, using the PubMed database, covering clinical studies, systematic reviews, meta-analyses, and current international guidelines from the past ten years. Emphasis was placed on studies investigating novel diagnostic modalities, therapeutic innovations, and prognostic markers. Emerging evidence supports the multifactorial pathophysiology of varicocele, involving oxidative stress, hypoxia, inflammatory pathways, and potential genetic predisposition. Biomarkers, including microRNAs, antisperm antibodies, and sperm DNA fragmentation, offer diagnostic and prognostic utility, though their routine clinical implementation requires further validation. Advances in imaging, such as shear wave elastography, may improve diagnostic accuracy. While microsurgical subinguinal varicocelectomy remains the gold standard, technological refinements and non-surgical alternatives are being explored. Indications for treatment have expanded to include selected cases of non-obstructive azoospermia, hypogonadism, and optimization for assisted reproduction, though high-level evidence is limited. Full article

(This article belongs to the Special Issue Male Infertility Update: Current Knowledge on Etiology, Comorbidities, Diagnosis and Treatment: Clinical Topics)

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13 pages, 467 KiB

Open AccessReview

The Clinical and Medico-legal Aspects in the Challenge of Transfusion-Free Organ Transplants: A Scoping Review

by Matteo Bolcato, Ludovico Fava, Aryeh Shander, Christoph Zenger, Kevin M. Trentino, Mario Chisari, Vanessa Agostini, Ivo Beverina, Giandomenico Luigi Biancofiore and Vincenzo De Angelis

J. Clin. Med. 2025, 14(15), 5444; https://doi.org/10.3390/jcm14155444 (registering DOI) - 1 Aug 2025

Abstract

Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the “extreme” [...] Read more.

Background: Patient blood management (PBM) strategies have been shown to significantly reduce the use of blood products and enabled surgical procedures to be carried out safely without the need for transfusions. This evidence has raised questions about the possibilities of the “extreme” application of PBM strategies for complex surgical interventions, such as organ transplants, even in patients in whom it is not possible to proceed with transfusion. The aim of this scoping review was to identify and describe the current evidence available in the medical literature on the transplant of the four main solid organs: kidney, heart, liver, and lung in patients declining blood transfusions. Methods: A comprehensive literature search was conducted using PubMed from January 2000 to February 2025. Only articles reporting cases, case series, population samples, or comparative studies describing solid organ transplantation without the use of blood components were included. The results are presented separately for each solid organ. Results: Kidney: Nine studies were included, seven of which reported case reports or case series of kidney or kidney–pancreas transplants, and two articles were comparative studies. Liver: Nine studies reported bloodless liver transplants, eight were case reports or case series, and one was a comparative observational study. Heart: Five studies were included, four of which were case reports of heart transplants; in addition there was a comparative study describing eight heart transplants without the use of blood components to 16 transfusable transplant patients. Lung: Five studies reporting lung transplant without transfusion were reported, four of which were case reports performed in the absence of deaths, and two of which were bilateral. Furthermore, there was an article describing two single lung transplants without the use of blood components compared to ten transfusable transplant patients. Conclusions: The analysis performed demonstrates the possibility, depending on the organ, of performing solid organ transplant procedures without the use of blood components in selected and carefully prepared patients by experienced multidisciplinary teams. Full article

(This article belongs to the Special Issue Selected Papers from the 3rd International Online Conference on Clinical Medicine)

13 pages, 441 KiB

Open AccessArticle

Pulmonary Involvement in Patients with Positive Myositis Antibodies in Rheumatology: A Retrospective Monocentric Analysis

by Falk Schumacher, Malte Kanbach, Maximilian Zimmermann, Daniel Majorski, Wigbert Schulze, Maximilian Wollsching-Strobel, Doreen Kroppen, Sarah Bettina Stanzel, Wolfram Windisch, Johannes Strunk and Melanie Berger

J. Clin. Med. 2025, 14(15), 5443; https://doi.org/10.3390/jcm14155443 (registering DOI) - 1 Aug 2025

Abstract

Background: Pulmonary involvement is the most common prognosis-related organ involvement in idiopathic inflammatory myopathy (IIM). Owing to the large number of antibodies, the evidence for lung involvement and rare antibodies is limited. In everyday clinical practice, the interpretation of positive myositis antibodies represents [...] Read more.

Background: Pulmonary involvement is the most common prognosis-related organ involvement in idiopathic inflammatory myopathy (IIM). Owing to the large number of antibodies, the evidence for lung involvement and rare antibodies is limited. In everyday clinical practice, the interpretation of positive myositis antibodies represents a challenge. Methods: This study is a retrospective monocentric analysis. The data collection regarding positive myositis antibodies and possible pulmonary involvement was carried out from July 2019 to May 2022. Data analysis revealed positive results for one of the following antibodies: EJ, PL7, OJ, PL12, Mi-2α, TIF1γ, MDA5, SAE, NXP2, SRP, Ku, PM-Scl100 and PM-Scl75. In our analysis, patients with IIM, patients with inflammatory rheumatic disease other than IIM and patients without inflammatory rheumatic disease are described. The results of high-resolution computed tomography (HRCT), pulmonary function tests, echocardiographic examinations and their associated clinical findings are examined. Results: In the entire cohort, 209 patients with positive myositis antibodies were detected. In total, 22 (10.5%) patients had interstitial lung disease (ILD) patterns on HRCT. In the subgroup of patients with IIM, a significantly higher proportion of patients with lung involvement (n = 13, 35.1%) was found than in the group with other inflammatory rheumatic diseases (IRDs) (n = 6, 6.7%) or in the group without IRDs (n = 3, 3.7%). When the antibody groups were considered, the PL12-positive patients had the largest proportion of ILD (42%), followed by the MDA5-positive patients (40%). Conclusions: In patients with IIM, myositis antibodies are highly relevant for assessing the risk of lung involvement. In groups with other IRD or without IRD, antibody detection does not represent this high relevance for lung involvement. A differentiated assessment of the various MSAs or MAAs detected, as well as clinical parameters, allows for further important risk assessment for prognosis-relevant lung involvement. Full article

(This article belongs to the Section Immunology)

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13 pages, 456 KiB

Open AccessReview

The Role of Obstructive Sleep Apnea in Pulmonary Hypertension Associated with Lung Diseases (Group 3 Pulmonary Hypertension): A Narrative Review

by Athiwat Tripipitsiriwat, Atul Malhotra, Hannah Robertson, Nick H. Kim, Jenny Z. Yang and Janna Raphelson

J. Clin. Med. 2025, 14(15), 5442; https://doi.org/10.3390/jcm14155442 (registering DOI) - 1 Aug 2025

Abstract

Obstructive sleep apnea (OSA) could increase pulmonary artery pressure. However, the clinical consequences vary, mainly depending on comorbidities. Patients with pulmonary hypertension associated with lung diseases (World Health Organization (WHO) Group 3 pulmonary hypertension) are particularly vulnerable increases in pulmonary artery pressure. Managing [...] Read more.

Obstructive sleep apnea (OSA) could increase pulmonary artery pressure. However, the clinical consequences vary, mainly depending on comorbidities. Patients with pulmonary hypertension associated with lung diseases (World Health Organization (WHO) Group 3 pulmonary hypertension) are particularly vulnerable increases in pulmonary artery pressure. Managing pulmonary hypertension in this specific patient population presents a considerable challenge. While positive airway pressure therapy for OSA has shown promise in improving pulmonary hemodynamics in patients with obesity hypoventilation syndrome and chronic obstructive pulmonary disease, evidence is lacking for similar improvements in those with other pulmonary diseases and hypoventilation disorders. Furthermore, pulmonary-artery-specific therapies may carry a risk of clinical worsening in this group. Weight management and new pharmacotherapy have together emerged as a crucial intervention, demonstrating benefits for both OSA and pulmonary hemodynamics. We reviewed key studies that provide insights into the influence of OSA on WHO Group 3 pulmonary hypertension and the clinical management of both conditions. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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10 pages, 808 KiB

Open AccessArticle

Donor–Recipient Race Mismatch Is Associated with Lower Survival After Liver Transplantation for Primary Sclerosing Cholangitis

by Mark W. Russo, Will Wheless, Wida S. Cherikh, Alice E. Toll, Alexandra T. Lewis and Andrew S. deLemos

J. Clin. Med. 2025, 14(15), 5441; https://doi.org/10.3390/jcm14155441 (registering DOI) - 1 Aug 2025

Abstract

Background: Patient survival after liver transplantation is lower in donor–recipient race mismatched patients for indications other than primary sclerosing cholangitis. Objectives: To determine if survival is lower after liver transplantation in donor–recipient race mismatched recipients with primary sclerosing cholangitis. Methods: The [...] Read more.

Background: Patient survival after liver transplantation is lower in donor–recipient race mismatched patients for indications other than primary sclerosing cholangitis. Objectives: To determine if survival is lower after liver transplantation in donor–recipient race mismatched recipients with primary sclerosing cholangitis. Methods: The Organ Procurement and Transplantation Network database was analyzed for deceased donor adult liver transplant recipients with primary sclerosing cholangitis. Graft and patient survival by donor–recipient race were estimated using Kaplan–Meier survival method and compared using the log-rank test. Multivariable analysis was performed using Cox regression. Results: From 2002 to 2018, 5-year patient survival in White (n = 2223) and Black recipients (n = 491), was 89.8% and 87.1%, respectively. Five-year patient survival for the donor–recipient pairs, White–White (n = 1622), Black–Black (n = 110), Black–White (n = 335), and White–Black (n = 314) was 90.8%, 91.1%, 87.1%, and 86.0%, respectively, p = 0.026. In multivariable analysis, 5-year patient mortality was higher in Black recipients of White donors [HR 1.69, 95% CI 1.16, 2.45], compared to White recipients of White donors. Conclusions: Five-year patient mortality after deceased donor liver transplantation for primary sclerosing cholangitis is higher in Black recipients who received livers from White donors compared to matched White donors and recipients. Full article

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

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17 pages, 1471 KiB

Open AccessArticle

RANKL/OPG Axis and Bone Mineral Density in Pediatric Inflammatory Bowel Disease

by Mariusz Olczyk, Agnieszka Frankowska, Marcin Tkaczyk, Anna Socha-Banasiak, Renata Stawerska, Anna Łupińska, Zuzanna Gaj, Ewa Głowacka and Elżbieta Czkwianianc

J. Clin. Med. 2025, 14(15), 5440; https://doi.org/10.3390/jcm14155440 (registering DOI) - 1 Aug 2025

Abstract

Background: Inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), may impair bone metabolism, particularly in children. The RANKL/OPG axis, as a key regulator of bone turnover, may contribute to these disturbances. However, data in the pediatric population [...] Read more.

Background: Inflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), may impair bone metabolism, particularly in children. The RANKL/OPG axis, as a key regulator of bone turnover, may contribute to these disturbances. However, data in the pediatric population remain limited. Methods: A single-center, prospective observational study included 100 children aged 4–18 years, with a comparable number of girls and boys. Among them, 72 had IBD (27 CD, 45 UC) and 28 were healthy controls. Anthropometric, biochemical, and densitometric assessments were performed, including serum levels of RANKL and OPG, and markers of inflammation and bone turnover. Results: Children with CD had significantly lower height and weight percentiles compared to UC and controls. Serum RANKL and the RANKL/OPG ratio were significantly elevated in IBD patients, particularly in CD (p < 0.01). Total body BMD Z-scores were lower in IBD compared to controls (p = 0.03). Low BMD was found in 14.7% of UC and 26.3% of CD patients. In both groups, over 30% had values in the “gray zone” (−1.0 to −2.0). A positive correlation was observed between height and weight and bone density (p < 0.01). Higher OPG was associated with lower body weight (p < 0.001), while increased RANKL correlated with osteocalcin (p = 0.03). Patients receiving biological therapy had significantly lower BMD. Conclusions: Pediatric IBD is associated with significant alterations in the RANKL/OPG axis and reduced bone density. These findings support early screening and suggest RANKL/OPG as a potential biomarker of skeletal health. Full article

(This article belongs to the Special Issue Inflammatory Bowel Diseases in 2024 and Beyond: From Diagnosis to Treatment)

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13 pages, 3144 KiB

Open AccessArticle

Radial Head Prosthesis with Interconnected Porosity Showing Low Bone Resorption Around the Stem

by Valeria Vismara, Enrico Guerra, Riccardo Accetta, Carlo Cardile, Emanuele Boero, Alberto Aliprandi, Marco Porta, Carlo Zaolino, Alessandro Marinelli, Carlo Cazzaniga and Paolo Arrigoni

J. Clin. Med. 2025, 14(15), 5439; https://doi.org/10.3390/jcm14155439 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims [...] Read more.

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims to assess radiological outcomes, focusing on bone resorption around the stem, for radial head replacement using a modular, cementless radial head prosthesis with interconnected porosity. Methods: A series of 42 cases was available for review. Patients underwent radial head arthroplasty using a three-dimensional-printed radial head prosthesis. Patients were eligible for inclusion if they had undergone at least one follow-up between 6 and 15 months post-operatively. A scoring system to detect bone resorption was developed and administered by two independent evaluators. Results: Forty-two patients (14 males, 28 females), with an average age of 59 ± 11 years (range: 39–80 years), were analyzed with a minimum of six months’ and a maximum of 32 months’ follow-up. At follow-up, 50 radiological evaluations were collected, with 29 showing ≤3 mm and 12 showing 3–6 mm resorption around the stem. The average resorption was 3.5 mm ± 2.3. No correlation was found between the extent of resorption and the time of follow-up. The developed scoring system allowed for a high level of correlation between the evaluators’ measurements of bone resorption. Conclusions: Radial head prosthesis with interconnected porosity provided a low stem resorption rate for patients after a radial head fracture at short-to-mid-term follow-up after the definition of a reliable and easy-to-use radiological-based classification approach. (Level of Evidence: Level IV). Full article

(This article belongs to the Special Issue Trends and Prospects in Shoulder and Elbow Surgery)

15 pages, 611 KiB

Open AccessArticle

Mapping the Mind: Gray Matter Signatures of Personality Pathology in Female Adolescent Anorexia Nervosa Persist Through Treatment

by Lukas Lenhart, Manuela Gander, Ruth Steiger, Agnieszka Dabkowska-Mika, Malik Galijasevic, Stephanie Mangesius, Martin Fuchs, Kathrin Sevecke and Elke R. Gizewski

J. Clin. Med. 2025, 14(15), 5438; https://doi.org/10.3390/jcm14155438 (registering DOI) - 1 Aug 2025

Abstract

Background: Comorbid personality disorders (PDs) in patients with anorexia nervosa (AN) are associated with increased psychopathology, higher suicide risk, and poorer treatment response and outcomes. This study aimed to examine associations between gray matter (GM) volume and PDs in female adolescents with [...] Read more.

Background: Comorbid personality disorders (PDs) in patients with anorexia nervosa (AN) are associated with increased psychopathology, higher suicide risk, and poorer treatment response and outcomes. This study aimed to examine associations between gray matter (GM) volume and PDs in female adolescents with AN before and after short-term psychotherapeutic and nutritional therapy. Methods: Eighteen female adolescents with acute AN, mean age 15.9 years, underwent 3T magnetic resonance imaging before and after weight restoration. The average interval between scans was 2.6 months. Structural brain changes were analyzed using voxel-based morphometry. PDs were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II) and the Assessment of Identity Development Questionnaire. Results: SCID-II total scores showed significant positive associations with GM volume in the mid-cingulate cortex at both time points and in the left superior parietal–occipital lobule at baseline. The histrionic subscale correlated with GM volume in the thalamus bilaterally and the left superior parietal–occipital lobule in both assessments, as well as with the mid-cingulate cortex at follow-up. Borderline and antisocial subscales were associated with GM volume in the thalamus bilaterally at baseline and in the right mid-cingulate cortex at follow-up. Conclusions: PDs in female adolescent patients with AN may be specifically related to GM alterations in the thalamus, cingulate, and parieto-occipital regions, which are present during acute illness and persist after weight restoration therapy. Full article

(This article belongs to the Section Mental Health)

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17 pages, 1340 KiB

Open AccessArticle

Enhanced Respiratory Sound Classification Using Deep Learning and Multi-Channel Auscultation

by Yeonkyeong Kim, Kyu Bom Kim, Ah Young Leem, Kyuseok Kim and Su Hwan Lee

J. Clin. Med. 2025, 14(15), 5437; https://doi.org/10.3390/jcm14155437 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: Identifying and classifying abnormal lung sounds is essential for diagnosing patients with respiratory disorders. In particular, the simultaneous recording of auscultation signals from multiple clinically relevant positions offers greater diagnostic potential compared to traditional single-channel measurements. This study aims to improve [...] Read more.

Background/Objectives: Identifying and classifying abnormal lung sounds is essential for diagnosing patients with respiratory disorders. In particular, the simultaneous recording of auscultation signals from multiple clinically relevant positions offers greater diagnostic potential compared to traditional single-channel measurements. This study aims to improve the accuracy of respiratory sound classification by leveraging multichannel signals and capturing positional characteristics from multiple sites in the same patient. Methods: We evaluated the performance of respiratory sound classification using multichannel lung sound data with a deep learning model that combines a convolutional neural network (CNN) and long short-term memory (LSTM), based on mel-frequency cepstral coefficients (MFCCs). We analyzed the impact of the number and placement of channels on classification performance. Results: The results demonstrated that using four-channel recordings improved accuracy, sensitivity, specificity, precision, and F1-score by approximately 1.11, 1.15, 1.05, 1.08, and 1.13 times, respectively, compared to using three, two, or single-channel recordings. Conclusion: This study confirms that multichannel data capture a richer set of features corresponding to various respiratory sound characteristics, leading to significantly improved classification performance. The proposed method holds promise for enhancing sound classification accuracy not only in clinical applications but also in broader domains such as speech and audio processing. Full article

(This article belongs to the Section Respiratory Medicine)

23 pages, 1139 KiB

Open AccessArticle

A Critical Appraisal of Off-Label Use and Repurposing of Statins for Non-Cardiovascular Indications: A Systematic Mini-Update and Regulatory Analysis

by Anna Artner, Irem Diler, Balázs Hankó, Szilvia Sebők and Romána Zelkó

J. Clin. Med. 2025, 14(15), 5436; https://doi.org/10.3390/jcm14155436 (registering DOI) - 1 Aug 2025

Abstract

Background: Statins exhibit pleiotropic anti-inflammatory, antioxidant, and immunomodulatory effects, suggesting their potential in non-cardiovascular conditions. However, evidence supporting their repurposing remains limited, and off-label prescribing policies vary globally. Objective: To systematically review evidence on statin repurposing in oncology and infectious diseases, and to [...] Read more.

Background: Statins exhibit pleiotropic anti-inflammatory, antioxidant, and immunomodulatory effects, suggesting their potential in non-cardiovascular conditions. However, evidence supporting their repurposing remains limited, and off-label prescribing policies vary globally. Objective: To systematically review evidence on statin repurposing in oncology and infectious diseases, and to assess Hungarian regulatory practices regarding off-label statin use. Methods: A systematic literature search (PubMed, Web of Science, Scopus, ScienceDirect; 2010–May 2025) was conducted using the terms “drug repositioning” OR “off-label prescription” AND “statin” NOT “cardiovascular,” following PRISMA guidelines. Hungarian off-label usage data from the NNGYK (2008–2025) were also analyzed. Results: Out of 205 publications, 12 met the inclusion criteria—75% were oncology-focused, and 25% focused on infectious diseases. Most were preclinical (58%); only 25% offered strong clinical evidence. Applications included hematologic malignancies, solid tumors, Cryptococcus neoformans, SARS-CoV-2, and dengue virus. Mechanisms involved mevalonate pathway inhibition and modulation of host immune responses. Hungarian data revealed five approved off-label statin uses—three dermatologic and two pediatric metabolic—supported by the literature and requiring post-treatment reporting. Conclusions: While preclinical findings are promising, clinical validation of off-label statin use remains limited. Statins should be continued in cancer patients with cardiovascular indications, but initiation for other purposes should be trial-based. Future directions include biomarker-based personalization, regulatory harmonization, and cost-effectiveness studies. Full article

(This article belongs to the Section Pharmacology)

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30 pages, 4515 KiB

Open AccessArticle

Implant-Supported Oral Rehabilitation in Head and Neck Cancer Patients: A 20-Year Single-Center Study (2005–2024)

by Manuel Tousidonis, Santiago Ochandiano, Carlos Navarro-Cuellar, Carlos Navarro-Vila, Javier López de Atalaya, Cristina Maza, Ana María Lopez Lopez, Ignacio Navarro-Cuellar, Alba García Sevilla, Gema Arenas de Frutos, Raul Antunez-Conde, Paloma Planells del Pozo and Jose Ignacio Salmeron

J. Clin. Med. 2025, 14(15), 5435; https://doi.org/10.3390/jcm14155435 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: Oral cancer resection often leads to maxillofacial defects and dentition loss, compromising patients’ quality of life. Implant-supported prosthetic rehabilitation offers a reliable solution to restore function, though factors such as bone reconstruction, radiotherapy, and timing of implant placement (immediate vs. delayed) may [...] Read more.

Background/Objectives: Oral cancer resection often leads to maxillofacial defects and dentition loss, compromising patients’ quality of life. Implant-supported prosthetic rehabilitation offers a reliable solution to restore function, though factors such as bone reconstruction, radiotherapy, and timing of implant placement (immediate vs. delayed) may influence outcomes. This study aimed to evaluate long-term implant survival and rehabilitation timelines in oncologic patients, comparing two cohorts (2005–2014 and 2015–2024) to assess the impact of evolving clinical practices. Methods: A retrospective cohort study was conducted at Hospital General Universitario Gregorio Marañón (Madrid, Spain), including 304 patients who underwent ablative oral cancer surgery and subsequent implant-based rehabilitation between 2005 and 2024. Data on demographics, oncologic treatment, reconstruction, implant timing, and prosthetic rehabilitation were collected. Outcomes were compared using Kaplan–Meier analysis and appropriate statistical tests between the 2005–2014 (n = 122) and 2015–2024 (n = 182) cohorts. Results: A total of 2341 Ticare Implants^® were placed, supporting 281 prostheses. Implant placement during primary surgery increased from 41% to 71% (p < 0.001). The median time from surgery to prosthesis significantly decreased from 24 to 15 months (p < 0.001). Five-year implant survival was 95% in the early cohort versus 97% in the later cohort. Implant survival was comparable between irradiated and non-irradiated patients (~94–96%). Fixed prostheses became more frequent (92% vs. 79%, p = 0.002). Conclusions: Implant-supported rehabilitation in oncologic patients is highly feasible and durable, with improved timelines and functional outcomes associated with early implant placement and modern digital planning strategies. Full article

(This article belongs to the Special Issue Research Progress in Osseointegrated Oral Implants)

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16 pages, 604 KiB

Open AccessArticle

Once-Weekly Semaglutide Improves Body Composition in Spanish Obese Adults with Type 2 Diabetes: A 48-Week Prospective Real-Life Study

by Irene Caballero-Mateos, Cristóbal Morales-Portillo and Beatriz González Aguilera

J. Clin. Med. 2025, 14(15), 5434; https://doi.org/10.3390/jcm14155434 (registering DOI) - 1 Aug 2025

Abstract

Objective: The objective of this study was to assess changes in body composition, with a specific focus on fat mass (FM) and fat-free mass (FFM), in obese adults with type 2 diabetes (T2D) treated with once-weekly (OW) subcutaneous (s.c.) semaglutide. Methods: This was [...] Read more.

Objective: The objective of this study was to assess changes in body composition, with a specific focus on fat mass (FM) and fat-free mass (FFM), in obese adults with type 2 diabetes (T2D) treated with once-weekly (OW) subcutaneous (s.c.) semaglutide. Methods: This was a single-center, 12-month, real-world, ambispective study (6-month prospective and 6-month retrospective). Body composition parameters were assessed via segmental multifrequency bioelectrical impedance analysis (SMF-BIA). Results: A total of 117 patients with DM2, with a median age of 56 years, a median HbA1c level of 9.4%, and a median body weight of 102.5 kg, were included in the study. The median body weight, body fat mass, and visceral fat significantly decreased at 6 months, with values of −9.3, −7.5, and −1.8 kg, respectively. There were further reductions from 6 to 12 months, albeit at a slower rate. The median skeletal muscle mass significantly decreased at 6 months (−1.2 kg), although no further significant reductions were observed at 12 months. Conclusions: OW s.c. semaglutide for 12 months significantly improved body composition parameters, mainly at the expense of fat mass loss, with the preservation of skeletal muscle mass. These changes are clinically meaningful, since they impact general metabolic health and are associated with improvements in metabolic control and clinical parameters associated with renal and CV risks, as well as presumable improvements in quality of life. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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