Journal of Clinical Medicine

13 pages, 441 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Immunology)

► Show Figures

Figure 1

13 pages, 456 KiB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

10 pages, 808 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

17 pages, 1471 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Graphical abstract

13 pages, 3144 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

15 pages, 611 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

17 pages, 1340 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Respiratory Medicine)

23 pages, 1139 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Pharmacology)

► Show Figures

Graphical abstract

30 pages, 4515 KiB

Open AccessArticle

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

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

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

Abstract

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

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

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

► Show Figures

Figure 1

16 pages, 604 KiB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

14 pages, 898 KiB

Open AccessArticle

Cardiovascular Risk in Rheumatic Patients Treated with JAK Inhibitors: The Role of Traditional and Emerging Biomarkers in a Pilot Study

by Diana Popescu, Minerva Codruta Badescu, Elena Rezus, Daniela Maria Tanase, Anca Ouatu, Nicoleta Dima, Oana-Nicoleta Buliga-Finis, Evelina Maria Gosav, Damiana Costin and Ciprian Rezus

J. Clin. Med. 2025, 14(15), 5433; https://doi.org/10.3390/jcm14155433 (registering DOI) - 1 Aug 2025

Abstract

Background: Despite therapeutic advances, morbidity and mortality remain high in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), primarily due to increased cardiovascular risk. Objectives: Our study aimed to evaluate the cardiovascular risk profile and biomarker dynamics in patients with RA and [...] Read more.

Background: Despite therapeutic advances, morbidity and mortality remain high in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), primarily due to increased cardiovascular risk. Objectives: Our study aimed to evaluate the cardiovascular risk profile and biomarker dynamics in patients with RA and PsA treated with Janus kinase inhibitors (JAKis). To our knowledge, this is the first study assessing Lp(a) levels in this context. Methods: This prospective, observational study assessed 48 adult patients. The follow-up period was 12 months. Traditional cardiovascular risk factors and biological markers, including lipid profile, lipoprotein(a) [Lp(a)], and uric acid (UA), were assessed at baseline and follow-up. Correlations between JAKi therapy, lipid profile changes, and cardiovascular risk factors were investigated. Cox regression analysis was used to identify predictors of non-major cardiovascular events. Results: A strong positive correlation was observed between baseline and 12-month Lp(a) levels (r = 0.926), despite minor statistical shifts. No major cardiovascular events occurred during follow-up; however, 47.9% of patients experienced non-major cardiovascular events (e.g., uncontrolled arterial hypertension, exertional angina, and new-onset arrhythmias). Active smoking [hazard ratio (HR) 9.853, p = 0.005], obesity (HR 3.7460, p = 0.050), and arterial hypertension (HR 1.219, p = 0.021) were independent predictors of these events. UA (HR 1.515, p = 0.040) and total cholesterol (TC) (HR 1.019, p = 0.034) were significant biochemical predictors as well. Elevated baseline Lp(a) combined with these factors was associated with an increased event rate, particularly after age 60. Conclusions: Traditional cardiovascular risk factors remain highly prevalent and predictive, underscoring the need for comprehensive cardiovascular risk management. Lp(a) remained stable and may serve as a complementary biomarker for risk stratification in JAKi-treated patients. Full article

(This article belongs to the Section Immunology)

► Show Figures

Figure 1

21 pages, 547 KiB

Open AccessReview

Targeting Psychotic and Cognitive Dimensions in Clinical High Risk for Psychosis (CHR-P): A Narrative Review

by Michele Ribolsi, Federico Fiori Nastro, Martina Pelle, Eleonora Esposto, Tommaso B. Jannini and Giorgio Di Lorenzo

J. Clin. Med. 2025, 14(15), 5432; https://doi.org/10.3390/jcm14155432 (registering DOI) - 1 Aug 2025

Abstract

Schizophrenia (SCZ) is a debilitating disorder with substantial societal and economic impacts. The clinical high risk of psychosis (CHR-P) state generally precedes the onset of SCZ, offering a window for early intervention. However, treatment guidelines for CHR-P individuals remain contentious, particularly regarding antipsychotic [...] Read more.

Schizophrenia (SCZ) is a debilitating disorder with substantial societal and economic impacts. The clinical high risk of psychosis (CHR-P) state generally precedes the onset of SCZ, offering a window for early intervention. However, treatment guidelines for CHR-P individuals remain contentious, particularly regarding antipsychotic (AP) medications. Although several studies have examined the effects of APs on reducing the risk of conversion to psychosis, the novelty of this narrative review lies in its focus on differentiating APs’ effects on positive and negative symptoms, as well as cognitive functioning, in CHR-P individuals. Evidence suggests that APs may be cautiously recommended for attenuated positive symptoms to stabilize individuals for psychological interventions, but their use in treating negative symptoms is generally discouraged due to limited efficacy and potential side effects. Similarly, the effects of APs on cognitive abilities remain underexplored, with results indicating a lack of significant neurocognitive outcomes. In conclusion, APs’ use in CHR-P patients requires careful consideration due to limited evidence and potential adverse effects. Future research should focus on individual symptom domains and treatment modalities to optimize outcomes in this critical population. Until then, a cautious approach emphasizing non-pharmacological interventions is advisable. Full article

(This article belongs to the Section Mental Health)

15 pages, 651 KiB

Open AccessArticle

The Impact of Comorbidities on Pulmonary Function Measured by Spirometry in Patients After Percutaneous Cryoballoon Pulmonary Vein Isolation Due to Atrial Fibrillation

by Monika Różycka-Kosmalska, Marcin Kosmalski, Michał Panek, Alicja Majos, Izabela Szymczak-Pajor, Agnieszka Śliwińska, Jacek Kasznicki, Jerzy Krzysztof Wranicz and Krzysztof Kaczmarek

J. Clin. Med. 2025, 14(15), 5431; https://doi.org/10.3390/jcm14155431 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: Pulmonary vein isolation (PVI) via cryoballoon ablation (CBA) is a recommended therapeutic strategy for patients with symptomatic paroxysmal and persistent atrial fibrillation (AF) who are refractory to antiarrhythmic drugs. Although PVI has demonstrated efficacy in reducing AF recurrence and improving patients’ quality [...] Read more.

Background/Objectives: Pulmonary vein isolation (PVI) via cryoballoon ablation (CBA) is a recommended therapeutic strategy for patients with symptomatic paroxysmal and persistent atrial fibrillation (AF) who are refractory to antiarrhythmic drugs. Although PVI has demonstrated efficacy in reducing AF recurrence and improving patients’ quality of life, its impact on respiratory function is not well understood, particularly in patients with comorbid conditions. The aim of the study was to search for functional predictors of the respiratory system in the process of evaluating the efficiency of clinical assessment of CBA in patients with AF. Methods: We conducted a prospective study on 42 patients with symptomatic AF who underwent CBA, assessing their respiratory function through spirometry before and 30 days after the procedure. Exclusion criteria included pre-existing lung disease and cardiac insufficiency. The impact of variables such as body mass index (BMI), coronary artery disease (CAD) and heart failure (HF) on spirometry parameters was analyzed using statistical tests. Results: No significant changes were observed in overall post-PVI spirometry parameters for the full cohort. However, post hoc analyses revealed a significant decline in ΔMEF₇₅ in patients with CAD and BMI ≥ 30 kg/m², whereas ΔFEV₁/FVCex was significantly increased in patients with HF, as well as in patients with ejection fraction (EF) < 50%. Conclusions: CBA for AF does not universally affect respiratory function in the short term, but specific subgroups, including patients with CAD and a higher BMI, may require post-procedure respiratory monitoring. In addition, PVI may improve lung function in patients with HF and reduced EF. Full article

(This article belongs to the Special Issue Clinical Aspects of Cardiac Arrhythmias and Arrhythmogenic Disorders)

► Show Figures

Figure 1

17 pages, 2839 KiB

Open AccessSystematic Review

Comparative Outcomes of Intra-Aortic Balloon Pump Versus Percutaneous Left Ventricular Assist Device in High-Risk Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

by Dhiran Sivasubramanian, Virushnee Senthilkumar, Nithish Nanda Palanisamy, Rashi Bilgaiyan, Smrti Aravind, Sri Drishaal Kumar, Aishwarya Balasubramanian, Sathwik Sanil, Karthick Balasubramanian, Dharssini Kamaladasan, Hashwin Pilathodan and Kiruba Shankar

J. Clin. Med. 2025, 14(15), 5430; https://doi.org/10.3390/jcm14155430 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: High-risk percutaneous coronary interventions (HR-PCIs) often require mechanical circulatory support (MCS) to maintain hemodynamic stability. Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVADare two commonly used MCS devices that differ in their mechanisms. We aimed to evaluate and [...] Read more.

Background/Objectives: High-risk percutaneous coronary interventions (HR-PCIs) often require mechanical circulatory support (MCS) to maintain hemodynamic stability. Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVADare two commonly used MCS devices that differ in their mechanisms. We aimed to evaluate and compare the clinical outcomes associated with IABP and PLVAD use in HR-PCIs without cardiogenic shock. Methods: We conducted a search of PubMed, Scopus, Cochrane, Mendeley, Web of Science, and Embase to identify relevant randomized controlled trials and cohort studies, and we included 13 studies for the systematic review and meta-analysis. The primary goal was to define the difference in early mortality (in-hospital and 30-day mortality), major bleeding, and major adverse cardiovascular event (MACE) components (cardiogenic shock, acute kidney injury (AKI), and stroke/TIA) in IABP and PLVAD. We used a random-effects model with the Mantel–Haenszel statistical method to estimate odds ratios (ORs) and 95% confidence intervals. Results: Among 1 trial and 12 cohort studies (35,554 patients; 30,351 IABP and 5203 PLVAD), HR-PCI with IABP was associated with a higher risk of early mortality (OR = 1.53, 95% CI [1.21, 1.94]) and cardiogenic shock (OR = 2.56, 95% CI [1.98, 3.33]) when compared to PLVAD. No significant differences were found in the rates of arrhythmia, major bleeding, AKI, stroke/TIA, or hospital length of stay. Conclusions: In high-risk PCIs, PLVAD use is associated with lower early mortality and cardiogenic shock risk compared to IABP, with no significant differences in other major outcomes. Full article

(This article belongs to the Section Cardiovascular Medicine)

► Show Figures

Figure 1

16 pages, 1018 KiB

Open AccessReview

Fractional Flow Reserve in the Left Anterior Descending Artery

by Chang-Ok Seo, Hangyul Kim and Jin-Sin Koh

J. Clin. Med. 2025, 14(15), 5429; https://doi.org/10.3390/jcm14155429 (registering DOI) - 1 Aug 2025

Abstract

Fractional flow reserve (FFR) is a standard physiological index for guiding coronary revascularization, with a threshold of >0.80 typically used to defer intervention. However, due to its distinct anatomical and physiological features, the left anterior descending artery (LAD) often exhibits lower FFR values [...] Read more.

Fractional flow reserve (FFR) is a standard physiological index for guiding coronary revascularization, with a threshold of >0.80 typically used to defer intervention. However, due to its distinct anatomical and physiological features, the left anterior descending artery (LAD) often exhibits lower FFR values than non-LAD vessels for lesions of similar angiographic severity. These vessel-specific differences raise concerns about applying a uniform FFR cutoff across all coronary territories. Observational studies indicate that LAD lesions deferred at an FFR of 0.80 may have similar or better outcomes than non-LAD lesions do. LAD lesions also tend to show lower post-percutaneous coronary intervention FFR values, suggesting that vessel specific target thresholds may be more prognostically appropriate. Additionally, some evidence suggests that instantaneous wave-free ratio may offer greater prognostic value than FFR, specifically in LAD lesions, a trend not consistently seen in other arteries. In patients with acute myocardial infarction and multivessel disease, the prognostic relevance of non-culprit lesion FFR may vary by coronary territory, particularly in the LAD. This review outlines the physiological rationale and clinical evidence for vessel-specific interpretation of FFR, with a focus on the LAD, and explores its potential clinical implications and limitations. Full article

(This article belongs to the Special Issue Interventional Cardiology—Challenges and Solutions)

► Show Figures

Figure 1

11 pages, 487 KiB

Open AccessPerspective

Constipation in Ulcerative Colitis: An Underestimated Problem

by Gabrio Bassotti, Sara Bologna and Elisabetta Antonelli

J. Clin. Med. 2025, 14(15), 5428; https://doi.org/10.3390/jcm14155428 (registering DOI) - 1 Aug 2025

Abstract

Ulcerative colitis is a chronic intestinal disorder that belongs to the category of inflammatory bowel diseases, and is usually characterized by the presence of bloody diarrhea and abdominal pain, due to an accelerated transit and intestinal sensibilization following inflammation of the colonic mucosa. [...] Read more.

Ulcerative colitis is a chronic intestinal disorder that belongs to the category of inflammatory bowel diseases, and is usually characterized by the presence of bloody diarrhea and abdominal pain, due to an accelerated transit and intestinal sensibilization following inflammation of the colonic mucosa. However, the literature reports that ulcerative colitis may sometimes feature fecal stasis with constipation. This apparent paradox may be partially explained by the motor abnormalities of the large bowel following inflammation, damage to the enteric innervation, and the onset of parietal fibrosis over time. Moreover, some anorectal abnormalities such pelvic floor dyssynergia may explain the symptoms of constipation reported in subsets of patients. Since these abnormalities may be responsible for diagnostic delays and non- or partial responses to therapy, it is important to recognize them as early as possible to avoid incorrect clinical and therapeutic approaches to these patients. Full article

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

► Show Figures

Figure 1

13 pages, 1189 KiB

Open AccessArticle

The Role of Biodegradable Temporizing Matrix in Paediatric Reconstructive Surgery

by Aikaterini Bini, Michael Ndukwe, Christina Lipede, Ramesh Vidyadharan, Yvonne Wilson and Andrea Jester

J. Clin. Med. 2025, 14(15), 5427; https://doi.org/10.3390/jcm14155427 (registering DOI) - 1 Aug 2025

Abstract

Introduction: Biodegradable Temporizing Matrix (BTM) is a new synthetic dermal substitute suitable for wound closure and tissue regeneration. The data in paediatric population remain limited. The study purpose is to review the indications for BTM application in paediatric patients; evaluate the short-term and [...] Read more.

Introduction: Biodegradable Temporizing Matrix (BTM) is a new synthetic dermal substitute suitable for wound closure and tissue regeneration. The data in paediatric population remain limited. The study purpose is to review the indications for BTM application in paediatric patients; evaluate the short-term and long-term results, including complications and functional outcomes, as well as to share some unique observations regarding the use of BTM in paediatric population. Patients and Methods: Patients undergoing reconstructive surgery and BTM application during the last three years were included. Data collected included patient demographics, primary diagnosis, previous surgical management, post-operative complications and final outcomes. BTM was used in 32 patients. The indications varied including epidermolysis bullosa (n = 6), burns (n = 4), trauma (n = 7), infection (n = 4), ischemia or necrosis (n = 11). Results: The results were satisfying with acceptable aesthetic and functional outcomes. Complications included haematomaunderneath the BTM leading to BTM removal and re-application (n = 1), BTM infection (n = 1) and split-thickness skin graft failure on top of BTM requiring re-grafting (n = 2). Conclusions: BTM can be a good alternative to large skin grafts, locoregional flaps or even free flaps. The big advantages over other dermal substitutes or skin grafts are that BTM is less prone to infection and offers excellent scarring by preserving the normal skin architecture. Specifically in children, BTM might not require grafting, resulting in spontaneous healing with good scarring. In critically ill patients, BTM reduces the operation time and there is no donor site morbidity. BTM should be considered in the reconstructive ladder when discussing defect coverage options in children and young people. Full article

(This article belongs to the Special Issue Trends in Plastic and Reconstructive Surgery)

► Show Figures

Figure 1

15 pages, 1521 KiB

Open AccessReview

The Effect of Heterogeneous Definitions of Massive Transfusion on Using Blood Component Thresholds to Predict Futility in Severely Bleeding Trauma Patients

by Samuel J. Thomas, Vraj S. Patel, Connor P. Schmitt, Aleksey T. Zielinski, Mia N. Aboukhaled, Christopher A. Steinberg, Ernest E. Moore, Hunter B. Moore, Scott G. Thomas, Dan A. Waxman, Joseph B. Miller, Connor M. Bunch, Michael W. Aboukhaled, Emmanuel J. Thomas, Saniya K. Zackariya, Halina Oryakhail, Alexander Mehreteab, Reagan E. Ludwig, Sarah M. George, Aayan I. Siddiqi, Bilal M. Zackariya, Aadil Qasim, Mark M. Walsh and Mahmoud D. Al-Fadhl Show full author list Hide full author list

J. Clin. Med. 2025, 14(15), 5426; https://doi.org/10.3390/jcm14155426 (registering DOI) - 1 Aug 2025

Abstract

In the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further [...] Read more.

In the trauma resuscitation literature, there are inconsistent definitions of what constitutes massive transfusion and a unit of blood, complicating the use of transfusion cut-points to declare futility. This is problematic as it can lead to the inefficient use of blood products, further exacerbating current blood product shortages. Previous studies have used various transfusion cut-points per hour to define futility in retrospective analyses but have not accurately defined futility at the bedside due to patient survival even at large rates and volumes of blood transfused. In an attempt to use transfusion cut-points as a marker to help define futility, guidelines have been proposed to limit blood product waste in transfusions for severely bleeding trauma patients, such as Suspension of Transfusion and Other Procedures (STOP) for patients older than 15 and the Futility of Resuscitation Measure (FoRM), used to determine futility in patients older than 60. In an effort to construct effective bedside futile resuscitation criteria with 100% positive predictive value and specificity, this review proposes the use of specific blood component transfusion cut-points combined with parameters from both STOP and FoRM to allow for a comprehensive and accurate method of declaring futility in severely bleeding trauma patients. Full article

(This article belongs to the Special Issue Current Trends and Prospects of Critical Emergency Medicine)

► Show Figures

Figure 1

14 pages, 454 KiB

Open AccessArticle

The Evaluation of Blood Prooxidant–Antioxidant Balance Indicators and Cortisol Pre- and Post-Surgery in Patients with Benign Parotid Gland Tumors: A Preliminary Study

by Sebastian Bańkowski, Jan Pilch, Bartosz Witek, Jarosław Markowski, Wirginia Likus, Michał Rozpara and Ewa Sadowska-Krępa

J. Clin. Med. 2025, 14(15), 5425; https://doi.org/10.3390/jcm14155425 (registering DOI) - 1 Aug 2025

Abstract

Background: The majority of parotid gland tumors are benign, e.g., pleomorphic adenoma (PA) and Warthin’s tumor (WT). From a biomedical point of view, oxidative stress is of significant importance due to its established association with the initiation and progression of various types of [...] Read more.

Background: The majority of parotid gland tumors are benign, e.g., pleomorphic adenoma (PA) and Warthin’s tumor (WT). From a biomedical point of view, oxidative stress is of significant importance due to its established association with the initiation and progression of various types of cancer, including parotid gland cancers. This study aimed to assess whether blood prooxidant–antioxidant markers could aid in diagnosing and guiding surgery for recurrent malignancies after parotid tumor treatment. Methods: We examined patients (n = 20) diagnosed with WT (n = 14) and PA (n = 6) using histopathological verification and computed tomography (CT) who qualified for surgical treatment. Blood samples were taken before the surgery and again 10 days later for biochemical analysis. The activities of the antioxidant enzymes (SOD, CAT and GPx), the non-enzymatic antioxidants (GSH and UA) and oxidative stress markers (MDA and TOS) were determined in the blood. The activities of CK and LDH and the concentrations of Cor and TAS were measured in the serum. Hb and Ht were determined in whole blood. Results: The patients’ SOD, CAT, and GPx activities after surgery did not differ significantly from their preoperative levels. However, following surgery, their serum TOS levels were significantly elevated in all the patients compared to baseline. In contrast, the plasma MDA concentrations were markedly reduced after surgery. Similarly, the GSH concentrations showed a significant decrease postoperatively. No significant changes were observed in the CK and LDH activities, TAS concentrations, or levels of Hb, Ht and Cor following surgery. Conclusions: The surgical removal of salivary gland tumors did not result in a reduction in oxidative stress at 10 days after surgery. Therefore, further studies are needed to determine the effectiveness of endogenous defense mechanisms in counteracting the oxidative stress induced by salivary gland tumors. Full article

(This article belongs to the Section Oncology)

► Show Figures

Figure 1

Journal Description

Journal of Clinical Medicine

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Further Information

Guidelines

MDPI Initiatives

Follow MDPI