Journal of Clinical Medicine

16 pages, 1770 KiB

Open AccessArticle

The Impact of Diabetes Mellitus and Metformin Use on Outcomes After Endovascular Aneurysm Repair

by Tara A. R. van Merrienboer, Veerle Warlich, Suzanne Holewijn, Wouter Driessen, Kak K. Yeung and Michel M. P. J. Reijnen

J. Clin. Med. 2025, 14(1), 295; https://doi.org/10.3390/jcm14010295 - 6 Jan 2025

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Abstract

Objective: To study the influence of diabetes mellitus (DM) and metformin treatment on aneurysm sac remodeling after endovascular aneurysm repair (EVAR). Methods: A retrospective single-center cohort analysis was conducted on consecutive patients who underwent elective EVAR for an infrarenal abdominal aortic [...] Read more.

Objective: To study the influence of diabetes mellitus (DM) and metformin treatment on aneurysm sac remodeling after endovascular aneurysm repair (EVAR). Methods: A retrospective single-center cohort analysis was conducted on consecutive patients who underwent elective EVAR for an infrarenal abdominal aortic aneurysm (AAA) between January 2011 and December 2021. Differences between study groups were analyzed and Kaplan–Meier analysis were employed to describe overall and reintervention-free survival. Cox regression analysis was performed to identify predictors of sac shrinkage. Results: A total of 529 patients were included: 74 (14.0%) had DM and metformin treatment, 26 (4.9%) had DM without metformin treatment, and 429 (81.1%) did not have DM. At one-year follow-up, diabetic patients showed significantly less sac shrinkage compared to non-diabetic patients (40.0% vs. 52.0%; p = 0.038), with a trend toward more stable sac behavior in diabetic patients (52% vs. 42%; p = 0.055). At last follow-up, sac shrinkage was significantly less in diabetic patients on metformin treatment compared to non-diabetics (48.6% vs. 59.9%; p = 0.047). No differences in sac shrinkage were observed between diabetics with and without metformin treatment. The presence of endoleak was significantly higher in groups showing stable sac behavior and growth. Through nine-year follow-up, overall survival was significantly less in diabetic patients compared to non-diabetic ones (23.5% vs. 37.5%; p < 0.001). Conclusions: This study showed a negative impact of diabetes mellitus and metformin treatment on sac shrinkage following EVAR. The presence of any type of endoleak was associated with reduced sac shrinkage at both time points. Overall survival was significantly lower in diabetic patients compared to non-diabetic patients. Full article

(This article belongs to the Section Vascular Medicine)

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12 pages, 1493 KiB

Open AccessArticle

Association of Physical Function, Quantity, and Quality of the Quadriceps with Postoperative Physical Activity Before Total Knee Arthroplasty

by Takaya Watabe, Takuya Sengoku, Goro Sakurai, Shinya Yoshida and Yuta Taniguchi

J. Clin. Med. 2025, 14(1), 294; https://doi.org/10.3390/jcm14010294 - 6 Jan 2025

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Abstract

Background/Objectives: This single-center cohort study investigated preoperative risk factors such as physical function, quantity, and quality of the quadriceps femoris for physical activity (PA) 1 year after total knee arthroplasty (TKA). Methods: This study included 204 patients with knee osteoarthritis who underwent TKA; [...] Read more.

Background/Objectives: This single-center cohort study investigated preoperative risk factors such as physical function, quantity, and quality of the quadriceps femoris for physical activity (PA) 1 year after total knee arthroplasty (TKA). Methods: This study included 204 patients with knee osteoarthritis who underwent TKA; they were divided into increased and decreased PA groups. Items with significant differences between the two groups in non-operative-side quadriceps strength, knee injury and osteoarthritis outcome scores (KOOS), Sport/Rec scores, operative-side cross-sectional area (CSA) of the vastus medialis (VM), and operative-side computed tomography attenuation values (CTV) of the vastus lateralis (VL) were fitted in the multiple logistic regression analysis. The cutoff value of the preoperative CSA of the VM required for PA to exceed the required points at 1 year postoperatively was calculated using the receiver operating characteristic (ROC) curve. Results: Multivariate logistic regression analysis showed that the non-operative-side quadriceps strength KOOS sport/rec, operative-side CSA of VM, and operative-side CTV of the VL were significantly associated with increased PA after TKA. The ROC-calculated cutoff value was 10.2 cm². Conclusions: These results suggested that preoperative muscle quantity and quality, particularly in the VM, could play important roles in postoperative PA outcomes after TKA. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 821 KiB

Open AccessArticle

Impact of Vision Defects on Tooth Shade Selection: A Comparative of Spectrophotometry and Shade Guides in a Cross-Sectional Clinical Study

by Mario Alvarado-Lorenzo, Eva Lozano-Garcia, Pedro Colino-Gallardo, Luis Daniel Pellicer Castillo, Victor Díaz-Flores García and Alfonso Alvarado-Lorenzo

J. Clin. Med. 2025, 14(1), 293; https://doi.org/10.3390/jcm14010293 - 6 Jan 2025

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Abstract

Introduction: Tooth shade selection is a fundamental factor in the success of dental restorations, and visual impairment may adversely affect this process. The aim of this cross-sectional clinical study was to determine whether visual impairment influences shade selection using two methods: spectrophotometry and [...] Read more.

Introduction: Tooth shade selection is a fundamental factor in the success of dental restorations, and visual impairment may adversely affect this process. The aim of this cross-sectional clinical study was to determine whether visual impairment influences shade selection using two methods: spectrophotometry and shade guides. Materials and Methods: The sample consisted of 2796 maxillary and mandibular teeth, and shade selection was measured subjectively with a shade guide (VITA Classic, VITA Zahnfabrik) and objectively with a spectrophotometer (VITA Easyshade^® V, VITA Zahnfabrik, Bad Säckingen, Germany). In all cases, three measurements were taken on each tooth, with a waiting time of 15 min between samples. Shade selection was compared between observers with normal vision, myopia, astigmatism, and hyperopia. Results: The results show that myopic subjects perceived the lower central incisors (2.63, p < 0.05), upper lateral incisors (2.42, p < 0.05), lower lateral incisors (2.34, p < 0.05), and lower canines (2.64, p < 0.05) more clearly. Non-astigmatic subjects perceived the lower second premolar as lighter than astigmatic subjects (−2.01, p < 0.05). Conclusions: It can be concluded that myopes see teeth more clearly, but no differences have been found in astigmatism and hyperopes. Full article

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

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10 pages, 878 KiB

Open AccessArticle

Robotic Rectus Abdominis Myoperitoneal Flap for Posterior Vaginal Wall Reconstruction: Experience at a Single Institution

by Noama Iftekhar, Kathryn Cataldo, Seungwon Jong Seo, Brett Allen, Casey Giles, Matthew William Kelecy, Joshua MacDavid and Richard C. Baynosa

J. Clin. Med. 2025, 14(1), 292; https://doi.org/10.3390/jcm14010292 - 6 Jan 2025

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Abstract

Background: The adoption of robotic surgery has been widespread and increasing amongst gynecologic surgeons given the ability to decrease morbidity. It is important that plastic surgeons adjust their reconstructive algorithm to ascertain the benefits of robotic-assisted surgery. Herein we report our outcomes of [...] Read more.

Background: The adoption of robotic surgery has been widespread and increasing amongst gynecologic surgeons given the ability to decrease morbidity. It is important that plastic surgeons adjust their reconstructive algorithm to ascertain the benefits of robotic-assisted surgery. Herein we report our outcomes of robotic-assisted rectus abdominis muscle reconstruction of the posterior vaginal wall along with a current literature review on robotic-assisted reconstructive pelvic surgery. Methods: An IRB-approved retrospective review was completed of all patients who underwent robotic pelvic reconstruction between 2016 and 2024 at a single institution. Patients who underwent posterior vaginal wall reconstruction utilizing a robotic-assisted rectus abdominis muscle (RRAM) were selected for final analysis. Results: Thirty-two patients were identified who underwent pelvic reconstruction using robotic surgical techniques. Five (mean age = 56.2, 32–72; mean BMI = 30.0, 24–39.9) underwent posterior vaginal wall reconstruction with an RRAM flap. Two patients (40%) had minor wound complications, and one patient (20%) had vaginal stenosis eight years after operation. None had major complications requiring a return to the OR or hospital admission. All patients went on to achieve successful healing. Conclusions: In the literature, robotic-assisted surgery has shown significant advantages, including reduced morbidity with decreased intra-operative blood loss, reduced pain, faster recovery, and shorter hospital stays. The RRAM flap for pelvic reconstruction is well tolerated in patients despite comorbidities and preserves the minimally invasive benefits of extirpative surgery. As the technology becomes more widely incorporated, it is important for plastic surgeons to integrate robotic surgical techniques into their practice. Full article

(This article belongs to the Special Issue Gynecological Surgery: New Clinical Insights and Challenges)

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31 pages, 4653 KiB

Open AccessReview

Examining Cough’s Role and Relief Strategies in Interstitial Lung Disease

by Chee Yao Lim, Sanam Wasim Khan, Tarek Alsibai and Gayathri Sathiyamoorthy

J. Clin. Med. 2025, 14(1), 291; https://doi.org/10.3390/jcm14010291 - 6 Jan 2025

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Abstract

Chronic cough is a distressing and prevalent symptom in interstitial lung disease (ILD), significantly impairing quality of life (QoL) and contributing to disease progression, particularly in idiopathic pulmonary fibrosis (IPF). It is associated with physical discomfort, psychological distress, and social isolation and is [...] Read more.

Chronic cough is a distressing and prevalent symptom in interstitial lung disease (ILD), significantly impairing quality of life (QoL) and contributing to disease progression, particularly in idiopathic pulmonary fibrosis (IPF). It is associated with physical discomfort, psychological distress, and social isolation and is often refractory to conventional therapies. The pathophysiology of cough in ILD is complex and multifactorial, involving neural hypersensitivity, structural lung changes, inflammatory processes, and comorbid conditions such as gastroesophageal reflux disease (GERD). Evaluating cough in ILD relies on subjective and objective tools to measure its severity, frequency, and impact on daily life, although standardization of these measures remains challenging. Management strategies span pharmacological interventions, including neuromodulators such as opiates, antifibrotic agents, pharmacologic and surgical GERD treatments, and non-pharmacological approaches like behavioral therapies, cough suppression techniques, and pulmonary rehabilitation and physiotherapy. Emerging treatments, such as P2X3 receptor antagonists and airway hydration therapies, offer promising avenues but require further investigation through robust clinical trials. This review aims to demonstrate the importance of addressing cough in ILD as a significant symptom and present objective and subjective methods of quantifying coughs, while providing insights into effective and emerging therapeutic options. By highlighting these potential therapies, we hope to guide healthcare practitioners in considering them through a thorough evaluation of benefits and risks on a case-by-case basis, with relevance both in the U.S. and internationally. Full article

(This article belongs to the Special Issue Updates on Interstitial Lung Disease)

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10 pages, 1799 KiB

Open AccessArticle

Macular Pigment Changes and Visual Recovery Following Successful Full-Thickness Macular Hole Closure Using the Inverted Flap Technique

by Michele Rinaldi, Nicola Galantuomo, Maria Laura Passaro, Gilda Cennamo, Flavia Chiosi and Ciro Costagliola

J. Clin. Med. 2025, 14(1), 290; https://doi.org/10.3390/jcm14010290 - 6 Jan 2025

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Abstract

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, [...] Read more.

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, cross-sectional, comparative study included 16 eyes from FTMH patients who achieved anatomical hole closure following pars plana vitrectomy with the inverted ILM flap technique. Each eye underwent a comprehensive ophthalmologic examination, including BCVA and intraocular pressure measurements, anterior segment evaluation, fundus examination, and macular assessment with Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT, Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany). Macular pigment optical density (MPOD) was measured using one-wavelength reflectometry (Visucam 200, Zeiss Meditec, Jena, Germany). These evaluations were conducted preoperatively and at 1, 3, and 6 months postoperatively to assess changes over time and correlate MPOD with visual outcomes. Results: Significant baseline differences were observed between FTMH patients and controls for BCVA, mean MPOD, maximum MPOD, and MPOD volume (p < 0.05). Postoperative BCVA improved significantly (p = 0.0011), with a notable increase in MPOD volume at 6 months (p = 0.01). A positive correlation was found between BCVA improvement and MPOD volume increase (r = 0.739; p = 0.002). Conclusions: In conclusion, MPOD measurement may serve as a valuable addition to the follow-up of FTMH surgery, providing insights into photoreceptor function and macular metabolic activity, potentially correlating with visual recovery. Further longitudinal studies are needed to clarify its relationship with clinical variables, such as metamorphopsia and OCT microstructural findings. Full article

(This article belongs to the Section Ophthalmology)

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15 pages, 1251 KiB

Open AccessArticle

A β-Thalassemia Cell Biobank: Updates, Further Validation in Genetic and Therapeutic Research and Opportunities During (and After) the COVID-19 Pandemic

by Roberto Gambari, Maria Rita Gamberini, Lucia Carmela Cosenza, Cristina Zuccato and Alessia Finotti

J. Clin. Med. 2025, 14(1), 289; https://doi.org/10.3390/jcm14010289 - 6 Jan 2025

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Abstract

Background: Cellular biobanks are of great interest for performing studies finalized in the development of personalized approaches for genetic diseases, including β-thalassemia and sickle cell disease (SCD), important diseases affecting the hematopoietic system. These inherited genetic diseases are characterized by a global [...] Read more.

Background: Cellular biobanks are of great interest for performing studies finalized in the development of personalized approaches for genetic diseases, including β-thalassemia and sickle cell disease (SCD), important diseases affecting the hematopoietic system. These inherited genetic diseases are characterized by a global distribution and the need for intensive health care. The aim of this report is to present an update on the composition of a cellular Thal-Biobank, to describe its utilization since 2016, to present data on its application in studies on fetal hemoglobin induction and on gene editing, and to discuss its employment as a “unique tool” during and after the COVID-19 pandemic. Methods: The methods were as follows: freezing, cryopreservation, long-term storage, and thawing of erythroid precursor cells from β-thalassemia patients; fetal hemoglobin (HbF) induction; CRISPR-Cas9 gene editing; HPLC analysis of the hemoglobin pattern. Results: The updated version of the Thal-Biobank is a cellular repository constituted of 990 cryovials from 221 β-thalassemia patients; the phenotype (pattern of hemoglobin production) is maintained after long-term storage; fetal hemoglobin induction and CRISPR-Cas9 gene editing can be performed using biobanked cells. In representative experiments using an isoxazole derivative as HbF inducer, the HbF increased from 13.36% to more than 60%. Furthermore, in CRIPR/Cas9 gene editing, de novo production of HbA was obtained (42.7% with respect to the trace amounts found in untreated cells). Conclusions: The implemented Thal-Biobank was developed before the COVID-19 outbreak and should be considered a tool of great interest for researchers working on β-thalassemia, with the aim of developing innovative therapeutic protocols and verifying the impact of the COVID-19 pandemic on erythroid precursor cells. Full article

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

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17 pages, 2236 KiB

Open AccessArticle

Approach to Mental Health Through a Frequency Modulated Auditory Intervention: A Controlled and Randomized Clinical Trial

by Beatriz Estalayo-Gutiérrez, María José Álvarez Pasquín and Francisco Germain

J. Clin. Med. 2025, 14(1), 288; https://doi.org/10.3390/jcm14010288 - 6 Jan 2025

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Abstract

Objective: The clinical trial Effect of Modulated Auditory Stimulation on Interaural Auditory Perception (NCT0544189) aimed to determine whether an auditory intervention (AI)—“Bérard in 10”—can enhance the effect of standard therapies for people with anxiety and/or depression. Methods: Design: unblinded, randomized, controlled [...] Read more.

Objective: The clinical trial Effect of Modulated Auditory Stimulation on Interaural Auditory Perception (NCT0544189) aimed to determine whether an auditory intervention (AI)—“Bérard in 10”—can enhance the effect of standard therapies for people with anxiety and/or depression. Methods: Design: unblinded, randomized, controlled clinical trial. Location: Mejorada del Campo Health Centre, Madrid (Primary Care). Participants: A total of 233 patients selected by systematic sampling and meeting the following selection criteria: age of majority, absence of severe acute pathology or chronic decompensated pathology. They were evaluated with the Goldberg and Hamilton tests and classified into the Emotional Well-Being group (EWB, n = 86) or the Anxiety and/or Depression group (AD, n = 147). Just half of each group received an AI. Intervention: Listening to classical music processed through a frequency modulator (Earducator) to attenuate abnormal frequencies, 30 min per session, two sessions a day for 5 days. Main measurements: Hamilton Tests for Anxiety and Hamilton Test for Depression, at 3 and 6 months. Results: In the analysis by protocol, EWB with AI (n = 14) obtained lower scores in anxiety and depression at 3 and 6 months than EWB without AI (n = 36) (p < 0.05), the effects being large and moderate, respectively; AD with AI (n = 31) had lower scores on anxiety and depression at 3 months and anxiety at 6 months than AD without AI (n = 52) (p < 0.05), the effect being small. No damage reported. Conclusions: The AI “Bérard in 10” significantly prevents the onset of anxiety and depression and somewhat improves the effect of standard treatments in primary care. Full article

(This article belongs to the Section Mental Health)

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10 pages, 391 KiB

Open AccessSystematic Review

Effects of Animal-Assisted Therapy for Anxiety Reduction in Children and Adolescents: A Systematic Review

by Constança Brandão, Maria Sampaio, Valéria Sousa-Gomes, Marisalva Fávero and Diana Moreira

J. Clin. Med. 2025, 14(1), 287; https://doi.org/10.3390/jcm14010287 - 6 Jan 2025

Viewed by 871

Abstract

Background: Animal-Assisted Therapy (AAT) is a clinical approach aimed at building valuable human–animal relationships with both preventive and therapeutic goals. It is provided by a healthcare professional and involves animals (meeting certain criteria) as an integral part of the treatment process. This [...] Read more.

Background: Animal-Assisted Therapy (AAT) is a clinical approach aimed at building valuable human–animal relationships with both preventive and therapeutic goals. It is provided by a healthcare professional and involves animals (meeting certain criteria) as an integral part of the treatment process. This type of therapy has been shown to have multiple benefits in several areas, such as reducing anxiety in a variety of different groups of people. However, few studies have specifically investigated the benefits of AAT in reducing anxiety in children and adolescents. This systematic review aimed to comprehensively assess the evidence regarding the effectiveness of AAT in reducing anxiety among children and adolescents while also identifying research gaps in this field. Methods: Studies focusing on the relationship of these two variables were obtained from multiple databases (EBSCO, PubMed, and Web of Science). Results: AAT has grown and the literature demonstrates several benefits of this approach. However, few studies have demonstrated the benefits of AAT for reducing anxiety in children and adolescents. Conclusions: Most of these few studies show that this type of intervention can help reduce anxiety levels. Full article

(This article belongs to the Section Clinical Pediatrics)

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20 pages, 578 KiB

Open AccessReview

Artificial Intelligence in Sepsis Management: An Overview for Clinicians

by Elena Giovanna Bignami, Michele Berdini, Matteo Panizzi, Tania Domenichetti, Francesca Bezzi, Simone Allai, Tania Damiano and Valentina Bellini

J. Clin. Med. 2025, 14(1), 286; https://doi.org/10.3390/jcm14010286 - 6 Jan 2025

Viewed by 1050

Abstract

Sepsis is one of the leading causes of mortality in hospital settings, and early diagnosis is a crucial challenge to improve clinical outcomes. Artificial intelligence (AI) is emerging as a valuable resource to address this challenge, with numerous investigations exploring its application to [...] Read more.

Sepsis is one of the leading causes of mortality in hospital settings, and early diagnosis is a crucial challenge to improve clinical outcomes. Artificial intelligence (AI) is emerging as a valuable resource to address this challenge, with numerous investigations exploring its application to predict and diagnose sepsis early, as well as personalizing its treatment. Machine learning (ML) models are able to use clinical data collected from hospital Electronic Health Records or continuous monitoring to predict patients at risk of sepsis hours before the onset of symptoms. Background/Objectives: Over the past few decades, ML and other AI tools have been explored extensively in sepsis, with models developed for the early detection, diagnosis, prognosis, and even real-time management of treatment strategies. Methods: This review was conducted according to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research Type) framework to define the study methodology. A critical overview of each paper was conducted by three different reviewers, selecting those that provided original and comprehensive data relevant to the specific topic of the review and contributed significantly to the conceptual or practical framework discussed, without dwelling on technical aspects of the models used. Results: A total of 194 articles were found; 28 were selected. Articles were categorized and analyzed based on their focus—early prediction, diagnosis, mortality or improvement in the treatment of sepsis. The scientific literature presents mixed outcomes; while some studies demonstrate improvements in mortality rates and clinical management, others highlight challenges, such as a high incidence of false positives and the lack of external validation. This review is designed for clinicians and healthcare professionals, and aims to provide an overview of the application of AI in sepsis management, reviewing the main studies and methodologies used to assess its effectiveness, limitations, and future potential. Full article

(This article belongs to the Special Issue Sepsis: New Insights into Diagnosis and Treatment)

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12 pages, 266 KiB

Open AccessArticle

Non-Classical Complications of Adult-Onset Still’s Disease: A Multicenter Spanish Study

by Javier Narváez, Judith Palacios-Olid, María Jesús García de Yebenes, Susana Holgado, Alejandro Olivé, Ivette Casafont-Solé, Santos Castañeda, Cristina Valero-Martínez, María Martín-López, Patricia E. Carreira, Maribel Mora-Limiñana, Laura Nuño-Nuño, Angel Robles-Marhuenda, Pilar Bernabeu, José Campos, Jenaro Graña, Vera Ortiz-Santamaria, Marisol Camacho-Lovillo, Carmen Vargas, Judith Sanchez-Manubens and Jordi Anton Show full author list Hide full author list

J. Clin. Med. 2025, 14(1), 285; https://doi.org/10.3390/jcm14010285 - 6 Jan 2025

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Abstract

Objective: To investigate the prevalence and clinical spectrum of atypical or non-classical complications in adult-onset Still’s disease (AOSD) beyond macrophage activation syndrome (MAS) and to identify factors linked to their occurrence. Methods: Multicenter cross-sectional study of AODS cases included in the Spanish registry [...] Read more.

Objective: To investigate the prevalence and clinical spectrum of atypical or non-classical complications in adult-onset Still’s disease (AOSD) beyond macrophage activation syndrome (MAS) and to identify factors linked to their occurrence. Methods: Multicenter cross-sectional study of AODS cases included in the Spanish registry on Still’s disease. Results: This study included 107 patients (67% women), of whom 64 (59.8%) developed non-classical complications. These include macrophage activation syndrome in 9.5%, atypical skin manifestations in 38.8%, cardiac involvement in 22.7% (comprising pericarditis, myocarditis, pulmonary arterial hypertension, and noninfectious endocarditis), pleuritis in 28.9%, transient pulmonary infiltrates in 4%, significant headache in 14.1%, lower abdominal pain with evidence of peritonitis in 8.4%, and secondary amyloidosis in 0.9%. In the multivariate logistic regression analysis, lymphadenopathy (OR 2.85, 95% CI 1.03–7.91, p = 0.044) and the systemic score system (SSC) index (OR 1.86, 95% CI 1.29–2.69, p = 0.001) were independently associated with the development of non-classical clinical manifestations. In contrast, typical exanthema was associated with a reduced risk of these complications (OR 0.32, 95% CI 0.11–0.95, p = 0.041). Conclusions: In addition to the typical clinical manifestations and MAS, a significant proportion of patients with AOSD develop uncommon complications, some of which can be potentially life-threatening. These should be considered in the evaluation and follow-up of patients. Early recognition and prompt management are crucial to significantly reduce morbidity and mortality. Full article

(This article belongs to the Special Issue Systemic Autoinflammatory Diseases—Clinical Rheumatic Challenges: 3rd Edition)

10 pages, 715 KiB

Open AccessArticle

Open vs. Robot-Assisted Artificial Urinary Sphincter Implantation in Women with Stress Urinary Incontinence: A Multicenter Comparative Study

by Alexandre Dubois, Grégoire Capon, Olivier Belas, Adrien Vidart, Andrea Manunta, Juliette Hascoet, Lucas Freton, Frederic Thibault, Vincent Cardot, Frédéric Dubois, Luc Corbel, Emmanuel Della Negra, François Haab, Laurence Peyrat, Jean-Nicolas Cornu, Philippe Grise, Aurélien Descazeaud, Georges Fournier and Benoit Peyronnet

J. Clin. Med. 2025, 14(1), 284; https://doi.org/10.3390/jcm14010284 - 6 Jan 2025

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Abstract

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary [...] Read more.

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary studies using robotic techniques have shown promising results, but only one small study has compared robotic to open procedures. This study aims to compare the outcomes of robotic and open artificial urinary sphincter implantation in women with stress urinary incontinence due to intrinsic sphincter deficiency in a large multicenter cohort. Methods: Data were collected retrospectively from female patients who underwent open or robot-assisted artificial urinary sphincter implantation from 2006 to 2020 at 12 urology departments. The primary outcome was the rate of complications within 30 days after surgery, graded using the Clavien-Dindo Classification. Perioperative and functional outcomes were compared between the two groups. Results: A total of 135 patients were included, with 71 in the robotic group and 64 in the open group. The open group had a higher rate of intraoperative complications (27.4% vs. 12.7%; p = 0.03) and postoperative complications (46.8% vs. 15.5%; p < 0.0001). More patients in the robotic group achieved full continence (83.3% vs. 62.3%; p = 0.01). The open group had higher explantation (27.4% vs. 1.4%; p < 0.0001) and revision rates (17.5% vs. 5.6%; p = 0.02). The estimated 1-year explantation-free survival rate was higher in the robotic group. (98.6% vs. 78.3%; p = 0.001). Conclusions: Robot-assisted implantation may reduce perioperative morbidity and improve functional outcomes compared to open implantation in women with stress urinary incontinence. Full article

(This article belongs to the Section Nephrology & Urology)

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16 pages, 1016 KiB

Open AccessSystematic Review

Effects of Hippotherapy and Horse-Riding Simulators on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review

by Antonio Ortega-Cruz, Víctor Sánchez-Silverio, Víctor Riquelme-Aguado, Jose Luis Alonso-Perez, Vanesa Abuín-Porras and Jorge Hugo Villafañe

J. Clin. Med. 2025, 14(1), 283; https://doi.org/10.3390/jcm14010283 - 6 Jan 2025

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Abstract

Background/Objectives: Cerebral palsy (CP) can have a negative impact on gross motor function. Conventional hippotherapy and horse-riding simulators (HRS) have shown promising results on gross motor function in populations with neurological disorders. This review aims to update the knowledge on the effectiveness [...] Read more.

Background/Objectives: Cerebral palsy (CP) can have a negative impact on gross motor function. Conventional hippotherapy and horse-riding simulators (HRS) have shown promising results on gross motor function in populations with neurological disorders. This review aims to update the knowledge on the effectiveness of hippotherapy on gross motor function in children with CP. Methods: A search was conducted in Academic Search Ultimate, CINAHL, Medline complete, and PEDro covering publications between 2012 and 2022. Two authors identified studies that met the inclusion criteria; a third author resolved discrepancies. Studies were included if they analyzed the effects of hippotherapy on the gross motor function of children with CP. The quality of the methodology was assessed according to the PEDro scale. Results: Of the 150 studies initially identified, 9 were included in this review. The studies showed fair (N = 3) and good (N = 6) methodological quality on the PEDro scale. The majority used conventional hippotherapy (N = 7), while a minority used HRS (N = 2). The most commonly used protocol for conventional hippotherapy was 1–2 sessions of 30–45 min per week for 8 weeks (N = 4), whereas for HRS, these protocols were varied. Seven studies on conventional hippotherapy and one study on HRS showed improvements in gross motor function. However, the hippotherapy protocols were not very standardized and the samples were neither homogeneous nor representative. Conclusions: Conventional hippotherapy and HRS appear to have evidence to support their benefits on gross motor function in children with CP. However, more clinical trials with standardized protocols and more representative samples are needed to confirm these effects. Full article

(This article belongs to the Special Issue Cerebral Palsy: Clinical Rehabilitation and Treatment)

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16 pages, 13004 KiB

Open AccessArticle

Removal of Spontaneously Fractured Leads with Their Proximal Ends in the Heart and Vasculature—Description of Different Approaches and Tools

by Andrzej Kutarski, Wojciech Jacheć, Radosław Pietura, Marek Czajkowski, Paweł Stefańczyk, Jarosław Kosior, Sebastian Sawonik and Dorota Nowosielecka

J. Clin. Med. 2025, 14(1), 282; https://doi.org/10.3390/jcm14010282 - 6 Jan 2025

Viewed by 453

Abstract

Background: Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal [...] Read more.

Background: Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal ends. Methods: Retrospective analysis of 72 cases from a database containing 3847 TLEs (transvenous lead extraction). Results: Most of the leads were passive, especially unipolar. Procedure complexity in such cases was high but with satisfying effectiveness (procedural success rate 93.06%) and independent of the position of the proximal end. The rate of major complications was 2.78%, which may be attributed to long implant duration (152.2 months). Extraction of such leads did not influence long-term survival. The femoral approach was most often used (62.50%). In 79.16% of leads, mechanical dissection was required. In 66.7%, proximal ends were strongly attached to the wall, and a loop had to be applied. In 15.28% of procedures, the lead was wrapped around a pig-tail catheter (“spaghetti twisting technique”). Conclusions: (1) Spontaneous lead fracture with the proximal ends migrated into the vascular space is a rare finding (1.87% of the TLE). (2) Removal of such leads requires the use of different approaches as well as dedicated and non-dedicated tools. (3) Despite a high level of procedure complexity, its effectiveness is high, with an acceptable rate of major complications. Full article

(This article belongs to the Special Issue Clinical Outcomes of Cardiac Surgery)

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13 pages, 679 KiB

Open AccessArticle

Exploring the Relationship Between Continuously Monitored Vital Signs, Clinical Deterioration, and Clinical Actions

by Roel V. Peelen, Yassin Eddahchouri, Ilse M. Spenkelink, Harry van Goor and Sebastian J. H. Bredie

J. Clin. Med. 2025, 14(1), 281; https://doi.org/10.3390/jcm14010281 - 6 Jan 2025

Viewed by 677

Abstract

Continuous monitoring on the general ward leads to more and earlier interventions to prevent clinical deterioration. These clinical actions influence outcomes and may serve as an indicator of impending deterioration. This study aims to correlate clinical actions with clinical endpoints and deviating vital [...] Read more.

Continuous monitoring on the general ward leads to more and earlier interventions to prevent clinical deterioration. These clinical actions influence outcomes and may serve as an indicator of impending deterioration. This study aims to correlate clinical actions with clinical endpoints and deviating vital signs. Methods: This cohort study prospectively charted all patients undergoing continuous vital sign monitoring on a gastro-intestinal and oncological surgery, and an internal ward of an academic hospital in The Netherlands from 1 August 2018 till 31 July 2019 (METC 2018-4330, NCT04189653). Clinical actions recorded in electronic medical records were analyzed to assess correlations with patient outcomes, hospital length of stay, and alarming monitoring minutes. Results: A total of 1529 patients were included, of which 68 patients had a negative clinical endpoint. There were 2749 clinical actions recorded. Clinical actions correlated to negative clinical endpoints (ρ = 0.259; p < 0.001, OR: 3.4 to 79.5) and to the length of stay (ρ = 0.560; p < 0.001). Vital sign deviations correlated with clinical actions (ρ = 0.025–0.056; p < 0.001–p = 0.018). In the last 72 h before a clinical endpoint, for alarming minutes, this correlation with clinical actions was more pronounced (ρ = 0.340, p < 0.001). Conclusions: Predefined clinical actions performed on admitted general ward patients correlated with negative endpoints, an increased length of stay, and with deviating vital signs, especially in the period directly preceding severe deterioration. Clinical actions have potential as an intermediate measurement of deterioration. Full article

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

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18 pages, 2438 KiB

Open AccessSystematic Review

Neonatal Feeding Practices and SARS-CoV-2 Transmission in Neonates with Perinatal SARS-CoV-2 Exposure: A Systematic Review and Meta-Analysis

by Kikelomo Babata, Rehena Sultana, Jean-Michel Hascoët, Riya Albert, Christina Chan, Kelly Mazzarella, Tanaz Muhamed, Kee Thai Yeo, Juin Yee Kong and Luc P. Brion

J. Clin. Med. 2025, 14(1), 280; https://doi.org/10.3390/jcm14010280 - 6 Jan 2025

Viewed by 744

Abstract

Background: The risk of neonatal SARS-CoV-2 infection from the mother’s own milk (MoM) in neonates who are exposed to maternal SARS-CoV-2 during the perinatal period remains unclear. We conducted a systematic review to assess the association between MoM feeding and neonatal SARS-CoV-2 infection [...] Read more.

Background: The risk of neonatal SARS-CoV-2 infection from the mother’s own milk (MoM) in neonates who are exposed to maternal SARS-CoV-2 during the perinatal period remains unclear. We conducted a systematic review to assess the association between MoM feeding and neonatal SARS-CoV-2 infection in neonates who were born to SARS-CoV-2-positive pregnant persons. Methods: PubMed Central and Google Scholar were searched for studies published by 14 March 2024 that reported neonatal SARS-CoV-2 infection by feeding type. This search, including Scopus, was updated on 17 December 2024. The primary outcome was neonatal SARS-CoV-2 infection. The meta-analysis was conducted using a random effects model with two planned subgroup analyses: time of maternal PCR testing (at admission vs. previous 2 weeks) and dyad handling (isolation vs. some precautions vs. variable/NA). Results: The primary outcome was available in both arms of nine studies, including 5572 neonates who received MoM and 2215 who received no MoM. The GRADE rating was low quality, because the studies were observational (cohorts). The frequency of SARS-CoV-2 infection was similar in both arms (2.7% MoM vs. 2.2% no MoM), with a common risk ratio of 0.82 (95% confidence interval 0.44, 1.53, p = 0.54). No significant differences were observed in the subgroup analyses. Limitations include observational and incomplete data, other possible infection sources, small sample sizes for subgroup analyses, and neonates with more than one feeding type. Conclusions: Feeding MoM was not associated with an increased risk of neonatal SARS-CoV-2 infection among neonates who were born to mothers with perinatal infection. These data, along with reports showing a lack of active replicating SARS-CoV-2 virus in MoM, further support women with perinatal SARS-CoV-2 infection feeding MoM. Registration: PROSPERO ID CRD42021268576. Full article

(This article belongs to the Section Infectious Diseases)

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9 pages, 2421 KiB

Open AccessArticle

Comparative Analysis of Liposuction and Conservative Treatment in Lipedema Patients: A Modified Body-Q Questionnaire Study

by Marie-Luise Aitzetmüller-Klietz, Mahmut Ozturk, Tobias Seefeldt, Philipp Wiebringhaus, Sascha Veiz Wellenbrock, Baksan Tav, Tobias Hirsch, Kamran Harati and Matthias Aitzetmüller-Klietz

J. Clin. Med. 2025, 14(1), 279; https://doi.org/10.3390/jcm14010279 - 6 Jan 2025

Viewed by 571

Abstract

Background: Despite its estimated high prevalence among women and increasing awareness, lipedema remains under-investigated. Ignoring its debilitating nature, surgical treatment for this condition is frequently covered by health insurance only in advanced stages and after the exhaustion of conservative therapies. Methods: [...] Read more.

Background: Despite its estimated high prevalence among women and increasing awareness, lipedema remains under-investigated. Ignoring its debilitating nature, surgical treatment for this condition is frequently covered by health insurance only in advanced stages and after the exhaustion of conservative therapies. Methods: A total of 1015 patients with lipedema were recruited via social media platforms. Of these, 860 patients provided answers to at least one complete section of the modified Body-Q questionnaire (response rate 85%). The Mann–Whitney U and Kruskal–Wallis tests were utilized to assess the impact of the surgical treatment by means of patient-reported outcomes on the self-perception of various body areas. Results: The satisfaction scores among conservatively treated patients for abdominal appearance, arms, back, body, buttocks, and inner thighs showed a statistically significant decline with increasing stages of lipedema. The comparison of patient evaluation scores in the appearance domain demonstrated better patient self-perception scores in patients who received at least one session of the surgical treatment for the hips and thighs (p < 0.01), inner thighs (p < 0.01), and excess skin (0.01) scales. On the body scale, the patients who underwent liposuction again reported better satisfaction scores; however, this did not reach statistical significance (p < 0.081). In the health-related quality of life domain, the patients who received liposuction treatment reported a better outcome in the body image (p < 0.01), physical function (p = 0.05), physical symptoms (p = 0.04), and psychological function (p < 0.01) scales. Conclusions: The current study underscores the burden of lipedema of affected patients and its negative impact on self-perception. As the disease progresses, conservatively treated patients experience a decline in satisfaction with various aspects of their appearance. However, surgical interventions, particularly liposuction, does not address esthetic concerns but significantly improve health-related quality of life across multiple domains, emphasizing the comprehensive benefits of surgical intervention in the management of lipedema. Full article

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

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10 pages, 512 KiB

Open AccessArticle

Utility of Abdominal Radiographs After Posterior Spinal Fusion for Neuromuscular Scoliosis

by Tyler A. Tetreault, Rachel Lai, Tiffany N. Phan, Kenneth D. Illingworth, David L. Skaggs, Tishya A. L. Wren and Lindsay M. Andras

J. Clin. Med. 2025, 14(1), 278; https://doi.org/10.3390/jcm14010278 - 6 Jan 2025

Viewed by 596

Abstract

Background/Objectives: Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between [...] Read more.

Background/Objectives: Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between ileus and mechanical obstruction but expose patients to radiation, add cost, and may lead to unnecessary work up. The aim of this study was to determine how often KUBs led to a change in treatment after PSF in patients with NMS. Methods: A retrospective review was conducted of NMS patients with ≥2-year follow-up treated with PSF between January 2014 and December 2019 at a tertiary pediatric hospital. Results: Of the 133 patients (age 13.7, SD 2.6 years; preoperative curve magnitude 82.8, SD 23.0 degrees; follow-up 44.7, SD 15.4 months), 22.6% (30/133) underwent KUB imaging due to abdominal pain, distension, or delayed return of bowel function. In total, 93.3% (28/30) of the KUB imaging was consistent with ileus. One KUB study resulted in a gastroenterology consultation and bowel cleanout, and one raised concerns regarding possible pneumatosis of the colon, prompting a pediatric surgery consultation and exploratory laparotomy which was unremarkable. Conclusions: KUBs were performed in nearly 25% of NMS patients during the acute postoperative period, but rarely provided useful diagnostic information leading to changes in management. In the presence of postoperative abdominal distension, feeding intolerance, and delayed return of bowel function, we advocate for continuing conservative measures until bowel function returns, reserving abdominal radiographs for patients with a worsening exam despite bowel rest or additional causes for concern. Full article

(This article belongs to the Section Clinical Neurology)

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11 pages, 2296 KiB

Open AccessArticle

Improving Sternal Closure Outcomes in Cardiac Surgery: Polyethylene Suture Tapes vs. Steel Wires

by Zain Khalpey, Ujjawal Aditya Kumar, Usman Aslam, Tyler Phillips, Zacharya Khalpey, Anthony Cooper and Robert Riley

J. Clin. Med. 2025, 14(1), 277; https://doi.org/10.3390/jcm14010277 - 6 Jan 2025

Viewed by 1725

Abstract

Background: Steel wires are often inadequate for sternal closure for patients at high risk of sternal complications. This study compares a novel sternal closure system to conventional steel wires to assess its potential to reduce sternal complication rates and improve clinical outcomes. Methods: [...] Read more.

Background: Steel wires are often inadequate for sternal closure for patients at high risk of sternal complications. This study compares a novel sternal closure system to conventional steel wires to assess its potential to reduce sternal complication rates and improve clinical outcomes. Methods: A retrospective study was conducted on 300 consecutive patients undergoing cardiac surgery via median sternotomy. A total of 150 patients underwent steel wire sternal closure, while 150 underwent suture tape closure. Preoperative, intraoperative, and postoperative data were collected and analyzed for both groups. Results: Rates of sternal wound infections (1% vs. 5%, p = 0.0363) and sternal dehiscence (0% vs. 5%, p = 0.0297) were lower in the suture tape group. Suture tape patients had significantly less pain at 14 and 30 days (p = 0.0002 and 0.0071). The requirement for sternal protection adjuncts was eliminated with suture tape closure. Sternal closure time was significantly shorter in the suture tape group (11 vs. 19 min, p < 0.0001). Conclusions: Suture tapes proved safe, feasible, and effective for sternal closure, demonstrating significant advantages for sternal closure over steel wires, with reduced rates of sternal dehiscence, infection, postoperative incisional pain, and closure time. These superior outcomes and the elimination of sternal protection adjuncts can potentially reduce healthcare costs. Our experiences suggest that this novel sternal closure system has significant potential, with larger prospective studies warranted to optimize sternal closure strategies. Full article

(This article belongs to the Special Issue Cardiac Surgery: Current Developments and Trends)

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7 pages, 208 KiB

Open AccessCase Report

An Atypical Case of Rhabdomyolysis Following an Atypical Antidepressant Overdose

by Raluca Ungureanu, Ana-Maria Dumitriu, Cristian Cobilinschi, Rǎzvan Ene, Mihaela Buiuc, Ioana Marina Grințescu and Liliana Mirea

J. Clin. Med. 2025, 14(1), 276; https://doi.org/10.3390/jcm14010276 - 6 Jan 2025

Viewed by 579

Abstract

Background: Bupropion, an atypical antidepressant and smoking cessation aid, is known for its potential to cause seizures, cardiotoxicity and neurotoxicity in overdose scenarios. However, overdoses may present variably, and muscular and renal complications, such as rhabdomyolysis and acute kidney injury (AKI), can [...] Read more.

Background: Bupropion, an atypical antidepressant and smoking cessation aid, is known for its potential to cause seizures, cardiotoxicity and neurotoxicity in overdose scenarios. However, overdoses may present variably, and muscular and renal complications, such as rhabdomyolysis and acute kidney injury (AKI), can emerge in unexpected ways. Previous reports have shown that severe overdoses can lead to a spectrum of complications, but the precise mechanisms linking bupropion overdose with rhabdomyolysis remain poorly understood. Clinical presentation: This paper presents the management of a severe rhabdomyolysis case following deliberate ingestion of 4 g of immediate-release bupropion. The report highlights the unexpected presentation of bupropion overdose, including a lack of typical neurotoxic or muscular symptoms, and the subsequent involvement of multiple factors in the decision to initiate early renal replacement therapy, despite the absence of overt acute kidney injury (AKI). Conclusions: This case underscores the importance of individualized patient assessment and the challenges of managing rare and complex drug overdoses. Early intervention with renal replacement therapy, despite the absence of acute kidney injury, may be justified in cases of significant rhabdomyolysis and potential renal complications. Clinicians should maintain a high degree of suspicion for complications like rhabdomyolysis in overdose scenarios and consider early renal support in patients at risk of renal failure, even in the absence of overt kidney injury. The findings also point to the need for a more nuanced approach to diagnosing and treating bupropion overdose in critically ill patients. Full article

(This article belongs to the Section Pharmacology)

11 pages, 487 KiB

Open AccessArticle

Clinical Outcomes of Cardiac Transplantation in Heart Failure Patients with Previous Mechanical Cardiocirculatory Support

by Michele D’Alonzo, Amedeo Terzi, Massimo Baudo, Mauro Ronzoni, Nicola Uricchio, Claudio Muneretto and Lorenzo Di Bacco

J. Clin. Med. 2025, 14(1), 275; https://doi.org/10.3390/jcm14010275 - 6 Jan 2025

Viewed by 557

Abstract

Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new [...] Read more.

Objectives: Heart failure (HF) remains a significant public health issue, with heart transplantation (HT) being the gold standard treatment for end-stage HF. The increasing use of mechanical circulatory support, particularly left ventricular assist devices (LVADs), as a bridge to transplant (BTT), presents new perspectives for increasingly complex clinical scenarios. This study aimed to compare long-term clinical outcomes in patients in heart failure with reduced ejection fraction (HFrEF) receiving an LVAD as BTT to those undergoing direct-to-transplant (DTT) without mechanical support, focusing on survival and post-transplant complications. Methods: A retrospective, single-center study included 105 patients who underwent HT from 2010. Patients were divided into two groups: BTT (n = 28) and DTT (n = 77). Primary endpoints included overall survival at 1 and 7 years post-HT. Secondary outcomes involved late complications, including organ rejection, renal failure, cardiac allograft vasculopathy (CAV), and cerebrovascular events. Results: At HT, the use of LVADs results in longer cardiopulmonary bypass and cross-clamping times in the BTT group; nevertheless, surgical complexity does not affect 30-day mortality. Survival at 1 year was 89.3% for BTT and 85.7% for DTT (p = 0.745), while at 7 years, it was 80.8% and 77.1%, respectively (p = 0.840). No significant differences were observed in the incidence of major complications, including permanent dialysis, organ rejection, and CAV. However, a higher incidence of cerebrovascular events was noted in the BTT group (10.7% vs. 2.6%). Conclusions: LVAD use as BTT does not negatively impact early post-transplant survival compared to DTT. At long-term follow-up, clinical outcomes remained similar across groups, supporting LVADs as a viable option for bridging patients to transplant. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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10 pages, 4895 KiB

Open AccessArticle

Does Scapular and Thoracic Morphology Affect Latarjet Alpha Angle?

by Taha Kizilkurt, Muhammed Furkan Darilmaz, Furkan Okatar and Ali Ersen

J. Clin. Med. 2025, 14(1), 274; https://doi.org/10.3390/jcm14010274 - 6 Jan 2025

Viewed by 355

Abstract

Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap [...] Read more.

Purpose: This study aimed to determine the relationship between alpha angle (the angle between the screws and the glenoid) and thoracic diameters in patients undergoing the Latarjet procedure. Defining the relationship between thoracic morphology and alpha angle is aimed at filling the gap in the literature and improving surgical outcomes. Methods: This retrospective study analyzed 74 patients who underwent the Latarjet procedure for recurrent anterior shoulder instability between 2022 and 2024. All procedures were performed by the same surgeon using a standardized protocol to ensure consistency of surgical technique across cases. In postoperative chest CT scans, alpha angle, anteroposterior diameter of the thorax, transverse diameter of hemithorax, scapular inclination, and glenoid version were evaluated. Results: The study included predominantly male patients (90%) with a mean age of 26.4 ± 6.4 years who underwent Latarjet procedures predominantly on the right side (60%). Significant associations were observed between thoracic morphology and alpha angle on postoperative CT scans. There was a significant positive correlation between anterior-posterior/transverse diameter ratio (AP/T) and alpha angle (r = 0.407, p < 0.001), as well as correlations between scapular inclination, glenoid version, thoracoscapular angle, and alpha angle (r = 0.275, p = 0.018; r = 0.241, p = 0.039; r = −0.288, p = 0.013, respectively). Patients were divided based on an alpha angle threshold of 15 degrees, with results indicating worse outcomes for angles above this threshold. Additionally, the AP/T ratio demonstrated predictive value for poor outcomes (AUC = 0.660, p = 0.018) with a threshold of 1.2545. Conclusions: This study highlights the direct impact of thoracic morphology on the alpha angle observed on post-Latarjet chest CT scans. Specifically, patients with a higher ratio of anterior-posterior to transverse thoracic diameter (AP/T) show a proportional increase in alpha angle. When the AP/T ratio exceeds 1.25, surgeons may face challenges in achieving the target alpha angle. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 2102 KiB

Open AccessArticle

Clinical and Topographic Screening for Scoliosis in Children Participating in Routine Sports: A Prevalence and Accuracy Study in a Spanish Population

by José María González-Ruiz, Nada Mohamed, Mostafa Hassan, Kyla Fald, Eva de los Ríos Ruiz, Pablo Pérez Cabello, Álvaro Rubio Redondo, Bruna da Rosa, Thomaz Nogueira Burke and Lindsey Westover

J. Clin. Med. 2025, 14(1), 273; https://doi.org/10.3390/jcm14010273 - 6 Jan 2025

Viewed by 596

Abstract

Background: Idiopathic scoliosis (IS) is a common spinal deformity affecting 0.5% to 5.2% of children worldwide, with a higher reported range in Spain (0.7–7.5%). Early detection through screening is crucial to prevent the progression of mild cases to severe deformities. Clinical methods [...] Read more.

Background: Idiopathic scoliosis (IS) is a common spinal deformity affecting 0.5% to 5.2% of children worldwide, with a higher reported range in Spain (0.7–7.5%). Early detection through screening is crucial to prevent the progression of mild cases to severe deformities. Clinical methods such as the ADAM test and trunk rotation angle (TRA) are widely used, but the development of three-dimensional (3D) surface topography (ST) technologies has opened new avenues for non-invasive screening. The objectives of this study were (1) to perform clinical and ST-based scoliosis screening in a sample of healthy children involved in club sports, (2) to estimate the agreement between clinical and ST screening methods, (3) to describe the prevalence of scoliosis by sport, sex, and age, and (4) to evaluate the diagnostic performance of both screening approaches using available radiographs as a reference standard. Methods: A total of 343 children (58.7% males, 41.3% females; mean age 11.69 ± 2.05 years) were screened using both clinical and ST methods. Clinical screening included the ADAM test and TRA measurement, while ST screening was performed using BackSCNR^®, a markerless 3D scanning software. The children with positive screening results were recommended to obtain radiographs to confirm the diagnosis. Kappa agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for both screening modalities using radiographic results as the gold standard. Results: The prevalence of scoliosis was 3.2% (n = 11) based on radiographic confirmation. The prevalence by sport was highest in swimming (17.6%), with minimal differences by sex (males 3.6%, females 2.5%). The clinical screening showed a sensitivity of 73%, specificity of 97%, PPV of 47%, NPV of 99%, and accuracy of 96%. The ST screening showed a sensitivity of 36%, specificity of 99%, PPV of 80%, NPV of 97%, and accuracy of 97%. The kappa values indicate a moderate influence of chance for both methods (clinical κ = 0.55; ST κ = 0.48). The balanced accuracy was 84% for the clinical screening and 68% for the ST screening. Conclusions: The clinical screening method showed superior sensitivity and balanced accuracy compared to ST screening. However, ST screening showed higher specificity and PPV, suggesting its potential as a complementary tool to reduce the high positive predictive value. These results highlight the importance of combining screening methods to improve the accuracy of the early detection of IS in physically active children, with the radiographic confirmation of the positive screened cases remaining essential for accurate diagnosis. Full article

(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)

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10 pages, 227 KiB

Open AccessArticle

Outcomes of a Structured Olfactory and Gustatory Rehabilitation Program in Children with Post-COVID-19 Smell and Taste Disturbances

by Smai Khalid Almalki, Ahmed Mohamed Azzam, Saad A. Alhammad, Sami Alabdulwahab, Ahmed Ali Alshamrani and Abdulmajeed Nasser Alotaibi

J. Clin. Med. 2025, 14(1), 272; https://doi.org/10.3390/jcm14010272 - 6 Jan 2025

Viewed by 695

Abstract

Background/Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is closely related to SARS-CoV and uses angiotensin-converting enzyme 2 as its cellular receptor. In early 2020, reports emerged linking CoV disease 2019 (COVID-19) to olfactory and gustatory disturbances. These disturbances could be attributed to [...] Read more.

Background/Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is closely related to SARS-CoV and uses angiotensin-converting enzyme 2 as its cellular receptor. In early 2020, reports emerged linking CoV disease 2019 (COVID-19) to olfactory and gustatory disturbances. These disturbances could be attributed to virus-induced damage to olfactory neurons or immune responses, thereby affecting sensory functions. This randomized controlled trial aimed to evaluate the effectiveness of a structured orofacial rehabilitation program in improving smell (olfaction) and taste (gustation) sensations in children post-COVID-19. Methods: Forty children recovering from COVID-19 in government hospitals in Saudi Arabia were included and randomly assigned to the control group or the experimental group. The orofacial program included (a) facilitation of olfactory function using the 40-item modified Arabic version of the University of Pennsylvania Smell Identification Test (UPSIT); (b) assessment of gustatory function using taste strips with four varying concentrations; and (c) orofacial myofunctional therapy. The intervention was applied three times a week and lasted for 3 months. Results: The experimental group showed a significantly greater improvement in UPSIT scores (median change of 24.1%) than the control group (14.7%; p = 0.010). However, no significant difference was found in the taste strip test scores among the groups or between male and female participants. Conclusions: This study suggests that a structured orofacial rehabilitation program could enhance olfactory and gustatory functions in children recovering from COVID-19. Full article

(This article belongs to the Section Clinical Pediatrics)

13 pages, 4328 KiB

Open AccessArticle

Semi-Automatic Refinement of Myocardial Segmentations for Better LVNC Detection

by Jaime Rafael Barón, Gregorio Bernabé, Pilar González-Férez, José Manuel García, Guillem Casas and Josefa González-Carrillo

J. Clin. Med. 2025, 14(1), 271; https://doi.org/10.3390/jcm14010271 - 6 Jan 2025

Viewed by 580

Abstract

Background: Accurate segmentation of the left ventricular myocardium in cardiac MRI is essential for developing reliable deep learning models to diagnose left ventricular non-compaction cardiomyopathy (LVNC). This work focuses on improving the segmentation database used to train these models, enhancing the quality of [...] Read more.

Background: Accurate segmentation of the left ventricular myocardium in cardiac MRI is essential for developing reliable deep learning models to diagnose left ventricular non-compaction cardiomyopathy (LVNC). This work focuses on improving the segmentation database used to train these models, enhancing the quality of myocardial segmentation for more precise model training. Methods: We present a semi-automatic framework that refines segmentations through three fundamental approaches: (1) combining neural network outputs with expert-driven corrections, (2) implementing a blob-selection method to correct segmentation errors and neural network hallucinations, and (3) employing a cross-validation process using the baseline U-Net model. Results: Applied to datasets from three hospitals, these methods demonstrate improved segmentation accuracy, with the blob-selection technique boosting the Dice coefficient for the Trabecular Zone by up to 0.06 in certain populations. Conclusions: Our approach enhances the dataset’s quality, providing a more robust foundation for future LVNC diagnostic models. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy)

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13 pages, 517 KiB

Open AccessSystematic Review

The Efficacy of Defensive Antibacterial Coating (DAC™) Periprosthetic Joint Infection Prevention in the Hip: A Systematic Review

by Antonio Bove, Adriano Braile, Giovanni Matino, Nicola Del Regno, Sabrina Sirico, Nicola Orabona and Mariantonia Braile

J. Clin. Med. 2025, 14(1), 270; https://doi.org/10.3390/jcm14010270 - 5 Jan 2025

Viewed by 703

Abstract

Background: Periprosthetic joint infections (PJIs) are a significant issue in joint replacement surgery patients, affecting results and mortality. Recent research focuses on developing hydrogels (HG) and antimicrobial coatings to reduce pressure injuries, with DAC™ HG showing lower infection risk in hip revision surgery. [...] Read more.

Background: Periprosthetic joint infections (PJIs) are a significant issue in joint replacement surgery patients, affecting results and mortality. Recent research focuses on developing hydrogels (HG) and antimicrobial coatings to reduce pressure injuries, with DAC™ HG showing lower infection risk in hip revision surgery. However, the effectiveness of DAC™ hydrogel in PIJs is still unknown. Here, we attempt to update the literature in this field, pointing out methodological flaws and providing guidance for further research. Methods: We conducted a systematic literature review using the PRISMA guidelines. Quality assessment was performed with the Newcastle–Ottawa Scale (NOS) and the Coleman Methodology Score (CMS). Results: Among 27 records from the initial search, 3 studies resulted eligible for final evaluation. It was observed that following the three surgical procedures performed in combination with DAC™ loaded with specific antibiotics, the quality of life of the treated patients had improved. No side effects associated with DAC™ treatment were in fact observed. Conclusions: The amount and quality of scientific evidence are yet insufficient to either encourage or dissuade the use of such hydrogels in hip prosthesis, despite some intriguing first results. These challenges will be better addressed by randomized controlled trials or longitudinal prospective investigations. Full article

(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)

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16 pages, 2312 KiB

Open AccessCase Report

Single-Stage Microsurgical Clipping of Multiple Intracranial Aneurysms in a Patient with Cerebral Atherosclerosis: A Case Report and Review of Surgical Management

by Corneliu Toader, Matei Serban, Razvan-Adrian Covache-Busuioc, Mugurel Petrinel Radoi, Ghaith Saleh Radi Aljboor, Horia Petre Costin, Milena-Monica Ilie, Andrei Adrian Popa and Radu Mircea Gorgan

J. Clin. Med. 2025, 14(1), 269; https://doi.org/10.3390/jcm14010269 - 5 Jan 2025

Viewed by 725

Abstract

The management of multiple intracranial aneurysms presents significant clinical challenges, particularly when complicated by underlying conditions such as cerebral atherosclerosis. This case report highlights the successful treatment of a 66-year-old female diagnosed with three intracranial aneurysms located in the right middle cerebral artery [...] Read more.

The management of multiple intracranial aneurysms presents significant clinical challenges, particularly when complicated by underlying conditions such as cerebral atherosclerosis. This case report highlights the successful treatment of a 66-year-old female diagnosed with three intracranial aneurysms located in the right middle cerebral artery (MCA), pericallosal artery, and M2 segment. The patient also had a history of systemic atherosclerosis and right-sided breast cancer, factors that increased the complexity of surgical intervention. The aim of this report is to demonstrate the efficacy of single-stage microsurgical clipping in managing multiple aneurysms with favorable outcomes in a complex patient profile. Methods: The patient underwent right-sided pterional craniotomy for microsurgical clipping of all three aneurysms during a single-stage procedure. Two aneurysms in the MCA were clipped using Yasargil clips, and a third aneurysm located at the bifurcation of the pericallosal artery was also secured with a clip. The procedure was performed under microscopic visualization, with meticulous dissection of the atherosclerotic vessels and careful intraoperative hemostasis. Postoperative care involved proactive perioperative management, including blood pressure control and vigilant neurological monitoring. Results: Postoperative imaging at three months confirmed proper clip placement with no evidence of residual aneurysm filling or ischemic complications. The patient exhibited a full neurological recovery, with no deficits or further complications, highlighting the effectiveness of the surgical approach in managing multiple aneurysms concurrently. Conclusions: This case supports the use of single-stage microsurgical clipping as an effective treatment for patients with multiple intracranial aneurysms, even in the presence of complicating factors such as atherosclerosis. A meticulous surgical technique and perioperative management are critical to achieving favorable outcomes and reducing the risk of delayed ischemia or other postoperative complications. Full article

(This article belongs to the Special Issue Neurovascular Diseases: Clinical Advances and Challenges)

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15 pages, 641 KiB

Open AccessArticle

Preoperative Home-Based Multimodal Physiotherapy in Patients Scheduled for a Knee Arthroplasty Who Catastrophize About Their Pain: A Randomized Controlled Trial

by Marc Terradas-Monllor, Hector Beltran-Alacreu, Mirari Ochandorena-Acha, Ester Garcia-Oltra, Francisco Aliaga-Orduña and José Hernández-Hermoso

J. Clin. Med. 2025, 14(1), 268; https://doi.org/10.3390/jcm14010268 - 5 Jan 2025

Viewed by 827

Abstract

Background: Chronic pain affects about 20% of total knee arthroplasty (TKA) patients, with high pain catastrophizing being a key predictor. Screening and addressing this modifiable factor may improve postoperative outcomes. Objective: We aimed to compare the effectiveness of two preoperative home-based [...] Read more.

Background: Chronic pain affects about 20% of total knee arthroplasty (TKA) patients, with high pain catastrophizing being a key predictor. Screening and addressing this modifiable factor may improve postoperative outcomes. Objective: We aimed to compare the effectiveness of two preoperative home-based multimodal physical therapy interventions on pain catastrophizing in high-catastrophizing TKA patients. Secondarily, the study aimed to assess postoperative outcomes over six months. Methods: A total of 40 patients with symptomatic osteoarthritis and moderate pain catastrophizing were randomly allocated to the control, therapeutic patient education (TPE), and multimodal physiotherapy (MPT) groups. Preoperative interventions comprised pain neuroscience education, coping skills training, and therapeutic exercise, differing in the number of sessions and degree of supervision. All outcomes were assessed before and after the treatment in the preoperative period, and 1, 3, and 6 months post-surgery. The primary outcome measure was pain catastrophizing. Results: Both intervention groups showed a preoperative reduction in pain catastrophizing. TPE patients had lower pain ratings at rest and lower catastrophizing scores at 1 and 6 months post-surgery, reduced kinesiophobia and improved dynamic balance at 3 and 6 months post-surgery, and higher self-efficacy at 1 month post-surgery. MPT patients exhibited lower pain catastrophizing and pain intensity during walking at 1 month post-surgery, and better outcomes in kinesiophobia, self-efficacy, and dynamic balance at 1, 3, and 6 months post-surgery, along with higher walking speed at 6 months post-surgery. Conclusions: Preoperative physiotherapy reduces preoperative pain catastrophizing and improves postoperative pain-related outcomes, behaviors, and cognitions in high-catastrophizing TKA patients. Registration is with the United States Clinical Trials Registry (NCT03847324). Full article

(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)

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12 pages, 1820 KiB

Open AccessArticle

Management, Flow, and Outcomes of Patients with Aortic Stenosis Followed by a Heart Valve Clinic: The Untold “Behind the Scene” from a High-Volume, Real-World Experience

by Federico Cammertoni, Natalia Pavone, Piergiorgio Bruno, Gabriele Di Giammarco, Francesco Burzotta, Enrico Romagnoli, Antonella Lombardo, Francesca Graziani, Marialisa Nesta, Maria Grandinetti, Serena D’Avino, Alberta Marcolini, Gessica Cutrone, Edoardo Maria D’Acierno, Rudy Panzera, Gabriele Mazzenga, Marco Montesano and Massimo Massetti

J. Clin. Med. 2025, 14(1), 267; https://doi.org/10.3390/jcm14010267 - 5 Jan 2025

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Abstract

Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with [...] Read more.

Background: According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC’s program, but few data have been reported so far. Methods: We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024. For each outpatient visit, symptoms, physical examination, echocardiographic data, complementary tests, and indications were acquired. Also, adverse events (hospitalization, unplanned procedures, and death) were retrieved. Results: A total of 320 patients were included. Mean visits/patient ratio was 1.2. At the first visit, 69.7% already had severe aortic stenosis, and severe symptoms (NYHA ≥ III) were evident in 24.4%. In addition, 26.5%, 59.1%, 12.8%, and 1.6% were in Généreux stage I, II, III, and IV, respectively. Overall, 197 (78.5%) and 54 (21.5%) patients received an indication for transcatheter AVR and surgical AVR, respectively. AVR-free survival was 46%, 23%, and 6% at 6, 12, and 24 months, respectively (mean 8.8 months CI95% 7.7–9.9). Adverse event-free survival was 97.2%, 95.5%, and 85% at 3, 6, and 12 months, respectively. Conclusions: Patients referred to our HVC already had an advanced disease with cardiac damage. Transcatheter AVR was mostly indicated, and it showed excellent short-term results. A low rate of adverse events was seen among patients in follow-up, but the odds of receiving AVR were high and driven by Généreux’s stage. Despite these favorable results, further efforts to sensitize earlier patient referral should be made. Full article

(This article belongs to the Special Issue Guidelines for the Management of Severe Aortic Stenosis)

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18 pages, 2624 KiB

Open AccessArticle

Risk Factors and Impact of Intra-Articular Scarring After Open Reduction and Internal Fixation in Mandibular Condylar Head Fractures—A Prospective Analysis

by Clarissa Sophie Reichert, Simon Patrik Pienkohs, Linda Skroch, Axel Meisgeier and Andreas Neff

J. Clin. Med. 2025, 14(1), 266; https://doi.org/10.3390/jcm14010266 - 5 Jan 2025

Viewed by 468

Abstract

Background: During the routine removal of osteosynthesis materials after surgical treatment (ORIF) of condylar head fractures (CHFs), as performed at our clinic, localised and sometimes pronounced intra-articular scarring were observed quite regularly. This prospective study therefore investigates the causes of intra-articular scarring and [...] Read more.

Background: During the routine removal of osteosynthesis materials after surgical treatment (ORIF) of condylar head fractures (CHFs), as performed at our clinic, localised and sometimes pronounced intra-articular scarring were observed quite regularly. This prospective study therefore investigates the causes of intra-articular scarring and its impact on functionality after surgical treatment (ORIF) of condylar head fractures (CHFs). Methods: Moreover, 80/98 patients with 96/114 CHFs (ORIF between 2014 and 2024) were evaluated when performing hardware removal. Statistical analysis used logistic regression and sign tests. Results: Postoperative scarring was seen in 72/96 cases (75%), either localised (n = 54; 56%) or pronounced (n = 18; 19%). Scarring correlated with limitations of laterotrusion for pronounced scarring (p = 0.016; OR = 6.806; 95% CI [1.422, 32.570]; large effect size) and with limitations of mediotrusion for localised scarring (p = 0.013; OR = 0.236; 95% CI [0.076, 0.734]; very small effect size). Factors favouring localised scarring were reduced ipsilateral dental support (p = 0.022; OR = 3.36; 95% CI [1.191, 9.459]; medium effect size) and major fragmentation (p = 0.029; OR = 3.182; 95% CI [1.123, 9.013]; medium effect size). However, there was no correlation between scarring and types (screws w/wo microplates) or number of osteosynthesis materials. Pronounced scarring showed a significantly higher risk for osseous degenerative complications (p = 0.041; OR = 4.171; CI [1.058, 16.452]; medium effect size). Conclusions: Intra-articular scarring after ORIF of CHFs poses a risk for functional limitations and osseous degenerative changes. Early adhesiolysis during the removal of hardware seems favourable for functional outcomes after CHFs. Full article

(This article belongs to the Section Orthopedics)

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J. Clin. Med., Volume 14, Issue 1 (January-1 2025) – 295 articles

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