Journal of Clinical Medicine

15 pages, 1099 KB

Open AccessArticle

Beyond Volume Metrics: Outcomes of Open Abdominal Aortic Aneurysm Repair in a Small-to-Medium Volume Hospital—Challenging the Centralization Paradigm: A Single-Centre Retrospective Analysis

by Alessandro Robaldo, Pietro Federico Ricciardi, Luca Giovannacci, Alexandre Azoulay, Elena Garbero, Ludovica Ettorre, Jacopo Galafassi, Matteo Bernasconi and Giorgio Prouse

J. Clin. Med. 2026, 15(15), 5939; https://doi.org/10.3390/jcm15155939 (registering DOI) - 30 Jul 2026

Abstract

Background/Objectives: Centralisation of open abdominal aortic aneurysm (AAA) repair is widely advocated, but supporting evidence often conflates institutional volume with individual surgeon expertise. We report outcomes of open AAA repair at a small- to medium-volume centre and assess the contributions of surgeon [...] Read more.

Background/Objectives: Centralisation of open abdominal aortic aneurysm (AAA) repair is widely advocated, but supporting evidence often conflates institutional volume with individual surgeon expertise. We report outcomes of open AAA repair at a small- to medium-volume centre and assess the contributions of surgeon experience, multidisciplinary perioperative care, and supervised surgical teaching. Methods: Retrospective analysis of all consecutive patients undergoing open AAA repair between January 2017 and December 2023. Endovascular procedures were excluded. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included perioperative morbidity, acute kidney injury (AKI), length of stay, and overall survival. Results: A total of 195 patients underwent open AAA repair (162 elective; 33 urgent/emergency), with a mean of 27.9 cases annually. Mean age was 70.2 years (SD 8.1), and 85.6% were male. Thirty-day mortality was 1.5% overall (3/195) and 1.2% (2/162) for elective cases, with no significant difference between elective and urgent/emergency cases (1.2% vs. 3.0%; p = 0.430). No perioperative strokes occurred; myocardial infarction occurred in three patients (1.5%). Median operative time was 261 min (IQR 210–320), reflecting systematic supervised teaching in approximately 95% of cases. AKI occurred in 10.3%; clinically significant renal insufficiency at 30 days occurred in 5.1%, and no patient required permanent renal replacement therapy. The perioperative reintervention rate was 9.2%, and median hospital stay was 8 days (IQR 7–12). At a mean follow-up of 62.3 months (SD 25.1), overall mortality was 7.7% and aneurysm-related mortality 1.0%. Kaplan–Meier estimated overall survival was 98.5%, 95.8%, and 89.0% at 1, 3, and 7 years, respectively. Conclusions: Favourable outcomes can be achieved at small- to medium-volume centres through concentrated surgeon expertise, structured teaching, and a high-functioning multidisciplinary team. These findings support a more nuanced assessment of open AAA repair that considers surgeon experience, team performance, and demonstrated outcomes rather than institutional volume alone. Full article

(This article belongs to the Special Issue Clinical Advances in Aortic Disease and Revascularization: 2nd Edition)

► Show Figures

Figure 1

13 pages, 596 KB

Open AccessArticle

by Luca Cavaggioni, Luisa Gilardini, Marina Croci, Silvia Martinelli, Paola Toja, Lucia Pasqualinotto and Simona Bertoli

J. Clin. Med. 2026, 15(15), 5938; https://doi.org/10.3390/jcm15155938 (registering DOI) - 30 Jul 2026

Abstract

Background: Relative muscular function has emerged as a clinically relevant marker of muscle quality and health in obesity. However, limited evidence is available regarding age-related associations between relative handgrip strength and body composition outcomes in women with obesity. Methods: This cross-sectional [...] Read more.

Background: Relative muscular function has emerged as a clinically relevant marker of muscle quality and health in obesity. However, limited evidence is available regarding age-related associations between relative handgrip strength and body composition outcomes in women with obesity. Methods: This cross-sectional study included 419 female outpatients with obesity (age range 18–80 years). Participants were stratified into age groups according to sample distribution. Body composition was assessed using Body Mass Index (BMI), waist circumference (WC), fat mass percentage (FM%), fat-free mass (FFM%), and waist-to-height ratio (WHtR). Relative handgrip strength (relative HST) was assessed together with balance performance (M-BESS), lower-body functional performance (5STS), and movement quality (FMS CS). Kruskal–Wallis analyses were performed for all functional measures. Age-stratified linear regressions and pooled models including relative HST × age-group interaction terms were used to examine associations with body composition outcomes; whole-sample models were additionally adjusted for age and physical activity level (IPAQ-SF). Results: Significant differences across groups were observed for BMI (p = 0.0006), FM% (p = 0.0308), relative HST (p = 0.0002), M-BESS score (p < 0.0001), and 5STS performance (p < 0.0001). Relative HST was significantly associated with lower FM% and higher FFM% across all age groups. In addition, significant associations with lower WC were observed in middle-aged and older women. However, pooled interaction analyses provided no evidence that the associations between relative HST and FM%, FFM%, WC, or WHtR differed significantly across age groups (p of all interactions > 0.29). Conclusions: Relative HST was associated with body composition outcomes across different age groups of women with obesity, but the strength of these associations did not differ significantly by age group. These findings suggest that relative HST may provide clinically relevant information beyond traditional anthropometric measures. However, prospective studies are needed to determine its potential clinical utility in individualized, person-centered obesity management. Full article

(This article belongs to the Special Issue The Complex Interplay Between Physical Activity, Sleep, Diet, and Obesity: Clinical Insights for Treatment and Prevention)

► Show Figures

Figure 1

13 pages, 2748 KB

Open AccessCase Report

Restoring Ventricular Geometry: Left Ventricular Reconstruction in a Patient with a Giant Left Ventricular Aneurysm and End-Stage Heart Failure

by Moldovan Horatiu, Dobra Irina, Robu Mircea, Safta Maria Sabina, Andrada Guta, Voicu Alexandra, Gabriel Goretzki, Lucian Dorobantu, Menicanti Lorenzo and Ondin Zaharia

J. Clin. Med. 2026, 15(15), 5937; https://doi.org/10.3390/jcm15155937 (registering DOI) - 30 Jul 2026

Abstract

Post-infarction left ventricular aneurysm is an uncommon but severe mechanical complication of transmural myocardial infarction, particularly in patients with delayed presentation or incomplete myocardial salvage. It may lead to profound distortion of left ventricular geometry, adverse remodelling, intraventricular thrombosis, mitral regurgitation, pulmonary hypertension, [...] Read more.

Post-infarction left ventricular aneurysm is an uncommon but severe mechanical complication of transmural myocardial infarction, particularly in patients with delayed presentation or incomplete myocardial salvage. It may lead to profound distortion of left ventricular geometry, adverse remodelling, intraventricular thrombosis, mitral regurgitation, pulmonary hypertension, and advanced heart failure. We report the case of a 65-year-old male patient referred two months after a late-presenting anterior ST-segment elevation myocardial infarction caused by proximal occlusion of the left anterior descending coronary artery. At admission, the patient presented with severe decompensated heart failure, low-output status, multiorgan dysfunction, and a left ventricular ejection fraction of 12%. Transthoracic echocardiography and cardiac magnetic resonance imaging demonstrated a giant apical left ventricular aneurysm involving approximately 75% of the ventricular cavity, partial intraluminal thrombosis, extensive transmural scarring in the left anterior descending territory, and imaging features suggestive of a chronic contained free-wall rupture/pseudoaneurysmal component. Following multidisciplinary evaluation, the patient underwent surgical ventricular reconstruction using an endoventricular circular restoration technique guided by an intraventricular balloon sizer, combined with left internal thoracic artery bypass grafting to the left anterior descending artery. The early postoperative course required temporary inotropic, vasopressor, inhaled nitric oxide, and intra-aortic balloon pump support, followed by progressive haemodynamic recovery. The patient was discharged on postoperative day seven with functional improvement to NYHA class II. At six-month follow-up, he remained clinically stable without overt signs of heart failure, and echocardiography showed preserved ventricular geometry and improvement of left ventricular ejection fraction to 45%. This case highlights the potential role of carefully planned, balloon-guided surgical ventricular reconstruction in selected patients with giant post-infarction left ventricular aneurysms and end-stage heart failure when residual viable myocardium is present. Full article

(This article belongs to the Special Issue Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations)

► Show Figures

Figure 1

12 pages, 438 KB

Open AccessReview

Aspirin in Primary Prevention of CVD: A Pragmatic Outline and Advice for Treatment Personalization

by Francesca Santilli, Dirk Sibbing and Augusto Maria Lavalle Cobo

J. Clin. Med. 2026, 15(15), 5936; https://doi.org/10.3390/jcm15155936 - 29 Jul 2026

Abstract

Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality. While low-dose aspirin is well established for secondary prevention, its role in primary prevention is controversial because modest benefits in cardiovascular benefits must be balanced against increased bleeding risk, as highlighted [...] Read more.

Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality. While low-dose aspirin is well established for secondary prevention, its role in primary prevention is controversial because modest benefits in cardiovascular benefits must be balanced against increased bleeding risk, as highlighted by recent large trials. Current guidelines recommend restricting aspirin use to individuals at higher cardiovascular risk without elevated bleeding risk, yet significant heterogeneity persists in defining these thresholds. Evidence from randomized trials, guidelines, cohort and modeling analyses, and post hoc or observational subgroup studies suggests that selected patients with advanced subclinical atherosclerosis or specific high-risk markers may have a more favorable risk–benefit profile, although the certainty and directness of evidence vary across subgroups. This narrative review and pragmatic clinical guide presents an illustrative tiered framework based on clinical, imaging, and biomarker markers—such as coronary artery calcium score, carotid plaque score, and lipoprotein(a)—to support individualized discussion of preventive aspirin therapy. The framework is not a validated risk calculator or standalone treatment algorithm, and decisions should balance absolute cardiovascular risk, major bleeding risk, evidence certainty, and patient preferences. Full article

(This article belongs to the Section Cardiovascular Medicine)

21 pages, 368 KB

Open AccessArticle

Vitamin B12, Homocysteine and Cognitive Impairment in Elderly Patients with Type 2 Diabetes

by Malgorzata Gorska-Ciebiada and Maciej Ciebiada

J. Clin. Med. 2026, 15(15), 5935; https://doi.org/10.3390/jcm15155935 - 29 Jul 2026

Abstract

Background: Type 2 diabetes (T2DM) increases the risk of mild cognitive impairment (MCI); however, the mechanisms of this process have not yet been fully identified. The aim of the study was to determine the levels of vitamin B12 and homocysteine in elderly diabetic [...] Read more.

Background: Type 2 diabetes (T2DM) increases the risk of mild cognitive impairment (MCI); however, the mechanisms of this process have not yet been fully identified. The aim of the study was to determine the levels of vitamin B12 and homocysteine in elderly diabetic patients, with and without cognitive impairment, and identify the risk factors associated with MCI in this group. Methods: A total of 385 elderly diabetic patients were screened for MCI (using the Montreal Cognitive Assessment). Several clinical and biochemical data were recorded. Results: MCI subjects had lower vitamin B12 levels (251 ± 36.9 pg/mL) and higher homocysteine concentrations (15.9 ± 4 ng/mL) compared to controls (vitamin B12: 339.9 ± 40.7 pg/mL; homocysteine: 11.4 ± 3.1 ng/mL). In MCI subjects, vitamin B12 levels were negatively correlated with homocysteine or HbA_1c levels and positively correlated with MoCA scores. The univariate logistic regression showed factors associated with MCI in elderly diabetic patients were the following: older age and fewer years of education, longer history of diabetes, a higher number of co-morbidities, higher levels of HbA_1c, triglycerides and homocysteine, lower levels of vitamin B12, presence of cardiovascular disease, hypertension, hyperlipidemia, retinopathy, and nephropathy. Independent factors associated with MCI evaluated in the multivariate model included lower levels of vitamin B12, higher levels of triglycerides, and a higher number of co-morbidities and fewer years of formal education. Conclusions: Vitamin B12 is associated with MCI in elderly diabetic patients. The role of homocysteine and vitamin B12 in the common pathogenesis of cognitive impairment and diabetes requires future prospective and more extensive studies. Full article

(This article belongs to the Special Issue New Insights in Cognitive Aging and Mild Cognitive Impairment)

13 pages, 527 KB

Open AccessArticle

Factors Associated with Antibiotic Initiation After DaBT-Hib-IPV Vaccination in NICU-Hospitalized Preterm Infants: The Role of C-Reactive Protein

by Hüseyin Şimşek, Mustafa Akçalı, Mehtap Durukan Tosun, Berfin Özmen and Suna Özdem

J. Clin. Med. 2026, 15(15), 5934; https://doi.org/10.3390/jcm15155934 - 29 Jul 2026

Abstract

Objective: The purpose of this study was to evaluate the factors, particularly post-vaccination C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR), associated with the clinical decision to initiate antibiotic treatment following the 2-month diphtheria–acellular pertussis–tetanus–Haemophilus influenzae Type B–inactivated poliovirus (DaBT-Hib-IPV) vaccine in [...] Read more.

Objective: The purpose of this study was to evaluate the factors, particularly post-vaccination C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR), associated with the clinical decision to initiate antibiotic treatment following the 2-month diphtheria–acellular pertussis–tetanus–Haemophilus influenzae Type B–inactivated poliovirus (DaBT-Hib-IPV) vaccine in hospitalized infants. Methods: A retrospective review was conducted on the medical records of 46 infants. The study included infants hospitalized between 2022 and 2024 at Mersin City Training and Research Hospital who received the 2-month vaccine and subsequently underwent post-vaccination laboratory testing. Infants were categorized based on whether they received antibiotic treatment. Results: Antibiotics were administered to 20 infants, and 26 were observed without any treatment. Despite having a significantly higher gestational age (p = 0.027), the hospital stays of the antibiotic group were significantly longer (median 99 vs. 78 days, p < 0.001). C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) were elevated in the antibiotic group (CRP = 2.82 vs. 1.63 mg/dL, p < 0.001; NLR= 0.90 vs. 0.72, p = 0.041). Culture positivity was low in antibiotic recipients (3/20, 15%). CRP was the only independent predictor of antibiotic administration when adjusted for gestational age and weight at vaccination (Exp(B) = 3.997, p = 0.003). Conclusions: In this cohort of NICU-hospitalized, predominantly preterm infants, a population that does not represent the general population of vaccinated 2-month-old infants, post-vaccination elevations in CRP and NLRs were associated with the clinical decision to initiate antibiotic treatment; however, in the absence of a validated infection reference standard, these markers cannot be assumed to reliably differentiate true infection from vaccine-induced inflammation. To prevent unnecessary antibiotic use and optimize patient management, these markers must be evaluated in conjunction with clinical findings, culture results, and supplementary biomarkers. Full article

(This article belongs to the Section Clinical Pediatrics)

► Show Figures

Figure 1

22 pages, 1457 KB

Open AccessArticle

Homozygous Nonsense DSP Variants Selectively Affecting Desmoplakin I Cause Carvajal Syndrome in a Consanguineous Arabian Family with Four Affected Female Siblings

by Dalal A. Al-Mutairi, Mustafa A. Al-Qbandi, Ahmed AlTurki, Athbi A. Naief and Adam S. Helms

J. Clin. Med. 2026, 15(15), 5933; https://doi.org/10.3390/jcm15155933 - 29 Jul 2026

Abstract

Introduction: Arrhythmogenic cardiomyopathy (ACM) is a myocardial disorder characterized by fibrofatty replacement of the myocardium and is associated with heart failure and sudden cardiac death. It can involve either ventricle, including left-dominant forms defined partly by genetic findings. Methods: We investigated a consanguineous [...] Read more.

Introduction: Arrhythmogenic cardiomyopathy (ACM) is a myocardial disorder characterized by fibrofatty replacement of the myocardium and is associated with heart failure and sudden cardiac death. It can involve either ventricle, including left-dominant forms defined partly by genetic findings. Methods: We investigated a consanguineous family with four affected daughters presenting with ACM, epidermolytic palmoplantar keratoderma, and woolly hair. The two eldest siblings died suddenly during childhood. The remaining two affected siblings underwent genetic analysis using autozygosity mapping and whole-exome sequencing, followed by segregation analysis. Results: Autozygosity mapping identified a shared identity-by-descent (IBD) interval at the DSP locus on chromosome 6. Exome sequencing revealed a novel homozygous nonsense variant (c.4297C>T; p.Gln1433*; rs1554108283) in exon 23 of DSP. This variant introduces a premature termination codon within the region specific to transcript variant 1, sparing transcript variant 2. Both parents were heterozygous carriers. Cardiac imaging in the affected siblings demonstrated biventricular involvement, including left ventricular systolic dysfunction and right ventricular dilatation. Skin biopsy in one patient confirmed epidermolytic palmoplantar keratoderma. Conclusions: We describe a novel homozygous nonsense variant in the transcript 1-specific region of DSP causing Carvajal syndrome, characterized by severe biventricular ACM, epidermolytic palmoplantar keratoderma, and woolly hair, in a consanguineous Arabian family with four affected sisters. Full article

(This article belongs to the Section Cardiovascular Medicine)

► Show Figures

Graphical abstract

23 pages, 1194 KB

Open AccessReview

Glucagon-like Peptide-1 Receptor Agonists and Chronic Pain: Preclinical Antinociceptive Mechanisms, Indirect Metabolic–Functional Effects, and Clinical Considerations—A Narrative Review

by Sung-woo Hyung, Ui Jin Park, Jeong Hwan Ryu and Siwook Chung

J. Clin. Med. 2026, 15(15), 5932; https://doi.org/10.3390/jcm15155932 - 29 Jul 2026

Abstract

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly encountered in pain practice, but reported pain improvement may reflect direct antinociception, weight loss, metabolic change, or disease-specific effects. This structured narrative review examined these possibilities and relevant safety issues. Methods: PubMed/MEDLINE, Embase, and Web [...] Read more.

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly encountered in pain practice, but reported pain improvement may reflect direct antinociception, weight loss, metabolic change, or disease-specific effects. This structured narrative review examined these possibilities and relevant safety issues. Methods: PubMed/MEDLINE, Embase, and Web of Science Core Collection were searched through 15 May 2026. Peer-reviewed human studies, key mechanistic preclinical studies, systematic reviews and meta-analyses, and professional guidance relevant to pain outcomes or procedural safety were considered. Metabolic-only and non-peer-reviewed reports were excluded, and human pain-primary evidence was prioritized. Results: Preclinical data support plausible mechanisms involving spinal microglia, interleukin-10, beta-endorphin, neuroinflammation, and sensory-neuron signaling, but direct analgesic efficacy at systemic clinical doses has not been demonstrated. In STEP 9 (n = 407), mean WOMAC pain scores at 68 weeks changed from baseline by −41.7 points with semaglutide 2.4 mg and −27.5 points with a placebo; body weight changed by −13.7% and −3.2%, respectively. Liraglutide produced additional weight loss without superior knee-pain reduction. Diabetic peripheral neuropathy evidence was mainly structural or neurophysiologic; idiopathic intracranial hypertension and ROSE-010-treated irritable bowel syndrome showed disease-specific signals, whereas fibromyalgia- and opioid-related findings remained observational or hypothesis-generating. Gastrointestinal dysmotility, reduced intake, and lean-mass loss may offset functional benefits. Conclusions: GLP-1RAs are not established analgesics. Current human signals are best interpreted as indirect metabolic–functional or disease-specific effects. Future trials should use validated pain-primary outcomes, control for weight loss, and monitor treatment-related harms. Full article

(This article belongs to the Special Issue Regional Anesthesia and Pain Management: Mastering Clinical Art for Optimal Patient Satisfaction)

► Show Figures

Figure 1

14 pages, 811 KB

Open AccessReview

Perforated Gastric Cancer: Epidemiology, Diagnosis, and Surgical Management Strategies

by Sang-Ho Jeong, Sung Jin Oh, Kyung Won Seo and Jae-Seok Min

J. Clin. Med. 2026, 15(15), 5931; https://doi.org/10.3390/jcm15155931 - 29 Jul 2026

Abstract

Gastric cancer complicated by free perforation is a rare but life-threatening oncological emergency, accounting for 0.3% ~ 3.9% of all gastric cancer cases. This review summarizes current evidence on the epidemiology, diagnosis, surgical management, and prognostic determinants of perforated gastric cancer, with emphasis [...] Read more.

Gastric cancer complicated by free perforation is a rare but life-threatening oncological emergency, accounting for 0.3% ~ 3.9% of all gastric cancer cases. This review summarizes current evidence on the epidemiology, diagnosis, surgical management, and prognostic determinants of perforated gastric cancer, with emphasis on stage-adapted treatment strategies. It should be noted, however, that the available evidence is derived exclusively from retrospective studies, and all recommendations should be interpreted in the context of this inherent limitation. Relevant studies addressing perforation patterns, perioperative outcomes, one-stage versus two-stage gastrectomy, repair-only approaches, and management of metastatic disease were reviewed. Perforation typically arises from tumors located on the anterior wall or greater curvature, where transmural invasion creates direct communication with the peritoneal cavity, resulting in diffuse peritonitis and substantial postoperative mortality. Available pooled evidence suggests that radical resection, when oncologically and physiologically feasible, is associated with better survival than repair-only strategies. Comparative retrospective data suggest that two-stage gastrectomy may be associated with higher R0 resection rates and lower in-hospital mortality compared with emergency one-stage resection, without compromising long-term survival when curative resection is ultimately achieved; however, these findings should be interpreted with caution given the exclusively retrospective evidence base and the inherent patient selection bias in all published comparisons. In patients with stage IV disease or confirmed distant metastases, stomach-preserving source control followed by systemic chemotherapy may be a rational alternative. Prognosis is primarily determined by TNM stage and R0 resection status, similar to non-perforated gastric cancer. Individualized treatment based on tumor stage, resectability, peritoneal contamination, and physiological reserve is essential. Full article

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

► Show Figures

Figure 1

30 pages, 1318 KB

Open AccessSystematic Review

Association Between Arterial Hypertension and Periodontitis: A Systematic Review and Meta-Analysis

by Ani Matinyan-Hakobyan, Beatriz Gonzalez-Navarro, Sonia Egido-Moreno, Fabiola Mazza-Padrón, Anna Oliveras-Serrano and Jose López-López

J. Clin. Med. 2026, 15(15), 5930; https://doi.org/10.3390/jcm15155930 - 29 Jul 2026

Abstract

Background: Periodontitis and arterial hypertension are highly prevalent chronic conditions that share common risk factors and inflammatory pathways. Increasing evidence suggests a potential association between both diseases; however, the strength and consistency of this relationship remain unclear. Methods: A systematic review [...] Read more.

Background: Periodontitis and arterial hypertension are highly prevalent chronic conditions that share common risk factors and inflammatory pathways. Increasing evidence suggests a potential association between both diseases; however, the strength and consistency of this relationship remain unclear. Methods: A systematic review and meta-analysis of observational studies was conducted following PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, and the Cochrane Library without date restrictions. Studies evaluating the association between periodontitis and arterial hypertension in humans were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. A random-effects meta-analysis was performed using adjusted odds ratios (ORs). Results: Results: Thirty-six studies were included in the systematic review; of these, 11 studies reporting a directly comparable, adjusted odds ratio were included in the quantitative meta-analysis, comprising a total of 48,761 participants. The pooled analysis demonstrated a statistically significant association between periodontitis and hypertension (OR = 1.65; 95% CI: 1.42–1.93; p < 0.00001). Heterogeneity was substantial (I² = 65%) but was partly explained by periodontal case definition, with a stronger association among studies using the AAP/EFP classification (OR = 1.90; 95% CI: 1.57–2.30) than those using alternative periodontal indices (OR = 1.35; 95% CI: 1.21–1.50). The overall certainty of evidence, assessed using GRADE, was rated as Very Low. Conclusions: This systematic review and meta-analysis identifies a consistent positive association between periodontitis and arterial hypertension across observational studies. Given the very low certainty of the underlying evidence, this finding should be interpreted as a signal warranting further investigation rather than a robust, settled conclusion. Causality cannot be established from the available observational evidence, and the potential relevance of periodontal health to cardiovascular risk merits further research. Full article

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

15 pages, 244 KB

Open AccessArticle

Implementation of an Enhanced Recovery After Surgery (ERAS) Pathway Is Associated with Improved Short-Term Outcomes After Colorectal Surgery: A Retrospective Bi-Centre Study

by Paolo Panaccio, Maira Farrukh, Maria Marino, Vincenzo Casolino, Giuseppe Di Martino, Pierluigi Di Sebastiano, Tommaso Grottola and Fabio Francesco di Mola

J. Clin. Med. 2026, 15(15), 5929; https://doi.org/10.3390/jcm15155929 - 29 Jul 2026

Abstract

Background: Enhanced Recovery After Surgery (ERAS) pathways have become the standard of care in elective colorectal surgery. However, implementation remains heterogeneous across institutions, and the relative contribution of ERAS pathways and minimally invasive surgery to improved postoperative outcomes remains uncertain. This study evaluated [...] Read more.

Background: Enhanced Recovery After Surgery (ERAS) pathways have become the standard of care in elective colorectal surgery. However, implementation remains heterogeneous across institutions, and the relative contribution of ERAS pathways and minimally invasive surgery to improved postoperative outcomes remains uncertain. This study evaluated the association between ERAS implementation and short-term outcomes in two university-affiliated colorectal units with different levels of ERAS adoption. Methods: A retrospective bi-centre observational study was conducted, and comprised 802 consecutive patients who underwent elective colorectal resection between January 2016 and December 2024. Patients managed according to a standardized ERAS pathway (Group 1, n = 406) were compared with patients who received conventional perioperative care (Group 2, n = 396). Primary endpoints included postoperative morbidity, anastomotic leakage, and length of hospital stay (LOS). Secondary endpoints included mortality, readmission, postoperative complications, and hospitalization-related costs. Multivariable logistic regression was performed, adjusting for age, sex, ASA score, tumour stage, and tumour location. Results: Baseline demographic characteristics were largely comparable between groups, although patients in the conventional care group had a higher proportion of ASA III–IV status. Overall postoperative morbidity was significantly lower in the ERAS cohort (8.6% vs. 20.9%, p < 0.001), together with a lower incidence of anastomotic leakage (1.2% vs. 4.5%, p < 0.001). Median LOS was reduced from 9 to 8 days overall and, among patients who underwent laparoscopic surgery, from 6 to 4 days (p = 0.010). After multivariable adjustment, conventional perioperative management remained independently associated with higher postoperative morbidity (OR 2.62, 95% CI 1.60–4.09; p < 0.001) and anastomotic leakage (OR 1.92, 95% CI 1.01–4.98; p = 0.048). Mortality, surgical site infections, intra-abdominal abscesses, and other postoperative complications were comparable between groups. Based on regional reimbursement tariffs, ERAS implementation was associated with an estimated annual reduction of 567 hospital bed-days. Conclusions: Implementation of a standardized ERAS pathway was associated with reduced postoperative morbidity, lower anastomotic leakage rates, and shorter hospital stay after elective colorectal surgery. These benefits persisted after adjustment for major clinical confounders, supporting the effectiveness of standardized perioperative care. The greatest reduction in hospital stay was observed when ERAS was combined with minimally invasive surgery, emphasizing the complementary role of these strategies in optimizing postoperative recovery. Full article

(This article belongs to the Section General Surgery)

24 pages, 658 KB

Open AccessReview

Laser Interstitial Thermal Therapy for High-Grade Gliomas: Current Evidence, Clinical Applications and Emerging Role of Artificial Intelligence

by Sergey Chudievich, Maria Pospelova, Alexey Ulitin, Yulia Ruzankina, Konstantin Samochernykh, Konstantin Kukanov, Anastasia Nechaeva and Maxim Shevtsov

J. Clin. Med. 2026, 15(15), 5928; https://doi.org/10.3390/jcm15155928 - 29 Jul 2026

Abstract

Background: High-grade gliomas pose formidable challenges in neuro-oncology, with a median overall survival (OS) of 12–18 months. Laser interstitial thermal therapy (LITT) offers a minimally invasive cytoreductive option for deep-seated or recurrent tumors, achieving ablation rates of 85–98%. In parallel, artificial intelligence and [...] Read more.

Background: High-grade gliomas pose formidable challenges in neuro-oncology, with a median overall survival (OS) of 12–18 months. Laser interstitial thermal therapy (LITT) offers a minimally invasive cytoreductive option for deep-seated or recurrent tumors, achieving ablation rates of 85–98%. In parallel, artificial intelligence and machine learning are increasingly being applied to neuro-oncology to improve diagnosis, treatment planning, and outcome prediction, although these applications remain largely investigational. Methods: A literature search was conducted using the PubMed, MEDLINE, Embase, and ClinicalTrials.gov databases. The search terms included “laser interstitial thermotherapy,” “glioblastoma,” and “high-grade glioma”, “machine learning”, “artificial intelligence”. A total of 196 articles were identified. Inclusion criteria comprised primary studies, meta-analyses, and systematic reviews involving human data, with LITT used as a primary or secondary treatment modality. Sixty-nine studies were included in this review, while case reports and animal studies were excluded. Results: LITT represents a precision therapy for inoperable gliomas, achieving ablation rates of 85–98%. For primary glioblastoma, median overall survival (mOS) ranges from 11–16 months, and median progression-free survival (mPFS) from 4–9.5 months. In recurrent glioblastoma, LITT demonstrates a median overall survival ranging from 8.5 to 14.1 months and a median progression-free survival of 3–3.5 months with lower complication rates (5.7% vs. 13.8%) and shorter hospital stays (2.2 vs. 7 days). Overall complication rates range from 20–35%, predominantly due to cerebral edema, which is generally responsive to steroid therapy. Its value may be expanded by machine learning tools that integrate clinical, molecular, and imaging features to support patient selection and predict outcomes, though these remain at the proof-of-concept stage. In addition, LITT may serve as a platform for combination therapies, including immunotherapy, chemotherapy, targeted agents, and radiotherapy. Conclusions: Based on current evidence, LITT demonstrates outcomes that appear favorable in selected patient populations with high-grade gliomas and may be considered as a treatment option for primary tumors with challenging localization, near-spherical geometry, and volumes of approximately 30 cm³. It has a particularly important role in recurrent glioblastomas with similar characteristics, offering efficacy comparable to resection but with an improved safety profile in retrospective comparisons. LITT is evolving from a technically focused ablation method into a data-driven therapeutic platform. Integration with artificial intelligence may improve precision, safety, and personalization, helping define the role of LITT within modern neuro-oncology as higher-quality clinical evidence continues to accumulate. Full article

(This article belongs to the Special Issue Clinical and Diagnostic Strategies for Glioma Treatment)

► Show Figures

Figure 1

15 pages, 11253 KB

Open AccessReview

Myocardial Strain in Perioperative Medicine: A Practical Review for Anesthesiologists

by Christophe Beyls, Filipe André Gonzalez, Erwan Donal and Yazine Mahjoub

J. Clin. Med. 2026, 15(15), 5927; https://doi.org/10.3390/jcm15155927 - 29 Jul 2026

Abstract

Myocardial strain imaging, derived from speckle-tracking echocardiography (STE), has evolved from a research tool into a reproducible technique for detecting subclinical myocardial dysfunction. Recent advances in automated contouring and artificial intelligence have improved feasibility, reproducibility, and analysis speed, making multichamber strain assessment increasingly [...] Read more.

Myocardial strain imaging, derived from speckle-tracking echocardiography (STE), has evolved from a research tool into a reproducible technique for detecting subclinical myocardial dysfunction. Recent advances in automated contouring and artificial intelligence have improved feasibility, reproducibility, and analysis speed, making multichamber strain assessment increasingly accessible in perioperative practice. Perioperative cardiovascular complications, including myocardial injury after non-cardiac surgery (MINS), postoperative atrial fibrillation (POAF), and heart failure, are associated with substantial postoperative morbidity and mortality. Conventional echocardiographic parameters, particularly left ventricular ejection fraction (LVEF), lack sensitivity for detecting early myocardial dysfunction. By quantifying myocardial deformation, strain imaging identifies subtle abnormalities in ventricular and atrial mechanics before conventional echocardiographic abnormalities become evident. Among available parameters, left ventricular global longitudinal strain (LV-GLS) and left atrial reservoir strain (LASr) provide the strongest evidence for perioperative risk stratification, with impaired values independently associated with MINS and POAF, respectively. Right ventricular strain (RV-GLS, RV-FWLS) and right atrial reservoir strain (RASr) remain promising but less standardized parameters supported mainly by observational data. Despite these advances, several barriers continue to limit widespread implementation, including vendor variability, the lack of standardized thresholds, and the absence of validated transesophageal echocardiography (TEE)-specific reference values. Importantly, current evidence supports myocardial strain primarily as a tool for risk stratification rather than for guiding therapy. No randomized trial has demonstrated that strain-guided perioperative management improves clinical outcomes, and its incremental value beyond established perioperative tools, including clinical risk scores, biomarkers, and conventional echocardiography, remains to be established. This review aims to provide a practical framework for the perioperative use of myocardial strain by summarizing the current evidence, clarifying its methodological limitations, simplifying its acquisition and interpretation for non-expert users, distinguishing established clinical applications from future research directions, and identifying the key evidence gaps that must be addressed before strain-guided strategies can be incorporated into routine perioperative care. Full article

(This article belongs to the Special Issue Advances in Perioperative Anesthesia: Emerging Techniques and Clinical Practices)

► Show Figures

Graphical abstract

15 pages, 675 KB

Open AccessArticle

Immediate Changes in Physical Function, Psychological Health, and Health-Related Quality of Life Following a Five-Day Multicomponent Coastal Health Program in Postmenopausal Women: A Randomized Controlled Trial

by Sung-Hyeon Kim, Jin-Hwa Jung, Ji-Eun Baek, Ho-Jin Shin and Hwi-Young Cho

J. Clin. Med. 2026, 15(15), 5926; https://doi.org/10.3390/jcm15155926 - 29 Jul 2026

Abstract

Background/Objectives: After menopause, hormonal, age-related, and lifestyle factors may adversely affect physical functioning and psychological well-being. This study compared immediate changes in physical function, psychological health, and health-related quality of life following a five-day Combined Marine Treatment Program (CMTP) with those observed [...] Read more.

Background/Objectives: After menopause, hormonal, age-related, and lifestyle factors may adversely affect physical functioning and psychological well-being. This study compared immediate changes in physical function, psychological health, and health-related quality of life following a five-day Combined Marine Treatment Program (CMTP) with those observed under a usual-routine control condition. Methods: A parallel-group randomized controlled trial was conducted with 62 postmenopausal women allocated equally to the CMTP and control groups. The CMTP included coastal walking, resistance exercises, mindfulness meditation, and visits to local natural attractions. Participants in the control group continued their customary daily activities. The co-primary outcomes were the Timed Up and Go test and the Short Form-36. Secondary outcomes were grip strength, pinch strength, static balance, the 10-item Perceived Stress Scale, and the Beck Depression Inventory-II. Mixed repeated-measures analysis of variance was used to test whether temporal changes differed between groups. Trial registration was completed through the Clinical Research Information Service of the Republic of Korea (KCT0009741). Results: Changes over time differed significantly between groups for the Timed Up and Go test, grip strength, pinch strength, eyes-open sway area, eyes-closed sway area, eyes-closed sway velocity, and all self-reported outcomes. Post-intervention values differed significantly between groups for the Timed Up and Go test, pinch strength, both eyes-closed balance measures, and all self-reported outcomes. No adverse events were reported during the trial. Conclusions: Relative to the usual-routine condition, the five-day CMTP was associated with immediate changes in selected performance-based physical outcomes and broader changes across self-reported psychological and health-related quality-of-life outcomes. Brief multicomponent coastal health programs therefore warrant further study in postmenopausal women. Full article

(This article belongs to the Topic Integrative Clinical and Translational Advances in Rehabilitation Medicine: From Mechanisms to Population Health)

► Show Figures

Figure 1

13 pages, 1200 KB

Open AccessArticle

Ipsilesional Handgrip Strength and Functional Outcomes After Stroke: A Retrospective Cohort Study

by Eidmantė Lileikyte, Karolina Lukaševič, Raimondas Savickas and Laura Petrusevičienė

J. Clin. Med. 2026, 15(15), 5925; https://doi.org/10.3390/jcm15155925 - 29 Jul 2026

Abstract

Background and Objectives: Handgrip strength of the ipsilesional hand is increasingly recognized as a prognostic marker in stroke rehabilitation. Therefore, this retrospective observational cohort study investigated the association between baseline ipsilesional handgrip strength and functional outcomes after subacute stroke, while additionally incorporating [...] Read more.

Background and Objectives: Handgrip strength of the ipsilesional hand is increasingly recognized as a prognostic marker in stroke rehabilitation. Therefore, this retrospective observational cohort study investigated the association between baseline ipsilesional handgrip strength and functional outcomes after subacute stroke, while additionally incorporating age- and sex-adjusted normative handgrip strength thresholds, sex-stratified analyses, and exploratory regression models. Materials and Methods: This study was conducted on 180 ischaemic stroke patients admitted to the Neurorehabilitation Unit between 2020 and 2024. Handgrip strength of both hands was measured at admission and discharge. Functional status was assessed using standardized assessments: the Functional Independence Measure (FIM) and the Barthel Index (BI). Correlation analyses were performed to evaluate associations between handgrip strength and functional outcomes. Results: Among 180 participants, those with age- and sex-adjusted normative ipsilesional handgrip strength demonstrated significantly higher FIM scores both before and after rehabilitation (p = 0.008 and p = 0.042), whereas no significant differences were found for the remaining functional outcome measures. In sex-stratified regression analyses, baseline handgrip strength of the ipsilesional hand was significantly associated with FIM score at discharge in both male (B = 0.705, 95% CI: 0.312 to 1.099, p < 0.001) and female participants (B = 0.735, 95% CI: 0.076 to 1.394, p = 0.029). Conclusions: The results of this study confirmed that handgrip strength of the ipsilesional hand is significantly associated with functional outcomes at the end of inpatient stroke rehabilitation. These findings support its potential value as a simple clinical indicator of functional recovery, although the proposed regression models require external validation before clinical application. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

13 pages, 2670 KB

Open AccessSystematic Review

Estrogen Receptor Beta (ERβ) Expression in Colorectal Cancer (CRC)—A Systematic Review and Meta-Analysis

by Yael Sher and Yaron Niv

J. Clin. Med. 2026, 15(15), 5924; https://doi.org/10.3390/jcm15155924 - 29 Jul 2026

Abstract

Background: ERβ is an estrogen receptor isoform expressed in the normal human colon and has been proposed to act as a tumor suppressor gene. The loss of ERβ expression has been associated with advanced stages of CRC. The aim was to investigate the [...] Read more.

Background: ERβ is an estrogen receptor isoform expressed in the normal human colon and has been proposed to act as a tumor suppressor gene. The loss of ERβ expression has been associated with advanced stages of CRC. The aim was to investigate the relationship between ERβ expression and CRC progression, quantifying the difference between tumor tissues and normal controls, and early-stage versus late-stage tumors. Methods: English Medical literature searches were conducted using PubMed, Embase, and Google Scholar up to 31 December 2025 according to PRISMA. Case–control studies comparing ERβ expression in CRC biopsy specimens with that in healthy controls were included. A meta-analysis was performed using Comprehensive Meta-analysis (Version 4). Pooled ORs and 95% confidence intervals were calculated using a random-effects model. Heterogeneity was assessed using the Cochrane Q test and the I² statistic. Publication bias was evaluated. Results: Six studies, representing 13 sub-studies, were selected according to the inclusion criteria, involving 1183 patients and 1000 normal mucosa/tumor early-stage patients. The OR for ERβ expression was 0.211 (95%CI: 0.122–0.363), significantly lower in advanced tumor stages than in normal mucosa and early tumor stages (p < 0.0001). Positivity rates were 76.40% in controls and early-stage tumor patients versus 51.31% in tumor patients (all stages). Heterogeneity was high (I² = 78%), but sensitivity analysis confirmed the robustness of the results. Publication bias was not significant. The studies used different methods and positivity cut-off values, with high heterogeneity, and were from only five countries, indicating the possibility of variation in results across other geographical areas or ethnic groups. Conclusions: ERβ expression is significantly lower in CRC tissues than in healthy controls and progressively decreases as the disease progresses. This finding underscores ERβ’s potential role as a prognostic factor and highlights the viability of ERβ activation as a novel therapeutic strategy. Full article

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

► Show Figures

Figure 1

13 pages, 2152 KB

Open AccessFeature PaperArticle

Use of the Term “Atypical Hepatic Hemangioma” in Radiology Reports: An Analysis of Diagnostic Precision

by Shlomit Tamir, Tomer Krutik, Ran Kedem Mashraki, Ilan Shelef, Eli Atar, Ahuva Grubstein, Jacob Sosna and Gal Ben-Arie

J. Clin. Med. 2026, 15(15), 5923; https://doi.org/10.3390/jcm15155923 - 29 Jul 2026

Abstract

Background/Objectives: Hepatic hemangiomas are the most common benign liver tumors, typically diagnosed confidently by their classic imaging features. However, a subset displays atypical characteristics that complicate diagnosis. We hypothesized that the term “atypical hemangioma” is used inconsistently and may contribute to both [...] Read more.

Background/Objectives: Hepatic hemangiomas are the most common benign liver tumors, typically diagnosed confidently by their classic imaging features. However, a subset displays atypical characteristics that complicate diagnosis. We hypothesized that the term “atypical hemangioma” is used inconsistently and may contribute to both over-investigation of benign lesions and missed malignancies. Accordingly, this study aimed to assess the implications of the use of this term in radiology reports. Methods: This retrospective multicenter study reviewed 327 hepatic lesions labeled as atypical hemangiomas in radiology reports from two tertiary hospitals between 2013 and 2023. Two abdominal radiologists independently assessed imaging characteristics. Final diagnoses were based on imaging stability, histopathology or clinical follow-up. Results: Of the 327 lesions, 305 (93.3%) were benign and 22 (6.7%) malignant. Among the malignant lesions, 11 (50%) had no recommendations for further workup, and 10 (45%) did not mention malignancy in the differential diagnosis. Malignant lesions were significantly larger (mean size: 49.5–50.8 mm vs. 28.1–29.1 mm; p < 0.001), more likely to have ill-defined margins (50–54.5% vs. 17.9–18.1%; p ≤ 0.001), early heterogeneous enhancement (46.2% vs. ~9.5%; p < 0.001), and restricted diffusion (75–100% vs. 7.8–17.6%; p < 0.001). Among the benign lesions, 128 (42%) could have been confidently diagnosed at baseline, yet 62 of these lesions underwent unnecessary additional workup. Conclusions: The term “atypical hemangioma” is inconsistently used and associated with both delayed cancer diagnosis and excessive workup of benign lesions. Standardized terminology and risk-adapted strategies may improve diagnostic accuracy, optimize management, and minimize patient harm. Prospective validation of standardized imaging criteria is warranted. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

► Show Figures

Figure 1

25 pages, 2161 KB

Open AccessReview

Psychoactive and Neurobiological Effects of Ketamine in Humans: A Scoping Review of Clinical Evidence

by Sidorela Turtulli and Eugenia Papadaki

J. Clin. Med. 2026, 15(15), 5922; https://doi.org/10.3390/jcm15155922 - 29 Jul 2026

Abstract

Background/Objectives: Ketamine has attracted interest in psychiatry due to its rapid antidepressant effects, particularly in patients with inadequate response to conventional treatments. This scoping review maps ketamine’s neuropharmacology, mechanisms of action, clinical applications, safety, and use in psychiatric disorders. Methods: This [...] Read more.

Background/Objectives: Ketamine has attracted interest in psychiatry due to its rapid antidepressant effects, particularly in patients with inadequate response to conventional treatments. This scoping review maps ketamine’s neuropharmacology, mechanisms of action, clinical applications, safety, and use in psychiatric disorders. Methods: This scoping review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. PubMed, Scopus, Web of Science, and Google Scholar were searched for English-language publications addressing ketamine pharmacology, clinical applications, and psychoactive effects. Included sources comprised randomized controlled trials, observational studies, systematic reviews, and relevant mechanistic studies, while non-English publications, editorials, commentaries, and studies without sufficient methodological information were excluded. Data were extracted using a structured data-charting form and synthesized narratively and thematically. Results: A total of 69 studies were included in the final synthesis. Ketamine demonstrated early improvements in depressive symptoms, especially in treatment-resistant depression (TRD), although the durability of benefits varied across studies. Intravenous racemic ketamine was the most extensively investigated administration route, while intranasal esketamine represents the primary approved formulation for TRD. Mechanistically, the drug acts through N-methyl-D-aspartate receptor antagonism and downstream modulation of glutamatergic signaling, synaptic plasticity and neural connectivity. Comparisons with conventional antidepressants and neuromodulatory interventions highlighted ketamine’s faster onset of action, although variability remained regarding long-term effects and treatment strategies. Conclusions: Ketamine represents an important rapid-acting treatment for TRD and severe depressive episodes associated with suicidal ideation. However, information regarding long-term efficacy and safety remains limited due to study heterogeneity, short follow-up periods, and variability in dosing protocols. Further research is needed to address gaps related to long-term outcomes, maintenance strategies, and optimal dosing approaches. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

15 pages, 3273 KB

Open AccessArticle

Regional Tear Film Quality Changes Across Eye Gaze Directions Revealed by Spatial Mapping and Threshold Sensitivity Analysis

by Wen-Pin Lin, Rowan Abass, Wei-Ren Lin, Richard Wu, Arwa Fathy and Ahmed Abass

J. Clin. Med. 2026, 15(15), 5921; https://doi.org/10.3390/jcm15155921 - 29 Jul 2026

Abstract

Objectives: This study aimed to determine whether eccentric gaze produces a regional, gaze-aligned redistribution of tear-film quality that is more apparent in spatial analysis than in whole-map summary measures. Methods: This was a secondary analysis of a previously acquired Medmont Meridia [...] Read more.

Objectives: This study aimed to determine whether eccentric gaze produces a regional, gaze-aligned redistribution of tear-film quality that is more apparent in spatial analysis than in whole-map summary measures. Methods: This was a secondary analysis of a previously acquired Medmont Meridia composite-topography dataset from 38 healthy participants, using only the Medmont data. Tear-film quality maps from the ahead, right, left, up, and down gaze were interpolated onto a common grid, aligned to a shared reference frame, and analysed using descriptive global measures, regional spatial mapping, and a threshold-based directional sector analysis. The threshold analysis used an operational cut-off of 0.35 to classify good-quality pixels, with lower values indicating better tear-film quality. Robustness was assessed by repeating the same analysis across nearby cut-offs from 0.30 to 0.40. As Placido-based topography measures reflection from the tear layer rather than the ocular surface itself, and as ocular rotation changes lid position and exposed ocular surface area, aligned comparisons were interpreted as comparisons of the exposed tear-film pattern rather than exact point-for-point anatomical tracking. Results: Global tear-film summary measures showed only modest variation with gaze direction, whereas spatial mapping revealed systematic regional redistribution of tear-film quality across eccentric gaze conditions. At the 0.35 operational threshold, the gaze-aligned good-pixel index was positive for right gaze (0.297 ± 0.200), left gaze (0.213 ± 0.174), up gaze (0.204 ± 0.219), and down gaze (0.308 ± 0.260). All four indices remained greater than zero after Holm correction (all pHolm < 0.001), and all remained greater than the matched ahead-gaze sector indices (all pHolm < 0.001). Threshold sensitivity analysis across cut-offs from 0.30 to 0.40 showed that the positive directional pattern was preserved for all gaze directions. Conclusions: Tear-film quality varies regionally with gaze direction, a pattern that was clearer in spatial maps and sector indices than in global summaries. Straight-ahead measurements may therefore provide an incomplete account of tear-film behaviour during eccentric gaze. As the analysis involved healthy participants and did not assess symptoms or diagnostic performance, the clinical relevance of this pattern requires validation in symptomatic populations. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

Journal Description

Journal of Clinical Medicine

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI