Journal of Clinical Medicine

11 pages, 464 KiB

Open AccessArticle

Cervical Regeneration Following Monopolar Electrosurgical Conization: A Prospective Evaluation of Volume, Length, and Transformation Zone Reformation

by Şule Gül Aydın, Sevda Baş, Fatma Özmen, Şeyma Yaşar, Zeynel Abidin Taş, Ahmet Zeki Nessar, Sevtap Seyfettinoğlu and Mehmet Ali Narin

J. Clin. Med. 2025, 14(16), 5918; https://doi.org/10.3390/jcm14165918 - 21 Aug 2025

Abstract

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for [...] Read more.

Background: The aim of this study was to evaluate the cervical regeneration process following monopolar electrosurgical conization (MESC), using a multimodal approach including ultrasonographic, cytologic, colposcopic, and histologic assessments, and to determine the relationship between the extent of excision and the capacity for cervical tissue regeneration. Methods: This prospective observational study included 28 patients who underwent MESC due to abnormal cervical cytology or biopsy-confirmed cervical intraepithelial neoplasia. Preoperative, postoperative one month and six month cervical measurements were obtained using two-dimensional transvaginal ultrasonography. Monthly colposcopic evaluations were conducted, cervical biopsies were taken at the third month, and a cytological assessment was performed at the sixth month. Cervical volume and length regeneration were calculated and analyzed in relation to the dimensions of the excised cone. Regeneration percentages and their correlations with excised tissue dimensions were evaluated using paired t-tests and Pearson correlation analysis. Results: Mean cervical volume and length regeneration rates at six months were 84.61% ± 5.64 and 86.36% ± 3.33, respectively. The transformation zone was histologically visible in 32.1% of patients at three months and cytologically in 75.9% at six months. An inverse correlation was observed between both cone volume and length and cervical regeneration (p < 0.005). Patients with larger preoperative cervical dimensions exhibited a higher regenerative capacity. Positive surgical margins were found in only one patient (3.4%), and no high-grade cytologic abnormalities were noted at follow-up. Conclusions: MESC may enable substantial cervical regeneration within six months. Larger excisions impair healing and delay transformation zone reformation, which may inform the optimal timing for initiating gynecological and colposcopic examinations, as well as for performing cervical interventions when indicated. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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17 pages, 792 KiB

Open AccessArticle

Does Preoperative CT Improve Outcomes in Femoral Neck Fracture Fixation? A Retrospective Study

by Ludovico Lucenti, Andrea Sodano, Flora Maria Chiara Panvini, Andrea Vescio, Giacomo Papotto, Gianluca Testa and Vito Pavone

J. Clin. Med. 2025, 14(16), 5917; https://doi.org/10.3390/jcm14165917 - 21 Aug 2025

Abstract

Background/Objectives: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using [...] Read more.

Background/Objectives: Femoral neck fractures are a growing concern due to their increasing incidence in both elderly and younger populations. Preoperative CT scan evaluation is often used for better understanding of fracture patterns of femoral neck fractures that need to be treated using cannulated screws. Methods: The present study retrospectively analyzed 55 patients treated with cannulated screw fixation over seven years. Preoperative CT scans, fracture classification (Garden and Pauwels), and surgical timing were evaluated. Results: All 55 patients were treated with three cannulated screws by nine fellowship-trained surgeons. The average age of the CT-yes group was 54.44 years (SD 15.45), while the average age of the CT-no group was 56.93 (SD 14.95). Differences in age among the two groups were not statistically significant. In 4 patients, the treatment with cannulated screws failed, leading to a subsequent total hip arthroplasty for avascular necrosis (AVN). Three of them belonged to the CT-yes group, while only one belonged to the CT-no group. A statistical analysis showed no significant differences between patients who underwent a CT scan and those who did not have a CT scan and their results (p = 0.282).Results indicate no statistically significant difference in outcomes between patients who underwent a CT scan before the surgical treatment and those who did not, while a well-conducted X-ray assessment is essential and can be sufficient to fully understand and treat most of the fractures. Conclusions: The risks of avascular necrosis and non-union must be considered in the decision-making process regarding the suitable treatment. Early surgery did not significantly improve treatment results, but it is recommended. Fixation with cannulated screws remains a good treatment, especially for some patterns of fractures and younger patients. Given the study’s limitations, including the small sample size and retrospective nature, prospective multicenter studies are warranted to better understand the role of CT scans in optimizing surgical planning and improving patient outcomes. Full article

(This article belongs to the Section Orthopedics)

13 pages, 4621 KiB

Open AccessArticle

Enigmatic Cases of Finger Proximal Interphalangeal Joint Swelling: Case Series and Focused Review of the Literature

by Gershon Zinger, Yaakov Applbaum and Amos Peyser

J. Clin. Med. 2025, 14(16), 5916; https://doi.org/10.3390/jcm14165916 - 21 Aug 2025

Abstract

Objectives: This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger’s proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our [...] Read more.

Objectives: This case series and focused literature review address the diagnostic challenges and management strategies for patients presenting with atraumatic, isolated swelling, and stiffness of a single finger’s proximal interphalangeal (PIP) joint. The dual emphasis is on synthesizing the lessons learned from our case series and providing a structured framework for clinical reasoning, including imaging, biopsy, and laboratory assessment. Non-traumatic causes of finger swelling may include rheumatological disease, atypical infection, tumor, or metabolic conditions. Routine evaluation includes history, examination, and radiographs. Additional evaluation may include ultrasound, inflammatory screening labs, magnetic resonance imaging (MRI) and computed tomography (CT). Despite these efforts, a diagnosis may still be elusive. The objective of this study is to provide a useful clinical differential diagnosis and provide lessons learned from this unique group of patients. Methods: Starting in February 2017, patients with isolated unilateral PIP swelling were followed. Clinical information was collected, including history, examination, and laboratory and imaging studies. Patients were followed until a specific diagnosis was obtained. In addition to the series of patients, a focused literature review is given to present additional unusual causes of atraumatic isolated PIP swelling that were not found in this series. Results: There were five cases that met the criteria. This includes two cases ultimately diagnosed with psoriatic arthritis, and one case each of osteoid osteoma, gout and palindromic rheumatoid arthritis. Conclusions: The single most effective test that helped to reach the final diagnosis in this series was the CT scan. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 616 KiB

Open AccessArticle

The Significance of Enzymatic Cholestasis in Inflammatory Bowel Disease Patients for the Diagnosis of Primary Sclerosing Cholangitis—A Retrospective Study

by Matei Mandea, Dragos M. Oancea, Mihaela C. Ghioca, Speranta M. Iacob, Razvan A. Iacob, Ioana. G. Lupescu and Liliana S. Gheorghe

J. Clin. Med. 2025, 14(16), 5915; https://doi.org/10.3390/jcm14165915 - 21 Aug 2025

Abstract

This retrospective longitudinal study evaluated the significance of cholestasis syndrome and the diagnosis of primary sclerosing cholangitis (PSC) in inflammatory bowel disease (IBD) patients from a tertiary center in Romania. Methods: From 2011 to 2022, 3767 patients suspected for IBD were evaluated, with [...] Read more.

This retrospective longitudinal study evaluated the significance of cholestasis syndrome and the diagnosis of primary sclerosing cholangitis (PSC) in inflammatory bowel disease (IBD) patients from a tertiary center in Romania. Methods: From 2011 to 2022, 3767 patients suspected for IBD were evaluated, with 2499 confirmed cases. Of these, 34 patients (1.36%) had an IBD-PSC phenotype. Of the IBD-PSC cases, 56% were associated with UC and 44% with CD. Results: Enzymatic cholestasis was observed in 13.3% of IBD patients, with gamma-glutamyl transpeptidase (GGT) elevated in 70.2% and alkaline phosphatase (ALP) in 51.3%. However, only 10.2% of the patients with enzymatic cholestasis were diagnosed with PSC. Other liver diseases identified included metabolic-associated steatotic liver disease (MASLD), chronic viral hepatitis, Primary Biliary Cholangitis, autoimmune hepatitis, and liver neoplasms. A higher incidence of cholangiocarcinoma (11.76% vs. 0.24%, p < 0.001) and liver-related death (8.82% vs. 0.65%, p < 0.001) was found between IBD-PSC patients and those without PSC. PSC-CD patients were diagnosed at a younger age (30.2 vs. 43 years, p < 0.001), had higher rates of severe disease (73.3% vs. 10.5%, p < 0.001), required more biological treatment (60% vs. 15.7%, p < 0.001), and experienced higher mortality (20% vs. 0%, p < 0.001). Discussions: This study represents the most extensive cohort analysis of PSC-IBD patients in Romania and Eastern Europe, highlighting clinical differences between PSC-UC and PSC-CD phenotypes. Conclusions: The regular monitoring of ALP and GGT in IBD patients helps detect liver diseases, including PSC. However, only one in ten patients with IBD and enzymatic cholestasis was diagnosed with PSC. Full article

(This article belongs to the Collection Clinical Research in Hepatology)

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10 pages, 1502 KiB

Open AccessCase Report

Pulmonary Infiltrates in a Non-Cystic Fibrosis Bronchiectasis Patient: A Case Report

by Francesco Rocco Bertuccio, Nicola Baio, Simone Montini, Valentina Ferroni, Vittorio Chino, Lucrezia Pisanu, Marianna Russo, Ilaria Giana, Elisabetta Gallo, Lorenzo Arlando, Klodjana Mucaj, Mitela Tafa, Maria Arminio, Emanuela De Stefano, Alessandro Cascina, Angelo Guido Corsico, Giulia Maria Stella and Valentina Conio

J. Clin. Med. 2025, 14(16), 5914; https://doi.org/10.3390/jcm14165914 - 21 Aug 2025

Abstract

Background: Scedosporium apiospermum is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic [...] Read more.

Background: Scedosporium apiospermum is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic resistance to multiple antifungal agents. Case Presentation: We report the case of a 66-year-old immunocompetent woman with idiopathic bilateral non-cystic fibrosis bronchiectasis, who presented with subacute cough and increased sputum production. Chest high-resolution CT revealed new subsolid and ground-glass infiltrates superimposed on stable bronchiectatic changes. Bronchoalveolar lavage (BAL) cultures isolated S. apiospermum as the sole pathogen. The patient was treated with oral voriconazole (200 mg BID) for 4 weeks, followed by a 4-week course of aerosolized amphotericin B. Clinical and radiological improvement was observed, and no relapse occurred during follow-up. Discussion: This case highlights the potential for S. apiospermum to cause clinically relevant pulmonary infection in structurally abnormal but immunocompetent lungs. Non-CF bronchiectasis may facilitate fungal colonization due to impaired mucociliary clearance and chronic mucus retention. Combined antifungal therapy involving systemic voriconazole and inhaled amphotericin B (though not yet standardized) was employed based on clinical rationale and the available literature, resulting in favorable outcomes. Conclusions:S. apiospermum pulmonary infection, although rare in immunocompetent hosts with bronchiectasis, should be considered in cases of new or persistent infiltrates. Early recognition and individualized antifungal strategies, including the potential role of inhaled agents, may improve clinical outcomes. This case reinforces the importance of multidisciplinary collaboration in the management of complex fungal infections in chronic airway disease. Full article

(This article belongs to the Section Respiratory Medicine)

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28 pages, 978 KiB

Open AccessReview

Artificial Intelligence in Alzheimer’s Disease Diagnosis and Prognosis Using PET-MRI: A Narrative Review of High-Impact Literature Post-Tauvid Approval

by Rafail C. Christodoulou, Amanda Woodward, Rafael Pitsillos, Reina Ibrahim and Michalis F. Georgiou

J. Clin. Med. 2025, 14(16), 5913; https://doi.org/10.3390/jcm14165913 - 21 Aug 2025

Abstract

Background: Artificial intelligence (AI) is reshaping neuroimaging workflows for Alzheimer’s disease (AD) diagnosis, particularly through PET and MRI analysis advances. Since the FDA approval of Tauvid, a PET tracer targeting tau pathology, there has been a notable increase in studies applying AI to [...] Read more.

Background: Artificial intelligence (AI) is reshaping neuroimaging workflows for Alzheimer’s disease (AD) diagnosis, particularly through PET and MRI analysis advances. Since the FDA approval of Tauvid, a PET tracer targeting tau pathology, there has been a notable increase in studies applying AI to neuroimaging data. This narrative review synthesizes recent, high-impact literature to highlight clinically relevant AI applications in AD imaging. Methods: This review examined peer-reviewed studies published between January 2020 and January 2025, focusing on the use of AI, including machine learning, deep learning, and hybrid models for diagnostic and prognostic tasks in AD using PET and/or MRI. Studies were identified through targeted PubMed, Scopus, and Embase searches, emphasizing methodological diversity and clinical relevance. Results: A total of 111 studies were categorized into five thematic areas: Image preprocessing and segmentation, diagnostic classification, prognosis and disease staging, multimodal data fusion, and emerging innovations. Deep learning models such as convolutional neural networks (CNNs), generative adversarial networks (GANs), and transformer-based architectures were widely employed by the research community in the field of AD. At the same time, several models reported strong diagnostic performance, but methodological challenges such as reproducibility, small sample sizes, and lack of external validation limit clinical translation. Trends in explainable AI, synthetic imaging, and integration of clinical biomarkers are also discussed. Conclusions: AI is rapidly advancing the field of AD imaging, offering tools for enhanced segmentation, staging, and early diagnosis. Multimodal approaches and biomarker-guided models show particular promise. However, future research must focus on reproducibility, interpretability, and standardized validation to bridge the gap between research and clinical practice. Full article

(This article belongs to the Special Issue Artificial Intelligence (AI) and Deep Learning (DL) in Medical Imaging)

19 pages, 2582 KiB

Open AccessArticle

Updated Swiss Growth References 2025: No Height Differences, but BMI Variations Associated with Migration

by Urs Eiholzer, Anika Stephan, Ilja Dubinski, Christiane Fritz and Cees Noordam

J. Clin. Med. 2025, 14(16), 5912; https://doi.org/10.3390/jcm14165912 - 21 Aug 2025

Abstract

Background/Objectives: The 2019 Swiss growth references for height, weight, and BMI were based on a large dataset from the German-speaking part of Switzerland (Cohort 2019). The current study aimed to ensure national representativeness by proportionate amounts of additional data from the French-speaking (Suisse [...] Read more.

Background/Objectives: The 2019 Swiss growth references for height, weight, and BMI were based on a large dataset from the German-speaking part of Switzerland (Cohort 2019). The current study aimed to ensure national representativeness by proportionate amounts of additional data from the French-speaking (Suisse Romande) and Italian-speaking (Ticino) regions to validate the 2019 growth curves and to update the national growth references. It also investigated the influence of parental migration background on child growth. Methods: Anthropometric data from 43,290 children and adolescents—including 11,816 new cases—were analyzed (Cohort 2019 + 2025). Percentile curves were modeled using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) framework. Results: The extended dataset largely confirms the 2019 growth references. Variations in height percentiles were small and clinically negligible. Clinically relevant differences in BMI percentiles were observed in girls, with the most pronounced deviations—up to 0.8 kg/m²—at the 97th percentile. Analyses by parental migration background revealed relevant differences in BMI. Conclusions: The extended Swiss Growth References (Cohort 2019 + 2025) are robust and provide valid reference data for all Swiss children and adolescents, offering contemporary tools for decision-making in clinical practice. To maintain their validity over time, targeted updates are required, with special attention to demographic changes resulting from migration. Full article

(This article belongs to the Section Clinical Pediatrics)

18 pages, 308 KiB

Open AccessArticle

Predictors of Metabolic Syndrome in Polish Women—The Role of Body Composition and Sociodemographic Factors

by Katarzyna Dereń, Magdalena Zielińska, Anna Bartosiewicz and Edyta Łuszczki

J. Clin. Med. 2025, 14(16), 5911; https://doi.org/10.3390/jcm14165911 - 21 Aug 2025

Abstract

Background: The increasing prevalence of overweight and obesity worldwide is one of the most serious public health challenges, reaching epidemic proportions. Excessive body weight is often accompanied by metabolic disorders such as insulin resistance, atherogenic dyslipidaemia and hypertension—collectively known as metabolic syndrome. This [...] Read more.

Background: The increasing prevalence of overweight and obesity worldwide is one of the most serious public health challenges, reaching epidemic proportions. Excessive body weight is often accompanied by metabolic disorders such as insulin resistance, atherogenic dyslipidaemia and hypertension—collectively known as metabolic syndrome. This cross-sectional study aimed to identify predictors of metabolic syndrome in women using logistic regression analysis based on selected sociodemographic, anthropometric, and lifestyle variables. Methods: The study included 250 women aged 23–85 recruited in the Podkarpackie region of Poland. Data on sociodemographic characteristics and smoking status were collected via a questionnaire. Physical activity and sedentary behaviours were assessed using the Global Physical Activity Questionnaire. Body composition was measured using bioelectrical impedance analysis. Fasting capillary blood samples and blood pressure measurements were obtained by qualified medical staff in accordance with standard procedures. Results: Obesity was strongly associated with metabolic syndrome components, particularly abnormal blood pressure (66.3%) and fasting glucose (64%), both of which were statistically significant (p < 0.01). Age was a significant predictor of metabolic syndrome (OR = 1.06; p < 0.01) and its components, including hypertension, dysglycaemia and dyslipidaemia. Waist-to-hip ratio was strongly linked to metabolic syndrome (OR = 356.97; p < 0.01) and obesity (OR = 5.89 × 10³⁰; p < 0.001); however, these exceptionally high values should be interpreted with caution, as they may reflect statistical artifacts due to model instability or sample characteristics, rather than a meaningful or generalizable association. Higher body fat mass was associated with an increased risk of obesity, hypertension and dysglycaemia (OR = 1.42, 1.06 and 1.06 respectively; p < 0.01). Conclusions: These results emphasise the significant role of obesity as a risk factor for metabolic syndrome in women, highlighting the need for personalised preventive strategies that consider lifestyle and sociodemographic factors, such as targeted health education, promotion of physical activity, and dietary counselling adapted to the needs of women at risk. 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)

15 pages, 1106 KiB

Open AccessReview

Temporary Peripheral Nerve Stimulation (PNS) of the Cervical Medial Branch Nerve (CMBN) for Chronic Axial Neck Pain—A Literature Review and Case Series

by Vinicius Tieppo Francio, Kelsey Gustafson, Logan Leavitt, Ryan Zwick, Christopher M. Lam, Andrew Sack, Dawood Sayed and Usman Latif

J. Clin. Med. 2025, 14(16), 5910; https://doi.org/10.3390/jcm14165910 - 21 Aug 2025

Abstract

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing [...] Read more.

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing literature and present a retrospective single-center case series of patients who underwent temporary PNS targeting the cervical medial branch nerves (CMBNs) for chronic axial neck pain. Methods: This investigation comprises a narrative literature review alongside a single-center, retrospective case series evaluating percutaneous, temporary PNS for the management of cervical spondylosis facet arthropathy in the absence of myelopathy or radiculopathy. The primary outcomes were pain reduction, as measured by the numeric rating scale, and improvements in functional disability, with assessments conducted at baseline and at 60 days post-intervention. Results: PNS represents a neuromodulatory, nondestructive intervention that targets the CMBN to alleviate chronic axial neck pain, in contrast to the destructive mechanisms inherent in cervical radiofrequency ablation (CRFA). Although PNS has been applied to other neural targets, its use in the cervical region is sparsely documented, with limited case studies available. Notably, this case series is the first to report pain and disability outcomes specifically associated with CMBN PNS. At the 60-day follow-up, 66% of subjects achieved the minimal clinically important difference (MCID) for pain reduction, while 77% met the MCID for disability reduction. Moreover, our analysis uniquely examined the impact of previous CRFA and a history of cervical spine surgery on treatment outcomes, revealing that patients with such interventions experienced more modest improvements compared to their surgery- and CRFA-naive counterparts. Conclusions: The current literature reveals a significant gap regarding the use of CMBN PNS, underscoring an unmet need in the treatment algorithm for chronic axial neck pain beyond conservative modalities. Our findings suggest that CMBN PNS may offer a promising adjunctive therapy for carefully selected patients with refractory chronic axial neck pain who have not improved after medications, physical therapy, or injections. Additionally, the comparative analysis of outcomes in patients with a history of CRFA or cervical surgery underscores potential advantages of PNS prior to destructive therapies. Future research, ideally in the form of prospective studies with larger cohorts and extended follow-up durations, is warranted to further evaluate long-term outcomes and refine the place of PNS in the treatment algorithm. Full article

(This article belongs to the Special Issue Neck Pain: Advancements in Assessment and Contemporary Management)

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15 pages, 260 KiB

Open AccessArticle

Dental Health Status of Incarcerated Individuals in Silesia: A Five-Year Retrospective Case-Control Study

by Jakub Fiegler-Rudol, Piotr Ziobro, Anna Zawilska, Karolina Lau and Janusz Kasperczyk

J. Clin. Med. 2025, 14(16), 5909; https://doi.org/10.3390/jcm14165909 - 21 Aug 2025

Abstract

Background: Incarcerated individuals often experience poor oral health due to limited access to care and socioeconomic disadvantages. Objective: This study assessed the dental health status of incarcerated individuals in Silesia over a five-year period using the Decayed, Missing, and Filled Teeth [...] Read more.

Background: Incarcerated individuals often experience poor oral health due to limited access to care and socioeconomic disadvantages. Objective: This study assessed the dental health status of incarcerated individuals in Silesia over a five-year period using the Decayed, Missing, and Filled Teeth (DMFT) index and compared their outcomes to a matched control group from the general population. Methods: We conducted a retrospective observational case-control study at the University Centre for Dentistry in Bytom, reviewing records of 136 incarcerated patients (mean age 36.8 ± 7.9 years; 9.4% women) and a matched control group between 2019 and 2024. Results: Incarcerated individuals had a higher mean DMFT score (14.4 ± 5.7) compared to controls (11.5 ± 6.5; mean difference = 2.95, 95% CI: 1.53 to 4.37; Cohen’s d = 0.49), with more decayed (4.9 ± 3.2 vs. 3.4 ± 2.4) and missing teeth (4.3 ± 3.2 vs. 3.5 ± 2.6). Most incarcerated patients (65.5%) required oral surgical treatment, most commonly for retained roots (25.9%) and impacted teeth (24.5%). No significant DMFT differences were observed based on age or sex, although disparities were most pronounced in older female prisoners (mean DMFT 17.8 vs. 9.8 in controls aged 40+). Conclusions: Incarcerated individuals in Silesia demonstrated a significantly higher burden of untreated dental disease and greater tooth loss compared to non-incarcerated controls over the five-year period. The predominance of advanced dental conditions requiring surgical intervention highlights missed opportunities for early and preventive care in this vulnerable population. Full article

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

11 pages, 535 KiB

Open AccessArticle

Comparison of Pulsed Radiofrequency and Endoscopic Piriformis Release for Refractory Piriformis Syndrome: A Propensity Score-Matched Retrospective Cohort Study

by Eunsung Park, Duyoung Choi and Cheol Lee

J. Clin. Med. 2025, 14(16), 5908; https://doi.org/10.3390/jcm14165908 - 21 Aug 2025

Abstract

Background/Objective: Piriformis syndrome (PS) causes sciatic nerve entrapment and chronic pain. In refractory cases, pulsed radiofrequency (PRF) and endoscopic piriformis release (EPR) are used, but comparative evidence is limited. Methods: This retrospective cohort study compared PRF and EPR in patients treated from 2018 [...] Read more.

Background/Objective: Piriformis syndrome (PS) causes sciatic nerve entrapment and chronic pain. In refractory cases, pulsed radiofrequency (PRF) and endoscopic piriformis release (EPR) are used, but comparative evidence is limited. Methods: This retrospective cohort study compared PRF and EPR in patients treated from 2018 to 2024 at a tertiary hospital using propensity score matching (PSM). Patients with PS, unresponsive to conservative treatment (≥3 months), were included. PRF targeted the sciatic nerve under imaging guidance; EPR involved endoscopic decompression. Primary outcomes were Numeric Rating Scale (NRS) scores at 3 and 6 months. Secondary outcomes included patient satisfaction, reintervention rates, complications, and the Oswestry Disability Index (ODI), where available. After PSM, 115 patients were analyzed per cohort. Multivariate regression identified the predictors of pain improvement. Results: From 465 eligible patients (PRF 350; EPR 115), after PSM, 230 patients were analyzed (115 per cohort). The baseline NRS score was 7.4 ± 1.4 (PRF) vs. 7.5 ± 1.3 (EPR). At 3 months, EPR showed a lower NRS score (2.6 ± 1.3) compared to PRF (3.2 ± 1.6; p = 0.032). At 6 months, the EPR NRS score was 2.2 ± 1.1 vs. 2.9 ± 1.5 for PRF (p = 0.018). EPR had a higher rate of ≥50% NRS score reduction (78% vs. 65%; p = 0.041). EPR patients reported higher satisfaction and fewer reinterventions but more complications. Regression analysis identified EPR (OR = 2.15), higher baseline NRS scores, and shorter symptom duration as predictors of improvement. Conclusions: EPR provided superior pain relief compared to PRF at 3 and 6 months, although with a higher risk of complications. PRF remains a safer initial option. Full article

(This article belongs to the Special Issue Clinical Insights and Emerging Strategies in Chronic Pain Management)

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15 pages, 557 KiB

Open AccessArticle

Long-Term Impact of Chronic Obstructive Pulmonary Disease and Atrial Fibrillation on Post-Acute Myocardial Infarction Long-Term All-Cause Mortality: Insights from the SAMI III Project

by Arthur Shiyovich, Harel Gilutz, Keren Skalsky and Ygal Plakht

J. Clin. Med. 2025, 14(16), 5907; https://doi.org/10.3390/jcm14165907 - 21 Aug 2025

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common comorbidities in patients with acute myocardial infarction (AMI) and are associated with adverse cardiovascular outcomes. However, the impact of their coexistence on long-term post-AMI outcomes remains unclear. This study aimed to [...] Read more.

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (AF) are common comorbidities in patients with acute myocardial infarction (AMI) and are associated with adverse cardiovascular outcomes. However, the impact of their coexistence on long-term post-AMI outcomes remains unclear. This study aimed to investigate the long-term effects of COPD and AF on AMI survivors. Methods: This retrospective cohort study analyzed data from consecutive AMI hospitalizations between 1 January 2002 and 31 October 2017. Patients were categorized into four groups based on the presence or absence of COPD and AF. The primary outcome was all-cause mortality up to 10 years post-discharge. Multivariate survival models were used to assess independent associations. Results: A total of 15,449 AMI survivors (mean age 66 ± 14 years, 30% female) were included, of whom 1386 (8.9%) had COPD, 2547 (16.5%) had AF, and 376 (2.4%) had both conditions. Over a median follow-up of 7.7 (IQR 3.3–10) years, 44.7% of the patients died. COPD (AdjHR = 1.89, 95% CI: 1.74–2.05), AF (AdjHR = 1.39, 95% CI: 1.31–1.48), and coexistence of both conditions (AdjHR = 1.82, 95% CI: 1.61–2.04) were associated with an increased risk for mortality (p < 0.001 for each). However, in patients with both conditions, the mortality risk was comparable to that of COPD alone. Conclusions: While both COPD and AF are associated with increased long-term mortality after AMI, COPD appears to be the primary independent driver of this risk. These findings underscore the need for proactive screening and individualized management in this high-risk population. Full article

(This article belongs to the Section Respiratory Medicine)

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14 pages, 500 KiB

Open AccessArticle

Surgical Treatment of Severe Aortic Stenosis: Sutureless Versus Stented Bioprosthetic Aortic Valve Replacement

by Alessandro Ricasoli, Carmelo Mignosa, Salvatore Lentini, Laura Asta, Adriana Sbrigata, Claudia Altieri and Calogera Pisano

J. Clin. Med. 2025, 14(16), 5906; https://doi.org/10.3390/jcm14165906 - 21 Aug 2025

Abstract

Objective: The aim of this study is to analyze the effects of sutureless aortic valve bioprosthesis implantation compared with stented conventional bioprosthesis in patients with severe aortic stenosis. This is a propensity matching institutional study. Materials and Methods: We compared 37 patients [...] Read more.

Objective: The aim of this study is to analyze the effects of sutureless aortic valve bioprosthesis implantation compared with stented conventional bioprosthesis in patients with severe aortic stenosis. This is a propensity matching institutional study. Materials and Methods: We compared 37 patients who underwent aortic valve replacement with Carpentier Edwards Perimount implantation (group 1) with 37 patients with sutureless Perceval S implanted (group 2). Preoperative, intraoperative, and postoperative parameters were studied. Results: The cross-clamp time, the mechanical ventilation times, the intensive care unit, and the hospital stay were significantly shorter in group 2 than in group 1 (p-value < 0.001). The cardio-pulmonary bypass time was 74 [45, 201] minutes in group 2 and 82 [48, 654] minutes in group 1 (p-value = 0.113). The postoperative mean gradients were 13 [6, 44] mmHg in group 2 and 14 [6, 19] mmHg in group 1 (p-value 0.285), and the effective orifice areas in these two groups were 1.5 ± 0.18 cm² vs. 1.1 ± 0.4 cm² (p = 0.002). The percentage of minimally invasive approach was higher in group 2 than in group 1. The echocardiographic follow-up analysis showed that the mean and maximum gradients with a sutureless prosthesis implant were lower than that of a traditional prosthesis, although this difference was not statistically significant. Conclusions: The Perceval S valve seems to be an effective alternative solution for biological valve implantation with good hemodynamic characteristics as compared with Carpentier Edwards Perimount prosthesis, providing shorter ischemic and extracorporeal circulation time and better postoperative recovery. Perceval S valve implantation facilitates the minimally invasive approach. Full article

(This article belongs to the Special Issue Advances in the Diagnosis, Treatment, and Prognosis of Aortic Stenosis)

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16 pages, 640 KiB

Open AccessReview

New Trends in Airway Management During Endoscopic Retrograde Cholangiopancreatography: A Narrative Review

by Federica Maiellare, Fabio Sbaraglia, Miryam Del Vicario, Riccardo Fattore, Giuliano Ferrone, Monica Lucente, Alessandra Piersanti, Domenico Posa, Giorgia Spinazzola, Daniele De Padova, Caterina Malatesta, Carmela Memoli and Marco Rossi

J. Clin. Med. 2025, 14(16), 5905; https://doi.org/10.3390/jcm14165905 - 21 Aug 2025

Abstract

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to [...] Read more.

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to the complexity of procedures and patient comorbidities. This narrative review aims to underscore the current absence of definitive evidence supporting a single airway management strategy during ERCP. In each section, we examine the strengths and limitations of various airway management strategies, including spontaneous breathing, endotracheal intubation, and newer techniques such as high-flow nasal oxygen (HFNO) and supraglottic airway devices (SGAs), tailored for endoscopic procedures. We explore and discuss the multifactorial determinants that influence clinical decision-making, including patient-specific risk factors, procedural complexity, resource availability, and potential complications. Any anesthesiological choice must guarantee the immobility of the patient and the versatility of the position and must be integrated with the preferences and skills of the endoscopist, the available means in the endoscopic suite, and the internal protocols. Spontaneous breathing with sedation may be appropriate for low-risk, short-duration procedures but carries risks of hypoventilation and aspiration, while GA with a device to manage airways improves procedural conditions and perioperative risks. Still, it is resource-intensive and may delay recovery. Transitions between different strategies are inherently fluid, reflecting the need for a flexible, patient-centered approach tailored to the specific clinical context. Rigorous future research is essential to establish evidence-based guidelines that enhance both safety and efficiency of airway management in this setting. Full article

(This article belongs to the Section Anesthesiology)

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12 pages, 1291 KiB

Open AccessArticle

The Impact of Early Mobilization on the Incidence of Intensive Care Unit: Acquired Weakness in Patients with Sepsis in the Critical Care—The Shinshu Multicenter Prospective Cohort Study (EROSCCS Study)

by Yasunari Sakai, Kohei Taniuchi, Takuma Karasawa, Ken Matsui, Takeshi Matsumoto, Shota Ikegami, Hiroshi Imamura and Hiroshi Horiuchi

J. Clin. Med. 2025, 14(16), 5904; https://doi.org/10.3390/jcm14165904 - 21 Aug 2025

Abstract

Background: Post-Intensive Care Syndrome (PICS), which includes Intensive Care Unit-Acquired Weakness (ICU-AW), can lead to lasting functional impairments even after patients are discharged from the hospital. Early mobilization is a key strategy for preventing ICU-AW, a major contributor to PICS. The primary [...] Read more.

Background: Post-Intensive Care Syndrome (PICS), which includes Intensive Care Unit-Acquired Weakness (ICU-AW), can lead to lasting functional impairments even after patients are discharged from the hospital. Early mobilization is a key strategy for preventing ICU-AW, a major contributor to PICS. The primary objective of this study is to assess the impact of early mobilization on ICU-AW in critically ill sepsis patients, while also evaluating the feasibility of a larger, multicenter study through comparison with previous data. Methods: This multicenter observational study, conducted in four hospitals in Nagano Prefecture, Japan, from April 2020 to March 2023, included sepsis patients admitted to the ICU or emergency departments. Patients were classified into ICU-AW and non-ICU-AW groups based on admission data. Background factors and discharge outcomes (complications, ADL, physical function) were assessed. Logistic regression analysis was performed to evaluate the relationship between early mobilization and ICU-AW incidence, with a subgroup analysis on the impact of a dedicated team or physiotherapist. Results: A total of 154 sepsis patients were enrolled, with 76 (49.4%) diagnosed with ICU-AW at discharge. The most common infection source in ICU-AW patients was the urinary tract (31%). Early mobilization (≥3 days) significantly reduced ICU-AW incidence, with adjusted odds ratios of 3.73 (95% CI = 1.79–7.77) for treatment details and 2.93 (95% CI = 1.22–7.08) for patient factors. However, the presence of a dedicated team or physiotherapist did not significantly affect ICU-AW incidence, with adjusted odds ratios of 0.50 (95% CI = 0.24–10.6) and 0.99 (95% CI = 0.40–2.47), respectively. Conclusions: Early mobilization effectively reduced ICU-AW incidence in sepsis patients, though a dedicated team or physiotherapist had no significant impact. Urinary tract infections were the most common infection source in ICU-AW patients. Early mobilization during dialysis for acute kidney injury shows promising potential and warrants further promotion. Full article

(This article belongs to the Section Intensive Care)

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11 pages, 1155 KiB

Open AccessArticle

The Endometrial Receptivity Test: The Impact of Combined Treatment with Pentoxifylline and Alpha-Tocopherol in Patients with Recurrent Implantation Failure or Recurrent Pregnancy Loss

by Laurine Prudhomme, Cécile Habran, Soraya Labied, Frédéric Wenders, Laetitia Rousseau, Carine Munaut and Laurie Henry

J. Clin. Med. 2025, 14(16), 5903; https://doi.org/10.3390/jcm14165903 - 21 Aug 2025

Abstract

Background/Objectives: The management of patients with recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL) is a real challenge. Studying endometrial proliferation and vascularization by ultrasound during the embryo implantation window is an option for investigating these failures. This approach involves measuring [...] Read more.

Background/Objectives: The management of patients with recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL) is a real challenge. Studying endometrial proliferation and vascularization by ultrasound during the embryo implantation window is an option for investigating these failures. This approach involves measuring the endometrial volume, the uterine arteries pulsatility index (PI), and the sub-endometrial flow index (VFI). Methods: The aim of our single-center retrospective study was to evaluate the benefit of treatment with pentoxifylline (400 mg twice daily) and alpha-tocopherol (500 IU twice daily), which was administered for at least 3 months. This study included 52 patients presenting abnormal ultrasound criteria, i.e., endometrial volume less than 2 cm³ and/or PI greater than 2.8 and/or VFI less than 0.25. Results: After treatment, we observed a significant increase in endometrial volume of 0.32 cm³ (p = 0.0054), as well as a significant increase in VFI of 0.49 (p = 0.041) in comparison to the control group. After treatment, the PI of the right uterine artery decreased significantly by 0.25 (p = 0.029) and the PI of the left uterine artery decreased by 0.27, but not significantly. In addition, our study showed that the clinical pregnancy rate (CPR) was more improved in the treated group compared to controls. Conclusions: Our study showed a promising benefit of pentoxifylline and alpha-tocopherol on endometrial properties; this needs to be corroborated by a larger prospective study. Full article

(This article belongs to the Special Issue Female Infertility: Clinical Diagnosis and Treatment)

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34 pages, 964 KiB

Open AccessSystematic Review

Resting-State Electroencephalogram (EEG) as a Biomarker of Learning Disabilities in Children—A Systematic Review

by James Chmiel, Jarosław Nadobnik, Szymon Smerdel and Mirela Niedzielska

J. Clin. Med. 2025, 14(16), 5902; https://doi.org/10.3390/jcm14165902 - 21 Aug 2025

Abstract

Introduction: Learning disabilities (LD) compromise academic achievement in approximately 5–10% of school-aged children, yet the neurophysiological signatures that could facilitate earlier detection or stratification remain poorly defined. Resting-state electroencephalography (rs-EEG) offers millisecond resolution and is cost-effective, but its findings have never been synthesized [...] Read more.

Introduction: Learning disabilities (LD) compromise academic achievement in approximately 5–10% of school-aged children, yet the neurophysiological signatures that could facilitate earlier detection or stratification remain poorly defined. Resting-state electroencephalography (rs-EEG) offers millisecond resolution and is cost-effective, but its findings have never been synthesized systematically across pediatric LD cohorts. Methods: Following a PROSPERO-registered protocol (CRD420251087821) and adhering to PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, Scopus, and PsycINFO through 31 March 2025 for peer-reviewed studies that recorded eyes-open or eyes-closed rs-EEG using ≥ 4 scalp electrodes in children (≤18 years) formally diagnosed with LD, and compared the results with typically developing peers or normative databases. Four reviewers independently screened titles and abstracts, extracted data, and assessed the risk of bias using ROBINS-I. Results: Seventeen studies (704 children with LD; 620 controls) met the inclusion criteria. The overall risk of bias was moderate, primarily due to small clinic-based samples and inconsistent control for confounding variables. Three consistent electrophysiological patterns emerged: (i) a 20–60% increase in delta/theta power over mesial-frontal, fronto-central and left peri-Sylvian cortices, resulting in markedly elevated θ/α and θ/β ratios; (ii) blunting or anterior displacement of the posterior alpha rhythm, particularly in language-critical temporo-parietal regions; and (iii) developmentally immature connectivity, characterized by widespread slow-band hypercoherence alongside hypo-connected upper-alpha networks linking left-hemisphere language hubs to posterior sensory areas. These abnormalities were correlated with reading, writing, and IQ scores and, in two longitudinal cohorts, they partially normalized in parallel with academic improvement. Furthermore, a link between reduced posterior/overall alpha and neuroinflammation has been found. Conclusions: Rs-EEG reveals a robust yet heterogeneous electrophysiological profile of pediatric LD, supporting a hybrid model that combines maturational delay with persistent circuit-level atypicalities in some children. While current evidence suggests that rs-EEG features show promise as potential biomarkers for LD detection and subtyping, these findings remain preliminary. Definitive clinical translation will require multi-site, dense-array longitudinal studies employing harmonized pipelines, integration with MRI and genetics, and the inclusion of EEG metrics in intervention trials. Full article

(This article belongs to the Special Issue Innovations in Neurorehabilitation)

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14 pages, 1341 KiB

Open AccessArticle

Optimizing Ovarian Stimulation for IVF in PCOS Patients: A Novel Day 1 GnRH Antagonist Protocol

by Sudarsan Ghosh Dastidar, Biswanath Ghosh Dastidar, Ratna Chattopadhyay and Chandan Chakraborty

J. Clin. Med. 2025, 14(16), 5901; https://doi.org/10.3390/jcm14165901 - 21 Aug 2025

Abstract

Objectives: Gonadotropin-releasing hormone (GnRH) antagonist protocols are preferred in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF) as they provide the best combination of flexibility, acceptable outcomes, and safety. Numerous studies have compared outcomes between GnRH agonist long protocol and [...] Read more.

Objectives: Gonadotropin-releasing hormone (GnRH) antagonist protocols are preferred in polycystic ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF) as they provide the best combination of flexibility, acceptable outcomes, and safety. Numerous studies have compared outcomes between GnRH agonist long protocol and standard flexible antagonist protocol. However, there are scant studies investigating the effectiveness of antagonist administration from day 1 of ovarian stimulation in PCOS patients. Methods: We performed a retrospective cohort study to compare laboratory and clinical outcomes in IVF between standard flexible day 5/day 6 versus day 1 GnRH antagonist protocol in PCOS patients. Results: Our data indicates significantly superior oocyte yield and top-quality embryo proportion in patients with antagonists from day 1. Cumulative clinical pregnancy rates also tended to be superior in this group. Conclusions: Our findings indicate that administration of GnRH antagonists from day 1 of stimulation in PCOS patients undergoing IVF may lead to superior results. Full article

(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS): State of the Art: 2nd Edition)

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21 pages, 1124 KiB

Open AccessArticle

Effects of Dance-Based Aerobic Training on Functional Capacity and Risk of Falls in Older Adults with Mild Cognitive Impairment

by Marcelina Sánchez-Alcalá, María del Carmen Carcelén-Fraile, Paulino Vico-Rodríguez, Marta Cano-Orihuela and María del Mar Carcelén-Fraile

J. Clin. Med. 2025, 14(16), 5900; https://doi.org/10.3390/jcm14165900 - 21 Aug 2025

Abstract

Background: Older adults with mild cognitive impairment are at increased risk for physical decline and falls due to decreased strength, flexibility, balance, and gait. Dance-based aerobic training has emerged as a promising and enjoyable intervention to promote physical function and cognitive stimulation. This [...] Read more.

Background: Older adults with mild cognitive impairment are at increased risk for physical decline and falls due to decreased strength, flexibility, balance, and gait. Dance-based aerobic training has emerged as a promising and enjoyable intervention to promote physical function and cognitive stimulation. This study aimed to evaluate the efficacy of a 12-week structured dance-based aerobic program, based on line dancing and Latin rhythms (e.g., salsa, merengue, and bachata), in improving functional capacity and reducing the risk of falls in older adults with mild cognitive impairment. Methods: A randomized controlled trial was conducted with 92 participants aged ≥65 years diagnosed with mild cognitive impairment. The participants were randomly assigned to an experimental group (dance-based training, twice weekly for 12 weeks) or a control group (usual activity). Outcomes included muscle strength (grip dynamometry), flexibility (back scratch and chair sit-and-reach tests), gait speed (Timed Up and Go test), balance (Tinetti scale), and total falls risk score (Tinetti). Mixed ANOVA and Cohen’s d were used for statistical analysis. Results: Significant improvements were observed in the experimental group on all variables compared to the control group. Muscle strength (p < 0.001, d = 0.86), gait speed (p = 0.026, d = 0.48), and upper and lower extremity flexibility (d = 0.43–0.79) improved significantly. The balance and gait components of the Tinetti scale also increased (p = 0.007 and p = 0.048, respectively), as did the total Tinetti score (p = 0.002, d = 0.67), indicating a reduction in the risk of falls. Conclusions: These findings suggest that, under structured conditions, dance-based aerobic training may serve as a promising non-pharmacological strategy to support healthy aging in older adults with mild cognitive impairment, although further validation in larger cohorts is needed. Full article

(This article belongs to the Special Issue Mental Disorders, Cognitive Impairment and Dementia Among Older Adults)

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