Journal of Clinical Medicine

19 pages, 3476 KiB

Open AccessPerspective

Perspectives on the Role of Thoracic Fascial Blocks in Cardiac Anaesthesia: Will They Represent a New Era?

by Giuseppe Sepolvere, Daniele Marianello, Cristina Santonocito, Simone Messina, Simona Silvetti, Federico Franchi, Gianluca Paternoster and Filippo Sanfilippo

J. Clin. Med. 2025, 14(3), 973; https://doi.org/10.3390/jcm14030973 (registering DOI) - 3 Feb 2025

Abstract

Cardiac surgery is continuously evolving, with increasing skills required by the cardiac anaesthesiologist. Following the advent of intraoperative echocardiography, we are witnessing a potential new revolution for the cardiac anaesthesiologist. A new era has indeed started with the implementation of thoracic fascial blocks [...] Read more.

Cardiac surgery is continuously evolving, with increasing skills required by the cardiac anaesthesiologist. Following the advent of intraoperative echocardiography, we are witnessing a potential new revolution for the cardiac anaesthesiologist. A new era has indeed started with the implementation of thoracic fascial blocks (TFBs) in the field of cardiac surgery. TFBs provide several advantages in the context of multimodal analgesia, with improved pain control and reduction of the side effects related to large doses of opioids. We envisage that implementation of TFBs is likely to become a pivotal concept in the field of enhanced recovery after cardiac surgery. We describe the main TFBs for the anterior and/or antero-lateral chest wall, and their peculiar use in cardiac surgery. In particular, we discuss indications and tips and tricks to enhance clinical results for the following blocks: (1) Pecto-Intercostal Plane (superficial and deep); (2) Rectus Sheath; (3) Interpectoral Plane and Pectoserratus Plane; (4) Serratus Anterior Plane; (5) Erector Spinae Plane. Nonetheless, the scientific evidence for the use of TFBs in the field of cardiac anaesthesia is not robust yet, mostly based on small-sized single-centre studies, making it difficult to achieve a high quality of evidence. Further, it remains unclear which cardiac surgery patients may benefit the most from these techniques. Full article

(This article belongs to the Section Anesthesiology)

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15 pages, 2443 KiB

Open AccessPerspective

Cardiac Arrest: Can Technology Be the Solution?

by Frédéric Lapostolle, Jean-Marc Agostinucci, Tomislav Petrovic and Anne-Laure Feral-Pierssens

J. Clin. Med. 2025, 14(3), 972; https://doi.org/10.3390/jcm14030972 (registering DOI) - 3 Feb 2025

Abstract

Out-of-hospital cardiac arrest (OHCA) mortality remains alarmingly high in most countries. The majority of pharmacological attempts to improve outcomes have failed. Randomized trials have shown limited survival benefits with vasopressin, fibrinolysis, amiodarone, or lidocaine. Even the benefits of adrenaline remain a matter of [...] Read more.

Out-of-hospital cardiac arrest (OHCA) mortality remains alarmingly high in most countries. The majority of pharmacological attempts to improve outcomes have failed. Randomized trials have shown limited survival benefits with vasopressin, fibrinolysis, amiodarone, or lidocaine. Even the benefits of adrenaline remain a matter of debate. In this context, relying on technology may seem appealing. However, technological strategies have also yielded disappointing results. This is exemplified by automated external chest compression devices. When first introduced, theoretical models, animal studies, and early clinical trials suggested they could improve survival. Yet, randomized trials failed to confirm this benefit. Similarly, to date, extracorporeal membrane oxygenation (ECMO), therapeutic hypothermia, and primary angioplasty have demonstrated inconsistent survival advantage. Other technological innovations continue to be explored, such as artificial intelligence to improve the diagnosis of cardiac arrest during emergency calls, mobile applications to dispatch citizen responders to patients in cardiac arrest, geolocation of defibrillators, and even the delivery of defibrillators via drones. Nevertheless, it is clear that the focus and investment should prioritize the initial links in the chain of survival: early alerting, chest compressions, and defibrillation. Significant improvements in these critical steps can be achieved through the education of children. Modern technological tools must be leveraged to enhance this training by incorporating gamification and democratizing access to education. These strategies hold the potential to fundamentally improve the management of cardiac arrest. Full article

(This article belongs to the Section Emergency Medicine)

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11 pages, 1621 KiB

Open AccessReview

Moving Beyond the Checklist—An Enhanced Approach to Context-Driven Overuse Injury Prevention in Overhead Youth Athletes

by Rachel Lau and Swarup Mukherjee

J. Clin. Med. 2025, 14(3), 971; https://doi.org/10.3390/jcm14030971 (registering DOI) - 3 Feb 2025

Abstract

The increasing discussions regarding the research-to-practice gap in sport injury prevention have led to a growing focus on the significance of context in injury prevention programs. A context-driven injury prevention program is advantageous to address and enhance injury prevention efforts in specific populations. [...] Read more.

The increasing discussions regarding the research-to-practice gap in sport injury prevention have led to a growing focus on the significance of context in injury prevention programs. A context-driven injury prevention program is advantageous to address and enhance injury prevention efforts in specific populations. Considering the prevalent concern for overuse injuries among overhead youth athletes, and the developmental and contextual factors unique to this population, this review introduces the OverHead Youth Athlete (OH-YA) overuse injury prevention process. Tailored to address the challenges of working with overhead youth athletes, the context-specific four-step framework includes the following: (1) development of a context-specific instrument with strong sample representation, (2) determination of the context-specific injury burden magnitude and associated factors, (3) development of a context-specific intervention with end-users, and (4) evaluation of the context-specific intervention. This framework would likely help maximize the use of typically limited resources in youth sports. Using shoulder overuse injuries among overhead youth athletes as a case study, the OH-YA overuse injury prevention process provides an enhanced approach to context-driven overuse injury prevention while illustrating the importance and integration of context to minimize the “research-to-practice” gap. Full article

(This article belongs to the Special Issue Youth Sports Injuries: From Prevalence to Prevention)

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11 pages, 526 KiB

Open AccessArticle

Preliminary Results of Microsurgical Sperm Retrieval in Azoospermic Patients: A Randomized Controlled Trial Comparing Operating Microscope vs. Surgical Loupes

by Mirko Preto, Luca Boeri, Lorenzo Cirigliano, Marco Falcone, Valentina Parolin, Federica Peretti, Ilaria Ferro, Natalia Plamadeala, Martina Scavone, Emanuele Zupo and Paolo Gontero

J. Clin. Med. 2025, 14(3), 970; https://doi.org/10.3390/jcm14030970 (registering DOI) - 3 Feb 2025

Abstract

Objectives: To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE—Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE—Group B) in adult males with non-obstructive azoospermia (NOA). Methods: A multicentric prospective randomized trial (ethics committee [...] Read more.

Objectives: To compare surgical outcomes and sperm retrieval rates (SRRs) between conventional microsurgical-assisted testicular sperm extraction (m-TeSE—Group A) and testicular sperm extraction performed with surgical loupes (l-TeSE—Group B) in adult males with non-obstructive azoospermia (NOA). Methods: A multicentric prospective randomized trial (ethics committee no. 202/2022) in accordance with the CONSORT guidelines was conducted from March 2022 to April 2024. Adult males with NOA without genetic alterations who signed the informed consent were enrolled. SRRs, intra- and postoperative complications (according to the Clavien–Dindo classification), and hormonal profile changes were considered as outcomes during the follow-up period. Results: A total of 42 NOA patients were enrolled. The median age was 35 years (IQR: 33–49). The preoperative median FSH was 16.5 mIU/mL (IQR: 11.6–22.5) and the total testosterone was 4.6 (3.5–5.6). Overall, the SRR was 22.6%, with sperm retrieved from 19 testes. Histopathological findings reported Sertoli cell-only syndrome (SCOS) in 46.4% (39 cases), hypospermatogenesis in 26.2%, and germ cell arrest in 26.2% of the patients. No intraoperative complications were recorded. The postoperative complications were minimal (Clavien–Dindo grade I), but no significant differences were recorded in-between the two surgical approaches. Considering the operative time of the testicular exploration alone, Group B seemed to be faster than the m-TeSE, with a median time saving of 8 min (p < 0.01). Conclusion: The use of surgical loupes was safe and comparable with m-TeSE in terms of the SRRs and complication rates. L-TeSE offered a reduction in the operative time compared with m-TeSE. Full article

(This article belongs to the Section Reproductive Medicine & Andrology)

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15 pages, 249 KiB

Open AccessArticle

Is Insulin Resistance an Independent Predictor of Atherosclerosis?

by Małgorzata Landowska, Bernadetta Kałuża, Cezary Watała, Emilia Babula, Aleksandra Żuk-Łapan, Kinga Woźniak, Aleksandra Kargul, Jonasz Jurek, Tomasz Korcz, Małgorzata Cicha-Brzezińska and Edward Franek

J. Clin. Med. 2025, 14(3), 969; https://doi.org/10.3390/jcm14030969 (registering DOI) - 3 Feb 2025

Abstract

Background: Insulin resistance (IR) is a condition that precedes the onset of type 2 diabetes mellitus (T2DM), which is regarded as an established risk factor for atherosclerosis (AS). Considering that the same metabolic changes as those caused by IR are evidenced to promote [...] Read more.

Background: Insulin resistance (IR) is a condition that precedes the onset of type 2 diabetes mellitus (T2DM), which is regarded as an established risk factor for atherosclerosis (AS). Considering that the same metabolic changes as those caused by IR are evidenced to promote the development of AS, we investigated whether IR estimated by the homeostasis model assessment of IR (HOMA-IR) could predict the occurrence of preclinical AS. Methods: The study participants were divided into two groups based on the presence of IR diagnosed during the baseline hospitalization and defined as a HOMA-IR value equal to or higher than 2.5. After a follow-up period of at least four years, a total of 79 (n = 79) were prospectively assessed in terms of the presence of preclinical AS, determined by either an abnormally low ankle–brachial index (ABI) (ABI < 0.9) or an increased carotid intima media thickness (CIMT) (CIMT > 1 mm). Results: Using the multivariate logistic regression analysis, it was demonstrated that the HOMA-IR was associated with an abnormally low ABI (odds ratio: 1.609, 95% confidence interval (CI): [1.041–2.487], p = 0.032). The Cox regression model revealed that the HOMA-IR was a predictor of both an abnormal ABI (hazard ratio: 1.435, CI: [1.076–1.913], p = 0.014) and increased CIMT (hazard ratio: 1.419, CI: [1.033–1.948], p = 0.031), independently of age, sex, dyslipidemia, smoking, triglycerides (TG), low-density lipoproteins (LDL), high-density lipoproteins (HDL), and total cholesterol levels. Conclusions: IR, as estimated by the HOMA-IR, may be considered as a predictor of preclinical AS, independently of cardiovascular risk factors. Full article

(This article belongs to the Special Issue Management of Dyslipidaemias: Enhancing Lipid Modification to Reduce Cardiovascular Risk)

12 pages, 1456 KiB

Open AccessArticle

Facial Nerve Graft in Malignant Tumors: The Role of Facial Rehabilitation

by Francesco Mattioli, Costanza Galloni, Chiara Alberti, Marco Bonali, Alfredo Lo Manto, Stella Baraldi, Roberto Tonelli, Federica Nizzoli, Elena Reggiani, Alice Barbazza, Carlotta Liberale, Marco Ferrari, Matteo Fermi, Matteo Alicandri-Ciufelli, Ignacio Javier Fernandez, Elisabetta Zanoletti, Piero Nicolai and Daniele Marchioni

J. Clin. Med. 2025, 14(3), 968; https://doi.org/10.3390/jcm14030968 (registering DOI) - 3 Feb 2025

Abstract

Background: Oncological surgery of the parotid gland or of the temporal bone may require the contemporary sacrifice of the facial nerve (FN). In such cases, the immediate repair of the sacrificed FN is recommended. The aim of this study is to evaluate [...] Read more.

Background: Oncological surgery of the parotid gland or of the temporal bone may require the contemporary sacrifice of the facial nerve (FN). In such cases, the immediate repair of the sacrificed FN is recommended. The aim of this study is to evaluate the impact of facial rehabilitation (FR) and, secondarily, of post-operative radiotherapy (PORT) on the FN outcome after FN sacrifice and reconstruction via cable graft. Methods: This is a multicentric retrospective study including patients affected by malignant tumors whose surgical excision required FN sacrifice and contextual FN reconstruction with a cable graft. Other FN reconstruction techniques were excluded. FN function was assessed using both House–Brackmann and Sunnybrook grading systems. Results: A total of 28 patients were included. Most of the patients underwent a total parotidectomy. The greater auricular nerve was the main donor for cable graft. FR and PORT were performed in 22 and 15 patients, respectively. In particular, 20 patients underwent neuro-muscular retraining (NMR). Patients who underwent FR had better FN outcomes compared to those who did not (p = 0.02 at 12 months and p = 0.0002 at 24 months). In contrast, there was no statistically significant difference between patients who underwent PORT and those who did not (p > 0.05). Pre-operative FN palsy is a risk factor of worse FN function outcomes after cable graft. Conclusions: Our study, even though it was limited to only 28 cases, may demonstrate that cable graft failure is not due to PORT, as widely believed among clinicians, but to the absence of a rehabilitation program. Moreover, we suggest that the key to obtaining the best possible FN function results after FN sacrifice is the association of a technically correct FN reconstruction with a proper and targeted FR. Full article

(This article belongs to the Section Otolaryngology)

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17 pages, 3275 KiB

Open AccessCase Report

Novel Gait Training with a Hybrid Assistive Limb Improved Delayed Progressive Spastic Paraplegia After a Lightning Strike

by Yuichiro Soma, Shigeki Kubota, Hideki Kadone, Yukiyo Shimizu, Kousei Miura, Yasushi Hada, Yoshiyuki Sankai and Masashi Yamazaki

J. Clin. Med. 2025, 14(3), 967; https://doi.org/10.3390/jcm14030967 (registering DOI) - 3 Feb 2025

Abstract

Background/Objectives: A 68-year-old man presented with progressive walking difficulty that developed into spastic paraplegia. This condition was a long-term consequence of a lightning strike injury sustained at the age of 22 years. His symptoms progressively deteriorated, eventually requiring double crutches for ambulation [...] Read more.

Background/Objectives: A 68-year-old man presented with progressive walking difficulty that developed into spastic paraplegia. This condition was a long-term consequence of a lightning strike injury sustained at the age of 22 years. His symptoms progressively deteriorated, eventually requiring double crutches for ambulation at approximately 40 years of age. A physical evaluation prior to hybrid assistive limb (HAL) training revealed a T10 level neurological injury and an American Spinal Cord Injury Association impairment scale grade D. Here, we aimed to evaluate the therapeutic effects of novel gait training with an HAL in this patient with chronic and progressive neural damage caused by a lightning strike. Methods: The HAL training program is composed of two sections. In the first section, one month of gait training with HAL was conducted across 10 sessions, with 2–3 sessions weekly. The second section followed 6 months later. A final evaluation was performed three months after the second section. Results: Electromyographic and kinematic evaluation showed that the HAL gait training inhibited abnormal antagonistic muscle activation in his lower extremities, especially after the first section. Our results collectively indicate that the repeated HAL gait training improved the gait pattern of this patient. Conclusions: Our results suggest that HAL gait training may improve the gait pattern in patients with delayed progressive spastic paraplegia, as observed in this case. In addition, a longer intervention period is recommended to facilitate better adaptation to HAL training. Hence, neurorehabilitation with an HAL could be an innovative treatment approach for delayed progressive spastic paraplegia. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 294 KiB

Open AccessArticle

Pre-Hospital Critical Care for Out-of-Hospital Cardiac Arrests with Return of Spontaneous Circulation: A Retrospective Observational Study

by Adam J. R. Watson, Delphi Henderson, Ryan Beecham, James Ward, Peter Owen, Julian Hannah, James Plumb and Ahilanandan Dushianthan

J. Clin. Med. 2025, 14(3), 966; https://doi.org/10.3390/jcm14030966 (registering DOI) - 3 Feb 2025

Abstract

Background/Objectives: Out-of-hospital cardiac arrests (OHCAs) are common, with return of spontaneous circulation (ROSC) achieved in approximately 25% of patients. However, it remains unknown whether post-ROSC care delivered by a pre-hospital critical care team (CCT) improves patient outcomes. We therefore aimed to investigate [...] Read more.

Background/Objectives: Out-of-hospital cardiac arrests (OHCAs) are common, with return of spontaneous circulation (ROSC) achieved in approximately 25% of patients. However, it remains unknown whether post-ROSC care delivered by a pre-hospital critical care team (CCT) improves patient outcomes. We therefore aimed to investigate this in OHCA patients admitted to our intensive care unit (ICU). Methods: In this retrospective observational study, consecutive adults with ROSC after non-traumatic OHCA admitted to our ICU between 1 September 2019 and 31 August 2022 were included. We compared patients who received post-ROSC care from a CCT to those who received standard care. The primary outcome was a good neurological outcome on hospital discharge (defined as Cerebral Performance Category 1–2). Descriptive statistics, Area Under the Receiver Operating Characteristic Curve (AUC) values, and adjusted Odds Ratios (ORs) are reported. We constructed multivariable logistic regression models that adjusted for the component variables of the MIRACLE2 score. Results: We included 126 OHCAs (median age 63 years, 69% male), which were largely witnessed (82%), involved bystander cardiopulmonary resuscitation (87%), and had an initial shockable rhythm (61%). The prevalence of good neurological outcomes was higher in patients who received post-ROSC care from a pre-hospital CCT (37% vs. 17%, p = 0.012). The MIRACLE2 score was a strong predictor of good neurological outcomes (AUC 0.932), and in our multivariable analysis, good neurological outcome was associated with both CCT presence post-ROSC (aOR 3.77, 95% CI 1.02–13.89) and the delivery of PHEA (aOR 4.10, 95% CI 1.10–15.27, p = 0.035). Furthermore, in patients meeting the Utstein criteria (n = 69), good neurological outcomes were also more prevalent with CCT presence post-ROSC (62% vs. 29%, p < 0.001). Conclusions: We found that post-ROSC care delivered by a pre-hospital CCT was associated with good neurological outcomes on hospital discharge. Full article

(This article belongs to the Section Emergency Medicine)

11 pages, 235 KiB

Open AccessArticle

Isotemporal Substitution Effect of 24-Hour Movement Behaviors on Well-Being, Cognition, and BMI Among Older Adults

by John Oginni, Suryeon Ryu, Yingying Chen and Zan Gao

J. Clin. Med. 2025, 14(3), 965; https://doi.org/10.3390/jcm14030965 (registering DOI) - 3 Feb 2025

Abstract

Background: This study investigated the interdependent relationships among older adults’ daily engagement in physical activity (PA), sedentary time (ST), sleep, and their well-being, cognition, and body mass index (BMI). Method: Forty healthy older adults (31 females; Mean [age] = 70.8 ± [...] Read more.

Background: This study investigated the interdependent relationships among older adults’ daily engagement in physical activity (PA), sedentary time (ST), sleep, and their well-being, cognition, and body mass index (BMI). Method: Forty healthy older adults (31 females; Mean [age] = 70.8 ± 5.58) were included in the analysis. Participants wore a Fitbit tracker for an average of 23 h a day, five days a week, over six months. The Fitbit device tracked lightly active time, active time, ST, and sleep durations. Quality of life and cognitive flexibility were assessed using validated instruments. BMI was calculated using participants’ self-reported height and weight. A compositional analysis (CODA) investigated the codependent associations among these variables and model time reallocation between behaviors. Results: Regression models utilizing CODA indicated significant associations between the outcomes of BMI (p = 0.05; Adj. R²= 0.20), while cognitive flexibility and quality of life revealed no association (p > 0.05). Shifting 10 min from ST to active time is associated with a theoretical decrease of −0.76 (95% CI, −1.49 to −0.04) units in BMI. Similarly, reallocating 10 min from active time to ST is associated with a theoretical increase of 1.17 (95% CI, 0.03 to 2.3) units in BMI. Reallocating 10 min between other movement behaviors yielded no statistical significance. Conclusions: Our study highlights the importance of promoting active time to improve BMI in this population. Encouraging 10 min bouts of PA among older adults, in place of ST, is vital for improving national PA guideline adherence. Full article

(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)

17 pages, 815 KiB

Open AccessReview

Acute Kidney Injury During Sepsis and Prognostic Role of Coexistent Chronic Heart Failure

by Jens Soukup and Rainer U. Pliquett

J. Clin. Med. 2025, 14(3), 964; https://doi.org/10.3390/jcm14030964 (registering DOI) - 3 Feb 2025

Abstract

Background: The recently updated definition of sepsis considers pathophysiologic mechanisms to guide initial therapy. Clearly, generalized recommendations for sepsis therapy may be limited by pre-existing multimorbidity in addition to sepsis-related multi-organ failure. In particular, a recommendation regarding fluid rescue therapy may require adequate [...] Read more.

Background: The recently updated definition of sepsis considers pathophysiologic mechanisms to guide initial therapy. Clearly, generalized recommendations for sepsis therapy may be limited by pre-existing multimorbidity in addition to sepsis-related multi-organ failure. In particular, a recommendation regarding fluid rescue therapy may require adequate cardiac function and/or the absence of sepsis-induced cardiomyopathy. In all sepsis patients with compromised cardiac function or sepsis-induced cardiomyopathy, a patient-specific therapy regimen is required to prevent pulmonary edema and early death. Similarly, in sepsis, acute kidney injury with or without pre-existing chronic kidney disease requires attention to be paid to excretory renal function to avoid hypervolemia-mediated acute heart failure. In addition, hyponatremia related to intravascular hypovolemia may be explained by vasopressin stimulation. However, hypothetically, vasopressin hyporesponsiveness may contribute to sepsis-related acute kidney injury. In this review, relevant cardiorenal pathomechanisms will be assessed in the context of sepsis therapy. Conclusions: In conclusion, therapy for sepsis with acute kidney injury has to take cardiac comorbidity, if present, into account. The extent to which vasopressin hyporesponsiveness aggravates sepsis-mediated hypovolemia and renal insufficiency should remain a subject of further study. Full article

(This article belongs to the Special Issue New Advances in Cardiorenal Syndrome: 2nd Edition)

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10 pages, 3121 KiB

Open AccessArticle

Hybrid CT Angio Suite for Acute Ischemic Stroke: A New Time-Saving Workflow Model?

by Pietro Trombatore, Simone Cottonaro, Iacopo Valente, Emilio Lozupone, Luigi Della Gatta, Alfio Cannella, Clara Di Lorenzo, Antonio Ragusa, Luca Mammino and Gianluca Galvano

J. Clin. Med. 2025, 14(3), 963; https://doi.org/10.3390/jcm14030963 (registering DOI) - 3 Feb 2025

Abstract

Objectives: Explore the effect of the introduction of a hybrid CT angio suite on the in-hospital workflow time of patients with acute ischemic stroke. Methods: This was a retrospective observational case-control study. All consecutive patients admitted to our emergency department with suspected ischemic [...] Read more.

Objectives: Explore the effect of the introduction of a hybrid CT angio suite on the in-hospital workflow time of patients with acute ischemic stroke. Methods: This was a retrospective observational case-control study. All consecutive patients admitted to our emergency department with suspected ischemic stroke who underwent stroke imaging and mechanical thrombectomy (MT) in the new hybrid CT angio suite from October 2023 to March 2024 were included in the study. The primary outcome was the evaluation of in-hospital workflow times by the assessment of both the time from hospital admission to the beginning of the endovascular treatment (door-to-groin time, DTG) and the time from the interpretation of imaging to arterial puncture (CT-to-groin time, CTTG). The secondary aim was the evaluation of the clinical outcome through the evaluation of the mRS at 3 months. These data were compared to the control group. Results: Between October 2023 and March 2024, 50 consecutive patients with suspected ischemic stroke underwent neuroimaging and MT in the hybrid CT angio suite. We observed a significant reduction of the median DTG time from 71 min to 36 min (p < 0.001) and the median CT-to-groin time from 44 min to 12 min (p < 0.001) compared to the control group. Conclusions: The introduction of the hybrid CT angio suite dedicated to acute ischemic stroke has definitely reduced in-hospital delays, allowing better management of these patients. Full article

(This article belongs to the Special Issue Neuroimaging in 2024 and Beyond)

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12 pages, 944 KiB

Open AccessArticle

Long-Term Clinical Relevance of Hyponatremia Identified During Acute Phase of Myocardial Infarction

by Karolina Eliasz, Konrad Stępień, Maja Wojtylak, Oliwia Andrasz, Katarzyna Majka, Gabriela Mazurek, Grzegorz Horosin, Jakub Plizga, Karol Nowak, Krzysztof Krawczyk, Mateusz Podolec, Jadwiga Nessler and Jarosław Zalewski

J. Clin. Med. 2025, 14(3), 962; https://doi.org/10.3390/jcm14030962 (registering DOI) - 3 Feb 2025

Abstract

Background/Objectives: Hyponatremia is associated with increased mortality in the general hospital population. We sought to investigate whether hyponatremia affects the long-term survival of patients following a myocardial infarction (MI) in both ST-segment elevation (STEMI) and non-ST elevation (NSTEMI) presentations. Methods: In this [...] Read more.

Background/Objectives: Hyponatremia is associated with increased mortality in the general hospital population. We sought to investigate whether hyponatremia affects the long-term survival of patients following a myocardial infarction (MI) in both ST-segment elevation (STEMI) and non-ST elevation (NSTEMI) presentations. Methods: In this study, 862 MI patients who were hospitalized between 2012 and 2017 were retrospectively followed-up within the median time period of 41.9 [28.2–73.5] months. All participants were assigned to a hyponatremic or normonatremic group with hyponatremia defined as a sodium level of less than 135 mEq/L on admission. Results: In the acute phase of an MI, hyponatremia was diagnosed in 31 (3.6%) patients. The patients with hyponatremia were less often male (38.7 vs. 70.4%, p < 0.001), and less frequently had Killip class I (63.3 vs. 80%) but more often had Killip class IV on admission (16.7 vs. 4.2%, p = 0.024) and more often had a history of impaired renal function (32.3 vs. 15.5%, p = 0.013) than those with normonatremia. Hyponatremic patients had higher troponin T levels on admission by 75.1% (p = 0.003), a higher isoenzyme MB of creatine kinase level by 34.4% (p = 0.006), and lower hemoglobin (by 8.5%, p = 0.001) levels as compared to the normonatremia group. Long-term mortality was significantly higher in the patients with hyponatremia versus normonatremia (18 [58.1%] vs. 243 [29.2%], log-rank p < 0.001). This was driven by differences in the NSTEMI population (65 vs. 30.5%, p < 0.001). By a Cox proportional hazard regression analysis, hyponatremia was associated with a higher long-term mortality (hazard ratio [HR] of 2.222, a 95% confidence interval [CI] of 1.309–3.773, and p = 0.003). Conclusions: Hyponatremia rarely identified in acute phase of MI was associated with higher long-term mortality, particularly in the NSTEMI population. Full article

(This article belongs to the Section Cardiology)

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13 pages, 2661 KiB

Open AccessArticle

Bilateral Simultaneous Cochlear Implants: How Early Activation Influences Wearing Hours

by Qusai Tawakkul, Fida Almuhawas, Sarah Alarifi, Nawaf Fatani and Abdulrahman Hagr

J. Clin. Med. 2025, 14(3), 961; https://doi.org/10.3390/jcm14030961 (registering DOI) - 3 Feb 2025

Abstract

Background/Objectives: Cochlear implantation (CI) is a transformative intervention for individuals with sensorineural hearing loss, providing auditory and speech perception improvements. Traditional CI activation occurs 4–6 weeks post-surgery; however, recent advancements allow for early activation within 1–2 days. The integration of data logging [...] Read more.

Background/Objectives: Cochlear implantation (CI) is a transformative intervention for individuals with sensorineural hearing loss, providing auditory and speech perception improvements. Traditional CI activation occurs 4–6 weeks post-surgery; however, recent advancements allow for early activation within 1–2 days. The integration of data logging in modern CI systems offers objective insights into processor usage and auditory exposure, which are crucial for optimizing rehabilitation outcomes. Methods: A retrospective study was conducted on 63 patients with bilateral simultaneous CIs using MED-EL SONNET2/RONDO3 devices. Patients were classified into early activation (n = 30, activation within 1–2 days) and classical activation groups (n = 33, activation after day 2). Data logging metrics, patient demographics, and implant details were analyzed using the Wilcoxon rank-sum test and Poisson regression. Results: Daily processor usage did not significantly differ between groups (9.5 ± 3.0 h/day for classical vs. 9.4 ± 3.7 h/day for early activation, p = 0.927). Subgroup analysis showed a significant 18% increase in processor usage with each additional year of patient age (IRR = 1.18, p < 0.001) and a 15% decrease in usage with each year delay in implantation age (IRR = 0.85, p < 0.001) among early activation users. Switch-on frequencies were comparable between groups, with no significant differences observed (p = 1.0). Conclusions: Early activation is feasible and associated with consistent CI usage, providing potential benefits in auditory rehabilitation. Future research should explore its impact on long-term speech and language outcomes to inform evidence-based practices. Full article

(This article belongs to the Section Otolaryngology)

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11 pages, 2182 KiB

Open AccessArticle

In-Office Hyaluronic Acid Injection of Vocal Folds in Patients with Presbyphonia

by Anastasiya Avdiyuk, Patricia Garnica, Ramón González-Herranz, Estefanía Miranda, Cristina García-García and Guillermo Plaza

J. Clin. Med. 2025, 14(3), 960; https://doi.org/10.3390/jcm14030960 (registering DOI) - 3 Feb 2025

Abstract

Objective: to evaluate the advantages and disadvantages of injection laryngoplasty with hyaluronic acid in patients older than 65 years with presbyphonia. Study Design: a retrospective observational study. Setting: an academic secondary medical center. Methods: This study was performed using a [...] Read more.

Objective: to evaluate the advantages and disadvantages of injection laryngoplasty with hyaluronic acid in patients older than 65 years with presbyphonia. Study Design: a retrospective observational study. Setting: an academic secondary medical center. Methods: This study was performed using a group of patients diagnosed with presbyphonia who were treated using injection laryngoplasty with hyaluronic acid and underwent a minimum follow-up of 12 months. Subjective parameters such as the Voice Handicap Index–10 (VHI-10) and the GRBAS scale (grade, roughness, breathiness, asthenia, strain) were measured, as well as objective parameters such as the closure defect area. The medical records of patients undergoing this procedure during the 2020–2023 period were reviewed. An analysis of the demographic and clinical variables of the group was performed, as well as the values of the VHI-10, GRBAS, difference, and improvement of the area of closure defect before and after the procedure, along with the treatment duration and sensation of improvement. Results: The mean pre- and postoperative VHI-10 decreased from 26.8 to 19.6, showing significant differences (p = 0.007). The postoperative GRBAS mean score was 5.6 and normality can be assumed when it is below 9. Out of the 16 patients, 11 of them reported subjective improvement in their symptoms. More than half of them showed an improvement in the closure defect greater than 80%, with a significant reduction in the area (p < 0.001). Conclusions: hyaluronic acid injection in patients with presbyphonia produced a clear subjective improvement in voice quality and a decrease in the closure defect area. Full article

(This article belongs to the Section Otolaryngology)

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6 pages, 4267 KiB

Open AccessCorrection

Correction: Godoy Hurtado et al. Low- and Negative-Pressure Hydrocephalus: New Report of Six Cases and Literature Review. J. Clin. Med. 2023, 12, 4112

by Alicia Godoy Hurtado, Patrick Barstchi, Juan Francisco Brea Salvago, Rajab Al-Ghanem, Jose Manuel Galicia Bulnes and Osamah El Rubaidi

J. Clin. Med. 2025, 14(3), 959; https://doi.org/10.3390/jcm14030959 (registering DOI) - 2 Feb 2025

Abstract

Following publication, concerns were raised regarding the peer-review process related to the publication of this article [...] Full article

(This article belongs to the Special Issue Recent Advances and Current Controversies in Hydrocephalus)

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10 pages, 5360 KiB

Open AccessCase Report

IgG4-RD-Associated Mikulicz Syndrome Without Classic Systemic Involvement—A Case Report

by Luis Ángel Mendoza-Vargas, Samuel Sevilla-Fuentes, Brandon Bautista-Becerril, Bertha Berthaúd-González, Ramcés Falfán-Valencia, Linda P. Félix-Martínez, Mauricio Avila-Páez and Jennifer Manilla-González

J. Clin. Med. 2025, 14(3), 958; https://doi.org/10.3390/jcm14030958 (registering DOI) - 2 Feb 2025

Abstract

Background: IgG4-related disease is a rare, chronic inflammatory disorder characterized by lymphoplasmacytic infiltration, ‘storiform’ fibrosis, and elevated IgG4 levels in affected tissues. This disease has a broad and heterogeneous clinical spectrum that includes four main phenotypes: pancreatic–hepatobiliary disease, retroperitoneal/aortic fibrosis, head and neck [...] Read more.

Background: IgG4-related disease is a rare, chronic inflammatory disorder characterized by lymphoplasmacytic infiltration, ‘storiform’ fibrosis, and elevated IgG4 levels in affected tissues. This disease has a broad and heterogeneous clinical spectrum that includes four main phenotypes: pancreatic–hepatobiliary disease, retroperitoneal/aortic fibrosis, head and neck disease, and Mikulicz syndrome. Case Description: An 85-year-old male patient with a clinical presentation, which is unusual outside Asia, of IgG4-related disease phenotype Mikulicz syndrome, characterized by bilateral dacryoadenitis, orbital pseudotumor, and no evidence of significant systemic participation. Despite extensive involvement in the orbital and glandular region, the patient did not develop serious organ complications, a behavior rarely documented in the literature. Despite the serum IgG4 levels being normal (<135 mg/dL), the clinical and radiological picture suggested IgG4-RD, emphasizing the need for a biopsy for a definitive diagnosis. Histopathological examination revealed a dense lymphoplasmacytic infiltrate, storiform fibrosis, and more than 40% IgG4-positive cells, confirming the diagnosis. Results: Treatment with prednisone was initiated alongside azathioprine for long-term control. Calcium and vitamin D3 supplementation were added to prevent glucocorticoid-induced osteoporosis. Remarkable clinical improvement was observed within 24 h, with progressive orbital and glandular symptoms resolution. Over a year, the patient exhibited complete resolution of the orbital tumors, total recovery of vision, and no relapses. The only sequelae observed were dry eye. Conclusions: This case highlights the need to consider IgG4-RD with normal serum IgG4 levels, the importance of histopathology for diagnosis, and the efficacy of steroids as first-line treatment. A multidisciplinary approach is essential for timely treatment. Full article

(This article belongs to the Topic Rheumatic Disorder: From Basic Science to Clinical Practice)

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13 pages, 851 KiB

Open AccessArticle

Proposal of a New Composite Score (DAMADECO) to Simultaneously Evaluate Asthma and CRSwNP Severity in Comorbid Patients

by Maria D’Amato, Patrizio Pasqualetti, Elena Cantone, Marco Caminati, Matteo Bonini, Fabiano Di Marco, Carlotta Pipolo, Veronica Seccia, Giovanni Sotgiu and Eugenio De Corso

J. Clin. Med. 2025, 14(3), 957; https://doi.org/10.3390/jcm14030957 (registering DOI) - 2 Feb 2025

Abstract

Background: Asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) are chronic respiratory conditions that frequently coexist. However, an integrated assessment tool for both conditions is currently lacking. This study aimed to develop and preliminarily evaluate a composite score capable of simultaneously assessing [...] Read more.

Background: Asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) are chronic respiratory conditions that frequently coexist. However, an integrated assessment tool for both conditions is currently lacking. This study aimed to develop and preliminarily evaluate a composite score capable of simultaneously assessing asthma and CRSwNP in comorbid patients. Methods: An expert panel comprising three pulmonologists, one allergist/clinical immunologist, and four ear, nose and throat (ENT) specialists developed a tool to capture asthma and CRSwNP severity. The tool (D’Amato-De Corso score, or DAMADECO score) incorporates eight parameters, four specific to asthma and four specific to CRSwNP, to assign individual scores for each condition. A composite score is then calculated to reflect the overall disease burden (ranging from −8: poor control and +8: optimal control). A retrospective pilot study was conducted to evaluate the tool. Results: The DAMADECO composite score was applied to 21 comorbid patients. The mean partial scores for asthma and CRSwNP were −1.57 and −1.67, respectively, with a mean total composite score of −3.24. A total of 13 out of 21 patients had uncontrolled domains in both diseases, while fewer patients had only uncontrolled domains in asthma (1/21) or CRSwNP (6/21). The DAMADECO score also allows researchers to track disease progression and monitor treatment effectiveness. Conclusions: The preliminary results suggest that the DAMADECO score is a promising tool for simultaneously assessing asthma and CRSwNP, addressing the unmet need for an integrated approach to comorbid respiratory diseases. Further validation studies are needed to validate the tool in larger patient populations. Full article

(This article belongs to the Section Pulmonology)

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13 pages, 821 KiB

Open AccessArticle

Predictors of Cardiovascular Symptoms Among Long COVID Patients: Data from the Polish Long COVID Cardiovascular (PoLoCOV-CVD) Study

by Joanna Kapusta, Siamala Sinnadurai, Mateusz Babicki, Żaneta Kałuzińska-Kołat, Wouter C. Meijers, Damian Kołat, Olivier C. Manintveld, Piotr Jankowski and Michał Chudzik

J. Clin. Med. 2025, 14(3), 956; https://doi.org/10.3390/jcm14030956 (registering DOI) - 2 Feb 2025

Abstract

Background and aims: Long COVID symptoms persist globally, with a notable rise in cardiovascular disease (CVD) among COVID-19 survivors, including those without prior risk factors or hospitalizations. This study aims to identify predictors of cardiovascular-related Long COVID symptoms. Methods: This study included subjects [...] Read more.

Background and aims: Long COVID symptoms persist globally, with a notable rise in cardiovascular disease (CVD) among COVID-19 survivors, including those without prior risk factors or hospitalizations. This study aims to identify predictors of cardiovascular-related Long COVID symptoms. Methods: This study included subjects with post-SARS-CoV-2 infections, categorizing them into three groups: non-Long COVID (non-LC), Long COVID (LC), and Long COVID with cardiovascular symptoms (cardio-LC) as part of the Polish Long COVID Cardiovascular (PoLoCOV-CVD) study collected between the years 2020 and 2022, comprising 4000 participants. Chi-square tests and logistic regression were used to report the prevalence and determinants of quality of life in cardio-LC, based on patient self-reported data including comorbidities and medications. Results: Of the 704 patients analyzed, 71.9% were female with a median age of 54 years (IQR: 45–64). Cardio-LC patients had statistically significant differences relative to the non-LC group in terms of blood pressure, elevated LDL cholesterol (p = 0.010), and non-HDL cholesterol (p = 0.013). In addition, cardio-LC patients were more likely to be female (p < 0.001) who exhibited psychological conditions, such as sleep disturbances (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001) compared to the non-LC group. However, the multivariable logistic regression analysis revealed that only the female gender and sleep disturbances remained an independent predictor associated with cardio-LC (OR: 1.66, CI 1.12–2.46; OR: 1.742, CI 1.12–2.70) compared to participants without Long COVID. Conclusions: The significant positive association of female gender and sleep disturbances with cardiovascular complications during Long COVID highlights critical demographic and psychological factors that deserve attention in clinical practice. Full article

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

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19 pages, 1045 KiB

Open AccessReview

Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment

by Tamara Filipovic, Aleksandar Filipović, Dejan Nikolic, Francesca Gimigliano, Jelena Stevanov, Marija Hrkovic and Ivana Bosanac

J. Clin. Med. 2025, 14(3), 955; https://doi.org/10.3390/jcm14030955 (registering DOI) - 2 Feb 2025

Abstract

Fibromyalgia (FM) is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions. The etiopathogenesis of FM is not sufficiently known, and regardless of numerous research, the clinical presentation is nonspecific, which [...] Read more.

Fibromyalgia (FM) is a chronic condition characterized by generalized musculoskeletal pain associated with other symptoms, especially sleep and mood disorders, fatigue, and cognitive dysfunctions. The etiopathogenesis of FM is not sufficiently known, and regardless of numerous research, the clinical presentation is nonspecific, which makes it difficult to approve a timely diagnosis and, subsequently, an adequate therapeutic approach. Genetic, hormonal, immunological, and environmental factors are cited as potential factors in the development of this condition. Diagnosis is based on a clinical approach and known diagnostic criteria, while additional methods, such as radiographic, magnetic resonance, or laboratory analyses, can be useful to exclude other conditions. The heterogeneity of FM significantly impacts both diagnosis and treatment, as it presents a wide spectrum of symptoms that vary in severity, combinations, and underlying contributing factors. This variability is a challenge for clinicians and requires a holistic, comprehensive, multidisciplinary, patient-centered approach. According to EULAR recommendations (The European League Against Rheumatism) from 2016, treatment begins with patient education and involves the simultaneous application of pharmacological and nonpharmacological treatments. The application of only pharmacological or nonpharmacological treatment is most often not successful. Due to differences in pain threshold, psychological factors, and comorbidities, patients may respond differently to the same interventions. Although there is no universal treatment, this review brings up the fact that the timely recognition of symptoms and a tailored treatment with a patient-centered plan can significantly improve the quality of life of patients. Full article

(This article belongs to the Section Clinical Rehabilitation)

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