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Search Results (2,065)

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12 pages, 960 KiB  
Article
Association Between Survival After Living Donor Liver Transplantation and Recipient Systemic Inflammation and Body Composition
by Jae Hwan Kim, Yeon Ju Kim, Hye-Mee Kwon, Kyung-Won Kim, Jin YanZhen, Sa-Jin Kang, In-Gu Jun, Jun-Gol Song and Gyu-Sam Hwang
J. Clin. Med. 2025, 14(16), 5889; https://doi.org/10.3390/jcm14165889 - 20 Aug 2025
Abstract
Background/Objectives: Preoperative sarcopenia in liver transplantation (LT) recipients is an important prognostic factor of LT outcomes. Systemic inflammatory status (SIS) has been proposed as a unifying mechanism for skeletal muscle loss; thus, considering SIS and sarcopenia together may enhance prognosis assessment in patients [...] Read more.
Background/Objectives: Preoperative sarcopenia in liver transplantation (LT) recipients is an important prognostic factor of LT outcomes. Systemic inflammatory status (SIS) has been proposed as a unifying mechanism for skeletal muscle loss; thus, considering SIS and sarcopenia together may enhance prognosis assessment in patients undergoing LT. Herein, we aimed to describe the relationship between the SIS and skeletal muscle index (SMI) with short-term and long-term mortality post-living donor LT (LDLT). Methods: In total, 3387 consecutive adult LDLT recipients were retrospectively evaluated. The neutrophil-to-lymphocyte ratio (NLR, using a cut-off of 3) was utilized as an SIS. SMI was calculated using computed tomography scans, measured at the third lumbar vertebra; sex-specific cut-offs were determined from contemporary donors. Univariate and multivariable Cox proportional hazard analyses were performed. Results: Decreasing SMI was associated with increasing NLR. Increasing NLR and decreasing SMI both showed dose-dependent relationships with a risk of 90-day mortality. Within sarcopenic patients, NLR > 3 (vs. NLR ≤ 3) was associated with higher 90-day (9.3% vs. 3.5%, p = 0.049) and overall mortality (28.4% vs. 19.1%, p = 0.045). Sarcopenia and NLR > 3 (vs. neither) were independent predictors of 90-day mortality (hazard ratio [HR] 2.48 [1.40–4.40], p = 0.002) and overall mortality (HR, 1.81 [1.37–2.38], p < 0.001) after multivariable adjustment. When stratified by age, sex, and MELD score, the association between sarcopenia and overall mortality persisted in all subgroups, with the highest risk observed in women (HR 3.43, 95% CI 1.83–6.43). Conclusions: Sarcopenia, with the systemic inflammatory response, nearly doubled the risk of 90-day and overall mortality post-LT, proposing that these readily available biomarkers are a practical index for predicting survival post-LT. Considering that these are potentially modifiable factors, our result may provide a new therapeutic target to improve survival post-LT. Full article
(This article belongs to the Section Anesthesiology)
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12 pages, 541 KiB  
Article
Efficacy of Non-Invasive Monopolar Radiofrequency for Treating Genitourinary Syndrome of Menopause: A Prospective Pilot Study
by Mariachiara Palucci, Marta Barba, Alice Cola, Clarissa Costa, Desirèe De Vicari and Matteo Frigerio
Clin. Pract. 2025, 15(8), 155; https://doi.org/10.3390/clinpract15080155 - 20 Aug 2025
Abstract
Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and recurrent [...] Read more.
Introduction: The decline of serum estrogen in postmenopausal women leads to several changes in the vulvovaginal and vesicourethral areas, resulting in the genitourinary syndrome of menopause (GSM), characterized by bothersome symptoms such as vaginal atrophy, lack of lubrication, dyspareunia, urgency, dysuria, and recurrent urinary tract infections. Nevertheless, this condition could also be experienced by younger women affected by hormone-dependent tumors. Although topical estrogens are considered “the gold standard”, hormonal treatments cannot be indicated in cancer survivors. As a result, energy-based devices using radiofrequency and laser technologies have emerged as alternative options. This prospective study aimed to evaluate the benefits of non-invasive monopolar radiofrequency (RF) in women affected by GSM who have contraindications to, did not respond to, or declined local estrogen therapy. Methods: The patients underwent five weekly sessions of second-generation monopolar RF. At baseline and at the fifth session, two validated questionnaires were administered to the patients: the Visual Analogue Scale (VAS) and the Female Sexual Function Index (FSFI-19). On the other hand, the vaginal mucosa status was evaluated by clinicians through the Vaginal Health Index (VHI). At the end of the cycle, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected. Results: Based on 44 patients who completed five sessions of radiofrequency, a significant improvement was observed in sexual function according to the FSFI scale (22.9 vs. 38.6; p < 0.001) and in VVA atrophy symptoms, as documented by the VAS score (223 vs. 125; p < 0.001). The mean VHI score increased by 3 points (p < 0.001). Moreover, according to PGI-I, 96% of patients reported a perceived improvement (PGI-I score ≤ 3). Conclusions: Radiofrequency could provide an innovative and safe therapeutic approach for patients suffering from GSM and VVA, especially when hormonal strategies are unsuitable. Full article
19 pages, 1949 KiB  
Article
Non-Invasive Dry Eye Disease Detection Using Infrared Thermography Images: A Proof-of-Concept Study
by Laily Azyan Ramlan, Wan Mimi Diyana Wan Zaki, Marizuana Mat Daud and Haliza Abdul Mutalib
Diagnostics 2025, 15(16), 2084; https://doi.org/10.3390/diagnostics15162084 - 20 Aug 2025
Abstract
Background/Objectives: Dry Eye Disease (DED) significantly impacts quality of life due to the instability of the tear film and reduced tear production. The limited availability of eye care professionals, combined with traditional diagnostic methods that are invasive, non-portable, and time-consuming, results in delayed [...] Read more.
Background/Objectives: Dry Eye Disease (DED) significantly impacts quality of life due to the instability of the tear film and reduced tear production. The limited availability of eye care professionals, combined with traditional diagnostic methods that are invasive, non-portable, and time-consuming, results in delayed detection and hindered treatment. This proof-of-concept study aims to explore the feasibility of using smartphone-based infrared thermography (IRT) as a non-invasive, portable screening method for DED. Methods: This study included infrared thermography (IRT) images of 40 subjects (22 normal and 58 DED). Ocular surface temperature changes at three regions of interest (ROIs): nasal cornea, center cornea, and temporal cornea, were compared with Tear Film Break-up Time (TBUT) and Ocular Surface Disease Index (OSDI) scores. Statistical correlations and independent t-tests were performed, while machine learning (ML) models classified normal vs. DED eyes. Results: In these preliminary results, DED eyes exhibited a significantly faster cooling rate (p < 0.001). TBUT showed a negative correlation with OSDI (r = −0.802, p < 0.001) and positive correlations with cooling rates in the nasal cornea (r = 0.717, p < 0.001), center cornea (r = 0.764, p < 0.001), and temporal cornea (r = 0.669, p < 0.001) regions. Independent t-tests confirmed significant differences between normal and DED eyes across all parameters (p < 0.001). The Quadratic Support Vector Machine (SVM) achieved the highest accuracy among SVM models (90.54%), while the k-Nearest Neighbours (k-NN) model using Euclidean distance (k = 3) outperformed overall with 91.89% accuracy, demonstrating strong potential for DED classification. Conclusions: This study provides initial evidence supporting the use of smartphone-based infrared thermography (IRT) as a screening tool for DED. The promising classification performance highlights the potential of this approach, though further validation on larger and more diverse datasets is necessary to advance toward clinical application. Full article
(This article belongs to the Special Issue Advances in Eye Imaging)
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16 pages, 3553 KiB  
Article
Real-World Effectiveness and Safety of Immune Checkpoint Inhibitors Combined with Chemotherapy in Taiwanese Patients with Extensive-Stage Small Cell Lung Cancer
by Cheng-Yu Chang, Yu-Feng Wei, Shih-Chieh Chang and Chung-Yu Chen
Curr. Oncol. 2025, 32(8), 472; https://doi.org/10.3390/curroncol32080472 - 19 Aug 2025
Abstract
Purpose: Extensive-stage small cell lung cancer (ES-SCLC) has poor prognosis. While immune checkpoint inhibitors (ICIs) with chemotherapy show survival benefits in trials, real-world data from Asia are scarce. This study evaluates real-world efficacy and safety of chemotherapy with or without ICIs in Taiwanese [...] Read more.
Purpose: Extensive-stage small cell lung cancer (ES-SCLC) has poor prognosis. While immune checkpoint inhibitors (ICIs) with chemotherapy show survival benefits in trials, real-world data from Asia are scarce. This study evaluates real-world efficacy and safety of chemotherapy with or without ICIs in Taiwanese patients with ES-SCLC and identifies survival predictors. Materials and Methods: A retrospective cohort study analyzed 114 patients with ES-SCLC treated between 2017 and 2023 at four Taiwanese medical centers. Patients received first-line chemotherapy alone (n = 68) or with ICIs (atezolizumab, durvalumab, pembrolizumab; n = 46). Primary endpoints were overall survival (OS) and progression-free survival (PFS), assessed via Kaplan–Meier methods and Cox regression. Results: Baseline characteristics were comparable, except poorer ECOG performance (≥2) in the chemotherapy group (27% vs. 9%; p = 0.021). IO–chemotherapy significantly improved OS (16.1 vs. 9.4 months; HR = 0.32, 95% CI: 0.20–0.52; p < 0.001) and PFS (7.8 vs. 5.5 months; HR = 0.40, 95% CI: 0.26–0.63; p < 0.001). Multivariate analysis confirmed IO–chemotherapy as an independent positive predictor (OS adjusted HR = 0.25, 95% CI: 0.14–0.44; PFS adjusted HR = 0.37, 95% CI: 0.22–0.61; both p < 0.001). Skin rash was more common with IO–chemotherapy (24% vs. 3%; p < 0.001). Immune-related adverse events (AEs) correlated with improved survival (median OS: 21.4 months with 1–2 AEs, 16.6 months with 3–4 AEs, 12.5 months without AEs). Conclusion: Immunochemotherapy significantly improves survival in Taiwanese patients with ES-SCLC, with manageable toxicity, supporting ICIs’ incorporation into standard treatment. Full article
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10 pages, 1557 KiB  
Article
Clinical and Radiological Outcomes of Ultrasound-Guided Closed-Circuit Irrigation of Calcific Tendinitis of the Shoulder: A Prospective Study
by Andrea De Grandis, Carlo D’Alessandro, Giovanni Sussan, Alberto Crimì, Lucrezia Tognolo, Daniele Coraci, Stefano Masiero, Roberto Ragazzi, Emilio Quaia and Filippo Crimì
Life 2025, 15(8), 1302; https://doi.org/10.3390/life15081302 - 16 Aug 2025
Viewed by 209
Abstract
Ultrasound-guided percutaneous interventions are well-established as effective treatments for shoulder calcific tendinopathy. In this work, we modified the conventional double-needle approach by incorporating a closed-circuit irrigation system and assessed the procedure’s clinical and radiological outcomes. We enrolled prospectively 24 patients (10 males; median [...] Read more.
Ultrasound-guided percutaneous interventions are well-established as effective treatments for shoulder calcific tendinopathy. In this work, we modified the conventional double-needle approach by incorporating a closed-circuit irrigation system and assessed the procedure’s clinical and radiological outcomes. We enrolled prospectively 24 patients (10 males; median age 54 years, IQR: 50–62) with painful calcific tendonitis of the shoulder between October 2023 and March 2024. All patients had a calcification > 5 mm treated with ultrasound-guided closed-circuit irrigation. Radiography, ultrasound evaluation, and OSS and SPADI clinical questionnaires were administered before the treatment and 3 months after. After the procedure, there was a significant reduction in the size of the calcifications (12 mm, IQR: 10–20 mm vs. 5.5 mm, IQR: 2–10 mm; p < 0.001). After the procedure, none of the patients experienced infections, while two developed bursitis. Three months after the procedure there were significant improvement in the OSS (16.5, IQR: 10–23 vs. 32, IQR: 36–45.5; p < 0.0001) and reduction in SPADI scores: pain (88, IQR: 74–95 before vs. 13, IQR: 4–24; p < 0.0001), disability (72, IQR: 60–90 before vs. 8, IQR: 4–20; p < 0.0001), and total score (78, IQR: 66–91 before vs. 11, IQR: 4–20; p < 0.0001). The closed-circuit double-needle irrigation for calcific tendinopathy of the shoulder is an effective treatment that improves both shoulder pain and function with a very low risk of short-term complications. Full article
(This article belongs to the Section Medical Research)
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18 pages, 487 KiB  
Article
Intersecting Pathways: The Impact of Philadelphia-Negative Chronic Myeloproliferative Neoplasms on the Pathogenesis and Progression of Heart Failure with Preserved Ejection Fraction
by Marius-Dragoș Mihăilă, Bogdan Caloian, Florina Iulia Frîngu, Samuel Bogdan Todor, Minodora Teodoru, Romeo Gabriel Mihăilă and Dana Pop
Diagnostics 2025, 15(16), 2042; https://doi.org/10.3390/diagnostics15162042 - 14 Aug 2025
Viewed by 216
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent worldwide due to ageing and comorbidities. Emerging evidence suggests that Philadelphia-negative chronic myeloproliferative neoplasms (MPNs), particularly those with JAK2 mutations, may contribute to the development of HFpEF, especially by promoting inflammation [...] Read more.
Background: Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent worldwide due to ageing and comorbidities. Emerging evidence suggests that Philadelphia-negative chronic myeloproliferative neoplasms (MPNs), particularly those with JAK2 mutations, may contribute to the development of HFpEF, especially by promoting inflammation and increasing thrombotic risk. Methods: This prospective case–control study assessed 58 patients with Philadelphia-negative MPNs and 41 controls, by clinical, paraclinical, and echocardiographic evaluation, to diagnose diastolic dysfunction and HFpEF according to the ESC guideline criteria. Results: Patients with MPNs had a significantly higher prevalence of HFpEF compared to controls (p = 0.008), higher H2FPEF scores (median 5 vs. 3, p < 0.001), and significant echocardiographic abnormalities, including a higher left ventricular mass index (LVMI) (100.1 vs. 76.6 g/m2, p < 0.001), E/e’ (11.00 vs. 7.00, p < 0.001), and pulmonary artery systolic pressure (PASP) (26.0 vs. 7.42 mmHg, p < 0.001). Multivariable logistic regression models identified male sex (OR = 8.993, p = 0.001) and the presence of JAK2 mutation (OR = 5.021, p = 0.002) as independent risk factors for HFpEF in this population. Conclusions: Patients with chronic MPNs, particularly males and those with JAK2 mutations, are at an increased risk of HFpEF, highlighting the importance of routine cardiologic assessment to improve outcomes in this patient population. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management in Cardiology)
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11 pages, 311 KiB  
Article
Characteristics and Outcomes of Diffuse Interstitial Pneumonias Discovered in the ICU: A Retrospective Monocentric Study—The “IPIC” (Interstitial Pneumonia in Intensive Care) Study
by Damien Eckert, Julien Bermudez, Marc Leone, Mathieu Di Bisceglie and Florent Montini
Diagnostics 2025, 15(16), 1995; https://doi.org/10.3390/diagnostics15161995 - 9 Aug 2025
Viewed by 274
Abstract
Background/Objectives: Interstitial lung disease (ILD) is a heterogenous group of disorders characterised by an association of inflammatory and fibrotic abnormalities of the lung. Acute respiratory failure (ARF) may represent the initial picture of the disease. This study aims to highlight the diagnosis [...] Read more.
Background/Objectives: Interstitial lung disease (ILD) is a heterogenous group of disorders characterised by an association of inflammatory and fibrotic abnormalities of the lung. Acute respiratory failure (ARF) may represent the initial picture of the disease. This study aims to highlight the diagnosis of ILD in the intensive care unit (ICU) and to describe the epidemiological, prognostic, and imaging features of patients diagnosed for the first time with ILD in the ICU. Methods: We conducted a single-centre retrospective study. We screened all 2459 patients admitted to our ICU from October 2017 to February 2020. The inclusion criteria consisted of the ILD diagnosis criteria. For each patient, clinical data and lung computed tomography scan patterns were analysed. The selected cases were then reviewed by an expert team at the tertiary care teaching hospital of Marseille (Hôpital Nord, Marseille, France). Results: During the study period, 26 ICU patients were diagnosed with ILD and 20 cases were confirmed by the expert team. The most frequent diagnoses were idiopathic ILD (n = 7, 35%), auto-immune disease-related ILD (n = 7, 35%), exposure-related ILD (n = 3, 15%), and carcinomatous lymphangitis (n = 3, 15%). Fifteen patients were men (75%), with a mean age of 70 (62–72) years. The median SOFA score was 4 (3–7), and 16 (80%) patients received invasive mechanical ventilation. The mean ratio of the oxygen pressure to the fraction of inspired oxygen was 174 (148–198) mmHg. The ICU mortality rate of our cohort was significantly higher than the average ICU mortality (65% vs. 26%, p < 0.003). The mortality rate was lower among the subgroup of auto-immune disease-related ILD (57%). Conclusions: We conducted a single-centre cohort study of patients diagnosed with ILD in the ICU. This rare cause of ARF was associated with poor outcome in the ICU, but auto-immune disease-related ILD seemed to have a better prognosis. High-resolution lung CT and identification of lesion patterns are the cornerstones of the diagnosis. Improved knowledge of ILD and multidisciplinary discussion (MDD) involving radiologists, pneumologists, and intensivists may result in an earlier diagnosis and eventually improved treatments. Full article
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12 pages, 1295 KiB  
Article
Non-Specific Pleuritis After Medical Thoracoscopy: The Portrait of an Open Issue and Practical Hints for Its Management
by Matteo Daverio, Mariaenrica Tinè, Umberto Semenzato, Roberta Prevedello, Matteo Dalla Libera, Elisabetta Cocconcelli, Elisabetta Balestro, Marco Damin, Paolo Spagnolo and Davide Biondini
Biomedicines 2025, 13(8), 1934; https://doi.org/10.3390/biomedicines13081934 - 8 Aug 2025
Viewed by 220
Abstract
Background/Objectives: Up to one third of pleural biopsies performed during medical thoracoscopy (MT) are labelled as non-specific pleuritis (NSP). The histological diagnosis of NSP has long been worrisome for pulmonologists, with the potential to evolve into a life-threatening condition. The aim of this [...] Read more.
Background/Objectives: Up to one third of pleural biopsies performed during medical thoracoscopy (MT) are labelled as non-specific pleuritis (NSP). The histological diagnosis of NSP has long been worrisome for pulmonologists, with the potential to evolve into a life-threatening condition. The aim of this study was to identify clinical and biological predictors for patients with a diagnosis of NSP to guide clinical decisions. Methods: Baseline, procedural and follow-up data of NSP patients were retrospectively analysed to identify potential outcome predictors. Results: Of the 272 patients who underwent MT, 192 (71%) were diagnosed with malignancies, 9 (3%) with benign diseases and 71 (26%) with NSP. At follow-up, 17% were diagnosed with malignant disease and 21% with a benign condition and 62% remained idiopathic. A thoracoscopist’s evaluation of the pleural appearance reported a PPV of 28% and an NPV of 91% to predict malignancy. Patients with a subsequent diagnosis of malignancy tended to have a higher volume of fluid drained than those with persistently idiopathic NSP [2.7 litres (L) vs. 1.6 L p = 0.06]. A lymphocytic pleural effusion was more common in the malignant and idiopathic groups (63% and 60%, respectively) than the benign group (16%; p = 0.06 and p = 0.01). The three groups had a similar rate of effusion recurrence. Overall survival was higher in patients with idiopathic pleural effusion than in those with malignant (p = 0.04) or benign disease (p = 0.008). Conclusions: NSP diagnosis hides a malignancy in one in five cases, underlying the importance of closely following up these patients. The volume of drained pleural fluid, cell count and thoracoscopist’s impression may guide clinicians in the challenging management of patients with NSP. Full article
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15 pages, 726 KiB  
Article
Cutaneous Squamous Cell Carcinoma Risk Factors: Are Current Criteria Still Valid? A Retrospective, Monocenter Analysis
by Maike Kaufhold, Sepideh Asadi, Yalda Ghoreishi, Annika Brekner, Stephan Grabbe, Henner Stege and Hadrian Nassabi
Life 2025, 15(8), 1257; https://doi.org/10.3390/life15081257 - 7 Aug 2025
Viewed by 368
Abstract
Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer entity in Germany, following basal cell carcinoma. Its incidence has increased fourfold over the past three decades. Early diagnosis and treatment are essential for achieving favorable outcomes. Our study aims [...] Read more.
Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer entity in Germany, following basal cell carcinoma. Its incidence has increased fourfold over the past three decades. Early diagnosis and treatment are essential for achieving favorable outcomes. Our study aims to identify prognostic factors based on real-world data to improve follow-up protocols and raise clinical vigilance. Methods: We conducted a retrospective, monocenter analysis with a total of 124 patients with at least one cSCC thicker than 3 mm, treated at the Department of Dermatology, University Medical Center Mainz, between 2010 and 2020. Tumor-specific criteria were correlated with patient-specific data, such as gender, age, immunosuppression, UV exposure and mortality. Results: A higher incidence of cSCC was found on UV-exposed skin (91.1%); however, tumors on non-UV-exposed skin were on average thicker (6.55 mm vs. 9.25 mm, p = 0.011) and associated with higher metastasis rates (10.6% vs. 63.3%, p < 0.001). Immunosuppression was strongly associated with a younger age at diagnosis (74 years vs. 81 years), a higher metastasis rate (29% vs. 10.8%, p = 0.021) and a worse 5Y-OS-rate (36.1% vs. 97.8%, p = 0.04). SLNB was performed in eight patients, with one positive SLN identified (12.5%). Local recurrence was observed in 18.1% (n = 21) of patients who did not experience SLNB, whereas no local recurrences (0%) were reported in patients with SLNB (p = 0.349). Discussion: Tumors on non-UV-exposed areas were thicker and more often metastatic, suggesting delayed detection or more aggressive tumor subtypes. Immunosuppression was associated with worse outcomes, underscoring the need for intensified follow-up. SLNB was rarely performed, and larger studies are needed to assess its role. Full article
(This article belongs to the Special Issue Skin Diseases and Dermatologic Comorbidities)
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12 pages, 1850 KiB  
Article
Pancreatic Cancer with Liver Oligometastases—Different Patterns of Disease Progression May Suggest Benefits of Surgical Resection
by Nedaa Mahamid, Arielle Jacover, Angam Zabeda, Tamar Beller, Havi Murad, Yoav Elizur, Ron Pery, Rony Eshkenazy, Talia Golan, Ido Nachmany and Niv Pencovich
J. Clin. Med. 2025, 14(15), 5538; https://doi.org/10.3390/jcm14155538 - 6 Aug 2025
Viewed by 314
Abstract
Background: Pancreatic adenocarcinoma (PDAC) with liver oligometastases (LOM) presents a therapeutic challenge, with optimal management strategies remaining uncertain. This study evaluates the long-term outcomes, patterns of disease progression, and potential factors influencing prognosis in this patient subset. Methods: Patients diagnosed with PDAC and [...] Read more.
Background: Pancreatic adenocarcinoma (PDAC) with liver oligometastases (LOM) presents a therapeutic challenge, with optimal management strategies remaining uncertain. This study evaluates the long-term outcomes, patterns of disease progression, and potential factors influencing prognosis in this patient subset. Methods: Patients diagnosed with PDAC and LOM were retrospectively analyzed. Disease progression patterns, causes of death, and predictors of long-term outcomes were assessed. Results: Among 1442 patients diagnosed with metastatic PDAC between November 2009 and July 2024, 129 (9%) presented with LOM, defined as ≤3 liver lesions each measuring <2 cm. Patients with LOM had significantly improved overall survival (OS) compared to those with high-burden disease (p = 0.026). The cause of death (local regional disease vs. systemic disease) could be determined in 74 patients (57%), among whom age at diagnosis, history of smoking, and white blood cell (WBC) count differed significantly between groups. However, no significant difference in OS was observed between the two groups (p = 0.64). Sixteen patients (22%) died from local complications of the primary tumor, including 6 patients (7%) who showed no evidence of new or progressive metastases. In competing risk and multivariable analysis, a history of smoking remained the only factor significantly associated with death due to local complications. Conclusions: Approximately one in five patients with PDAC-LOM died from local tumor-related complications—some without metastatic progression—highlighting a potential role for surgical intervention. Further multicenter studies are warranted to refine diagnostic criteria and better identify patients who may benefit from surgery. Full article
(This article belongs to the Section General Surgery)
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19 pages, 1856 KiB  
Article
Combination Therapy with Trehalose and Hyaluronic Acid Restores Tear Lipid Layer Functionality by Ameliorating Inflammatory Response Protein Markers on the Ocular Surface of Dry Eye Patients
by Natarajan Perumal, Caroline Manicam, Eunjin Jeong, Sarah Runde, Norbert Pfeiffer and Franz H. Grus
J. Clin. Med. 2025, 14(15), 5525; https://doi.org/10.3390/jcm14155525 - 5 Aug 2025
Viewed by 734
Abstract
Objectives: Topical lubricants are the fundamental treatment for dry eye disease (DED). However, the molecular mechanisms underlying their efficacy remain unknown. Here, the protective effects of Thealoz® Duo with 3% trehalose and 0.15% hyaluronic acid are investigated in DED patients by a [...] Read more.
Objectives: Topical lubricants are the fundamental treatment for dry eye disease (DED). However, the molecular mechanisms underlying their efficacy remain unknown. Here, the protective effects of Thealoz® Duo with 3% trehalose and 0.15% hyaluronic acid are investigated in DED patients by a longitudinal clinical study and subsequent elucidation of the tear proteome and cell signaling changes. Methods: Participants were classified as moderate to severe DED (DRY, n = 35) and healthy (CTRL, n = 23) groups. Specific DED subgroups comprising evaporative (DRYlip) and aqueous-deficient with DRYlip (DRYaqlip) were also classified. Only DED patients received Thealoz® Duo. All participants were clinically examined before (day 0, T1) and after the application of Thealoz® Duo at day 28 (T2) and day 56 (T3). Next, 174 individual tear samples from all groups at three time-points were subjected to proteomics analysis. Results: Clinically, Thealoz® Duo significantly improved the ocular surface disease index at T2 vs. T1 (DRY, p = 1.4 × 10−2; DRYlip, p = 9.2 × 10−3) and T3 vs. T1 (DRY, p = 2.1 × 10−5; DRYlip, p = 1.2 × 10−4), and the tear break-up time at T3 vs. T1 (DRY, p = 3.8 × 10−2; DRYlip, p = 1.4 × 10−2). Thealoz® Duo significantly ameliorated expression of inflammatory response proteins (p < 0.05) at T3, which was observed at T1 (DRY, p = 3.4 × 10−4; DRYlip, p = 7.1 × 10−3; DRYaqlip, p = 2.7 × 10−8). Protein S100-A8 (S100A8), Alpha-1-antitrypsin (SERPINA1), Annexin A1 (ANXA1), and Apolipoprotein A-I (APOA1) were found to be significantly reduced in all the DED subgroups. The application of Thealoz® Duo showed the therapeutic characteristic of the anti-inflammatory mechanism by promoting the expression of (Metalloproteinase inhibitor 1) TIMP1 in all the DED subgroups. Conclusions: Thealoz® Duo substantially improved the DED symptoms and restored the functionality of the tear lipid layer to near normal in DRYlip and DRY patients by ameliorating inflammation. Notably, this study unravels the novel mechanistic alterations underpinning the healing effects of Thealoz® Duo in DED subgroups in a time-dependent manner, which supports the improvement in corresponding clinical attributes. Full article
(This article belongs to the Section Ophthalmology)
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22 pages, 688 KiB  
Review
The Evolving Treatment Landscape for the Elderly Multiple Myeloma Patient: From Quad Regimens to T-Cell Engagers and CAR-T
by Matthew James Rees and Hang Quach
Cancers 2025, 17(15), 2579; https://doi.org/10.3390/cancers17152579 - 5 Aug 2025
Viewed by 550
Abstract
Multiple myeloma (MM) is predominantly a disease of the elderly. In recent years, a surge of highly effective plasma cell therapies has revolutionized the care of elderly multiple myeloma (MM) patients, for whom frailty and age-related competing causes of mortality determine management. Traditionally, [...] Read more.
Multiple myeloma (MM) is predominantly a disease of the elderly. In recent years, a surge of highly effective plasma cell therapies has revolutionized the care of elderly multiple myeloma (MM) patients, for whom frailty and age-related competing causes of mortality determine management. Traditionally, the treatment of newly diagnosed elderly patients has centered on doublet or triplet combinations composed of immunomodulators (IMIDs), proteasome inhibitors (PIs), anti-CD38 monoclonal antibodies (mAbs), and corticosteroids producing median progression-free survival (PFS) rates between 34 and 62 months. However, recently, a series of large phase III clinical trials examining quadruplet regimens of PIs, IMIDs, corticosteroids, and anti-CD38 mAbs have shown exceptional outcomes, with median PFS exceeding 60 months, albeit with higher rates of peripheral neuropathy (≥Grade 2: 27% vs. 10%) when PIs and IMIDs are combined, and infections (≥Grade 3: 40% vs. 29–41%) with the addition of anti-CD38mAbs. The development of T-cell redirecting therapies including T-cell engagers (TCEs) and CAR-T cells has further expanded the therapeutic arsenal. TCEs have shown exceptional activity in relapsed disease and are being explored in the newly diagnosed setting with promising early results. However, concerns remain regarding the logistical challenges of step-up dosing, which often necessitates inpatient admission, the infectious risks, and the financial burden associated with TCEs in elderly patients. CAR-T, the most potent commercially available therapy for MM, offers the potential of a ‘one and done’ approach. However, its application to elderly patients has been tempered by significant concerns of cytokine release syndrome, early and delayed neurological toxicity, and its overall tolerability in frail patients. Robust data in frail patients are still needed. How CAR-T and TCEs will be sequenced among the growing therapeutic armamentarium for elderly MM patients remains to be determined. This review explores the safety, efficacy, cost, and logistical barriers associated with the above treatments in elderly MM patients. Full article
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23 pages, 2663 KiB  
Article
How Nanofluids May Enhance Energy Efficiency and Carbon Footprint in Buildings?
by Sylwia Wciślik
Sustainability 2025, 17(15), 7035; https://doi.org/10.3390/su17157035 - 2 Aug 2025
Viewed by 377
Abstract
Nanofluids are an innovative working medium in solar hot water installations (DHWs), thanks to their increased thermal conductivity and heat transfer coefficient. The aim of this work was to assess the effect of Al2O3 nanofluids in a water–ethylene glycol base [...] Read more.
Nanofluids are an innovative working medium in solar hot water installations (DHWs), thanks to their increased thermal conductivity and heat transfer coefficient. The aim of this work was to assess the effect of Al2O3 nanofluids in a water–ethylene glycol base (40:60%) and with the addition of Tween 80 surfactant (0.2 wt%) on thermal efficiency (ε) and exergy (ηex) in a plate heat exchanger at DHW flows of 3 and 12 L/min. The numerical NTU–ε model was used with dynamic updating of thermophysical properties of nanofluids and the solution of the ODE system using the ode45 method, and the validation was carried out against the literature data. The results showed that the nanofluids achieved ε ≈ 0.85 (vs. ε ≈ 0.87 for the base fluid) and ηex ≈ 0.72 (vs. ηex ≈ 0.74), with higher entropy generation. The addition of Tween 80 reduced the viscosity by about 10–15%, resulting in a slight increase of Re and h-factor; however, the impact on ε and ηex was marginal. The environmental analysis with an annual demand of Q = 3000 kWh/year and an emission factor of 0.2 kg CO2/kWh showed that for ε < 0.87 the nanofluids increased the emissions by ≈16 kg CO2/year, while at ε ≈ 0.92, a reduction of ≈5% was possible. This paper highlights the need to optimize nanofluid viscosity and exchanger geometry to maximize energy and environmental benefits. Nowadays, due to the growing problems of global warming, the analysis of energy efficiency and carbon footprint related to the functioning of a building seems to be crucial. Full article
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14 pages, 3410 KiB  
Article
Gut Hormones and Postprandial Metabolic Effects of Isomaltulose vs. Saccharose Consumption in People with Metabolic Syndrome
by Jiudan Zhang, Dominik Sonnenburg, Stefan Kabisch, Stephan Theis, Margrit Kemper, Olga Pivovarova-Ramich, Domenico Tricò, Sascha Rohn and Andreas F. H. Pfeiffer
Nutrients 2025, 17(15), 2539; https://doi.org/10.3390/nu17152539 - 1 Aug 2025
Viewed by 338
Abstract
Background: Low-glycemic index (GI) carbohydrates like isomaltulose (ISO) are known to enhance incretin release and to improve postprandial glucose control at the following meal (an effect known as second meal effect, or SME), which is particularly beneficial for individuals with metabolic syndrome (MetS). [...] Read more.
Background: Low-glycemic index (GI) carbohydrates like isomaltulose (ISO) are known to enhance incretin release and to improve postprandial glucose control at the following meal (an effect known as second meal effect, or SME), which is particularly beneficial for individuals with metabolic syndrome (MetS). This study aimed to assess the most effective preprandial interval of ISO- or saccharose (SUC) snacks (1 h vs. 3 h preload) to enhance prandial incretin responses to a subsequent meal. Methods: In a randomized crossover design, 15 participants with MetS completed four experimental conditions on four non-consecutive days, combining two preload types (ISO or SUC) and two preload timings (Intervention A: 3 h preload; Intervention B: 1 h preload). Specifically, the four conditions were (1) ISO + Intervention A, (2) SUC + Intervention A, (3) ISO + Intervention B, and (4) SUC + Intervention B. The order of conditions was randomized and separated by a 3–7-day washout period to minimize carryover effects. On each study day, participants consumed two mixed meal tests (MMT-1 and MMT-2) with a standardized preload (50 g ISO or SUC) administered either 3 h or 1 h prior to MMT-2. Blood samples were collected over 9 h at 15 predefined time points for analysis of glucose, insulin, C-peptide, and incretin hormones (GLP-1, GIP, and PYY). Results: The unique digestion profile of ISO resulted in a blunted glucose ascent rate (ΔG/Δt: 0.28 vs. 0.53 mmol/L/min for SUC, p < 0.01), paralleled by synonyms PYY elevation over 540 min monitoring, compared with SUC. ISO also led to higher and more sustained GLP-1 and PYY levels, while SUC induced a stronger GIP response. Notably, the timing of ISO consumption significantly influenced PYY secretion, with the 3 h preload showing enhanced PYY responses and a more favorable SME compared to the 1 h preload. Conclusions: ISO, particularly when consumed 3 h before a meal (vs. 1 h), offers significant advantages over SUC by elevating PYY levels, blunting the glucose ascent rate, and sustaining GLP-1 release. This synergy enhances the second meal effect, suggesting ISO’s potential for managing postprandial glycemic excursions in MetS. Full article
(This article belongs to the Section Nutrition and Metabolism)
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11 pages, 708 KiB  
Article
The Role of 6-Hour ECG in Patients with Left Bundle Branch Block After TAVI in Determining Same-Day Discharge
by Muntaser Omari, Saif Memon, Debbie Stewart, Mohamed Ali, Richard Edwards, Rajiv Das, Timothy Cartlidge, Azfar Zaman, Mohamed Farag and Mohammad Alkhalil
J. Clin. Med. 2025, 14(15), 5408; https://doi.org/10.3390/jcm14155408 - 31 Jul 2025
Viewed by 441
Abstract
Background: Left bundle branch block (LBBB) following trans-catheter aortic valve implantation (TAVI) has been excluded from same-day discharge. Early identification of patients with stable LBBB can help facilitate same-day discharge. We aim to assess the role of 6-hour ECG to determine development [...] Read more.
Background: Left bundle branch block (LBBB) following trans-catheter aortic valve implantation (TAVI) has been excluded from same-day discharge. Early identification of patients with stable LBBB can help facilitate same-day discharge. We aim to assess the role of 6-hour ECG to determine development of LBBB in patients undergoing TAVI. Methods: This is a prospective single-centre study of patients who have LBBB following elective TAVI procedures. All patients underwent ECGs pre-TAVI, as well as immediately, 6 h, and 24 h post-TAVI. Changes in ECG were compared at 6 and 24 h with the one immediately post TAVI. Results: The study included 115 patients with uncomplicated procedures. The mean age was 81 ± 7 years, with 54% male. A self-expanding valve was used in 67% of patients. Following TAVI, prolongations of PR interval and QRS duration were dynamic and reduced at 6 h. The change in PR interval at 6 and 24 h was comparable [−11 (−20 to 3) vs. −2 (−24 to 16) ms, p = 0.18]. Similarly, there was no statistical difference in the change of QRS duration at 6 and 24 h compared to the ECG immediately post-TAVI [−10 (−40 to −2) vs. −7 (−34 to 0) ms, p = 0.055]. Changes in ECG were also comparable in patients undergoing balloon-expandable and self-expanding valves. Conclusions: The current study supports that 6-hour ECG has the potential to reduce the need for prolonged continuous monitoring post-TAVI. ECG at 6 h can help optimise patient flow and facilitate early discharge. Future studies with larger sample sizes are required to confirm our findings. Full article
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