Journal of Clinical Medicine

12 pages, 866 KiB

Open AccessArticle

Safety and Outcomes of Percutaneous Dilatational Tracheostomy in Patients with Hematologic Malignancies: A Retrospective Cohort Study

by Asaf Miller, Roee Noy, Omri Simchon, Natalia Gvozdev, Yotam Shkedy and Danny Epstein

J. Clin. Med. 2025, 14(2), 657; https://doi.org/10.3390/jcm14020657 - 20 Jan 2025

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Abstract

Background/Objectives: Patients with hematologic malignancy (HM) often experience high rates of thrombocytopenia, thrombocytopathy, anemia, leukopenia, and coagulopathy, which can significantly increase the risk of procedural and postoperative complications. This study aimed to evaluate the safety and outcomes of percutaneous dilatational tracheostomy (PDT) [...] Read more.

Background/Objectives: Patients with hematologic malignancy (HM) often experience high rates of thrombocytopenia, thrombocytopathy, anemia, leukopenia, and coagulopathy, which can significantly increase the risk of procedural and postoperative complications. This study aimed to evaluate the safety and outcomes of percutaneous dilatational tracheostomy (PDT) in critically ill patients with HM. Methods: This retrospective cohort study included patients with HM who underwent PDT between 2012 and 2023 at a tertiary academic center. The primary outcome was early (7-day) bleeding complications rate. Secondary outcomes included PDT-related mortality, and mortality at 1 week, 30 days, and 1 year. Analyses were performed using a propensity-matched cohort to ensure balanced comparisons between groups. Results: Of the 1627 patients included in the analysis, 65 (4%) had HM. Patients with HM had a significantly higher Charlson comorbidity index and exhibited significantly higher rates of thrombocytopenia (platelet count < 100,000/mcL) compared to those without HM (8.0 [IQR 5.0–11.3] vs. 5.0 [IQR 2.0–7.0], p < 0.001; and 49.2% vs. 5.0%, p < 0.001, respectively). After propensity score matching, the one-week mortality rate was significantly higher in the HM group (23.4% vs. 4.3%, p = 0.007). However, the rates of intraoperative and bleeding complications as well as one-year mortality rates were similar between the groups. Conclusions: PDT can be safely performed in critically ill patients with HM. However, these patients exhibit high early mortality rates following the procedure. Full article

(This article belongs to the Section Hematology)

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16 pages, 997 KiB

Open AccessArticle

Screening for Subclinical Atherosclerosis in Patients with Familial Hypercholesterolemia: Insights and Implications

by Muhammed Furkan Deniz, Baris Guven, Abdullah Omer Ebeoglu, Omer Burak Gul, Ali Nayir, Pelinsu Ozkan, Zubeyir Bulat, Ibrahim Turk, Ozlem Demirelce, Husamettin Alper Kimyonok, Habibe Deniz, Murat Kazım Ersanli, Veysel Oktay, Dildar Konukoglu and Umit Yasar Sinan

J. Clin. Med. 2025, 14(2), 656; https://doi.org/10.3390/jcm14020656 - 20 Jan 2025

Viewed by 675

Abstract

Background/Objectives: Familial hypercholesterolemia (FH) is a monogenic dyslipidemia that leads to early cardiovascular events. Subclinical atherosclerosis refers to the formation of atheromatous plaques in arterial beds before any clinical events. In our study, we investigated the presence, extent, and independent predictors of [...] Read more.

Background/Objectives: Familial hypercholesterolemia (FH) is a monogenic dyslipidemia that leads to early cardiovascular events. Subclinical atherosclerosis refers to the formation of atheromatous plaques in arterial beds before any clinical events. In our study, we investigated the presence, extent, and independent predictors of subclinical atherosclerosis among patients diagnosed with FH. Methods: This was a single-center, prospective, and cross-sectional study. This original study included 215 patients diagnosed with FH from a cohort of 1145 individuals assessed according to the Dutch Lipid Clinical Network (DLCN) criteria. Carotid and femoral ultrasonography were performed, and the coronary artery calcium score was measured to screen for subclinical atherosclerosis. Apolipoprotein A-I, apolipoprotein B, and lipoprotein (a) were analyzed using the nephelometric method. Results: The study cohort comprised 136 females (63%) with a mean age of 54 (43–62) years. The stigmata rate was 18%. The rate of statin use during subclinical atherosclerosis screening was 32% and only eight patients (4%) attained LDL-C values < 70 mg/dL. Subclinical atherosclerosis was observed in 148 patients (69%), with rates of 48%, 47.5%, and 40.5% in the coronary arteries, carotid bifurcation, and femoral bifurcation, respectively. Advanced age, male sex, high pretreatment low-density lipoprotein-cholesterol (LDL-C) level, diabetes, and a low Apo A-I/Apo B ratio were identified as independent predictors of subclinical atherosclerosis. Lp(a) levels ≥ 30 mg/dL predicted coronary atherosclerosis, while diabetes and low Apo A-I/Apo B ratios predicted carotid atherosclerosis, and smoking predicted femoral atherosclerosis. Conclusions: Subclinical atherosclerosis is prevalent, and medication adherence remains suboptimal among FH patients. Screening for subclinical atherosclerosis may impact the treatment strategies, via an increase in physician commitment to treatment protocols and improving patient compliance. Full article

(This article belongs to the Section Cardiology)

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14 pages, 995 KiB

Open AccessArticle

High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies

by Ming-Hung Wang, Chien-Yu Chen, Yu-Hung Lin, Yueh-Wei Liu, Yu-Yin Liu, Wei-Feng Li, Chang-Ting Lin, Szu-Wei Huang, Cheng-Hsi Yeh and Shih-Min Yin

J. Clin. Med. 2025, 14(2), 655; https://doi.org/10.3390/jcm14020655 - 20 Jan 2025

Viewed by 581

Abstract

Introduction: Pancreaticoduodenectomy (PD) is a major surgery associated with significant morbidity and mortality, especially in older adult patients. Malnutrition is a common complication in these patients and is linked to poorer outcomes. This study aimed to investigate the associations between preoperative nutritional status [...] Read more.

Introduction: Pancreaticoduodenectomy (PD) is a major surgery associated with significant morbidity and mortality, especially in older adult patients. Malnutrition is a common complication in these patients and is linked to poorer outcomes. This study aimed to investigate the associations between preoperative nutritional status using the Geriatric Nutritional Risk Index (GNRI) and postoperative outcomes in older adult patients who underwent PD. Methods: A retrospective cohort study was conducted on 363 older adult patients who underwent PD. The preoperative GNRI was calculated based on serum albumin levels and body mass index. GNRI ≤ 82, GNRI 83 to ≤98, and GNRI > 98 were classified as severely malnourished, moderately/mildly malnourished, and no malnourishment, respectively. Perioperative data, including demographics, comorbidities, and postoperative complications, were collected. Univariate and multivariate analyses were performed to assess the associations between the GNRI and outcomes such as length of hospital stay, postoperative complications, and overall survival. Results: Patients with a higher GNRI were more likely to experience Clavien–Dindo grade ≥ 3b postoperative complications (42.1% vs. 22.0% vs. 14.1%; p = 0.027) and pulmonary complications (26.3% vs. 11.9% vs. 4.2%; p = 0.016). These patients also stayed at the hospital for a longer duration (17.0% vs. 16.0% vs. 11.0%; p < 0.001). Multivariate analysis confirmed that the GNRI was an independent predictor of adverse outcomes, even after adjusting for other confounding factors. Conclusions: Our findings highlight the importance of preoperative nutritional assessment in older adult patients undergoing PD. Patients with low GNRI scores are at increased risk of postoperative complications and prolonged recovery. These results underscore the need for targeted nutritional interventions and regular monitoring of these patients. Future studies should focus on interventions to improve nutritional status in older adult patients undergoing PD. Full article

(This article belongs to the Section General Surgery)

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7 pages, 2078 KiB

Open AccessBrief Report

Dialysis Patients’ Evaluation of Lung Edema at Home Using a Mobile Phone Tele-Ultrasound Application: A Pilot Study

by Itamar Ben Shitrit, Aviya Kedmi, Khaled El Haj, Amit Kosto, Ofri Karni, Sharon Einav, Tomer Poleg, Ariel Avraham Hasidim, Noa Bineth, Tomer Gat, Alla Shnaider, Orli Barad and Lior Fuchs

J. Clin. Med. 2025, 14(2), 654; https://doi.org/10.3390/jcm14020654 - 20 Jan 2025

Viewed by 887

Abstract

Background: Home rehabilitation improves patient satisfaction and reduces the need for specialist consultations. Hemodialysis is a costly post-ICU service that requires frequent monitoring. Previous studies have demonstrated the feasibility and accuracy of patients self-scanning their lungs with an ultrasound device within the [...] Read more.

Background: Home rehabilitation improves patient satisfaction and reduces the need for specialist consultations. Hemodialysis is a costly post-ICU service that requires frequent monitoring. Previous studies have demonstrated the feasibility and accuracy of patients self-scanning their lungs with an ultrasound device within the hospital. Methods: In this single-center, prospective pilot study, we compared the quality of high-risk elderly patient-generated lung ultrasound images against physician-generated images as our primary outcome. The secondary outcome assessed image quality and B-line quantification between a home device and a gold standard device, when operated by the same clinician. Results: We enrolled nine participants (66% male, median age 76 years [IQR 66,79]). Analysis included 402 ultrasound clips (163 patient-generated, 239 physician-generated, and 237 in-clinic gold standard clips). Patient-generated images demonstrated high reliability (92% highly reliable or reliable) and were non-inferior to physician-generated images (p < 0.001). There was substantial agreement in B-line classification (Kw = 0.64, 95% CI: 0.46–0.82). The home device, when operated by the same physician, showed non-inferiority to the gold standard device (p < 0.001) with substantial B-line classification agreement (Kw = 0.64, 95% CI: 0.51–0.78). Conclusions: High-risk elderly patients can successfully generate self-scanned lung ultrasound images comparable to those produced by physicians. These promising results warrant further investigation through larger-scale and long-term studies. Full article

(This article belongs to the Section Pulmonology)

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22 pages, 1759 KiB

Open AccessReview

State of the Art of Primary PCI: Present and Future

by Andrea Mignatti, Julio Echarte-Morales, Matteo Sturla and Azeem Latib

J. Clin. Med. 2025, 14(2), 653; https://doi.org/10.3390/jcm14020653 - 20 Jan 2025

Viewed by 1318

Abstract

Primary percutaneous coronary intervention (PCI) has revolutionized the management of ST-elevation myocardial infarction (STEMI), markedly improving patient outcomes. Despite technological advancements, pharmacological innovations, and refined interventional techniques, STEMI prognosis remains burdened by a persistent incidence of cardiac death and heart failure (HF), with [...] Read more.

Primary percutaneous coronary intervention (PCI) has revolutionized the management of ST-elevation myocardial infarction (STEMI), markedly improving patient outcomes. Despite technological advancements, pharmacological innovations, and refined interventional techniques, STEMI prognosis remains burdened by a persistent incidence of cardiac death and heart failure (HF), with mortality rates plateauing over the last decade. This review examines current practices in primary PCI, focusing on critical factors influencing patient outcomes. Moreover, it explores future developments, emphasizing the role of microvascular dysfunction—a critical but often under-recognized contributor to adverse outcomes, including incident HF and mortality, and has emerged as a key therapeutic frontier. Strategies aimed at preserving microvascular function, mitigating ischemia–reperfusion injury, and reducing infarct size are discussed as potential avenues for improving STEMI management. By addressing these challenges, the field can advance toward more personalized and effective interventions, potentially breaking the current deadlock in mortality rates and improving longer-term prognosis. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Myocardial Infarction)

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Graphical abstract

26 pages, 2433 KiB

Open AccessArticle

Effects of Spinal Cord Stimulation in Patients with Small Fiber and Associated Comorbidities from Neuropathy After Multiple Etiologies

by Ángeles Canós-Verdecho, Ara Bermejo, Beatriz Castel, Rosa Izquierdo, Ruth Robledo, Elisa Gallach, Teresa Sevilla, Pilar Argente, Ismael Huertas, Isabel Peraita-Costa and María Morales-Suarez-Varela

J. Clin. Med. 2025, 14(2), 652; https://doi.org/10.3390/jcm14020652 - 20 Jan 2025

Viewed by 626

Abstract

Objectives: The aim of this study was to evaluate the effects of spinal cord stimulation (SCS) on pain, neuropathic symptoms, and other health-related metrics in patients with chronic painful peripheral neuropathy (PN) from multiple etiologies. Methods: A prospective single center observational longitudinal cohort [...] Read more.

Objectives: The aim of this study was to evaluate the effects of spinal cord stimulation (SCS) on pain, neuropathic symptoms, and other health-related metrics in patients with chronic painful peripheral neuropathy (PN) from multiple etiologies. Methods: A prospective single center observational longitudinal cohort study assessed SCS efficacy from April 2023 to May 2024, with follow-ups at 2, 4, 6, and 12 months in 19 patients suffering from the painful polyneuropathy of diverse etiologies: diabetic (DPN), idiopathic (CIAP), chemotherapy-induced (CIPN), and others. Patients were implanted with a neurostimulator (WaveWriter Alpha^TM, Boston Scientific Corporation, Valencia, CA, USA) and percutaneous leads targeting the lower limbs (T10–T11) and, if necessary, the upper limbs (C4–C7). Stimulation programming was individualized based on patient preference and best response. Assessments were performed before and after implantation and included pain intensity (VAS and DN4), neuropathic pain symptoms (NPSI and SF-MPQ-2), autonomic symptoms (SFN-SIQ and SAS), sensory and small fiber nerve injury (UENS), functionality (GAF), sleep (CPSI), global impression of change (CGI and PGI), and quality of life (EQ-VAS and EQ-5D). Intra-epidermal nerve fiber density (IENFD) via skin biopsy was also performed at baseline (diagnostic) and after 12 months to assess potential small fiber re-growth. Statistical analyses were conducted to determine the evolution of treatment success. Results: To date, 19 patients have undergone implantation and completed follow-up. SCS produced a significant consistent and sustained improvement in pain intensity by 49% in DN4 and 76% in VAS, in neuropathic pain symptoms by 73%, in autonomic symptoms by 26–30%, in the sensorimotor physical exam by 8%, in functionality by 44%, in sleep by 74%, and in quality of life (69% for EQ-VAS and 134% EQ-5D). Both clinicians and patients had a meaningful global impression of change, at 1.1 and 1.3, respectively. Distal intra-epidermal nerve fiber density improved by 22% at 12 months while proximal intra-epidermal nerve fiber density decreased by 18%. Conclusions: SCS is an effective therapy for managing various types of PN. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 920 KiB

Open AccessArticle

Utilization Trends of Glucose-Lowering Medications Among Adult Kidney Transplant Recipients with Type 2 Diabetes in the United States

by Panupong Hansrivijit, Helen Tesfaye, Deborah J. Wexler, Reza Abdi, Elisabetta Patorno and Julie M. Paik

J. Clin. Med. 2025, 14(2), 651; https://doi.org/10.3390/jcm14020651 - 20 Jan 2025

Viewed by 583

Abstract

Background: To date, there are limited studies describing the use of glucose-lowering medications (GLMs) in adult kidney transplant recipients (KTRs), and the uptake of sodium glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs). Thus, we aimed to evaluate the use of [...] Read more.

Background: To date, there are limited studies describing the use of glucose-lowering medications (GLMs) in adult kidney transplant recipients (KTRs), and the uptake of sodium glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1RAs). Thus, we aimed to evaluate the use of GLMs, including SGLT2i and GLP1RA, among adult KTRs with type 2 diabetes (T2D). Methods: This is an ecologic study of adult KTR with T2D. Data were sourced from two large U.S. health insurance claim databases from 2014 to 2023. The proportions of any user and incident use of GLMs were reported in percentage. Any use of GLM was defined through prescription claims, and incident use was further defined as the absence of any prior dispensing within the preceding 365 days. Results: From 2014 to 2023, we identified 33,913 adult KTRs with T2D who were prescribed any GLMs. Any use of SGLT2i and GLP1RA increased throughout the study period (0.4% to 14.4% for SGLT2i, and 2.8% to 12.5% for GLP1RA). While insulin was the most frequently used GLM, ranging from 58% to 74%, the usage gradually declined over time. By 2023, SGLT2i and GLP1RA were initiated nearly as frequently as insulin (5.1% for SGLT2i, 5.7% for GLP1RA, and 5.7% for insulin). Compared with insulin initiators, SGLT2i initiators (n = 1009) had a higher prevalence of cardiovascular comorbidities and proteinuria, while GLP1RA initiators (n = 2149) had a higher prevalence of obesity. Conclusions: Any use of both SGLT2i and GLP1RA among KTRs with T2D increased over time with the incident use of SGLT2i and GLP1RA as high as insulin by 2023. Our findings emphasize the need for the effectiveness and safety analysis of SGLT2i and GLP1RA among KTRs with T2D. Full article

(This article belongs to the Special Issue New Discoveries and Future Trends for Renal Transplantation: From Diagnosis to Treatment)

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16 pages, 1285 KiB

Open AccessArticle

Prediction Model for POstoperative atriaL fibrillAtion in caRdIac Surgery: The POLARIS Score

by Fabrizio Rosati, Massimo Baudo, Cesare Tomasi, Giacomo Scotti, Sergio Pirola, Giorgio Mastroiacovo, Gianluca Polvani, Gianluigi Bisleri, Stefano Benussi, Lorenzo Di Bacco and Claudio Muneretto

J. Clin. Med. 2025, 14(2), 650; https://doi.org/10.3390/jcm14020650 - 20 Jan 2025

Viewed by 760

Abstract

Background: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, occurring approximately in one-third of the patients. This study considered all-comer patients who underwent cardiac surgery to build a predictive model for POAF. Methods: A total of [...] Read more.

Background: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, occurring approximately in one-third of the patients. This study considered all-comer patients who underwent cardiac surgery to build a predictive model for POAF. Methods: A total of 3467 (Center 1) consecutive patients were used as a derivation cohort to build the model. The POLARIS score was then derived proportionally from the odds ratios obtained following multivariable logistic regression (MLR). The Brier Score, the area under the receiver operating characteristic curve, and the Hosmer–Lemeshow goodness-of-fit test were used to validate the model. Then, 2272 (Center 2) consecutive patients were used as an external validation cohort. Results: In the overall population (n = 5739), POAF occurred in 32.7% of patients. MLR performed in the derivation cohort showed that age, obesity, chronic renal failure, pulmonary hypertension, minimally invasive surgery, and aortic and mitral valve surgery were predictors of POAF. The derived POLARIS score was used to further stratify the population into four risk clusters: low (1.5–3), intermediate (3.5–5), high (5.5–7), and very high (7.5–9), each progressively showing an increase in POAF incidence. This was confirmed in a correlation analysis (Spearman’s rho: 0.636). Conclusions: The POLARIS score is a simple-to-use tool to stratify patients at higher risk of POAF. Precise identification of such patients might be used to implement clinical practice with the introduction of preoperative antiarrhythmic prophylaxis, further reducing the incidence of POAF and, potentially, its clinical sequelae, despite further investigations being warranted to test this model in prospective studies. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 13061 KiB

Open AccessCase Report

Are We Ready for Pseudotumors in Total Ankle Arthroplasty? A Case Report

by Federico Sgubbi, Antonio Mazzotti, Alberto Arceri, Simone Ottavio Zielli, Elena Artioli, Laura Langone, Marco Gambarotti and Cesare Faldini

J. Clin. Med. 2025, 14(2), 649; https://doi.org/10.3390/jcm14020649 - 20 Jan 2025

Viewed by 612

Abstract

Background: Pseudotumors are defined as exuberant non-neoplastic inflammatory masses. This condition can be associated with hip and knee arthroplasty but has not been reported in Total Ankle Arthroplasty (TAA). This paper reports a pseudotumor that formed following TAA, highlighting its clinical presentation, management, [...] Read more.

Background: Pseudotumors are defined as exuberant non-neoplastic inflammatory masses. This condition can be associated with hip and knee arthroplasty but has not been reported in Total Ankle Arthroplasty (TAA). This paper reports a pseudotumor that formed following TAA, highlighting its clinical presentation, management, and histopathology. Methods: A 55-year-old male with end-stage post-traumatic ankle osteoarthritis underwent TAA using a mobile-bearing prosthesis. The procedure was reported to be successful, with no immediate complications. Results: Three years postoperatively, following a period of symptom resolution, the patient presented with progressively worsening ankle pain, swelling, and limited weight-bearing ability. Imaging revealed indirect signs of a periarticular mass and loosening components. Revision surgery involved prosthesis explantation and mass excision for histological and microbiological analysis, followed by concomitant tibio-talo-calcaneal fusion with a retrograde nail. The histopathology identified a pseudotumor characterized by chronic inflammation, fibrous tissue, and necrotic debris, with no evidence of infection. The postoperative recovery was uneventful, with pain resolution and successful fusion confirmed at a one-year follow-up. Conclusions: In patients experiencing unexplained pain or symptoms following TAA, the possibility of a pseudotumor, although rare, should be considered. Prompt and comprehensive clinical and radiographic evaluation is crucial to raise suspicion and prevent this condition from being overlooked. Full article

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

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14 pages, 942 KiB

Open AccessArticle

Joint Analysis of Cardiovascular Control and Shear Wave Elastography to Determine Carotid Plaque Vulnerability

by Vlasta Bari, Beatrice Cairo, Francesca Gelpi, Fabiana Fancoli, Nicoletta Curcio, Giulia Matrone, Paolo Righini, Giovanni Nano, Alberto Porta and Daniela Mazzaccaro

J. Clin. Med. 2025, 14(2), 648; https://doi.org/10.3390/jcm14020648 - 20 Jan 2025

Viewed by 511

Abstract

Background/Objectives: Carotid artery stenosis (CAS) is one of the main causes of stroke, and the vulnerability of plaque has been proved to be a determinant. A joint analysis of shear wave elastography, a radiofrequency echo-based wall tracking technique for arterial stiffness evaluation, [...] Read more.

Background/Objectives: Carotid artery stenosis (CAS) is one of the main causes of stroke, and the vulnerability of plaque has been proved to be a determinant. A joint analysis of shear wave elastography, a radiofrequency echo-based wall tracking technique for arterial stiffness evaluation, and of autonomic and baroreflex function is proposed to noninvasively, preoperatively assess plaque vulnerability in asymptomatic CAS patients scheduled for carotid endarterectomy. Methods: Elastographic markers of arterial stiffness were derived preoperatively in 78 CAS patients (age: 74.2 + 7.7 years, 27 females). Autonomic and baroreflex markers were also assessed by means of an analysis of the beat-to-beat fluctuations in heart period and systolic arterial pressure, derived at rest in supine position (REST) and during active standing. Postoperative analysis identified 36 patients with vulnerable plaque (VULN) and 42 with stable plaque (STABLE). Results: Baroreflex sensitivity (BRS) at a respiratory rate decreased during STAND only in VULN patients, being much higher at REST compared to STABLE levels. Autonomic indexes were not helpful in separating experimental conditions and/or populations. The Young’s modulus (YM) of the plaque was lower in the VULN group than in the STABLE one. Cardiovascular control and elastographic markers were significantly correlated only in VULN patients. A multivariate logistic regression model built combining YM and BRS at the respiratory rate improved the prediction of plaque vulnerability, reporting an area under the ROC curve of 0.694. Conclusions: Noninvasive techniques assessing shear wave elastography and baroreflex control could contribute to the early detection of plaque vulnerability in patients with asymptomatic CAS. Full article

(This article belongs to the Section Vascular Medicine)

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15 pages, 1701 KiB

Open AccessArticle

Evaluation of Conventional and Combined Doppler Parameters in Preeclampsia: Diagnostic and Prognostic Insights

by Gulsan Karabay, Burak Bayraktar, Zeynep Seyhanli, Ahmet Arif Filiz, Betul Tokgoz Cakir, Gizem Aktemur, Nazan Vanli Tonyali, Recep Taha Agaoglu, Gulcan Kocaoglu, Umut Karabay and Kadriye Yakut Yucel

J. Clin. Med. 2025, 14(2), 647; https://doi.org/10.3390/jcm14020647 - 20 Jan 2025

Viewed by 571

Abstract

Background: The aim of this study was to examine the relationship between conventional and novel Doppler parameters, including cerebroplacental ratio (CPR), cerebral–placental–uterine ratio (CPUR), umbilical-to-cerebral ratio (UCR), and amniotic-to-umbilical-cerebral ratio (AUCR), with the diagnosis of preeclampsia (PE) and adverse neonatal outcomes in [...] Read more.

Background: The aim of this study was to examine the relationship between conventional and novel Doppler parameters, including cerebroplacental ratio (CPR), cerebral–placental–uterine ratio (CPUR), umbilical-to-cerebral ratio (UCR), and amniotic-to-umbilical-cerebral ratio (AUCR), with the diagnosis of preeclampsia (PE) and adverse neonatal outcomes in PE cases. Methods: This prospective case-control study was conducted at the Ankara Etlik City Hospital Perinatology Clinic between November 2023 and May 2024. The study population was divided into two groups: Group 1, consisting of 74 patients diagnosed with preeclampsia, and Group 2, consisting of 80 healthy control patients. Composite adverse perinatal outcomes (CANOs) include presence of at least one adverse outcome: 5th-minute APGAR score < 7, transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), need for continuous positive airway pressure (CPAP), need for mechanical ventilation, neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, need for phototherapy, intraventricular hemorrhage (IVH), and neonatal sepsis. Results: The CPR, CPUR, and AUCR were significantly lower in the PE group compared to the control group, while the UCR was notably higher in the PE group. Among the combined ratios, the CPUR exhibited the highest diagnostic performance for both PE diagnosis and the prediction of CANOs. Additionally, while the UCR, CPR, and AUCR were significant for PE diagnosis, only AUCR demonstrated a significant association with the prediction of CANOs. Conclusions: Combined Doppler parameters, especially CPUR and AUCR, offer valuable insights into diagnosing PE and predicting CANOs. CPUR demonstrated the highest diagnostic accuracy, underscoring its potential utility in clinical settings. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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13 pages, 1174 KiB

Open AccessArticle

Baseline Vitamin D Levels on Quality of Life and Pain Perception Among Patients with Chronic Pain with Long-Term Prescription Opioid Use: A Prospective Study

by Gabija Laubner Sakalauskienė, Indrė Stražnickaitė, Sigutė Miškinytė, Linas Zdanavičius, Jūratė Šipylaitė and Robertas Badaras

J. Clin. Med. 2025, 14(2), 645; https://doi.org/10.3390/jcm14020645 - 20 Jan 2025

Viewed by 509

Abstract

Objectives: To investigate the correlation between baseline serum concentrations of 25-hydroxyvitamin D (25-OHD) and quality of life (QoL), as well as pain perception in patients with chronic pain with long-term prescription opioid usage before opioid detoxification. Methods: We prospectively studied 45 patients with [...] Read more.

Objectives: To investigate the correlation between baseline serum concentrations of 25-hydroxyvitamin D (25-OHD) and quality of life (QoL), as well as pain perception in patients with chronic pain with long-term prescription opioid usage before opioid detoxification. Methods: We prospectively studied 45 patients with chronic pain with long-term prescription opioid usage who were selected for elective detoxification. Baseline serum 25-OHD levels were measured prior to detoxification, classifying patients as either vitamin D deficient (<75 nmol/L) or sufficient (≥75 nmol/L). QoL was assessed using the SF-36v2^TM questionnaire, while pain levels were assessed using Visual Analogue Scale (VAS) scores before treatment. Results: Mean pain scores before detoxification of the patients with sufficient baseline 25-OHD levels vs. those with deficient levels were, respectively, 6.06 ± 2.32 vs. 6.86 ± 2.10 (normalized scores 1.22 ± 0.571 vs. 0.950 ± 0.632; p = 0.164). The analysis of SF-36v2™ questionnaire scores revealed minimal variation between groups (35.00 ± 14.198 vs. 34.97 ± 13.52), indicating no significant association between Vitamin D levels and QoL (p = 0.913). Conclusions: The analysis of baseline 25-OHD levels in relation to QoL assessments and pain scores did not reveal a statistically significant association, indicating that variations in baseline vitamin D levels may not substantially impact QoL or pain perception. Further studies may help determine how to assess and optimize vitamin D levels in patients with chronic pain on long-term prescription opioids. Full article

(This article belongs to the Section Clinical Neurology)

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11 pages, 209 KiB

Open AccessArticle

Evolution of the Quality of Care in Patients with Decompensated Heart Failure in a Venezuelan Hospital

by Yaneth Torres, Daniel Benitez, Zenaida Morillo, Juan Salazar, Julio Contreras-Velasquez and Valmore Bermudez

J. Clin. Med. 2025, 14(2), 644; https://doi.org/10.3390/jcm14020644 - 20 Jan 2025

Viewed by 482

Abstract

Background/Objectives: Several parameters have been proposed for the objective measurement of the quality of care (QoC) and breaches of care in patients with heart failure (HF). Therefore, the objective of this study was to evaluate the measures of QoC in inpatients with decompensated [...] Read more.

Background/Objectives: Several parameters have been proposed for the objective measurement of the quality of care (QoC) and breaches of care in patients with heart failure (HF). Therefore, the objective of this study was to evaluate the measures of QoC in inpatients with decompensated HF in the cardiology department of a tertiary Venezuelan hospital. Methods: An observational, descriptive, ambispective study was conducted with adults of all genders diagnosed with decompensated HF between 2022 and 2024. Sociodemographic, clinical, and therapeutic variables were assessed, as well as psychobiologic habits, measures of QoC, readmissions, and in-hospital mortality within the first 6 months of care. Results: Among the 131 subjects evaluated, the average age was 63.6 ± 14.1 years, with 58% (n = 76) being male. Among the in-hospital measures of QoC, the most common was the programming for follow-up consultations (98.5%; n = 129), followed by the prescription of beta-blockers (90.1%; n = 118). An upwards trend was also observed in the later years regarding the frequency of left ventricle ejection fraction (LVEF) assessment (p < 0.001), and the use of iSGLT2 (p = 0.03). During follow-up, 36.6% of the patients died within 6 months, with those in NYHA class IV showing a higher probability of death (OR: 3.84; CI95%: 0.89–16.55; 0.04). Conclusions: The in-hospital measures for QoC in this population were similar to those in previous reports, with LVEF assessment and iSGLT2 prescription showing a particularly significant increase in recent years. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)

19 pages, 2063 KiB

Open AccessReview

Comprehensive Review of Lipid Management in Chronic Kidney Disease and Hemodialysis Patients: Conventional Approaches, and Challenges for Cardiovascular Risk Reduction

by Erica Abidor, Michel Achkar, Ibrahim Al Saidi, Tanvi Lather, Jennifer Jdaidani, Alaukika Agarwal and Suzanne El-Sayegh

J. Clin. Med. 2025, 14(2), 643; https://doi.org/10.3390/jcm14020643 - 20 Jan 2025

Viewed by 932

Abstract

Background/Objectives: Lipid disorders are very prevalent in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), leading to heightened cardiovascular risk. This review examines the effectiveness of lipid-lowering agents in these populations and explores gaps in the current research. The [...] Read more.

Background/Objectives: Lipid disorders are very prevalent in patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD), leading to heightened cardiovascular risk. This review examines the effectiveness of lipid-lowering agents in these populations and explores gaps in the current research. The goal of this review is to assess the efficacy of lipid-lowering therapies in CKD and ESRD patients and identify future research needs. It aims to provide a clearer understanding of how these treatments impact cardiovascular risk in high-risk populations. Methods: We conducted a literature search in Embase, PubMed, Cochrane, and Google Scholar databases using keywords including but not limited to: chronic kidney diseases, dialysis, hemodialysis, dyslipidemia, statins, ezetimibe, and lipid-lowering drugs. Findings from included studies were synthetized to provide an overview of the current management of dyslipidemia in ESRD and HD. Results: Statins show mixed results in CKD and ESRD, with limited benefits in reducing cardiovascular events in dialysis patients. Agents like PCSK9 inhibitors show promising results but require further research, while non-statin therapies like fibrates and omega–3 fatty acids have limited evidence for use in this population. Conclusions: The review underscores the need for further research into lipid-lowering agents in CKD and ESRD patients, highlighting the need for tailored lipid management strategies in vulnerable patients with unique risk factors. More studies are needed to refine treatment strategies and assess the role of exercise and accurate risk calculators in managing cardiovascular outcomes. Full article

(This article belongs to the Section Nephrology & Urology)

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8 pages, 209 KiB

Open AccessArticle

Endoscopic Resection of Large Non-Pedunculated Colonic Polyps Without Submucosal Injection Is Safe and Effective with Adequate Technique

by Melis Gokce Celdir, Gilles Jadd Hoilat, Alp Serhat Kahveci, Rami El Abiad and Henning Gerke

J. Clin. Med. 2025, 14(2), 642; https://doi.org/10.3390/jcm14020642 - 20 Jan 2025

Viewed by 545

Abstract

Background/Objectives: Endoscopic resection with lift polypectomy using submucosal injection (SI) for large non-pedunculated colorectal polyps is recommended to facilitate complete mucosal resection and decrease the risk of perforation; however, there are no studies comparing the safety and efficacy of large polypectomies with [...] Read more.

Background/Objectives: Endoscopic resection with lift polypectomy using submucosal injection (SI) for large non-pedunculated colorectal polyps is recommended to facilitate complete mucosal resection and decrease the risk of perforation; however, there are no studies comparing the safety and efficacy of large polypectomies with and without lift polypectomy. We aimed to evaluate the feasibility and safety of the polypectomy technique without SI compared to the routine use of SI. Methods: We performed a single tertiary center retrospective study evaluating all consecutive large non-pedunculated colorectal polyps (≥20 mm) referred to expert endoscopists in polypectomy from 2018 through 2021. We collected and analyzed data on demographics, polyp characteristics, resection technique, complications, and polyp recurrence in 6–12 months. Results: In 200 large non-pedunculated colonic polyp resections, 110 (55%) were performed with SI. The median polyp size was slightly larger in SI (30 mm IQR [20, 40] vs. 25 mm IQR [20, 30] in no-SI, p < 0.05), with a range of 20 to 130 mm. There were no differences in delayed bleeding rates. No perforation was noted in the no-SI group, and five perforations occurred in the SI group, without a statistically significant difference between groups. There was no statistically significant difference in the polyp recurrence rate at 6–12 months between the no-SI and SI groups (12% vs. 8% in no-SI vs. SI, respectively, p = 0.48). Conclusions: Complete removal of large non-pedunculated polyps without SI is feasible and safe in this large series. This approach had similar rates of clinically significant post-polypectomy bleeding and a non-significant difference in perforation rate compared to polyp resection with routine use of SI. Randomized trials are warranted to further assess the safety and efficacy of this approach. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

21 pages, 1015 KiB

Open AccessArticle

Ultrasound Evaluation of Gastric Emptying and Comparison with Patient-Reported Risk Factors in Elective Surgical Patients

by Sezgin Inan and Basar Erdivanli

J. Clin. Med. 2025, 14(2), 641; https://doi.org/10.3390/jcm14020641 - 20 Jan 2025

Viewed by 494

Abstract

Background/Objectives: Despite standard preoperative fasting guidelines, residual gastric content can persist in some patients, increasing the risk of aspiration pneumonitis. Multiple patient-specific factors may predict gastric content retention, but their predictive accuracy is limited. We hypothesized that ultrasound would more reliably identify [...] Read more.

Background/Objectives: Despite standard preoperative fasting guidelines, residual gastric content can persist in some patients, increasing the risk of aspiration pneumonitis. Multiple patient-specific factors may predict gastric content retention, but their predictive accuracy is limited. We hypothesized that ultrasound would more reliably identify residual gastric content compared to a comprehensive questionnaire and aimed to determine the most practical approach for risk assessment in elective surgical patients. Methods: We conducted a prospective, observational study in adult patients scheduled for elective surgery at a single center. All participants adhered to an 8 h fasting period. The primary outcome was the incidence of a “full stomach” on ultrasound. Secondary outcomes included the Perlas risk classification, comparisons of established volume estimation formulas, correlations with self-reported fasting duration, agreement between questionnaire-based predictions and ultrasound findings, and the time efficiency of each method. Multivariable logistic regression and Cohen’s kappa were used for analyses. Results: Data from 404 patients were analyzed. Despite prolonged fasting, 16.3% had a full stomach by ultrasound, suggesting incomplete gastric emptying. Early satiety and cholelithiasis significantly predicted a full stomach; prolonged fasting duration and female sex were protective. Questionnaire-based predictions demonstrated fair agreement with ultrasound (kappa = 0.327). The Michiko formula often yielded negative volumes, highlighting limitations in volume estimations. Ultrasound examination (3 min median) was faster than questionnaire completion (5 min). Conclusions: Ultrasound accurately detects residual gastric content, outperforming questionnaire-based assessments. Integrating it into routine preoperative evaluation may improve patient safety, although research is needed to refine volume estimation formulas and expand feasibility for patients with positioning limitations. Full article

(This article belongs to the Section Anesthesiology)

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Graphical abstract

7 pages, 191 KiB

Open AccessBrief Report

Impact of Earthquakes During COVID-19 Lockdown on the Pediatric Injury Pattern in the Zagreb Urban Area

by Dino Bobovec, Tomislav Žigman, Josip Lovaković, Goran Augustin, Anko Antabak and Ivan Dobrić

J. Clin. Med. 2025, 14(2), 640; https://doi.org/10.3390/jcm14020640 - 20 Jan 2025

Viewed by 500

Abstract

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, [...] Read more.

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children’s referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March–27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children. Full article

(This article belongs to the Section Clinical Pediatrics)

14 pages, 263 KiB

Open AccessArticle

Retrospective Analysis of R-COMP Therapy in Patients with Diffuse Large B-Cell Lymphoma (DLBCL): Assessing the Impact of Sample Selection Bias

by Chiara Romano, Francesco Branda, Nicola Petrosillo, Annalisa Arcari, Francesco Merli, Michele Spina, Giancarlo Ceccarelli, Massimo Ciccozzi, Fabio Scarpa and Luigi Rigacci

J. Clin. Med. 2025, 14(2), 639; https://doi.org/10.3390/jcm14020639 - 20 Jan 2025

Viewed by 492

Abstract

Background: Retrospective studies are often criticized for their susceptibility to case selection bias compared to prospective studies, which include all patients consecutively and are thus less prone to such limitations. However, the larger sample sizes typical of retrospective studies can sometimes offset [...] Read more.

Background: Retrospective studies are often criticized for their susceptibility to case selection bias compared to prospective studies, which include all patients consecutively and are thus less prone to such limitations. However, the larger sample sizes typical of retrospective studies can sometimes offset this drawback. On behalf of the Fondazione Italiana Linfomi (FIL), a substantial retrospective study involving 946 patients was conducted to examine the use of non-pegylated liposomal anthracycline (Myocet). This was followed by a prospective study, the Prospective Elderly Project, which enrolled 308 patients treated with the same liposomal anthracycline regimen. Methods: The objective of this analysis was to determine whether the patient cohort from the retrospective study significantly differed from the cohort in the prospective study. Statistical hypothesis testing was applied to assess whether the samples from both studies originated from the same underlying population. The Anderson–Darling test, a non-parametric statistical method, was utilized to evaluate and compare the overall survival distributions between the two patient cohorts. Results: The statistical tests produced conflicting results, suggesting a potential selection bias in the retrospective study or the possibility that the two groups were from the same population. These discrepancies may have arisen due to the choice of statistical methods or the quality of the data analyzed. Conclusions: This study highlights the challenges of comparing retrospective and prospective cohorts and underscores the importance of selecting appropriate statistical methodologies. The findings provide valuable insights and lay the groundwork for developing innovative approaches to improve such comparisons in future research. Full article

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

12 pages, 1492 KiB

Open AccessArticle

Predictive Value of the DETECT Algorithm for Pulmonary Arterial Hypertension in Systemic Sclerosis: Findings from an Italian Observational Study

by Stefano Stano, Claudia Iannone, Carlo D’Agostino, Maria Rosa Pellico, Livio Urso, Nicoletta Del Papa, Roberto Caporali and Fabio Cacciapaglia

J. Clin. Med. 2025, 14(2), 638; https://doi.org/10.3390/jcm14020638 - 20 Jan 2025

Viewed by 559

Abstract

Background/Objectives: Pulmonary arterial hypertension (PAH) is a complication of systemic sclerosis (SSc), and several screening algorithms have been proposed for the early detection of PAH in SSc. This study aimed to evaluate the predicting values of the DETECT algorithm for SSc-PAH screening in [...] Read more.

Background/Objectives: Pulmonary arterial hypertension (PAH) is a complication of systemic sclerosis (SSc), and several screening algorithms have been proposed for the early detection of PAH in SSc. This study aimed to evaluate the predicting values of the DETECT algorithm for SSc-PAH screening in patients with SSc undergoing right heart catheterization (RHC) based on 2015 ESC/ERS echocardiographic criteria in a real-life setting. Methods: Patients fulfilling the 2013 ACR/EULAR classification criteria for SSc and with available data for PAH screening with the DETECT algorithm and the 2015 ESC/ERS echocardiographic criteria were retrospectively enrolled from January to June 2017 and then followed for 5 years. Baseline and annual clinical, laboratory, and instrumental data were collected. Results: A total of 33 out of 131 (25%) patients were selected based upon the ESC/ERS echocardiographic criteria, but 30 (23%) underwent RHC, while 51 (39%) patients with SSc were positive based on the DETECT algorithm. PAH diagnosis was confirmed in 28/30 cases (93.3%). The DETECT algorithm showed lower specificity and positive predictive value (PPV) (p < 0.0001) but higher sensitivity and negative predictive value (NPV) (p < 0.0001) than ESC/ERS criteria. Notably, patients with SSc with a negative DETECT screening at baseline had a low probability of developing PAH during a 5-year follow-up (OR 0.15, 95% CI 0.10–0.60—p < 0.0001). Conclusions: The DETECT algorithm has proven to be an easy, fast, and inexpensive tool for screening PAH in patients with SSc. Overall, a low probability of PAH using DETECT is highly predictive of a good prognosis. Full article

(This article belongs to the Section Immunology)

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13 pages, 1316 KiB

Open AccessArticle

Dispatcher-Assisted CPR in Italy: A Nationwide Survey of Current Practices and Future Challenges in Emergency Medical Communication Centers

by Guglielmo Imbriaco, Giacomo Sebastiano Canova, Lorenzo Righi, Sara Tararan, Giorgia Di Mario and Nicola Ramacciati

J. Clin. Med. 2025, 14(2), 637; https://doi.org/10.3390/jcm14020637 - 19 Jan 2025

Viewed by 802

Abstract

Background/Objectives: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is widely recognized as a critical intervention that significantly reduces no-flow time, improving survival rates in out-of-hospital cardiac arrests (OHCAs). This study evaluates current practices and the organization of DA-CPR in Italian emergency medical communication centers (EMCCs) [...] Read more.

Background/Objectives: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is widely recognized as a critical intervention that significantly reduces no-flow time, improving survival rates in out-of-hospital cardiac arrests (OHCAs). This study evaluates current practices and the organization of DA-CPR in Italian emergency medical communication centers (EMCCs) and identifies areas for improvement. Methods: A cross-sectional survey was conducted between April and May 2024 among all Italian EMCCs, achieving a 92.6% response rate (62 out of 67) and covering 95.5% of the population. Data were collected on the availability of DA-CPR, additional medical instructions provided, standardized protocols, integration into dispatch software, availability of video call systems, and follow-up programs. Results: All responding EMCCs provide DA-CPR, with 79.1% (n = 49) initiating these protocols more than five years ago. In adult cardiac arrest, 74.2% (n = 46) provide instructions for chest compressions only. Standardized protocols are used in 69.4% (n = 43) of EMCCs, and 53.2% (n = 33) have these protocols integrated into their dispatch software. Additionally, 93.5% (n = 58) provide dispatcher-assisted instructions for other medical conditions, including pediatric CPR (90.3%, n = 56), neonatal CPR (90.3%, n = 56), foreign body airway obstruction (85.5%, n = 53), labor (56.5%, n = 35), and massive bleeding (41.9%, n = 26). A training path for DA-CPR is available in 48 EMCCs (77.4%), and in most cases, it is included in the basic dispatcher course (56.5%, n = 36), with 50% conducting periodic retraining. Moreover, 33.9% (n = 21) utilize video call systems to support dispatcher-assisted instructions. Data on DA-CPR are collected by 46.8% of EMCCs (n = 29), primarily on relevant cases, but only 25.8% (n = 16) have a follow-up path for patients. Conclusions: This study highlights a widespread implementation of DA-CPR across Italian EMCCs. However, regional disparities, mainly in protocols and technological support, indicate areas requiring urgent attention. Enhancing training programs and standardizing protocols could improve DA-CPR effectiveness and patient outcomes, thus guaranteeing equitable care nationwide. Future initiatives should focus on integrating support tools like video calls, expanding retraining programs, and establishing follow-up and debriefing paths. Full article

(This article belongs to the Special Issue "Italian Resuscitation Council" on Resuscitation Science and Emergencies—2nd Edition)

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11 pages, 1666 KiB

Open AccessArticle

Imaging Retrospective Study Regarding the Variability of the Osseous Landmarks for IAN Block

by Andrei Urîtu, Ciprian Roi, Alexandra Roi, Alexandru Cătălin Motofelea, Ioana Badea, Doina Chioran and Mircea Riviș

J. Clin. Med. 2025, 14(2), 636; https://doi.org/10.3390/jcm14020636 - 19 Jan 2025

Viewed by 524

Abstract

Background/Objectives: The aim of this study is to identify the most accurate and consistent landmarks for determining the precise location of the mandibular foramen (MF) and the mandibular ramus, suggesting appropriate adjustments to anesthesia techniques based on these variations in order to [...] Read more.

Background/Objectives: The aim of this study is to identify the most accurate and consistent landmarks for determining the precise location of the mandibular foramen (MF) and the mandibular ramus, suggesting appropriate adjustments to anesthesia techniques based on these variations in order to improve the success rate of the inferior alveolar nerve (IAN) block. Methods: CT scans of the mandibles from 100 patients were analyzed to measure the distance between the MF and various landmarks, including the sigmoid notch, gonion, posterior and anterior margins of the ramus, temporal crest, and the mandibular ramus height from the condyle to the gonion. The width of the mandibular ramus was also assessed, with correlations made to age and gender. Results: The MF was found to be closer to the sigmoid notch (mean = 21.2 mm), p = 0.393, than to the gonion (mean = 22.6 mm), p = 0.801, and closer to the posterior margin of the ramus (mean = 13.1 mm), p = 0.753, than to the anterior margin of the ramus. Additionally, the MF was closer to the temporal crest. Age also influenced the position of the MF, with a posterior and superior movement of the foramen, reducing the distance between the MF and the posterior margin of the ramus as well as the MF and the sigmoid notch (p < 0.001). Conclusions: A precise understanding of the MF’s location will help dentists and oral and maxillofacial surgeons improve the success of the IAN block, avoid injury to the inferior alveola neurovascular bundle, and minimize surgical complications such as paresthesia, permanent anesthesia, and hemorrhage. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Updates and Perspectives)

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16 pages, 2970 KiB

Open AccessFeature PaperArticle

Plasma Endothelin-1 Levels: Non-Predictors of Alzheimer’s Disease Reveal Age Correlation in African American Women

by Irene A. Zagol-Ikapitte, Mohammad A. Tabatabai, Derek M. Wilus and Donald J. Alcendor

J. Clin. Med. 2025, 14(2), 635; https://doi.org/10.3390/jcm14020635 - 19 Jan 2025

Viewed by 598

Abstract

Background/Objectives: Alzheimer’s disease (AD) and related dementias (ADRD) disproportionately impact racial and ethnic minorities. Contributing biological factors that explain this disparity have been elusive. Moreover, non-invasive biomarkers for early detection of AD are needed. Endothelin-1 (ET-1), a vasoconstrictive factor linked to cerebral vascular [...] Read more.

Background/Objectives: Alzheimer’s disease (AD) and related dementias (ADRD) disproportionately impact racial and ethnic minorities. Contributing biological factors that explain this disparity have been elusive. Moreover, non-invasive biomarkers for early detection of AD are needed. Endothelin-1 (ET-1), a vasoconstrictive factor linked to cerebral vascular disease pathology and neuronal injury, could provide insights to better understand racial disparities in AD. As a potent vasoconstrictive peptide that regulates contractions in smooth muscle, endothelial cells, and pericytes, ET-1 may result in cerebral vascular constriction, leading to cerebral hypoperfusion; over time, this may result in neuronal injury, contributing to the pathology of AD. The role of the ET-1 system as a driver of ethnic disparities in AD requires further investigation. In the United States (U.S.), ET-1 dysregulation in Hispanic/Latinx (H/L) ethnic populations has largely been unexplored. Genetics linking ET-1 dysregulation and racial disparities in AD also require further investigation. In this study, we examined the role of the ET-1 protein in human plasma as a potential biomarker with predictive value for correlating with the development of AD by age, race, and sex. Methods: We examined ET-1 protein levels using quantitative mass spectrometry in AA and NHW patients with AD, along with controls. Results: A partial correlation between age at draw and ET-1, stratified by race and sex, while controlling for AD status, was significant for female AAs (r = 0.385, p = 0.016). When the data were not stratified but controlled for AD status, the partial correlation between age at draw and ET-1 was not significant (r = 0.108, p = 0.259). Conclusions: Based on the small number of plasma specimens and no plasma specimens from H/L individuals with AD, we conclude that ET-1 was clearly not a significant factor in predicting AD in this study and will require a larger scale study for validation. Full article

(This article belongs to the Section Brain Injury)

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11 pages, 1253 KiB

Open AccessArticle

Three-Dimensional Posture Analysis-Based Modifications After Manual Therapy: A Preliminary Study

by Fabio Scoppa, Andrea Graffitti, Alessio Pirino, Jacopo Piermaria, Federica Tamburella and Marco Tramontano

J. Clin. Med. 2025, 14(2), 634; https://doi.org/10.3390/jcm14020634 - 19 Jan 2025

Viewed by 551

Abstract

Background/Objectives: Manual therapies like Osteopathic Manipulative Treatment (OMT) and Gentle Touch Intervention (GTI) are widely employed for improving posture and spinal alignment, but their effects as measured using advanced technologies remain underexplored. This study aims to evaluate the short-term postural effects of these [...] Read more.

Background/Objectives: Manual therapies like Osteopathic Manipulative Treatment (OMT) and Gentle Touch Intervention (GTI) are widely employed for improving posture and spinal alignment, but their effects as measured using advanced technologies remain underexplored. This study aims to evaluate the short-term postural effects of these interventions using a non-invasive three-dimensional rasterstereography-based approach, focusing on the cervical arrow, lumbar arrow, kyphotic angle, and lordotic angle parameters. Methods: A three-armed randomized controlled trial was conducted with 165 healthy participants. The subjects were divided into control (CTRL), OMT, and GTI groups. Their postural parameters were assessed pre- and post-intervention using the Spine3D system by Sensor Medica (Guidonia Montecelio, Italy). The statistical analyses included paired t-tests and an ANOVA, with the significance set at p < 0.05. Results: Significant reductions in the cervical arrow were observed in both the OMT (p < 0.005) and GTI (p < 0.05) groups, while the kyphotic angle significantly improved only in the GTI group (p < 0.05). No significant changes were found in the lumbar arrow or the lordotic angle across the groups. The control group showed no postural variations, reinforcing the specificity of the interventions. Conclusions: Both OMT and GTI influence spinal posture, particularly in the cervical and thoracic regions. GTI, with its gentle approach, demonstrated unique effects on the thoracic curvature, suggesting neurophysiological mechanisms. These findings highlight the potential of manual therapies for posture modulation and suggest future research should explore their long-term benefits and applications in clinical populations. Full article

(This article belongs to the Special Issue Manual Therapy for the Prevention and Management of Musculoskeletal and Related Disorders across the Life Course)

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12 pages, 1384 KiB

Open AccessArticle

Comparison of COVID-19 and Non-COVID-19 Tracheostomised Patients: Complications, Survival, and Mortality Risk Factors

by Marta Mesalles-Ruiz, Maitane Alonso, Marc Cruellas, Martí Plana, Anna Penella, Alejandro Portillo, Víctor Daniel Gumucio, Xavier González-Compta, Manel Mañós and Julio Nogués

J. Clin. Med. 2025, 14(2), 633; https://doi.org/10.3390/jcm14020633 - 19 Jan 2025

Viewed by 622

Abstract

Objectives: To compare the outcomes of tracheostomised COVID-19 patients with non-COVID-19 tracheostomised patients to identify factors influencing severity and mortality. Methods: A retrospective, single-centre cohort study was conducted on COVID-19 tracheostomised patients admitted from May 2020 to February 2022, compared with a cohort [...] Read more.

Objectives: To compare the outcomes of tracheostomised COVID-19 patients with non-COVID-19 tracheostomised patients to identify factors influencing severity and mortality. Methods: A retrospective, single-centre cohort study was conducted on COVID-19 tracheostomised patients admitted from May 2020 to February 2022, compared with a cohort of non-COVID-19 tracheostomised patients. Results: COVID-19 tracheostomised patients had a higher mortality rate (50% vs. 27.3% in non-COVID-19 patients). Mortality risk factors in COVID-19 tracheostomised patients included female sex (HR 1.99, CI 1.09–3.61, p = 0.025), ischemic heart disease (HR 5.71, CI 1.59–20.53, p = 0.008), elevated pre-tracheostomy values of PEEP (HR 1.06, CI 1.01–1.11, p = 0.017) and INR (HR 1.04, CI 1.01–1.07, p = 0.004), and ventilatory complications (HR 8.63, CI 1.09–68.26, p = 0.041). No significant differences in complication rates were found based on Sars-CoV-2 infection or tracheostomy type. Conclusions: Tracheostomy technique did not impact complications, discharge circumstances, or mortality, supporting the safety of bedside percutaneous tracheostomies for COVID-19 patients. COVID-19 tracheostomised patients exhibited a higher mortality rate. Full article

(This article belongs to the Topic Acute Respiratory Distress Syndrome (ARDS): Personalized Therapies and Beyond, 2nd Edition)

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9 pages, 4860 KiB

Open AccessArticle

Reliability of Tracheal Temperature as a Measurement of Core Body Temperature During Cardiac Surgery Using Cardiopulmonary Bypass

by Hyun-Uk Kang, Sou-Hyun Lee, Ji-Hyun Chin, In-Cheol Choi and Kyungmi Kim

J. Clin. Med. 2025, 14(2), 632; https://doi.org/10.3390/jcm14020632 - 19 Jan 2025

Viewed by 402

Abstract

Background: To compare tracheal temperature (T_ET) with nasopharyngeal temperature (T_NP) in patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Methods: T_ET was measured using a thermistor in the cuff of an endotracheal tube and T_NP [...] Read more.

Background: To compare tracheal temperature (T_ET) with nasopharyngeal temperature (T_NP) in patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Methods: T_ET was measured using a thermistor in the cuff of an endotracheal tube and T_NP was monitored using an esophageal stethoscope. Depending on the management of the CPB strategy, the operation was divided into four periods (pre-CPB, cooling, rewarming, and post-CPB). A Bland–Altman analysis was carried out to compare T_ET with T_NP in each period. The concordance correlation coefficient for repeated measures analysis and various time lags was used to validate the time lag maximizing the concordance correlation coefficient between the two methods. Results: A total of 7191 pairs of temperature recordings acquired from 24 patients were included in the analysis. During steady normothermia, 81.7% (95% confidence interval [CI], 79.8–83.5%) of the pairs had a difference within ±0.5 °C, with a mean bias of −0.28 °C and limits of agreement (LOA) of −0.74 °C to 0.18 °C. The LOA during the cooling and rewarming phase of CPB were −1.13 °C to 0.51 °C and −0.91 °C to 1.29 °C, respectively. The mean bias and LOA throughout the entire operation were −0.10 °C and −0.98 °C to 0.77 °C, respectively. Throughout the entire operation, −2 min of time lag on T_ET maximized the concordance correlation coefficient (0.94 [95% CI, 0.92–0.96] to 0.95 [95% CI, 0.93–0.96]), indicating an earlier response of T_ET than T_NP. Conclusions: T_ET could be an alternative to T_NP during cardiac surgery using CPB. Full article

(This article belongs to the Section Anesthesiology)

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14 pages, 593 KiB

Open AccessArticle

Assessing the Impact of the Prone Position on Acute Kidney Injury

by Eden Ezra, Itai Hazan, Dana Braiman, Rachel Gaufberg, Jonathan Taylor, Adva Alyagon, Amit Shira Babievb and Lior Fuchs

J. Clin. Med. 2025, 14(2), 631; https://doi.org/10.3390/jcm14020631 - 19 Jan 2025

Viewed by 407

Abstract

Background: Prone positioning is a standard intervention in managing patients with severe acute respiratory distress syndrome (ARDS) and is known to improve oxygenation. However, its effects on other organs, particularly the kidneys, are less well understood. This study aimed to assess the [...] Read more.

Background: Prone positioning is a standard intervention in managing patients with severe acute respiratory distress syndrome (ARDS) and is known to improve oxygenation. However, its effects on other organs, particularly the kidneys, are less well understood. This study aimed to assess the association between prone positioning and the development of acute kidney injury (AKI), specifically in overweight and obese patients. Methods: A retrospective pre–post study was conducted on a cohort of 60 critically ill ARDS patients who were placed in the prone position during hospitalization. The development of AKI was assessed using the Acute Kidney Injury Network (AKIN) criteria, with AKI measured by both creatinine levels (AKIN_Cr) and urine output (AKIN_UO). Patients were divided into two groups based on body mass index (BMI): overweight/obese (BMI ≥ 25) and non-obese (BMI < 25). Data were collected before and after prone positioning. Results: In overweight/obese patients (n = 39, 57 cases), both the median AKIN_Cr and AKIN_UO scores increased significantly following prone positioning (from 0 to 1, median p < 0.01, and from 0 to 2, median p < 0.01, respectively). No statistically significant changes in AKIN scores were observed in non-obese patients nor were significant differences found in either group after repositioning to supine. Conclusions: Prone positioning is associated with an increased risk of acute kidney injury in overweight and obese ARDS patients. This may be due to the kidneys’ susceptibility to intra-abdominal hypertension in these patients. Further research is needed to explore optimal proning strategies for overweight and obese populations. Full article

(This article belongs to the Section Intensive Care)

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18 pages, 665 KiB

Open AccessReview

Neurogenic Orthostatic Hypotension in Parkinson Disease—A Narrative Review of Diagnosis and Management

by Cristina Grosu, Otilia Noea, Alexandra Maștaleru, Emilian Bogdan Ignat and Maria Magdalena Leon

J. Clin. Med. 2025, 14(2), 630; https://doi.org/10.3390/jcm14020630 - 19 Jan 2025

Viewed by 522

Abstract

Background: Neurogenic orthostatic hypotension (NOH) is a significant non-motor manifestation of Parkinson’s disease (PD), that substantially affects patient disability and has a powerful impact on the quality of life of PD patients, while also contributing to increased healthcare costs. This narrative review aims [...] Read more.

Background: Neurogenic orthostatic hypotension (NOH) is a significant non-motor manifestation of Parkinson’s disease (PD), that substantially affects patient disability and has a powerful impact on the quality of life of PD patients, while also contributing to increased healthcare costs. This narrative review aims to summarize key insights into the diagnosis and management of NOH in individuals with PD. Methods: For diagnosing NOH, a recently introduced and valuable metric is the ΔHr/ΔSBP index. Additional tools, such as autonomic reflex testing and various blood tests, also can be used to help distinguish orthostatic hypotension (OH) from NOH. Results: Treatment strategies for NOH involve both non-pharmacological and pharmacological approaches. As NOH frequently coexists with other abnormal blood pressure patterns (supine hypertension, nocturnal hypertension, and non-dipping hypertension), its treatment can be a challenge for the clinician. Droxidopa and midodrine are the primary pharmacological agents for NOH, though emerging therapies, such as norepinephrine transporter inhibitors, are being investigated. Conclusions: Despite these advancements, further research is needed to better understand the underlying pathophysiology of NOH, enabling more tailored and effective treatment options for individuals with PD. Full article

(This article belongs to the Special Issue Symptoms and Treatment of Parkinson’s Disease)

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19 pages, 3013 KiB

Open AccessArticle

Clinical Outcomes of Catheter Ablation for Atrial Fibrillation in Patients with Acute Decompensated Heart Failure

by Yoshifumi Ikeda, Ritsushi Kato, Hitoshi Mori, Kenta Tsutsui, Kazuhisa Matsumoto, Masataka Narita, Wataru Sasaki, Daisuke Kudo, Naomichi Tanaka and Kazuo Matsumoto

J. Clin. Med. 2025, 14(2), 629; https://doi.org/10.3390/jcm14020629 - 19 Jan 2025

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Abstract

Background: The prognosis of acute decompensated heart failure (ADHF) and heart failure (HF) with atrial fibrillation (AF) has been dismal. This study was performed to investigate the clinical outcomes of catheter ablation (CA) performed in patients with concurrent ADHF and AF. Methods [...] Read more.

Background: The prognosis of acute decompensated heart failure (ADHF) and heart failure (HF) with atrial fibrillation (AF) has been dismal. This study was performed to investigate the clinical outcomes of catheter ablation (CA) performed in patients with concurrent ADHF and AF. Methods: We retrospectively analyzed ADHF patients with AF who were admitted to our institution from 2007 to 2017. Results: In total, 472 patients were included in this study, with a mean follow-up duration of 32.8 ± 32.9 months. The 5-year event-free rate (cardiovascular death and HF hospitalization) was 61.4%, and the 10-year event-free rate was 42.7%. A comparative analysis of the event group and control group revealed that patients in the event group were older (event group vs. control group: 72.1 ± 11.0 vs. 68.8 ± 13.4 years, p = 0.008) and had a higher proportion of Clinical Scenario 3 classifications (event group vs. control group: 24% vs. 12%, p = 0.001). Notably, patients in the event group had a lower sinus rhythm maintenance rate (event group vs. control group: 17% vs. 31%, p < 0.001) and CA rate (event group vs. control group: 9% vs. 21%, p = 0.003). The CA group had a higher event-free rate than the non-CA group, and this trend persisted even after matching the patients’ backgrounds (log-rank test: p < 0.001). Conclusions: Patients presenting with AF at the onset of ADHF showed a poor prognosis, whereas CA demonstrated potential for improving the prognosis for some of these patients. Full article

(This article belongs to the Special Issue Atrial Fibrillation and Its Complications: Preventive Strategies and Relative Evidence)

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11 pages, 208 KiB

Open AccessArticle

Dental Rehabilitation After Microvascular Reconstruction of Segmental Jaw Defects: A Ten-Year Follow-Up

by Katharina Zeman-Kuhnert, Alexander J. Gaggl, Gian B. Bottini, Benjamin Walch, Christoph Steiner, Georg Zimmermann and Christian Brandtner

J. Clin. Med. 2025, 14(2), 628; https://doi.org/10.3390/jcm14020628 - 19 Jan 2025

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Abstract

Background/Objectives: Defects in maxillary and mandibular continuity are common in maxillofacial practice. They can occur after trauma, osteonecrosis, congenital jaw deformities, or surgical resection of benign or malignant tumours. Reconstruction with microvascular bone flaps and subsequent prosthetic rehabilitation is considered the contemporary [...] Read more.

Background/Objectives: Defects in maxillary and mandibular continuity are common in maxillofacial practice. They can occur after trauma, osteonecrosis, congenital jaw deformities, or surgical resection of benign or malignant tumours. Reconstruction with microvascular bone flaps and subsequent prosthetic rehabilitation is considered the contemporary first line treatment. This study assessed the extent to which the underlying disease influences the treatment course of microvascular segmental jaw reconstruction. Methods: A retrospective review of prospectively collected data from all patients who underwent microvascular segmental jaw reconstruction from January 2011 to December 2020 was completed. The course of treatment as well as the process of dental rehabilitation was assessed. Results: Two hundred patients were included in the study. A total of 15.5% of patients were fitted with a conventional removable prosthesis, and implant-supported prosthetic restoration could be realized in 53.5% of patients. However, dental rehabilitation was not possible in 31.0% of patients. The outcomes of prosthetic restoration showed a statistically significant difference between the different underlying diseases (p < 0.0001). About 50% of patients with malignant diseases and osteonecrosis remained without dental rehabilitation. In contrast, more than 90% of patients with jaw continuity defects, due to benign diseases or malformations, were able to receive an implant-supported prosthesis. Among the diagnostic groups, there was a significant difference regarding the number of implants placed (p < 0.0001). There was a significant correlation between increased incidence of complications and the size of the bone flaps. Conclusions: The underlying disease influenced significantly the treatment course and the outcome of dental rehabilitation after microvascular jaw reconstruction. Full article

(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)

22 pages, 3581 KiB

Open AccessArticle

A Real-Life Study in Sequential Therapy for Severe Menopausal Osteoporosis

by Oana-Claudia Sima, Mihai Costachescu, Mihaela Stanciu, Claudiu Nistor, Mara Carsote, Denisa Tanasescu, Florina Ligia Popa and Ana Valea

J. Clin. Med. 2025, 14(2), 627; https://doi.org/10.3390/jcm14020627 - 19 Jan 2025

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Abstract

Background: Teriparatide (TPT) acts against severe primary (postmenopausal) osteoporosis (MOP), and it requires continuation with another anti-resorptive drug to conserve or enhance the effects on fracture risk reduction. Objective: To analyse the sequential pharmacotherapy in MOP who were treated upon a 24-month daily [...] Read more.

Background: Teriparatide (TPT) acts against severe primary (postmenopausal) osteoporosis (MOP), and it requires continuation with another anti-resorptive drug to conserve or enhance the effects on fracture risk reduction. Objective: To analyse the sequential pharmacotherapy in MOP who were treated upon a 24-month daily 20 µg TPT protocol (24-mo-TPT) followed by another 12 months of anti-resorptive drugs (12-mo-AR) amid real-life settings. Hypotheses: 1. TPT candidates had a more severe fracture risk profile versus those who did not fulfil the TPT criteria according to the national protocol of TPT initiation; 2. Patients treated with TPT improved their DXA profile after 24 mo; 3. After 1 year of therapy since the last TPT injection, the improved bone profile and fracture risk at the end of the TPT protocol were conserved; 4. The mineral metabolism assays and fracture risk status were similar at TPT initiation between those who finished the 24 mo protocol and those who prematurely stopped it. Methods: This was a longitudinal, retrospective, multicentre study in MOP. The entire cohort (group A) included the TPT group (B) versus the non-TPT group (non-B). Group B included subjects who finished 24-mo-TPT (group P) and early droppers (ED), and then both continued 12-mo-AR. Results: Group B (40.5%) from cohort A (N = 79) vs. non-B had lower T-scores, increased age and years since menopause. A similar profile of demographic features, BTM, and prevalent fractures (73%, respectively, 57%) was found in group P (72%) vs. ED (21.8%). Group P: osteocalcin was statistically significantly higher at 12 mo (+308.39%), respectively, at 24 mo (+171.65%) vs. baseline (p < 0.001 for each), while at 12-mo-AR became similar to baseline (p = 0.615). The cumulative probability of transient hypercalcemia-free follow-up of protocol had the highest value of 0.97 at 6 mo. An incidental fracture (1/32) was confirmed under 24-mo-TPT. BMD had a mean percent increase at the lumbar spine of +8.21% (p < 0.001), of +12.22% (p < 0.001), respectively, of +11.39% (p < 0.001). The pharmacologic sequence for 12-mo-AR included bisphosphonates (24.24% were oral BP) or denosumab (13%). BTM showed a suppression at 12-mo-AR (p < 0.05), while all BMD/T-scores were stationary. No incidental fracture was registered during 12-mo-AR. Conclusions: All research hypotheses were confirmed. This study in high-risk MOP highlighted an effective sequential pharmacotherapy in reducing the fracture risk as pinpointed by BMD/T-score measurements and analysing the incidental fractures profile. Full article

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

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J. Clin. Med., Volume 14, Issue 2 (January-2 2025) – 361 articles

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