You seem to have javascript disabled. Please note that many of the page functionalities won't work as expected without javascript enabled.

Search for Articles:

Title / Keyword

Author / Affiliation / Email

Journal

Article Type

Advanced Search

Section

Special Issue

Volume

Issue

Number

Page

Logical OperatorOperator

Search Text

Search Type

Journal Description

Journal of Clinical Medicine

Journal of Clinical Medicine is an international, peer-reviewed, open access journal of clinical medicine, published semimonthly online by MDPI. The International Bone Research Association (IBRA), Spanish Society of Hematology and Hemotherapy (SEHH), Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) and others are all affiliated with JCM, and their members receive a discount on article processing charges.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, CAPlus / SciFinder, and other databases.
Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.7 days after submission; acceptance to publication is undertaken in 2.7 days (median values for papers published in this journal in the first half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Companion journals for JCM include: Epidemiologia, Transplantology, Uro, Sinusitis, Rheumato, Journal of Clinical & Translational Ophthalmology, Journal of Vascular Diseases, Osteology, Complications, Therapeutics, Sclerosis, Pharmacoepidemiology and Journal of CardioRenal Medicine.
Journal Clusters of Hematology: Hemato, Hematology Reports, Thalassemia Reports and Journal of Clinical Medicine.

Impact Factor: 2.9 (2024); 5-Year Impact Factor: 3.3 (2024)

Imprint Information Journal Flyer Open Access ISSN: 2077-0383

Latest Articles

14 pages, 625 KB

Open AccessSystematic Review

Clinical Versus Dermoscopic Evaluation of Tumor Margins Prior to Surgical Excision—A Systematic Review

by Anestis Chrysostomidis, Evangelos Kostares, Antonios Saramantos, Konstantinos Lallas, Aimilios Lallas, Maria Kantzanou, Ioannis Tilaveridis and Athanassios Kyrgidis

J. Clin. Med. 2025, 14(17), 6014; https://doi.org/10.3390/jcm14176014 (registering DOI) - 26 Aug 2025

Background/Objectives: Accurate surgical margin delineation is essential in the treatment of non-melanoma skin cancers (NMSCs), particularly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), to reduce recurrence and metastasis. Dermoscopy improves diagnostic accuracy for skin tumors, but its utility for [...] Read more.

Background/Objectives: Accurate surgical margin delineation is essential in the treatment of non-melanoma skin cancers (NMSCs), particularly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), to reduce recurrence and metastasis. Dermoscopy improves diagnostic accuracy for skin tumors, but its utility for preoperative margin assessment remains underexplored. To compare dermoscopy-guided versus clinical visual inspection for preoperative margin assessment in NMSC excision, focusing on histological clearance rates and surgical outcomes. Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines. MEDLINE, Cochrane CENTRAL, Scopus, and Web of Science were searched from inception to 1 July 2025. Eligible studies included adult patients undergoing surgical excision of histologically confirmed BCC or cSCC, with preoperative margin evaluation using either dermoscopy or clinical examination. The primary outcome was the rate of complete histological excision. Study quality was assessed using the Newcastle–Ottawa Scale. A random-effects meta-analysis using the Freeman–Tukey transformation was performed. Results: Nine cohort studies comprising 900 NMSC lesions were included. Dermoscopy-guided excision demonstrated pooled histological clearance of 98.7% (95% CI: 97–99.8%), compared to 80–94% with clinical assessment. Moderate heterogeneity was observed (I² = 42%). However, variability in study design and limited data for cSCC restricted broader conclusions. Conclusions: Dermoscopy may enhance margin assessment and histological clearance in NMSC surgery, especially for BCC. Further standardized, high-quality studies are needed to confirm its role in surgical planning and extend evidence to SCC. Full article

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

► Show Figures

Figure 1

13 pages, 601 KB

Open AccessArticle

Effect of Volume on Postoperative Outcomes After Left Pancreatectomy: A Multicenter Prospective Snapshot Study (SPANDISPAN Project)

by Daniel Aparicio-López, José M. Ramia, Celia Villodre, Juan J. Rubio-García, Belén Hernández, Juli Busquets, Luis Secanella, Nuria Peláez, Maialen Alkorta, Itziar de-Ariño-Hervás, Mar Achalandabaso, Enrique Toledo-Martínez, Fernando Rotellar, Pablo Martí-Cruchaga, Miguel A. Gómez-Bravo, Gonzalo Suárez-Artacho, Marina Garcés-Albir, Luis Sabater, Gabriel García-Plaza, Francisco J. Alcalá, Enrique Asensio, David Pacheco, Esteban Cugat, Francisco Espín, María Galófre-Recasens, Belinda Sánchez-Pérez, Julio Santoyo-Santoyo, Jorge Calvo, Carmelo Loinaz, María I. García-Domingo, Santiago Sánchez-Cabús, Belén Martín-Arnau, Gerardo Blanco-Fernández, Isabel Jaén-Torrejimeno, Carlos Domingo-del-Pozo, Carmen Payá, Carmen González, Eider Etxebarría, Rafael López-Andújar, Cristina Ballester, Ana B. Vico-Arias, Natalia Zambudio-Carroll, Sergio Estévez, Manuel Nogueira-Sixto, José I. Miota, Belén Conde, Miguel A. Suárez-Muñoz, Jorge Roldán-de-la-Rua, Angélica Blanco-Rodríguez, Manuel González, Pilar E. González-de-Chaves-Rodríguez, Betsabé Reyes-Correa, Santiago López-Ben, Berta Tió, Javier Mínguez, Inmaculada Lasa-Unzué, Alberto Miyar, Lorena Solar, Fernando Burdío, Benedetto Ielpo, Alberto Carabias, María P. Sanz-Muñoz, Alfredo Escartín, Fulthon Vela, Elia Marqués, Adelino Pérez, Gloria Palomares, Antonio Calvo-Córdoba, José T. Castell, María J. Castro, María C. Manzanares, Enrique Artigues, Juan L. Blas, Luis Díez, Alicia Calero, José Quiñones, Mario Rodríguez, Cándido F. Alcázar-López and Mario Serradilla-Martín Show full author list Hide full author list

J. Clin. Med. 2025, 14(17), 6013; https://doi.org/10.3390/jcm14176013 (registering DOI) - 25 Aug 2025

Background/Objectives: Like many other countries, the management of pancreatic cancer in Spain has developed in a fragmented manner. This study analyzes clinical outcomes related to patient volume at different centers after left pancreatectomy (LP). Our goal is to determine whether our practices align [...] Read more.

Background/Objectives: Like many other countries, the management of pancreatic cancer in Spain has developed in a fragmented manner. This study analyzes clinical outcomes related to patient volume at different centers after left pancreatectomy (LP). Our goal is to determine whether our practices align with the standards established in the literature and assess whether centralization’s advantages significantly outweigh its disadvantages. Methods: The SPANDISPAN Project (SPANish DIStal PANcreatectomy) is an observational, prospective, multicenter study focused on LP conducted in Spanish Hepato-Pancreato-Biliary (HPB) Surgery Units from 1 February 2022 to 31 January 2023. HPB units were defined as high volume if they performed more than 10 LPs annually. Results: This study included 313 patients who underwent LP at 42 centers across Spain over the course of a year. A total of 40.3% of the procedures were performed in high-volume centers. Significant differences in preoperative variables were only observed in ASA scores, which were higher in the high-volume group. Intraoperatively, minimally invasive surgical techniques were performed more frequently in high-volume centers. Postoperatively, the administration of somatostatin, major complications, and B and C postoperative pancreatic fistula (POPF) were more frequent in low-volume hospitals. Conclusions: The findings revealed that high-volume centers had a higher rate of minimally invasive surgery, lower intraoperative bleeding, fewer complications, and reduced POPFs compared to low-volume centers. However, it is important to note that low-volume centers still demonstrated acceptable outcomes. Thus, the selective referral of more complex laparoscopic procedures could initiate a gradual centralization of surgical practices. Full article

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

13 pages, 694 KB

Open AccessArticle

Ischaemic Stroke in Patients with Known Atrial Fibrillation: A Snapshot from a Large University Hospital Experience

by Giulia Domna Scrima, Cristina Sarti, Giovanni Pracucci, Rita Nistri, Costanza Maria Rapillo, Benedetta Piccardi, Miroslava Stolcova, Francesca Ristalli, Alessio Mattesini, Carlo Nozzoli, Alessandro Morettini, Alberto Moggi Pignone, Patrizia Nencini, Carlo Di Mario, Rossella Marcucci and Francesco Meucci

J. Clin. Med. 2025, 14(17), 6012; https://doi.org/10.3390/jcm14176012 (registering DOI) - 25 Aug 2025

Objectives: Atrial fibrillation (AF) is associated with high risk of ischaemic stroke (IS). Oral anticoagulant therapy (OAT) is the standard of care for stroke prevention, even though its management remains challenging in clinical practice. An emerging problem is embolic events occurring on [...] Read more.

Objectives: Atrial fibrillation (AF) is associated with high risk of ischaemic stroke (IS). Oral anticoagulant therapy (OAT) is the standard of care for stroke prevention, even though its management remains challenging in clinical practice. An emerging problem is embolic events occurring on adequately conducted OAT, the so-called resistant stroke (RS). We aimed to describe pre-stroke prevention therapy, management on hospital discharge, and therapy at follow-up in all patients with AF hospitalized for IS and in the RS subgroup. Methods: We conducted a retrospective monocentric study of patients with known AF hospitalized for an IS. A subgroup with RS was identified. We recorded information on prevention therapy at home, recommended therapy at discharge, and data on outcome and prevention therapy at follow-up. Results: We identified 226 patients, 61% females, median age 84.04 years. Preventive therapy at home was performed in 121 (53.5%) (119 OAT and 2 Left Atrial Appendage Occlusion). At hospital discharge OAT was prescribed to 78.2% of patients. RS was diagnosed in 33 patients whose management at discharge was: same OAT in 12, shift to another Direct Oral Anticoauglant (DOAC) in 5, from DOAC to Vitamin K Antagonist (VKA) and vice versa in 11, non-specified OAT in 4. At final, follow-up of 208 days (range 85–443) 23.3% (34/146) did not assume OAT. OAT was significantly associated with survival probability (p < 0.001). Conclusions: Our findings confirm a scarce adoption of guidelines for AF-related embolic events, even in the absence of absolute contraindication to OAT. RS remains an underexplored clinical entity with empirical management, highlighting the need for targeted research and tailored therapeutic strategies. Full article

(This article belongs to the Special Issue Application of Anticoagulation and Antiplatelet Therapy)

20 pages, 809 KB

Open AccessReview

Pulmonary and Immune Dysfunction in Pediatric Long COVID: A Case Study Evaluating the Utility of ChatGPT-4 for Analyzing Scientific Articles

by Susanna R. Var, Nicole Maeser, Jeffrey Blake, Elise Zahs, Nathan Deep, Zoey Vasilakos, Jennifer McKay, Sether Johnson, Phoebe Strell, Allison Chang, Holly Korthas, Venkatramana Krishna, Manojkumar Narayanan, Tuhinur Arju, Dilmareth E. Natera-Rodriguez, Alex Roman, Sam J. Schulz, Anala Shetty, Mayuresh Vernekar, Madison A. Waldron, Kennedy Person, Maxim Cheeran, Ling Li and Walter C. Low Show full author list Hide full author list

J. Clin. Med. 2025, 14(17), 6011; https://doi.org/10.3390/jcm14176011 (registering DOI) - 25 Aug 2025

Coronavirus disease 2019 (COVID-19) in adults is well characterized and associated with multisystem dysfunction. A subset of patients develop post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID), marked by persistent and fluctuating organ system abnormalities. In children, distinct clinical and pathophysiological features [...] Read more.

Coronavirus disease 2019 (COVID-19) in adults is well characterized and associated with multisystem dysfunction. A subset of patients develop post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID), marked by persistent and fluctuating organ system abnormalities. In children, distinct clinical and pathophysiological features of COVID-19 and long COVID are increasingly recognized, though knowledge remains limited relative to adults. The exponential expansion of the COVID-19 literature has made comprehensive appraisal by individual researchers increasingly unfeasible, highlighting the need for new approaches to evidence synthesis. Large language models (LLMs) such as the Generative Pre-trained Transformer (GPT) can process vast amounts of text, offering potential utility in this domain. Earlier versions of GPT, however, have been prone to generating fabricated references or misrepresentations of primary data. To evaluate the potential of more advanced models, we systematically applied GPT-4 to summarize studies on pediatric long COVID published between January 2022 and January 2025. Articles were identified in PubMed, and full-text PDFs were retrieved from publishers. GPT-4-generated summaries were cross-checked against the results sections of the original reports to ensure accuracy before incorporation into a structured review framework. This methodology demonstrates how LLMs may augment traditional literature review by improving efficiency and coverage in rapidly evolving fields, provided that outputs are subjected to rigorous human verification. Full article

(This article belongs to the Section Epidemiology & Public Health)

16 pages, 1656 KB

Open AccessArticle

Propensity Score-Matched Comparison of Six-Strand All-Inside and Conventional Four-Strand Hamstring Autografts for ACL Reconstruction

by Young Jin Seo, Si Young Song and Dongju Kim

J. Clin. Med. 2025, 14(17), 6010; https://doi.org/10.3390/jcm14176010 (registering DOI) - 25 Aug 2025

Background/Objectives: All-inside ACL reconstruction has emerged as a minimally invasive alternative to conventional techniques, with potential advantages in graft configuration and reduced surgical trauma. This study aimed to compare the clinical outcomes of all-inside and full tibial tunnel ACL reconstruction, focusing on graft [...] Read more.

Background/Objectives: All-inside ACL reconstruction has emerged as a minimally invasive alternative to conventional techniques, with potential advantages in graft configuration and reduced surgical trauma. This study aimed to compare the clinical outcomes of all-inside and full tibial tunnel ACL reconstruction, focusing on graft diameter, postoperative stability, and functional recovery. We hypothesized that the all-inside technique would allow for thicker grafts and yield superior postoperative knee stability and functional outcomes, with postoperative anterior laxity as a major outcome of interest. Methods: This retrospective comparative study reviewed patients who underwent ACL reconstruction between January 2020 and February 2024. From January 2020 to September 2022, a four-strand hamstring autograft with full tibial tunnel technique (FT-4) was used, while from September 2022, a six-strand hamstring autograft with the all-inside technique (AI-6) was adopted to enable thicker grafts and optimize fixation. Among a total of 103 patients, 1:1 propensity score matching (PSM) was performed based on age, sex, BMI, laterality, ALL reconstruction, meniscal lesion, and preoperative anterior laxity (SSD). Graft diameter and clinical outcomes, including knee stability and functional scores, were compared between the matched groups. Results: After PSM, two comparable groups of 29 patients each were established. Graft diameter was significantly larger in the AI-6 group (9.5 ± 0.7 mm) compared to the FT-4 group (7.8 ± 0.8 mm, p < 0.001), while other baseline characteristics remained well balanced between the groups. At the final follow-up, both groups exhibited significant improvements in anterior laxity, functional scores, and pivot shift grades (all p < 0.001). The AI-6 group demonstrated superior outcomes with a significantly higher Lysholm score (82.2 ± 6.7 vs. 75.6 ± 8.9, p = 0.002), lower WOMAC score (8.0 ± 4.3 vs. 12.9 ± 10.5, p = 0.023), and reduced anterior laxity (1.6 ± 1.1 mm vs. 2.5 ± 1.4 mm, p = 0.005) compared to the FT-4 group, whereas no significant differences were observed in the IKDC, Tegner, Korean knee score, or pivot shift test results. A simple linear regression revealed a significant negative correlation between graft diameter and postoperative anterior laxity (B = −0.398, p = 0.048). Conclusions: The present study demonstrated that the use of a six-strand hamstring graft configuration in the AI-6 technique resulted in significantly thicker grafts and was associated with reduced postoperative anterior knee laxity compared to the FT-4 technique. While interpretation of these findings requires caution in light of MCID thresholds, the AI-6 group showed favorable outcomes in anterior laxity and selected functional scores, such as the Lysholm and WOMAC. This technique may offer practical clinical value, particularly in populations prone to smaller graft diameters, as it facilitates adequate graft thickness through multifold preparation, with the all-inside approach accommodating the inherent graft shortening. Full article

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

13 pages, 1031 KB

Open AccessArticle

The Application of a Flowable Composite as a Method for Donor Site Protection After Free Gingival Graft: A Comparative Analysis of Four Techniques

by Tomasz Jankowski, Agnieszka Jankowska, Wojciech Kazimierczak and Joanna Janiszewska-Olszowska

J. Clin. Med. 2025, 14(17), 6009; https://doi.org/10.3390/jcm14176009 (registering DOI) - 25 Aug 2025

Background/Objectives: Soft tissues are essential for maintaining the function and long-term success of dental implants. In many cases, implant placement necessitates soft tissue augmentation procedures such as free gingival grafts (FGGs) or connective tissue grafts (CTGs) to restore lost gingival architecture. Nevertheless, a [...] Read more.

Background/Objectives: Soft tissues are essential for maintaining the function and long-term success of dental implants. In many cases, implant placement necessitates soft tissue augmentation procedures such as free gingival grafts (FGGs) or connective tissue grafts (CTGs) to restore lost gingival architecture. Nevertheless, a significant challenge associated with FGG and CTG is postoperative pain, largely due to morbidity at the palatal donor site. To address this issue, various approaches have been proposed to reduce patient discomfort and promote improved wound healing at the donor site. This study aimed to compare the effectiveness of four different methods for protecting the palatal donor site following free gingival graft harvesting. Methods: A total of 76 patients undergoing implant therapy with an indication for free gingival grafting were selected and divided into four groups based on the method used to protect the palatal donor site: an absorbable gelatin sponge secured with sutures (GS); an absorbable gelatin sponge with sutures and cyanoacrylate tissue adhesive (GS+CTA); oxidized regenerated cellulose combined with cyanoacrylate tissue adhesive (ORC+CTA); and an absorbable gelatin sponge covered with a flowable resin composite and stabilized with sutures (GS+FRC). The effectiveness of each method was evaluated in terms of postoperative pain, bleeding, and wound healing. Results: Although the differences in pain intensity among the groups were not statistically significant throughout the observation period (p > 0.05), the GS+FRC group consistently exhibited the lowest mean pain scores. No statistically significant differences were observed between the groups regarding the incidence of secondary bleeding. The highest mean wound healing rate was recorded in the GS+FRC group (75.95 ± 18.75%), whereas the ORC+CTA group demonstrated the lowest rate (43.66 ± 25.74%). Conclusions: The use of an absorbable gelatin sponge covered with a flowable resin composite and secured with sutures, despite the presented limitations, appears to be a promising approach for palatal wound protection. While this group consistently demonstrated the lowest mean pain scores, differences in pain intensity among the groups were not statistically significant. Nonetheless, it achieved the most favorable outcomes in terms of wound epithelialization. Full article

(This article belongs to the Special Issue Dental Implantology: Clinical Updates and Perspectives)

► Show Figures

Figure 1

13 pages, 826 KB

Open AccessArticle

Association of Frailty Status with Staging and Mortality Risk of Cardiovascular-Kidney-Metabolic Syndrome in Middle-Aged and Older Populations: Insights from the 1999–2018 National Health and Nutrition Examination Survey

by Zhenkun Yang, Shuang Wu, Yuanjie Li, Hongyu Liu, Manlin Zhao, Yang Xu, Yunyu Chen, Yang Chen and Gregory Y. H. Lip

J. Clin. Med. 2025, 14(17), 6008; https://doi.org/10.3390/jcm14176008 (registering DOI) - 25 Aug 2025

Background: Cardiovascular-kidney-metabolic syndrome (CKM) represents a multisystem condition involving obesity, diabetes, chronic kidney disease, and cardiovascular diseases. Frailty, as measured by the Frailty Index (FI), is linked to adverse outcomes, but its association with CKM severity and mortality remains unclear. This study aimed [...] Read more.

Background: Cardiovascular-kidney-metabolic syndrome (CKM) represents a multisystem condition involving obesity, diabetes, chronic kidney disease, and cardiovascular diseases. Frailty, as measured by the Frailty Index (FI), is linked to adverse outcomes, but its association with CKM severity and mortality remains unclear. This study aimed to evaluate the relationship between frailty status, CKM staging, and mortality risk. Methods: We analysed data from 19,407 adults aged ≥ 45 years from NHANES 1999–2018. Frailty status was assessed using a 49-item Frailty Index (FI) and categorised as robust (FI ≤ 0.08), pre-frail (0.08 < FI < 0.25), or frail (FI ≥ 0.25). CKM was staged from 1 to 4 based on established clinical criteria. Multinomial logistic regression assessed the association between frailty status and CKM staging. Cox proportional hazards models evaluated the associations between frailty status and all-cause, cardiovascular, and non-cardiovascular mortality among CKM patients. Results: A total of 19,407 participants (median [IQR] age: 63.00 [54.00–72.00] years, 50.77% male), with 19,089 CKM patients. Frail individuals exhibited significantly higher odds of being assigned to advanced CKM stages. Over a median follow-up of 8.4 years, 4794 participants died. Kaplan–Meier curves and restricted cubic spline analyses demonstrated a clear gradient in mortality risk across frailty categories. Compared with the robust group, pre-frail and frail individuals had significantly higher risks of all-cause (HR = 1.47 and 2.83, respectively), cardiovascular (HR = 1.71 and 3.78), and non-cardiovascular mortality (HR = 1.40 and 2.57). Conclusions: Frailty status demonstrated a significant association with CKM staging and mortality outcomes. Early identification of frailty may help guide risk stratification and inform tailored interventions for individuals with CKM. Full article

(This article belongs to the Section Cardiovascular Medicine)

► Show Figures

Figure 1

19 pages, 1017 KB

Open AccessArticle

One Year After Mild COVID-19: Emotional Distress but Preserved Cognition in Healthcare Workers

by Irene Peláez, David Martínez-Íñigo, Roberto Fernandes-Magalhaes, María E. De Lahoz, Ana Belén del Pino, Sonia Pérez-Aranda, Alejandro García-Romero, Dino Soldic and Francisco Mercado

J. Clin. Med. 2025, 14(17), 6007; https://doi.org/10.3390/jcm14176007 (registering DOI) - 25 Aug 2025

Background/Objectives: Although COVID-19 may cause cognitive impairments for up to six months, the long-term effects of mild cases remain unclear. Given their high exposure and critical role in public health, assessing this impact on healthcare workers is essential. Aim: The present study aimed [...] Read more.

Background/Objectives: Although COVID-19 may cause cognitive impairments for up to six months, the long-term effects of mild cases remain unclear. Given their high exposure and critical role in public health, assessing this impact on healthcare workers is essential. Aim: The present study aimed to examine the cognitive and emotional effects of mild COVID-19 in 92 healthcare workers one year after infection. Methods: In total, 50 had experienced mild COVID-19, while 42 had not been infected. Participants completed a neuropsychological assessment evaluating attention, memory, and executive functions, along with self-reported measures of anxiety, depression, post-traumatic stress, occupational stress, and burnout. Results: No significant cognitive differences were observed between the groups. However, both exhibited moderate-to-severe psychological distress, with the COVID-19 group showing higher trait anxiety (p = 0.032). Emotional symptoms were significantly associated with neuropsychological performance—higher burnout (ρ from −0.20 to −0.28, p < 0.05) and stress (ρ from −0.25 to −0.33, p < 0.01) correlated with slower responses and more errors in tasks such as the D2 variation index, TESEN execution speed, Rey–Osterrieth Figure recall, and Digit Span forward span. Conclusions: These findings suggest no long-term cognitive impairment after mild COVID-19 but highlight the substantial emotional toll of the pandemic on healthcare workers. Future research should explore cognitive reserve as a protective factor. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

15 pages, 2877 KB

Open AccessFeature PaperArticle

Revealing New Trends in the Global Burden of Hepatocellular Cancer Related to Hepatitis C Virus by Region, Sociodemographic Index, and Sex

by Lynette Sequeira, Xiaohan Ying, Nazli Begum Ozturk, Deirdre Reidy, Arun B. Jesudian and Ahmet Gurakar

J. Clin. Med. 2025, 14(17), 6006; https://doi.org/10.3390/jcm14176006 (registering DOI) - 25 Aug 2025

Background/Objectives: Hepatocellular carcinoma (HCC) remains a leading cause of global cancer mortality, with increasing incidence and persistently poor survival. Hepatitis C virus (HCV) is a major risk factor for HCC, and while the advent of direct-acting antivirals (DAAs) has significantly altered HCV-related [...] Read more.

Background/Objectives: Hepatocellular carcinoma (HCC) remains a leading cause of global cancer mortality, with increasing incidence and persistently poor survival. Hepatitis C virus (HCV) is a major risk factor for HCC, and while the advent of direct-acting antivirals (DAAs) has significantly altered HCV-related hepatocellular cancer (HCC-HCV) risk, the global burden remains substantial. With the World Health Organization (WHO) aiming to reduce hepatitis-related deaths by 2030, we set out to evaluate global HCC-HCV trends from 1990 to 2021, stratified by sex, WHO region, and sociodemographic index (SDI), using data from the Global Burden of Disease (GBD) 2021 study. Methods: We analyzed age-standardized incidence (ASI), deaths, and disability-adjusted life years (DALYs) due to HCV-HCC from 1990 to 2021 using GBD 2021 data. Trends were stratified by WHO region, sociodemographic index (SDI), and sex. Joinpoint regression modeling was used to identify statistically significant temporal inflection points and calculate the annual percent change (APC) in unique time segments and average annual percent change (AAPC) over the entire study period (1990 to 2021). Results: Globally, deaths and DALYs attributable to HCV-HCC increased over the study period while ASI declined modestly. The region of the Americas exhibited the highest AAPC in all three metrics, potentially driven by an aging HCV-infected population, rising comorbidities (e.g., obesity, diabetes), and improved case detection. Nevertheless, on a global level, high-SDI regions showed the most favorable trends, particularly after 2016, likely reflecting the earlier adoption of DAAs and a differential success of WHO goals. Lower-SDI regions continued to exhibit increasing burden. Notably, ASI began to rise again between 2019 and 2021, suggesting an ongoing need to critically evaluate and restructure our approach to reducing HCV and HCV-HCC. Conclusions: Our findings underscore the urgent need for equity-driven, region-specific strategies to achieve better control of this highly morbid disease. Full article

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

► Show Figures

Figure 1

22 pages, 918 KB

Open AccessSystematic Review

Behavioural Interventions to Treat Oropharyngeal Dysphagia in Children with Cerebral Palsy: A Systematic Review of Randomised Controlled Trials

by Michelle McInerney, Sarah Moran, Sophie Molloy, Carol-Anne Murphy and Bríd McAndrew

J. Clin. Med. 2025, 14(17), 6005; https://doi.org/10.3390/jcm14176005 (registering DOI) - 25 Aug 2025

Background/Objectives: Swallowing disorder(s), or oropharyngeal dysphagia (OPD), are very common in children with cerebral palsy (CP) and pose a significant risk to their health. Behavioural interventions are frequently recommended when targeting OPD in children with CP; however, their efficacy has yet to [...] Read more.

Background/Objectives: Swallowing disorder(s), or oropharyngeal dysphagia (OPD), are very common in children with cerebral palsy (CP) and pose a significant risk to their health. Behavioural interventions are frequently recommended when targeting OPD in children with CP; however, their efficacy has yet to be determined. This systematic review aimed to synthesise the current evidence for behavioural interventions in the treatment of OPD in children with CP. Methods: A comprehensive search in six databases in October 2024 sought studies that (1) included participants aged 0–18 years with a diagnosis of CP and OPD; (2) utilised and described a behavioural intervention for OPD; and (3) used a randomised controlled trial (RCT) experimental design. Three reviewers independently extracted the data, and results were tabulated. The Revised Cochrane Risk of Bias (ROB-2) tool was used to determine the methodological quality of eligible articles. Results: From an initial yield of 2083 papers, 99 full-text studies were screened for eligibility. Seven RCTs involving 329 participants aged 9.5 months (SD = 2.03) to 10.6 yrs were included. CP description varied. Most studies used a combination of behavioural interventions to treat OPD (n = 6), and oral sensorimotor treatment was the most frequently utilised treatment (n = 4). Positive outcomes were reported in all (n = 7); however, there was high risk of bias in five studies. Conclusions: The use of behavioural interventions to treat OPD in children with CP continues to be supported by low-level evidence. Rigorously designed RCTs with larger samples of children with CP and OPD are needed to evaluate the true effects of behavioural interventions across the developmental phase of childhood. Importantly, consistency in describing and reporting baseline analysis of swallowing and OPD; together with treatment-component data, is a priority in future research. Full article

(This article belongs to the Section Clinical Rehabilitation)

► Show Figures

Figure 1

13 pages, 1061 KB

Open AccessArticle

Factors Involved in the Progression of Preclinical Atherosclerosis in People with Type 1 Diabetes

by Clara Viñals, Ignacio Conget, Montse Granados, Clara Solà, Denisse Ayala, Alex Mesa, Tonet Serés-Noriega, Mònica Domenech, Verónica Perea, Jesús Blanco, Irene Vinagre, Marga Giménez and Antonio J. Amor

J. Clin. Med. 2025, 14(17), 6004; https://doi.org/10.3390/jcm14176004 (registering DOI) - 25 Aug 2025

Background/objectives: Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. Methods: We conducted a prospective study [...] Read more.

Background/objectives: Individuals with type 1 diabetes (T1DM) face an elevated risk of cardiovascular disease (CVD), yet the factors driving atherosclerosis remain unclear. This study aimed to assess factors associated with preclinical atherosclerosis development or progression in T1DM. Methods: We conducted a prospective study in T1DM individuals without established CVD, aged ≥40 years, with diabetic kidney disease and/or ≥10 years of T1DM plus another cardiovascular risk factor (CVRF). Baseline evaluation followed a standardized CV risk assessment protocol, including carotid ultrasound and cardiovascular risk estimation using the Steno Type 1 Risk Engine (ST1RE). Ultrasound was repeated after 3–5 years; progression was defined as an increase in plaque number. CVRF control was considered optimal when LDL-cholesterol was within target based on atherosclerotic burden, blood pressure <130/80 mmHg, HbA1c <7%, and non-smoking status. Logistic regression models identified predictors of progression. Results: We included 151 participants (55.6% women; mean age 49.8 ± 8.9 years; T1DM duration 27.3 ± 9.1 years); 42.4% had plaques at baseline. Over a follow-up of 5.22 ± 1.29 years, despite improved CVRF control (p < 0.05), 40.4% experienced progression. Older age (OR 1.38 [1.1–1.8]) and active smoking (OR 3.29 [1.4–7.5]) were significant predictors of progression. Baseline cardiovascular risk measured by the ST1RE independently predicted progression (OR 1.09 [1.03–1.15]) after adjusting for other CVRFs. Persistent smoking (OR 2.52 [1.06–5.99]) and baseline ST1RE (OR 1.06 [1.02–1.11]) remained significant after accounting for baseline and follow-up CVRFs. Conclusions: Despite improved CVRF control, atherosclerosis progression is common in T1D. ST1RE may help identify individuals at highest risk for targeted preventive strategies. Full article

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

16 pages, 533 KB

Open AccessPerspective

The Future of Oncology in Psychiatric Medications

by Napoleon Waszkiewicz

J. Clin. Med. 2025, 14(17), 6003; https://doi.org/10.3390/jcm14176003 (registering DOI) - 25 Aug 2025

Recent years have provided numerous reports on the mechanisms of action of psychiatric medications (antidepressants, antipsychotics, mood stabilizers, and antidementia drugs) that directly inhibit the growth of cancer cells, as well as on their indirect effects on the psyche and immune system, and [...] Read more.

Recent years have provided numerous reports on the mechanisms of action of psychiatric medications (antidepressants, antipsychotics, mood stabilizers, and antidementia drugs) that directly inhibit the growth of cancer cells, as well as on their indirect effects on the psyche and immune system, and their supportive effects on chemotherapeutic agents. The mechanisms of the anticancer activity of psychiatric drugs include inhibition of dopamine and N-methyl-D-aspartate receptors that work via signaling pathways (PI3K/AKT/mTOR/NF-κB, ERK, Wnt/ß-catenin, and bcl2), metabolic pathways (ornithine decarboxylase, intracellular cholesterol transport, lysosomal enzymes, and glycolysis), autophagy, Ca²⁺-dependent signaling cascades, and various other proteins (actin-related protein complex, sirtuin 1, p21, p53, etc.). The anticancer potential of psychiatric drugs seems to be extremely broad, and the most extensive anticancer literature has been reported on antidepressants (fluoxetine, amitriptyline, imipramine, mirtazapine, and St John’s Wort) and antipsychotics (chlorpromazine, pimozide, thioridazine, and trifluoperazine). Among mood stabilizers, lithium and valproates have the largest body of literature. Among antidementia drugs, memantine has documented anticancer effects, while there is limited evidence for galantamine. Of the new psychiatric substances, the antipsychotic drug brexpiprazole and the antidepressant vortioxetine have a very interesting body of literature regarding glioblastoma, based on in vitro and in vivo animal survival studies. Their use in brain tumors and metastases is particularly compelling, as these substances readily cross the blood–brain barrier (BBB). Moreover, the synergistic effect of psychiatric drugs with traditional cancer treatment seems to be extremely important in the fight against chemo- and radio-resistance of tumors. Although there are some studies describing the possible carcinogenic effects of psychiatric drugs in animals, the anticancer effect seems to be extremely significant, especially in combination treatment with radio/chemotherapy. The emerging evidence supporting the anticancer properties of psychiatric drugs presents an exciting frontier in oncology. The anticancer properties of psychiatric drugs may prove particularly useful in the period between chemotherapy and radiotherapy sessions to maintain the tumor-inhibitory effect. While further research is necessary to elucidate the mechanisms, clinical implications, dose-dependence of the effect, and clear guidelines for the use of psychiatric medications in cancer therapy, the potential for these commonly prescribed medications to contribute to cancer treatment enhances their value in the management of patients facing the dual challenges of mental health and cancer. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

19 pages, 730 KB

Open AccessArticle

The Mediating Role of Social Support Between Pregnancy Anxiety and Emotional Suppression in Women with Threatened Preterm Labor

by Joanna Grzesik-Gąsior, Katarzyna Zalewska, Agnieszka Pieczykolan, Sebastian Kowalski, Karolina Żak-Kowalska, Iwona Niewiadomska and Agnieszka Bień

J. Clin. Med. 2025, 14(17), 6002; https://doi.org/10.3390/jcm14176002 (registering DOI) - 25 Aug 2025

Background: Threatened preterm labor is associated with heightened emotional distress in pregnant women, including anxiety, guilt, and depressive symptoms. Effective coping relies on psychosocial resilience, particularly emotional suppression and perceived social support. This study examined the mediating role of social support in [...] Read more.

Background: Threatened preterm labor is associated with heightened emotional distress in pregnant women, including anxiety, guilt, and depressive symptoms. Effective coping relies on psychosocial resilience, particularly emotional suppression and perceived social support. This study examined the mediating role of social support in the relationship between anxiety and emotional suppression. Methods: The study was conducted in Poland between December 2024 and June 2025 among 213 women hospitalized due to threatened preterm labor. Participants completed the Berlin Social Support Scales, the State–Trait Anxiety Inventory, the Courtauld Emotional Control Scale, and a structured interview. Results: Women hospitalized for threatened preterm labor have moderate levels of anxiety as a state (M = 44.08 ± 10.59) and trait (M = 39.75 ± 9.99). Mediation analyses revealed that two dimensions of social support—perceived available support and Buffering–Protective support—significantly influenced the relationship between anxiety and emotional suppression (anger, depression and anxiety). In contrast, need for support, support seeking, and Currently Received Support were not significant mediators. Conclusions: The results indicate a complex interplay between anxiety, perceived support, and emotional suppression. The hypothesized simple buffering model was not confirmed. However, perceived available support was associated with reduced emotional suppression, suggesting a protective role. Buffering–Protective Support showed an activating effect, possibly encouraging emotional inhibition in stressful situations. These results underscore the importance of assessing perceived social support in clinical settings and tailoring psychological interventions for pregnant women at risk of preterm labor. Full article

(This article belongs to the Section Mental Health)

13 pages, 667 KB

Open AccessArticle

Evaluation of the Diagnostic Accuracy of Serum Albumin and Globulin in Pyogenic Spondylitis

by Hideo Mitsui, Hyonmin Choe, Masashi Shimoda, Hironori Yamane, Yuta Hieda, Koki Abe, Yohei Ito, Hiroyuki Ike, Ken Kumagai, Naomi Kobayashi and Yutaka Inaba

J. Clin. Med. 2025, 14(17), 6001; https://doi.org/10.3390/jcm14176001 (registering DOI) - 25 Aug 2025

Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most [...] Read more.

Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most effective combinations. Methods: The retrospective cohort study analyzed 656 patients who visited the hospital for spinal diseases between 1 January 2004 and 31 March 2021; a total of 76 were diagnosed with pyogenic spondylitis. Blood samples were analyzed for serum albumin (Alb), total protein (TP), globulin (Glb), C-reactive protein (CRP), platelet count, white blood cell count, neutrophil count, lymphocyte count, and monocyte count. Combination markers, including albumin–globulin ratio (AGR), CRP–albumin ratio (CAR), CRP–AGR (CAGR), neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR), were also evaluated. Receiver operating characteristic curves were used to determine each marker’s diagnostic performance. Furthermore, multivariate analysis was performed to examine the odds ratios. Results: Patients with pyogenic spondylitis showed significantly different levels in Alb (p < 0.0001), Glb (p < 0.0001), CRP (p < 0.0001), platelet count (p < 0.0001), WBC count (p < 0.0006), neutrophil count (p = 0.0019), lymphocyte count (p = 0.0085), AGR (p < 0.0001), CAR (p < 0.0001), CAGR (p < 0.0001), NLR (p < 0.0001), and PLR (p < 0.0001). CRP (AUC = 0.80) showed good diagnostic accuracy, while combination markers CAR (AUC = 0.82) and CAGR (AUC = 0.83) had the highest areas under the curve (AUC). Multivariate analysis indicated that decreased age and the presence of comorbidities (including chronic kidney disease, chronic liver disease, malignancy, or diabetes), were independent predictors of early pyogenic spondylitis (OR_age = 0.93, OR_comorbidities = 16.98, p_age = 0.0005, and p_comorbidities = 0.0001). In patients with low-inflammatory pyogenic spondylitis, significant differences were observed in TP (p = 0.0293), Glb (p = 0.0012), CRP (p = 0.0023), platelet count (p = 0.0108), AGR (p = 0.0044), CAR (p = 0.0006), CAGR (p = 0.0004), PLR (p = 0.0192), and NLR (p = 0.0027), with CAGR showing the highest AUC (AUC = 0.70) among them. Conclusions: Serum combination markers (AGR, CAGR, CAR, PLR, and NLR) showed diagnostic value for pyogenic spondylitis, with CAGR achieving the highest accuracy. In low-inflammatory pyogenic spondylitis patients (CRP ≤ 1.0 mg/dL), these markers may aid diagnosis. Full article

(This article belongs to the Special Issue Clinical Advances in Orthopedic Infections)

► Show Figures

Figure 1

10 pages, 649 KB

Open AccessArticle

Effect of Subconjunctival Healaflow in Filtrating Surgery with Preserflo MicroShunt in Primary Open Angle Glaucoma

by Leonie F. Keidel, Miranda Gehrke, Stefan Kassumeh, Lara Buhl, Siegfried G. Priglinger and Marc J. Mackert

J. Clin. Med. 2025, 14(17), 6000; https://doi.org/10.3390/jcm14176000 (registering DOI) - 25 Aug 2025

Background/Objectives: This work aims to clarify whether the subtenon use of the sodium hyaluronate product Healaflow in filtrating surgery with PreserFlo MicroShunt positively influences the early postoperative course in terms of control of intraocular pressure, hypotony, and needling rate. Methods: A [...] Read more.

Background/Objectives: This work aims to clarify whether the subtenon use of the sodium hyaluronate product Healaflow in filtrating surgery with PreserFlo MicroShunt positively influences the early postoperative course in terms of control of intraocular pressure, hypotony, and needling rate. Methods: A retrospective, randomized controlled, interventional, single-center trial was performed at the Ludwig Maximilians-University Munich from January 2024 to July 2024. Only patients with primary open angle glaucoma (POAG) were included. In all patients, a complete ophthalmological examination including best corrected visual acuity (BCVA), automated refraction, and Goldman tonometry was performed at 2 days, 1–4 and 5–8 weeks, and 3–4 and 5–6 months after surgery. Healaflow was injected underneath the tenon during filtrating surgery with PreserFlo MicroShunt in addition to mitomycin C (MMC). The Healaflow group was compared to a control group with POAG patients in which Healaflow was not used during surgery with PreserFlo MicroShunt and MMC. Results: A total of 45 eyes of 45 patients were included, with 20 eyes in the Healaflow group and 25 eyes in the control group. In both groups, a significant reduction in IOP and medication could be observed: complete surgical success (IOP ≥ 6 mm Hg and ≤17 mm Hg, without surgical complications or complete loss of vision) was reached in 88% of patients in the Healaflow group at the last follow-up. In 95% of patients in the control group, complete success could be observed. The success rates did not significantly differ between the two groups (p = 0.568). Hypotony rates were 35% in the Healaflow and 12% in the control group after two days (p = 0.083); the rates equalized after 1–4 weeks (p = 1). Needling rates were comparable between both groups (25% versus 20%, p = 0.731). Conclusions: PreserFlo MicroShunt implantation with MMC was equally effective in terms of reduction in IOP and medication in both scenarios with additional or without the use of Healaflow. Postoperative hypotony and needling rates did not significantly differ between the two groups. The additional effects of Healaflow on anti-scarring and maintaining space are likely too minimal to cause significant differences in IOP or medication when already treated with MMC. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

7 pages, 1888 KB

Open AccessCase Report

Rare and Aggressive Disease: Urinary Bladder Leiomyosarcoma

by Zilvinas Venclovas, Kotryna Simkunaite, Vaidas Pijadin, Stasys Auskalnis, Mindaugas Jievaltas, Tomas Navickis and Daimantas Milonas

J. Clin. Med. 2025, 14(17), 5999; https://doi.org/10.3390/jcm14175999 (registering DOI) - 25 Aug 2025

Background: Bladder leiomyosarcoma is an extremely rare non-urothelial malignancy, accounting for less than 0.1% of all bladder tumors. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and the absence of standardized treatment protocols. Case presentation: We report [...] Read more.

Background: Bladder leiomyosarcoma is an extremely rare non-urothelial malignancy, accounting for less than 0.1% of all bladder tumors. It presents significant diagnostic and therapeutic challenges due to its aggressive nature and the absence of standardized treatment protocols. Case presentation: We report the case of a 61-year-old woman who presented with hematuria, dysuria, and suprapubic pain. Imaging revealed a large, locally invasive bladder mass, and histopathological examination following transurethral resection confirmed leiomyosarcoma. The patient underwent radical cystectomy with resection of adjacent bowel segments and urinary diversion. Histology showed a high-grade leiomyosarcoma (pT3N0) with extensive necrosis and a high mitotic index. Two months postoperatively, peritoneal dissemination was detected. Systemic chemotherapy with dacarbazine and doxorubicin initially led to the regression of metastases, but disease progression occurred within months, including lung, liver, and bone metastases. Palliative radiotherapy and second-line chemotherapy were initiated. As of now, 16 months have elapsed since surgery. Conclusions: This case underscores the aggressive clinical course of bladder leiomyosarcoma despite multimodal therapy and the urgent need for individualized management strategies. Given its rarity, this case contributes to the limited literature and highlights the importance of vigilant follow-ups and further studies to establish evidence-based treatment protocols. Full article

(This article belongs to the Special Issue Genitourinary Cancers: Clinical Advances and Practice Updates)

► Show Figures

Figure 1

15 pages, 2813 KB

Open AccessArticle

Thermal Imaging as a New Perspective in the Study of Physiological Changes in Pregnant Women—A Preliminary Study

by Karolina Rykała, Agnieszka Szurko, Daria Wziątek-Kuczmik, Agnieszka Kiełboń, Manuel Sillero-Quintana, Armand Cholewka and Teresa Kasprzyk-Kucewicz

J. Clin. Med. 2025, 14(17), 5998; https://doi.org/10.3390/jcm14175998 (registering DOI) - 25 Aug 2025

Background/Objectives: This study aimed to examine the dynamic thermal variations that occur in the posterior body regions of pregnant women by employing thermal imaging techniques. Methods: The study involved the participation of 34 women in various stages of pregnancy. The skin [...] Read more.

Background/Objectives: This study aimed to examine the dynamic thermal variations that occur in the posterior body regions of pregnant women by employing thermal imaging techniques. Methods: The study involved the participation of 34 women in various stages of pregnancy. The skin temperature (Tsk) distribution in specific body areas, including the spinal region and lower limbs, was analyzed under standard conditions. Results: The most considerable increase in body temperature (Tsk) recorded in female volunteers was achieved during the second trimester of pregnancy in physiologically stressed areas, such as the upper back (0.4 °C), lower back (0.77 °C), thighs (0.94 °C) and calves (0.32 °C). Contrastingly, a decrease in Tsk of noteworthy magnitude was observed in all body regions during the third trimester, with an average decrease of 1.7 °C. The lower back’s most substantial decrease was observed (1.95 °C). Furthermore, a disparity was observed in the Tsk distribution of the calves, with the highest ∆T_mean value recorded at approximately 0.5 °C, and the thighs exhibiting a ∆T_mean value of 0.25 °C. Conclusions: Preliminary studies have demonstrated the potential of thermal imaging as a reliable and safe method to support prenatal diagnosis. Its application can facilitate the early detection of health complications, including inflammatory states or posture and circulatory system disorders, thereby enhancing the standard of prenatal care. Full article

(This article belongs to the Section Obstetrics & Gynecology)

► Show Figures

Figure 1

10 pages, 2582 KB

Open AccessArticle

Non HIV-Associated Buffalo Hump as a Clinical Marker of Metabolic Disease

by Nae-Ho Lee, Beom Jin Lim, Jin Yong Shin, Yoon Kyu Chung and Si-Gyun Roh

J. Clin. Med. 2025, 14(17), 5997; https://doi.org/10.3390/jcm14175997 (registering DOI) - 25 Aug 2025

Background/Objectives: Cervicodorsal lipodystrophy, commonly referred to as “buffalo hump,” has traditionally been associated with Human Immunodeficiency Virus (HIV)-related antiretroviral therapy. However, similar deformities may also occur independently of HIV treatment. This study aimed to investigate non HIV-associated buffalo hump as a potential [...] Read more.

Background/Objectives: Cervicodorsal lipodystrophy, commonly referred to as “buffalo hump,” has traditionally been associated with Human Immunodeficiency Virus (HIV)-related antiretroviral therapy. However, similar deformities may also occur independently of HIV treatment. This study aimed to investigate non HIV-associated buffalo hump as a potential clinical marker of underlying metabolic or endocrine disorders. Methods: We retrospectively reviewed 12 HIV-negative patients who presented with cervicodorsal lipodystrophy between 2012 and 2022. Patient demographics, laboratory values, and imaging findings were analyzed. All patients underwent surgical resection of a hypertrophic fat pad. Exploratory statistical analyses were performed using Mann–Whitney U and Fisher’s exact tests and Spearman’s correlation analysis. Results: These 12 patients had a mean age of 56.92 ± 16.69 years and a mean Body Mass Index (BMI) of 30.15 ± 4.59 kg/m². Hypertension and diabetes were each present in 66.7% of patients, and hyperlipidemia in 75%. Three patients were newly diagnosed with metabolic disease. No significant differences were found between newly diagnosed and previously diagnosed patients in age (45.67 ± 21.46 vs. 60.67 ± 14.31 years, p = 0.194) or BMI (32.44 ± 2.39 vs. 29.39 ± 4.99 kg/m², p = 0.145). Group differences in hypertension, diabetes, hyperlipidemia, or liver dysfunction were also not significant (all p > 0.49). No correlation was observed between age and BMI (ρ = −0.158, p = 0.624). Conclusions: Although the small sample size precludes definitive conclusions, the prevalence of obesity, hypertension, and diabetes in this cohort was notably higher than reported in Korean population-based surveys. These findings suggest that non HIV-associated buffalo hump may serve as an externally visible marker of systemic metabolic burden. Metabolic screening should be considered even in the absence of overt systemic disease. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

► Show Figures

Figure 1

14 pages, 692 KB

Open AccessSystematic Review

Image-Based Robotic Unicompartmental Knee Arthroplasty Results in Fewer Radiologic Outliers with No Impact on Revision Rates Compared to Imageless Systems: A Systematic Review

by Horia Tomescu, George M. Avram, Giacomo Pacchiarotti, Randa Elsheikh, Octav Russu, Andrej M. Nowakowski, Michael T. Hirschmann and Vlad Predescu

J. Clin. Med. 2025, 14(17), 5996; https://doi.org/10.3390/jcm14175996 (registering DOI) - 25 Aug 2025

Background: Robotic-assisted unicompartmental knee arthroplasty (UKA) enhances the precision of component alignment compared to conventional techniques. Although various robotic systems exist, direct comparisons assessing their relative clinical performance remain limited. The purpose of this study is to provide a comparison between image-based [...] Read more.

Background: Robotic-assisted unicompartmental knee arthroplasty (UKA) enhances the precision of component alignment compared to conventional techniques. Although various robotic systems exist, direct comparisons assessing their relative clinical performance remain limited. The purpose of this study is to provide a comparison between image-based and imageless robotic UKA. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Five databases were searched: PubMed (via MEDLINE), Epistemonikos, Cochrane Library, Web of Science, and Scopus. Inclusion criteria were (1) studies comparing rUKA and cUKA with radiologic parameters and revision rates (prospective or retrospective), (2) human subjects, (3) meta-analyses for cross-referencing, and (4) English language. Data collected included (1) pre- and postoperative radiologic parameters, (2) radiologic outliers, and (3) revisions and their causes. A random-effects meta-analysis was employed to enable a generalizable comparison. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated for continuous variables, and log odds ratios (LORs) with 95% CIs for binary outcomes. Results: Image-based robotic UKA was associated with fewer joint line height outliers (LOR = 3.5, 95% CI: 0.69–6.30, p = 0.015) using a 2° threshold. HKA outliers (thresholds 2–3°) were also reduced (LOR = 0.6, 95% CI: 0.09–1.19, p = 0.024). Posterior tibial and posterior femoral implant fit were significantly lower with image-based systems (LOR = 1.7, 95% CI: 1.37–2.03, respectively, LOR = 1.7, 95% CI: 1.29–1.91; p < 0.001 for both). No significant differences in revision rates were observed. Conclusions: Image-based robotic systems may result in fewer outliers in key radiologic parameters, including hip–knee angle, joint-line height, posterior tibial, and posterior femoral fit, though reporting remains highly heterogeneous. Full article

(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities: 2nd Edition)

► Show Figures

Figure 1

24 pages, 4066 KB

Open AccessArticle

The Value of Indices and Measurements Used for Assessing Functional X-Rays of the Cervical Spine in Clinical Practice

by Marcin Janusz Łubiński, Piotr Kowalski, Filip Karol Kwiatkowski, Jolanta Ewa Kujawa, Gabriela Anna Figas and Agata Joanna Majos

J. Clin. Med. 2025, 14(17), 5995; https://doi.org/10.3390/jcm14175995 (registering DOI) - 25 Aug 2025

Background: Functional X-ray imaging of the cervical spine in flexion and extension remains a fundamental, objective method for mobility assessment. However, there remains no consensus on how to perform the measurements or which indicators are most useful in clinical practice. Methods: [...] Read more.

Background: Functional X-ray imaging of the cervical spine in flexion and extension remains a fundamental, objective method for mobility assessment. However, there remains no consensus on how to perform the measurements or which indicators are most useful in clinical practice. Methods: This study included 288 participants (197 female and 91 male); these included patients without CDD signs or with first-degree cervical spine CDD according to the Kellgren–Lawrence criteria. Cobb angle C2–C7, HDI, ROM, CIF, and CIE were measured. Results: The most significant correlations were observed for HDI, and the strongest correlations were between CIF measurements. The greatest mobility was noted for the centrally located segments of the cervical spine, particularly at the C4–C5 level. Conclusions: HDI appears to be the most reliable parameter for characterizing the mobility of the cervical spine. It is precise and has the highest number of correlations with other measurements, but it is very time-consuming. Cobb angle C2–C7 combines ease of performance with good diagnostic value. Full article

(This article belongs to the Special Issue Musculoskeletal Imaging and Intervention)

► Show Figures

Figure 1

More Articles...

Submit to JCM Review for JCM

Journal Menu

Journal Browser

► Journal Browser

Highly Accessed Articles

View More...

Latest Books

More Books and Reprints...

E-Mail Alert

News

25 August 2025
Journal of Clinical Medicine | Issue Cover Articles in 2025 (I)

19 August 2025
Meet Us at the 84th Annual Meeting of the Japanese Cancer Association, 25–27 September 2025, Kanazawa, Japan

19 August 2025
Journal of Clinical Medicine | 2025 Editorial Board Meeting of the “Orthopedics” Section Held on 24 June 2025

More News & Announcements...

Topics

Propose a Topic

Topic in Healthcare, IJERPH, JCM, Safety, Toxics

New Research in Work-Related Diseases, Safety and Health Topic Editors: Alicja Bortkiewicz, Małgorzata Kurpesa
Deadline: 31 August 2025

Topic in JCM, Diagnostics, JPM, Brain Sciences, JVD

Diagnosis and Management of Acute Ischemic Stroke Topic Editors: Hyo Suk Nam, Byung Moon Kim, Tae-jin Song, Minho Han
Deadline: 20 September 2025

Topic in Cancers, Current Oncology, JCM, Medicina, Onco

Cancer Biology and Radiation Therapy: 2nd Edition Topic Editors: Chang Ming Charlie Ma, Ka Yu Tse, Ming-Yii Huang, Mukund Seshadri
Deadline: 16 October 2025

Topic in Biomedicines, Cancers, Current Oncology, Diagnostics, JCM

Advances in Magnetic Resonance Imaging (MRI) and Its Role in Radiation Therapy Topic Editors: Indra J. Das, Minsong Cao
Deadline: 31 October 2025

More Topics

Conferences

Propose a Conference Collaboration

5–7 November 2025 CancersScape: Spatial Biology of the Tumor Ecosystem (Cancers 2025)

27 August 2025 Journal of Clinical Medicine Webinar | Interventional Radiology: From Diagnosis to Treatment, 27 August 2025

29–31 October 2025 The 1st International Online Conference on Personalized Medicine

More Conferences...

Special Issues

Propose a Special Issue

Special Issue in JCM

Pancreatic Cancer: Novel Strategies of Diagnosis and Treatment Guest Editors: Camelia Cristina Diaconu, Gina Gheorghe
Deadline: 26 August 2025

Special Issue in JCM

Clinical Updates in Stem Cell Transplants Guest Editors: Daniele Avenoso, Michele Malagola
Deadline: 26 August 2025

Special Issue in JCM

Endocrine Malignancies: Current Surgical Therapeutic Approaches: 2nd Edition Guest Editors: Mariarita Tarallo, Enrico Fiori, Marco Bononi
Deadline: 26 August 2025

Special Issue in JCM

Clinical Diagnostics and Therapeutics Advances in Acute and Chronic Heart Failure Guest Editors: Ilaria Battistoni, Emilia D'Elia
Deadline: 27 August 2025

More Special Issues

Topical Collections

Topical Collection in JCM

Promoting Physical Activity and Reducing Sedentary Behavior to Prevent Chronic Diseases Collection Editors: Zan Gao, Jung Eun Lee

Topical Collection in JCM

Practice and Research in Clinical Pharmacology Collection Editors: Antonio J. Carcas-Sansuán, Alberto M. Borobia Pérez

Topical Collection in JCM

Ocular Manifestations of Systemic Diseases Collection Editor: Anat Galor

Topical Collection in JCM

Pediatric and Adolescent Gynecology Collection Editor: Panagiotis Christopoulos

More Topical Collections

Back to TopTop