Journal of Clinical Medicine

17 pages, 709 KiB

Open AccessSystematic Review

The Influence of an Intense Training Regime in Professional and Non-Professional Athletes on Semen Parameters: A Systematic Review

by Francesca Greco, Giovanni Guarascio, Elisa Giannetta, Francesco Pio Oranges, Federico Quinzi, Gian Pietro Emerenziani and Maria Grazia Tarsitano

J. Clin. Med. 2025, 14(1), 201; https://doi.org/10.3390/jcm14010201 (registering DOI) - 1 Jan 2025

Abstract

Abstract: Background/Objectives: Male infertility is influenced by physiological factors like age, as well as lifestyle factors, including physical activity. However, the specific impact of sport activity on semen parameters, and thus on male fertility, remains unclear. Specifically, the aim of this systematic [...] Read more.

Abstract: Background/Objectives: Male infertility is influenced by physiological factors like age, as well as lifestyle factors, including physical activity. However, the specific impact of sport activity on semen parameters, and thus on male fertility, remains unclear. Specifically, the aim of this systematic review is to evaluate how an intense regime of training may affect sperm parameters in professional and non-profession athletes. Methods: Studies reporting sperm parameters associated with high training load were included. In April 2024, three electronic databases and literature sources (PubMed, Scopus, and Web of Science) were searched. Quality appraisal was performed independently by three authors using the National Heart, Lung, and Blood Institute Quality Assessment Tools (NHLBI-QAT). Results: Four studies met the inclusion criteria, reporting a total of 156 participants. Sixteen weeks of intensive cycling training produced a significant decrease in seminal volume, sperm concentration, sperm motility, and morphology, with a return to their initial levels, except for sperm morphology and sperm concentration, after at least one week of rest. In addition, in athletes with varicocele, a 6-month stop from sports activity went a long way toward improving sperm concentration and sperm motility. However, DNA fragmentation, a greater presence of round cells, and high numbers of active macrophages were described. At least 30 days improve semen parameters in professional and non-professional athletes. Conclusions: Intensive training could worsen seminal parameters and, consequently, male fertility. However, certainty of evidence is very low, and the results should be interpreted with caution. Full article

(This article belongs to the Special Issue Male Sexual and Reproductive Health: Clinical Aspects, Metabolic Profile, Environmental Factors and Lifestyle)

4 pages, 172 KiB

Open AccessEditorial

Scientific Progress in Polycystic Ovary Syndrome: Little by Little

by Johannes Ott and Marlene Hager

J. Clin. Med. 2025, 14(1), 200; https://doi.org/10.3390/jcm14010200 (registering DOI) - 1 Jan 2025

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Abstract

New international recommendations on the diagnosis and treatment of polycystic ovary syndrome (PCOS) were published in autumn 2023 [...] Full article

(This article belongs to the Special Issue Polycystic Ovary Syndrome: Clinical Diagnosis and Management)

14 pages, 1143 KiB

Open AccessArticle

A Comparative Study of Intense Pulsed Light with Two Different Filters in Meibomian Gland Dysfunction: A Prospective Randomized Study

by Hayoung Lee, Yoo Young Jeon, Kyu Sang Eah, Nahyun Park, Yea Eun Lee, Jeewon Han, Chung Min Lee, Changmin Kim, Ho Seok Chung, Jae Yong Kim and Hun Lee

J. Clin. Med. 2025, 14(1), 199; https://doi.org/10.3390/jcm14010199 (registering DOI) - 1 Jan 2025

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Abstract

Objectives: To compare the long-term efficacy and safety of intense pulsed light (IPL) treatments using a 590-nm and an acne filter. Methods: In this prospective, randomized, paired-eye trial study, 30 patients with moderate and severe meibomian gland dysfunction (MGD) were followed up for [...] Read more.

Objectives: To compare the long-term efficacy and safety of intense pulsed light (IPL) treatments using a 590-nm and an acne filter. Methods: In this prospective, randomized, paired-eye trial study, 30 patients with moderate and severe meibomian gland dysfunction (MGD) were followed up for at least one month after their last treatment. Group A received IPL treatment with an acne filter, a type of notch filter that blocks wavelengths between 600 and 800 nm, allowing IPL to emit wavelengths between 400–600 nm and 800–1200 nm. Group B received treatment with a 590 nm filter, a type of cut-off filter that blocks wavelengths below 590 nm. Clinical parameters, including tear osmolarity, matrix metalloproteinase (MMP)-9 expression, tear break-up time, ocular surface staining scores, Schirmer’s test I, lid margin telangiectasia scores, MG expressibility/secretion scores, and Ocular Surface Disease Index scores, were measured at baseline, 1, 6, and 12 months after their last treatment. Results: In the linear mixed model, significant time effects on all clinical parameters, except for MMP-9 grades and Schirmer’s test I results, were observed within each group. However, interactions between time points (baseline, 6 months, 12 months) and groups (Group A, B) were not significant. The generalized estimating equation model showed no significant interaction between time points and groups for MMP-9 positivity; however, a significant time effect on MMP-9 positivity was observed in Group A, with a decrease at 12 months after their last treatment when compared to baseline and 6 months. Conclusions: The IPL treatment modality for moderate to severe MGD demonstrated a significant therapeutic effect for one year under strictly controlled self-administration of other treatments. IPL treatment using acne filter is a promising treatment option for reducing MMP-9 positivity in MGD patients. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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3 pages, 166 KiB

Open AccessEditorial

Clinical Advances in the Diagnosis and Treatment of Cerebrovascular Diseases

by Asad Lak and Mario Zanaty

J. Clin. Med. 2025, 14(1), 198; https://doi.org/10.3390/jcm14010198 (registering DOI) - 1 Jan 2025

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Abstract

The management of cerebrovascular diseases has significantly evolved over the last decade or so [...] Full article

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

9 pages, 203 KiB

Open AccessArticle

Rehabilitation Progress in Patients Following Surgery for Acute Stanford Type A Aortic Dissection Extending Beyond the Ascending Aorta

by Joanna Nowak, Mariusz Listewnik, Aleksandra Rył, Jerzy Pacholewicz and Iwona Rotter

J. Clin. Med. 2025, 14(1), 197; https://doi.org/10.3390/jcm14010197 (registering DOI) - 1 Jan 2025

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Abstract

Background: The objective of this study was to assess the course of rehabilitation of patients hospitalized in the cardiac rehabilitation unit after surgery for acute Stanford type A aortic dissection, extending beyond the ascending aorta, and comparing these findings with those for patients [...] Read more.

Background: The objective of this study was to assess the course of rehabilitation of patients hospitalized in the cardiac rehabilitation unit after surgery for acute Stanford type A aortic dissection, extending beyond the ascending aorta, and comparing these findings with those for patients who, after the same type of surgery, had no remaining dissection. The aim was to develop an optimal cardiac rehabilitation model for this patient population, given the lack of clear guidelines. Additionally, the study aimed to evaluate their one-year survival. Methods: The study included patients referred to the cardiac rehabilitation unit after surgery for acute Stanford type A aortic dissection extending beyond the ascending aorta (a total of 25 patients). The study group was compared with a cohort of patients (a total of 58) who underwent similar cardiac surgery. The main difference was the absence of residual aortic dissection. All patients were assessed on admission to the cardiac rehabilitation unit and at discharge using the 6-min walk test and the Tinetti test. All patients underwent 2–3 weeks of rehabilitation following the same protocol; however, the study group had significantly reduced exercise loads. Results: Patients in the study group were admitted to the cardiac rehabilitation unit in a significantly worse functional status compared to the comparison group, but the final assessment showed comparable results for the Tinetti test and the 6-min walk test. There were no differences in one-year survival between the two groups. Conclusions: Early postoperative cardiac rehabilitation in patients after acute aortic dissection significantly improves the functional status of this patient group, and is safe. Full article

(This article belongs to the Section Cardiovascular Medicine)

12 pages, 803 KiB

Open AccessReview

From Symptoms to Satisfaction: Optimizing Patient-Centered Care in Dry Eye Disease

by Edoardo Villani, Stefano Barabino, Giuseppe Giannaccare, Antonio Di Zazzo, Pasquale Aragona and Maurizio Rolando

J. Clin. Med. 2025, 14(1), 196; https://doi.org/10.3390/jcm14010196 (registering DOI) - 1 Jan 2025

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Abstract

Dry eye disease (DED) is a multifactorial, chronic, and often relapsing condition with a significant impact on patient quality of life (QoL). Symptoms such as ocular discomfort and visual disturbances are diverse and frequently misaligned with objective clinical signs, complicating diagnosis and management. [...] Read more.

Dry eye disease (DED) is a multifactorial, chronic, and often relapsing condition with a significant impact on patient quality of life (QoL). Symptoms such as ocular discomfort and visual disturbances are diverse and frequently misaligned with objective clinical signs, complicating diagnosis and management. DED not only interferes with daily activities like reading, driving, and computer use but also imposes a substantial economic burden due to direct healthcare costs and reduced work productivity. Beyond its ocular manifestations, DED has been associated with higher prevalence rates of depression and anxiety, with a complex bidirectional relationship. Patients with DED may experience psychological distress that exacerbates symptoms, leading to a vicious cycle that further impairs QoL. This underscores the importance of integrating mental health screening into the management of DED, particularly for high-risk populations. Optimizing the care of DED patients requires empathy, effective communication, and the establishment of a therapeutic alliance that acknowledges patient experiences and involves them in personalized treatment plans. Such an approach can improve patient satisfaction, enhance treatment adherence, and address both ocular and psychological dimensions of the disease. This paper highlights current evidence on the impact of DED symptoms and its association with mental health and recommends strategies to improve clinical management through a patient-centered approach. Full article

(This article belongs to the Section Ophthalmology)

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3 pages, 136 KiB

Open AccessEditorial

Recent Advances in Ophthalmic Interventions: Exploring Innovations in Myopia, Cataract Surgery, and Visual Function

by Kazuno Negishi

J. Clin. Med. 2025, 14(1), 195; https://doi.org/10.3390/jcm14010195 (registering DOI) - 1 Jan 2025

Viewed by 128

Abstract

As our understanding of ophthalmic optics and visual function advances, the intersection between clinical practice and technological innovation becomes increasingly significant in enhancing patient outcomes [...] Full article

(This article belongs to the Special Issue Ophthalmic Optics and Visual Function—Part II)

10 pages, 382 KiB

Open AccessArticle

Colonic Polyp Study: Differences in Adenoma Characteristics Based on Colonoscopy History over 5-Year Follow-Up Period

by Sang Hyun Park, Kwang Il Hong, Hyun Chul Park, Young Sun Kim, Gene Hyun Bok, Kyung Ho Kim, Dong Suk Shin, Jae Yong Han, Young Kwan Kim, Yeun Jong Choi, Soo Hoon Eun, Byung Hoon Lim, Kyeong Kun Kwack and The Korean Society of Digestive Endoscopy Polyp Study

J. Clin. Med. 2025, 14(1), 194; https://doi.org/10.3390/jcm14010194 - 31 Dec 2024

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Abstract

Background: Timely detection and removal of colonic adenomas are critical for preventing colorectal cancer. Methods: This study analyzed differences in colonic adenoma characteristics based on colonoscopy history by reviewing the medical records of 14,029 patients who underwent colonoscopy between January and June 2020 [...] Read more.

Background: Timely detection and removal of colonic adenomas are critical for preventing colorectal cancer. Methods: This study analyzed differences in colonic adenoma characteristics based on colonoscopy history by reviewing the medical records of 14,029 patients who underwent colonoscopy between January and June 2020 across 40 primary medical institutions in Korea. Results: Adenoma and advanced neoplasia characteristics varied significantly with colonoscopy history (p < 0.05). In the first-time colonoscopy group, adenomas were more frequent in the sigmoid colon (S-colon) and rectum, with Is features and non-granular laterally spreading tumors. Advanced neoplasia was also more common in the S-colon and rectum, with Is and advanced-type features. In the <5-year group, adenomas were predominantly found in the transverse colon (T-colon) and descending colon (D-colon), with IIa and IIb features. Advanced neoplasia in this group was more frequent in the cecum and T-colon, with IIa and IIb features and laterally spreading tumors. In the ≥5-year group, adenomas were more commonly located in the ascending colon (A-colon) and cecum, with Ip features, while advanced neoplasia was more frequent in the A-colon and D-colon, also with Ip features. Conclusions: Although every segment of the colorectum should be carefully observed regardless of colonoscopy history, these findings suggest that prioritizing specific colonic segments for examination based on colonoscopy history may improve adenoma detection rates and reduce the incidence of colorectal cancer. However, further large-scale, prospective studies are needed to confirm these findings and support their application in clinical practice. Full article

(This article belongs to the Special Issue Updates in Digestive Diseases and Endoscopy)

11 pages, 931 KiB

Open AccessArticle

Elderly Prostate Cancer Patients Treated with Robotic Surgery Are More Likely to Harbor Adverse Pathology Features and Experience Disease Progression: Analysis of the Prognostic Impact of Adverse Pathology Risk Score Patterns Using Briganti’s 2012 Nomogram and EAU Risk Groups

by Antonio Benito Porcaro, Emanuele Serafin, Francesca Montanaro, Sonia Costantino, Lorenzo De Bon, Alberto Baielli, Francesco Artoni, Luca Roggero, Claudio Brancelli, Michele Boldini, Alberto Bianchi, Alessandro Veccia, Riccardo Rizzetto, Matteo Brunelli, Maria Angela Cerruto, Riccardo Giuseppe Bertolo and Alessandro Antonelli

J. Clin. Med. 2025, 14(1), 193; https://doi.org/10.3390/jcm14010193 - 31 Dec 2024

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Abstract

Background/Objectives: Prostate cancer (PCa) is prevalent among men over 70. Treatment may involve interventions like radical prostatectomy. The objective of this study was to investigate the combination of adverse pathology patterns on PCa progression through the Briganti 2012 nomogram and EAU risk classes [...] Read more.

Background/Objectives: Prostate cancer (PCa) is prevalent among men over 70. Treatment may involve interventions like radical prostatectomy. The objective of this study was to investigate the combination of adverse pathology patterns on PCa progression through the Briganti 2012 nomogram and EAU risk classes in elderly patients treated with robotic surgery. Methods: A cohort of 1047 patients treated from January 2013 to December 2021 was categorized as being older if aged 70 or above. The adverse pathology risk scores were ranked from zero to three. These scores were then analyzed for correlations with the Briganti 2012 nomogram via EAU risk groups and for PCa progression. Results: Overall, older age was detected in 287 patients who had higher rates of adverse pathology features combined into a pattern risk score of 3. Within each age group, the adverse pathology risk score patterns were positively predicted by the Briganti 2012 nomogram across EAU prognostic groups. After a median (95% CI) follow-up period of 95 months, PCa progression occurred in 237 patients, of whom 68 were elderly and more likely to progress as adverse pathology patterns increased, particularly for a risk score of 3 (p < 0.0001), which was almost three times higher than that in younger patients (p < 0.0001). Conclusions: Managing PCa in elderly patients is challenging due to their increasing life expectancy. The Briganti 2012 nomogram effectively predicts disease progression in this population. Elderly prostate cancer patients have higher severe pathology rates predicted independently by the Briganti 2012 nomogram, with nearly triple the risk of progression compared to that in younger cases, necessitating tailored treatment approaches. Full article

(This article belongs to the Special Issue Current Trends and Future Directions in the Treatment of Advanced Urological Cancers)

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11 pages, 570 KiB

Open AccessArticle

Feasibility of Using Pulsed Electromagnetic Field Therapy to Improve the Dynamic Postural Balance of Children with Cerebral Palsy: A Randomized, Sham-Controlled Pilot Study

by Márk Ágoston Pulay, Krisztina Kornis, Gabriella Bednárikné Dörnyei, Éva Feketéné Szabó, Mónika Horváth, Attila Matiscsák, Csaba Nyakas, Andrea Tenk Miklósné Zsebe, Tímea Vissi, Ágnes Mayer and Ibolya Túri

J. Clin. Med. 2025, 14(1), 192; https://doi.org/10.3390/jcm14010192 - 31 Dec 2024

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Abstract

Cerebral palsy (CP) manifests with abnormal posture and impaired selective motor control, notably affecting trunk control and dynamic balance coordination, leading to inadequate postural control. Previous research has indicated the benefits of pulsed electromagnetic field (PEMF) therapy for various musculoskeletal and neurological conditions. [...] Read more.

Cerebral palsy (CP) manifests with abnormal posture and impaired selective motor control, notably affecting trunk control and dynamic balance coordination, leading to inadequate postural control. Previous research has indicated the benefits of pulsed electromagnetic field (PEMF) therapy for various musculoskeletal and neurological conditions. Therefore, we conducted a randomized pilot study to assess the feasibility of our preliminary research design and examine the effect of the PEMF treatment among children with CP. Methods: Twelve children with spastic CP participated, with the study group undergoing PEMF treatment three times a week for four weeks. The treatment involved sine signal form, 20/200 Hz frequencies at an amplitude of 150 μT, initially administered for 8, 12, and 16 min per session. The control group received a sham treatment. Dynamic postural balance was evaluated using a force platform at baseline and post-intervention, and the data were analyzed. Data were processed using IBM SPSS 27 by repeated factorial analysis of variance. The significance level was α = 0.05. Results: No side effects of PEMF therapy were detected; this is important, because this intervention has not yet been applied among CP patients. The treatment group demonstrated a positive trend in fine balance coordination tests (p = 0.049); however, the small sample size and variability in control group performance suggest caution in interpreting these findings. Other test domains did not show significant differences. Conclusion: Our pilot study reveals the safety, feasibility, and potential efficacy of pulsed electromagnetic field (PEMF) therapy for children with cerebral palsy. With no observed side effects, the significant improvement in fine balance coordination suggests a promising avenue. Full article

(This article belongs to the Section Clinical Rehabilitation)

15 pages, 784 KiB

Open AccessFeature PaperArticle

Long-Term Eosinophil Depletion: A Real-World Perspective on the Safety and Durability of Benralizumab Treatment in Severe Eosinophilic Asthma

by Francesco Menzella, Mariarita Marchi, Marco Caminati, Micaela Romagnoli, Claudio Micheletto, Matteo Bonato, Giuseppe Idotta, Manuele Nizzetto, Giuseppina D’Alba, Massimiliano Cavenaghi, Michela Bortoli, Bianca Beghè, Laura Pini, Roberto Benoni, Gianluca Casoni, Rodolfo Muzzolon, Lucio Michieletto, Annamaria Bosi, Andrea Mastrototaro, Adela Diamandi, Mara Nalin and Gianenrico Senna Show full author list Hide full author list

J. Clin. Med. 2025, 14(1), 191; https://doi.org/10.3390/jcm14010191 - 31 Dec 2024

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Abstract

Background/Objectives: Benralizumab is an anti-IL-5 receptor alpha monoclonal antibody that induces the near-complete depletion of eosinophils. This study aimed to evaluate the long-term safety and effectiveness of benralizumab in patients with severe eosinophilic asthma (SEA) over an extended 48-month follow-up period, offering one [...] Read more.

Background/Objectives: Benralizumab is an anti-IL-5 receptor alpha monoclonal antibody that induces the near-complete depletion of eosinophils. This study aimed to evaluate the long-term safety and effectiveness of benralizumab in patients with severe eosinophilic asthma (SEA) over an extended 48-month follow-up period, offering one of the longest real-world perspectives available. Methods: This was a single-arm, retrospective, observational, multicenter study involving 123 SEA patients treated with benralizumab at a dosage of 30 mg every 4 weeks for the first 3 doses and then every 8 weeks. The safety endpoints focused on the frequency and nature of adverse events and the likelihood that they were induced by benralizumab. The efficacy endpoints focused on lung function, asthma exacerbations and control, and oral corticosteroid use. Results: Benralizumab, consistent with its mechanism of action, led to the rapid and nearly complete depletion of eosinophils. In total, 26 adverse events (21.1%) were observed, with 1.6% related to the treatment and 0.8% categorized as serious (vagal hypotension). Bronchitis was the most common unrelated adverse event (15.4%), occurring between months 36 and 38. Importantly, benralizumab effectiveness and safety were maintained consistently across the 48-month duration, resulting in significant improvements in lung function and reductions in oral corticosteroid use and exacerbation frequency. Conclusions: Benralizumab demonstrated a favorable safety profile, comparable to previously published studies, with perdurable effectiveness in controlling SEA and reducing oral corticosteroid use. Finally, this study provides evidence that near-complete eosinophil depletion does not increase long-term safety risks and supports benralizumab as a reliable treatment option for SEA patients. Full article

(This article belongs to the Special Issue Advances in Asthma: 2nd Edition)

32 pages, 901 KiB

Open AccessReview

Autoimmune Thyroid Disease and Pregnancy: The Interaction Between Genetics, Epigenetics and Environmental Factors

by Tatjana Bogović Crnčić, Božena Ćurko-Cofek, Lara Batičić, Neva Girotto, Maja Ilić Tomaš, Antea Kršek, Ines Krištofić, Tea Štimac, Ivona Perić, Vlatka Sotošek and Sanja Klobučar

J. Clin. Med. 2025, 14(1), 190; https://doi.org/10.3390/jcm14010190 - 31 Dec 2024

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Abstract

Autoimmune thyroid disease (AITD) is the leading cause of thyroid dysfunction globally, characterized primarily by two distinct clinical manifestations: Hashimoto’s thyroiditis (HT) and Graves’ disease (GD). The prevalence of AITD is approximately twice as high in women compared to men, with a particularly [...] Read more.

Autoimmune thyroid disease (AITD) is the leading cause of thyroid dysfunction globally, characterized primarily by two distinct clinical manifestations: Hashimoto’s thyroiditis (HT) and Graves’ disease (GD). The prevalence of AITD is approximately twice as high in women compared to men, with a particularly pronounced risk during the reproductive years. Pregnancy exerts profound effects on thyroid physiology and immune regulation due to hormonal fluctuations and immune adaptations aimed at fostering maternal–fetal tolerance, potentially triggering or exacerbating AITD. The impact of AITD on pregnancy outcomes is multifaceted. Both HT and GD have been associated with adverse obstetric and neonatal outcomes, including miscarriage, preterm delivery, preeclampsia and fetal growth restriction. Inadequately managed AITD can also affect fetal neurodevelopment due to disrupted maternal thyroid hormone availability during critical periods of brain maturation. This review explores the complex interplay between the genetic, epigenetic and environmental factors that drive AITD during pregnancy, highlighting their roles in disease development and impacts on pregnancy outcomes. Gaining a deeper understanding of these mechanisms is crucial for improving diagnostic tools, treatment options and preventive measures to enhance the health and well-being of both the mother and the newborn. Full article

(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment)

13 pages, 887 KiB

Open AccessArticle

Baseline and Follow-Up Cardiac Magnetic Resonance Imaging Findings in Children with Acute Myocarditis and Factors Associated with Late Gadolinium Enhancement

by Bekir Yukcu, Merve Maze Aydemir, Mehmet Balci, Mehmet Kanyilmaz, Aysel Turkvatan, Selman Gokalp, Alper Guzeltas and Sezen Ugan Atik

J. Clin. Med. 2025, 14(1), 189; https://doi.org/10.3390/jcm14010189 - 31 Dec 2024

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Abstract

Objectives: Cardiac magnetic resonance (CMR) plays a central role in the diagnosis and follow-up of acute myocarditis (AM). In this study, we aimed to evaluate baseline and follow-up CMR findings and associated factors in children with AM. Methods: A retrospective analysis [...] Read more.

Objectives: Cardiac magnetic resonance (CMR) plays a central role in the diagnosis and follow-up of acute myocarditis (AM). In this study, we aimed to evaluate baseline and follow-up CMR findings and associated factors in children with AM. Methods: A retrospective analysis of CMR in pediatric patients with clinical presentations suggestive of myocarditis was performed. Patients’ demographic characteristics, clinical data, and diagnostic test results, as well as CMR imaging results, were evaluated. Results: All 28 pediatric patients with acute myocarditis included in this study had late gadolinium enhancement (LGE) on initial CMR imaging. Additionally, 14 (50%) patients had increased extracellular volume (ECV), 4 (50%) patients had focal high-intensity areas on T2 STIR images, 15 (53.6%) patients had increased T1 relaxation time, and 17 (60.7%) patients had increased T2 relaxation time. At a median follow-up CMR of 6 months, 24 (85.7%) patients had LGE, 5 (17.9%) patients had increased ECV, and 7 (25%) patients had increased T1 relaxation time, while other parameters showed complete recovery. Baseline troponin and CRP levels, T1 relaxation time, T2 relaxation time, and increased ECV were found to be factors associated with the resolution of LGE. Conclusions: Baseline troponin and CRP levels, as well as T1 relaxation time, T2 relaxation time, and increased ECV, were effective parameters that seemed to predict the resolution of LGE. Larger and multicenter experiences would confirm these hypotheses. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

16 pages, 588 KiB

Open AccessReview

Cutaneous Adverse Drug Reactions Associated with SGLT2 Inhibitors

by Alexandra Laura Mederle, Patrick Dumitrescu, Claudia Borza and Nilima Rajpal Kundnani

J. Clin. Med. 2025, 14(1), 188; https://doi.org/10.3390/jcm14010188 (registering DOI) - 31 Dec 2024

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Abstract

Diabetes is a complex global healthcare burden involving multiple organ systems with its prevalence on the rise. SGLT2 inhibitors enhance glucose excretion. The objective of our literature review was to determine the association between cutaneous adverse drug reactions (CADRs) and the use of [...] Read more.

Diabetes is a complex global healthcare burden involving multiple organ systems with its prevalence on the rise. SGLT2 inhibitors enhance glucose excretion. The objective of our literature review was to determine the association between cutaneous adverse drug reactions (CADRs) and the use of SGLT2 inhibitors. We collected data on CADRs related to the use of SGLT2 inhibitors from all available published articles and studied their details to understand the patterns of their association. PubMed, Cochrane, Google, and Embase were searched for relevant articles. A total of 37 papers were included and studied. Most articles were case reports followed by pharmacovigilance studies, case series, and reviews. The cutaneous findings ranged from benign eruptions to severe reactions. The available literature suggests a strong link between the use of SGLT2 inhibitors and Fournier’s gangrene/necrotizing fasciitis. T2DM patients using SGLT2 inhibitors have also developed fixed drug eruptions, drug-induced pruritus, and Sweet syndrome/acute febrile neutrophilic dermatosis, among other skin lesions. We found that SGLT2 inhibitors present a risk of developing CADRs. Raising awareness among healthcare providers regarding CADRs to SGLT2 inhibitors can reduce complications, minimize hospitalizations, and improve patient care in the vulnerable population of diabetes patients. Full article

(This article belongs to the Section Pharmacology)

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11 pages, 1824 KiB

Open AccessArticle

A Comparative Analysis of the Effects of Misaligning Different Trifocal Intraocular Lenses

by Weijia Yan, Gerd U. Auffarth, Ramin Khoramnia and Grzegorz Łabuz

J. Clin. Med. 2025, 14(1), 187; https://doi.org/10.3390/jcm14010187 - 31 Dec 2024

Viewed by 196

Abstract

Objectives: This laboratory study aims to assess the effects of misaligning different trifocal intraocular lenses (IOLs) under varying spectral and corneal spherical aberration (SA) conditions. Methods: With an IOL metrology device under monochromatic and polychromatic conditions, the following models were studied: AT ELANA [...] Read more.

Objectives: This laboratory study aims to assess the effects of misaligning different trifocal intraocular lenses (IOLs) under varying spectral and corneal spherical aberration (SA) conditions. Methods: With an IOL metrology device under monochromatic and polychromatic conditions, the following models were studied: AT ELANA 841P, AT LISA Tri 839MP, FineVision HP POD F, Acrysof IQ PanOptix, and Tecnis Synergy ZFR00V. The SA was simulated using an aberration-free and average-SA cornea. The modulation transfer function (MTF) was measured at different pupil sizes for the on- and off-axis lens positions. Results: The IOLs exhibited varying responses to decentration up to 1 mm, showing the lowest impact in polychromatic light. The least affected was AT ELANA, with an MTF loss of 15.7% to 28.4% at 50 lp/mm across the studied conditions. It was followed by PanOptix and FineVision, with the MTF loss ranging from 19.1% to 36.0% and from 21.2% to 46.6%. AT LISA showed a more substantial reduction, i.e., 41.2% to 64.8%, but it was still lower than that of Synergy (51.1% to 78.8%). When decentration was induced at a 4.5 mm distance, its effect was more evident in conditions that were closer to each IOL’s SA correction. A tilt of 5° had a lesser impact than 1 mm decentration, with the effect being more severe at 4.5 mm. Conclusions: The off-axis position affects the optical quality of trifocal IOLs. Low- rather than high-SA-correcting trifocals perform better under misalignment. In polychromatic light, the impact of misalignment is less evident, suggesting a potential mitigating effect of chromatic aberration. Full article

(This article belongs to the Section Ophthalmology)

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15 pages, 290 KiB

Open AccessArticle

Decreased Physical Activity and Endurance Capacity in Patients Qualified for Haematopoietic Stem Cell Transplantation (HSCT)

by Michał Chmielewski, Agnieszka Szeremet, Małgorzata Stefańska, Paula Jabłonowska-Babij, Maciej Majcherek, Anna Czyż, Tomasz Wróbel and Iwona Malicka

J. Clin. Med. 2025, 14(1), 186; https://doi.org/10.3390/jcm14010186 - 31 Dec 2024

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Abstract

Background: Haematological malignancies and their treatment regimens often lead to various complications that impair patients’ physical functioning. This study aimed to assess the level of physical activity and exercise capacity in patients with haematological malignancies who were qualified for haematopoietic stem cell transplantation [...] Read more.

Background: Haematological malignancies and their treatment regimens often lead to various complications that impair patients’ physical functioning. This study aimed to assess the level of physical activity and exercise capacity in patients with haematological malignancies who were qualified for haematopoietic stem cell transplantation (HSCT). Methods: A prospective, single-centre study was conducted on patients with haematological malignancies qualified for HSCT (study group, n = 103) and a cohort of healthy volunteers (reference group, n = 100). The assessment protocol included the International Physical Activity Questionnaire (IPAQ) and the 6-Minute Walk Test (6MWT). Results: The median age was 57 years in the study group and 56 years in the reference group. In the IPAQ assessment, at least 50% of the study group reported no engagement in moderate or intense physical activity. In the 6MWT, the study group demonstrated a significantly shorter walking distance compared to the reference group (p < 0.0001). Factors such as group membership (study vs. reference group), age, gender, and body mass index (BMI) were found to have a significant impact on 6MWT performance. No significant differences were observed in IPAQ or 6MWT results among subgroups within the study group when categorized by diagnosis. Conclusions: Patients with haematological malignancies who qualified for HSCT often show physical activity levels below recommended standards, which can negatively impact their ability to endure physical exertion. Insufficient activity prior to transplantation may contribute to reduced exercise capacity. Therefore, prehabilitation programmes aimed at improving physical activity and structured exercise should be an integral part of their care. Full article

(This article belongs to the Section Clinical Rehabilitation)

11 pages, 207 KiB

Open AccessReview

Is There a Role for Hormonal Therapy in Men with Oligoasthenoteratozoospermia (OAT)?

by Selahittin Çayan, Ahmet Barış Altay, Amarnath Rambhatla, Giovanni M. Colpi and Ashok Agarwal

J. Clin. Med. 2025, 14(1), 185; https://doi.org/10.3390/jcm14010185 - 31 Dec 2024

Viewed by 203

Abstract

Hormonal factors play an essential role as an underlying causative factor of oligoasthenoteratozoospermia (OAT), and these patients can benefit from hormonal medications that modulate the hypothalamic–pituitary–gonadal axis. This review aims to outline the various medications used as hormonal therapy in treating infertile men [...] Read more.

Hormonal factors play an essential role as an underlying causative factor of oligoasthenoteratozoospermia (OAT), and these patients can benefit from hormonal medications that modulate the hypothalamic–pituitary–gonadal axis. This review aims to outline the various medications used as hormonal therapy in treating infertile men with OAT. This manuscript focuses on essential hormonal evaluation, identifying men who would benefit from treatment, selecting the appropriate medication, determining the duration of therapy, and evaluating hormonal treatment outcomes. Additionally, novel markers that can broaden the horizon of hormonal treatment in infertile men with OAT are discussed. Hormonal-based therapy options in men with OAT include selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), dopamine agonists, and injections such as gonadotropin-releasing hormone (GnRH) analogs and gonadotropins. Treatment duration and the expected success will dictate the final treatment type for couples. In conclusion, hormonal therapy may improve spermatogenesis in infertile men with low serum testosterone. Gonadotropins and SERMs may increase sperm parameters in men with infertility and normal serum gonadotropin levels. AIs might help improve spermatogenesis in infertile men with a total testosterone (ng/mL)/estradiol (pg/mL) ratio < 0.10. In addition, dopamine agonists may play a role in enhancing spermatogenesis in infertile men with hyperprolactinemia. Full article

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

12 pages, 1212 KiB

Open AccessArticle

Size Matters: Predicting Surgical Site Infection After Whole Breast Radiotherapy in the Era of Hypofractionation

by Sea-Won Lee, Yeong Ji Kim, Jae Won Song, Mina Yu, Jiyoung Rhu, Pill Sun Paik, Yong Hyuk Kim and Yun Hee Lee

J. Clin. Med. 2025, 14(1), 184; https://doi.org/10.3390/jcm14010184 - 31 Dec 2024

Viewed by 225

Abstract

Objectives: Few studies have analyzed surgical site infections associated with hypofractionated RT. The purpose of this study was to identify risk factors for surgical site infections with a particular focus on volumetric parameters that reflect the size of the volumes treated, including [...] Read more.

Objectives: Few studies have analyzed surgical site infections associated with hypofractionated RT. The purpose of this study was to identify risk factors for surgical site infections with a particular focus on volumetric parameters that reflect the size of the volumes treated, including tumors, surgical cavities, and breasts. Methods: A total of 145 early breast cancer patients who were surgically staged 0—II undergoing hypofractionated RT on the whole breast were retrospectively reviewed. Tumor size (cm) was measured from surgical pathology. Surgical cavity volume (cc) and breast volume (cc) were calculated by segmenting each axial slice of simulation CT. The cavity-to-breast ratio (%) was calculated as surgical cavity volume/breast volume × 100. Results: The incidence of surgical site infection was 4.8% at a median of 6.3 months after the completion of RT. In univariate analysis, tumor size (OR 2.01, p = 0.025), surgical cavity volume (OR 1.03, p = 0.013), cavity-to-breast ratio (OR 1.29, p = 0.005), and BMI (OR 1.23, p = 0.014) were significantly associated with surgical site infection. In multivariate analysis, the cavity-to-breast ratio (OR 1.24, p = 0.039) remained significantly associated with surgical site infection. Conclusions: This study highlights the importance of volumetric parameters, specifically the cavity-to-breast ratio, as significant predictors of surgical site infection in a pure cohort of early breast cancer patients undergoing breast-conserving surgery and hypofractionated RT. Tailored approaches, including the use of prophylactic antibiotics, prophylactic aspiration, and close follow-up, may reduce the morbidity associated with surgical site infection and prevent the potential compromise of tumor outcomes. Full article

(This article belongs to the Section Oncology)

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11 pages, 1113 KiB

Open AccessArticle

Machine Learning-Based Prediction of Prostate Biopsy Necessity Using PSA, MRI, and Hematologic Parameters

by Mustafa Sungur, Aykut Aykaç, Mehmet Erhan Aydin, Ozer Celik and Coskun Kaya

J. Clin. Med. 2025, 14(1), 183; https://doi.org/10.3390/jcm14010183 - 31 Dec 2024

Viewed by 192

Abstract

Background: To establish a machine learning (ML) model for predicting prostate biopsy outcomes using prostate-specific antigen (PSA) values, multiparametric magnetic resonance imaging (mpMRI) findings, and hematologic parameters. Methods: The medical records of the patients who had undergone a prostate biopsy were evaluated. Laboratory [...] Read more.

Background: To establish a machine learning (ML) model for predicting prostate biopsy outcomes using prostate-specific antigen (PSA) values, multiparametric magnetic resonance imaging (mpMRI) findings, and hematologic parameters. Methods: The medical records of the patients who had undergone a prostate biopsy were evaluated. Laboratory findings, mpMRI findings, and prostate biopsy results were collected. Patients with benign prostate pathology were classified as Group 1, and those with prostate cancer (PCa) were classified as Group 2. The following ML algorithms were used to create the ML model: ExtraTrees classifier, Light Gradient-Boosting Machine (LGBM) classifier, eXtreme Gradient Boosting (XGB) classifier, Logistic Regression, and Random Forest classifier. Results: A total of 244 male patients who met the inclusion criteria were included in this study. Among them, 171 (71.1%) were categorized in Group 1, and 73 (29.9%) in Group 2. The LGBM classifier model demonstrated the highest performance, achieving an accuracy rate of 81.6% and an AUC–ROC (area under the curve–receiver operating characteristic) of 78.4%, with sensitivity and specificity values of 66.7% and 88.2%, respectively, in predicting prostate biopsy outcomes. Conclusions: Pathological results can be predicted by ML models using PSA values, mpMRI findings, and hematologic parameters prior to a prostate biopsy, potentially reducing unnecessary biopsy procedures. Full article

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

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16 pages, 1429 KiB

Open AccessSystematic Review

A Comprehensive Analysis of Genioplasty in Facial Feminization Surgery: A Systematic Review and Institutional Cohort Study

by Alexis K. Gursky, Sachin R. Chinta, Hailey P. Wyatt, Maxwell N. Belisario, Alay R. Shah, Rami S. Kantar and Eduardo D. Rodriguez

J. Clin. Med. 2025, 14(1), 182; https://doi.org/10.3390/jcm14010182 - 31 Dec 2024

Viewed by 230

Abstract

Background: Facial feminization surgery (FFS) is critical to gender-affirming surgery, consisting of craniomaxillofacial procedures to align facial features with a patient’s gender identity. Central to FFS is genioplasty, which reshapes or repositions the chin; however, limited research exists on genioplasty in FFS. This [...] Read more.

Background: Facial feminization surgery (FFS) is critical to gender-affirming surgery, consisting of craniomaxillofacial procedures to align facial features with a patient’s gender identity. Central to FFS is genioplasty, which reshapes or repositions the chin; however, limited research exists on genioplasty in FFS. This review and cohort analysis aim to evaluate current practices and outcomes for individuals undergoing FFS with genioplasty. Methods: A systematic review included transfeminine individuals undergoing FFS with genioplasty. A retrospective study reviewed FFS cases with genioplasty between 2017 and 2024. Data collected included demographics, imaging, virtual surgical planning (VSP), complications, and patient-reported outcomes (PROs). Results: The review included 12 studies with 1417 patients, with 34.2% undergoing genioplasty. The mean age was 37.3 years, and 60.1% were White. Preoperative imaging and VSP were used in 66.7% of studies, 3D-printed cutting guides in 37.5%, and 3D reconstruction in 75.0%. Reduction genioplasty was the most common technique. All PROs indicated high satisfaction, with a 2.67% revision rate. Complications were low (0.55%), with infections being most frequent (0.48%). In the institutional cohort, 351 patients underwent FFS, with 64.4% undergoing genioplasty, significantly higher than in the review (p < 0.001). Sliding genioplasty was preferred without preoperative imaging or VSP. Postoperative dissatisfaction was 3.54%, with 0.88% requiring revision (p = 0.063). Complication rates (1.77%) were similar to those of the review (p = 0.065). Conclusions: Genioplasty is important in FFS, with low complication and revision rates and high patient satisfaction. However, gaps remain in validated PROs and technique-specific outcomes. While preoperative imaging and VSP show benefits, comparable outcomes are achievable without them. Full article

(This article belongs to the Special Issue Clinical Advances in Reconstructive Surgery: Innovations and Outcomes for Improved Patient Care)

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17 pages, 776 KiB

Open AccessArticle

Awareness and Knowledge About Preconception Healthcare: A Cross-Sectional Study of Early Years UAE Medical Students

by Sara Maki, Shamsa Al Awar, Sara Alhosani, Latifa Alshamsi, Shamma Alzaabi, Mohammad Ali Alsaadi, Mahra Alhammadi, Hamad Alhosani, Gehan Sayed Salam, Stanisław Wójtowicz and Kornelia Zaręba

J. Clin. Med. 2025, 14(1), 181; https://doi.org/10.3390/jcm14010181 - 31 Dec 2024

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Abstract

Background: Preconception health is critical for improving maternal and child health. The main objective of the study was to explore medical students’ health habits, quality of life, and knowledge of preconception healthcare. Methods: We conducted a cross-sectional study between 15 March 2023 and [...] Read more.

Background: Preconception health is critical for improving maternal and child health. The main objective of the study was to explore medical students’ health habits, quality of life, and knowledge of preconception healthcare. Methods: We conducted a cross-sectional study between 15 March 2023 and 31 May 2024 among medical students at United Arab Emirates University. To determine awareness and knowledge of preconception health, we administered a survey consisting of an author’s questionnaire with 35 questions covering sociodemographic characteristics and general knowledge of preconception health, as well as the WHO Quality of Life Scale-BREF (WHOQOL-BREF). Results: The participants were predominantly under 25 years old (98.5%), Emirati (91.1%), single (92.6%), and female (95.8%); only 3.4% had been pregnant before. Regarding health awareness and behaviors, a significant number of females (58.0%) had never visited a gynecologist. The majority of students (72.4%) participated in sports activities. The overall level of knowledge was low, with a mean level of 7.5 (SD = 6.36) out of 24. The Internet (webpages, blogs, webinars) (64.5%) was the major source of knowledge regarding healthcare information, followed by social media platforms (Twitter, Facebook, TikTok, Instagram) and mobile applications (57.5%), books (48.6%), and family members (57.0%). There was a statistically significant correlation between knowledge levels and the Internet (p < 0.004) or family (p < 0.001) as a source of knowledge. Additionally, there was a statistically significant positive correlation between knowledge and quality of life across all four WHOQOL domains. Conclusions: Medical knowledge might positively affect general well-being. Fostering stronger social networks and support systems could benefit preconceptional awareness and knowledge. Full article

(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)

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16 pages, 875 KiB

Open AccessArticle

Sex Differences in Management, Time to Intervention, and In-Hospital Mortality of Acute Myocardial Infarction and Non-Myocardial Infarction Related Cardiogenic Shock

by Anushka V. Desai, Rohan Rani, Anum S. Minhas and Faisal Rahman

J. Clin. Med. 2025, 14(1), 180; https://doi.org/10.3390/jcm14010180 - 31 Dec 2024

Viewed by 262

Abstract

Background/Objectives: Cardiogenic shock (CS) is associated with high mortality, particularly in women. With early intervention being a cornerstone of CS management, this study aims to explore whether sex differences exist in the utilization of critical interventions, timing of treatment, and in-hospital mortality for [...] Read more.

Background/Objectives: Cardiogenic shock (CS) is associated with high mortality, particularly in women. With early intervention being a cornerstone of CS management, this study aims to explore whether sex differences exist in the utilization of critical interventions, timing of treatment, and in-hospital mortality for patients with acute myocardial infarction (AMI) and non-AMI-CS. Methods: For this retrospective cohort study, we queried the National Inpatient Sample (years 2016–2021) for CS-related hospitalizations. We assessed sex differences in utilization, timing, and outcomes of CS interventions, adjusting for demographics, comorbidities, and prior cardiac interventions via multivariate logistic regressions. Results: Of 1,052,360 weighted CS hospitalizations, 60% were for non-AMI-CS and 40% were for AMI-CS. Women with CS had lower rates of all interventions. For AMI-CS, women had higher likelihoods of in-hospital mortality after revascularization (adjusted odds ratio 1.15 [95% confidence interval 1.09–1.22]), mechanical circulatory support (MCS) (1.15 [1.08–1.22]), and right heart catheterization (RHC) (1.10 [1.02–1.19]) (all p < 0.001). Similar trends were seen in the non-AMI-CS group. Women with AMI-CS were less likely to receive early (within 24 h of admission) revascularization (0.93 [0.89–0.96]), MCS (0.76 [0.73–0.80]), or RHC (0.89 [0.84–0.95]); women with non-AMI-CS were less likely to receive early revascularization (0.78 [0.73–0.84]) or RHC (0.83 [0.79–0.88]) (all p < 0.001). Regardless of CS type, in-hospital mortality was not significantly different between men and women receiving early MCS or revascularization. Conclusions: Sex disparities in the frequency of treatment of CS persist on a national scale, with women being more likely to die following treatment and less likely to receive early treatment. However, in-hospital mortality does not differ significantly when men and women are treated equally within 24 h of admission, suggesting that early intervention should be made a priority to mitigate sex-based differences in CS outcomes. Full article

(This article belongs to the Section Cardiology)

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12 pages, 1392 KiB

Open AccessArticle

A Large Study About Reproductive Factors That Predict Hysterosalpingography-Identified Tubal Pathology: An Insight into the Necessity of Preconception Screening

by Yurie Nako, Kuniaki Ota, Toshio Sujino, Junichiro Mitsui, Hisae Kamo, Shoko Katsumata, Yuko Takayanagi, Makiko Tajima, Tomonori Ishikawa, Akira Komiya and Kiyotaka Kawai

J. Clin. Med. 2025, 14(1), 179; https://doi.org/10.3390/jcm14010179 - 31 Dec 2024

Viewed by 265

Abstract

Background/Objectives: Hysterosalpingography (HSG) is pivotal in delineating tubal pathology, but is associated with pain and exposure to ionizing radiation. This study investigated which reproductive factors predict HSG-identified tubal pathology. Methods: From May 2016 to August 2023, 3322 infertile females with HSG [...] Read more.

Background/Objectives: Hysterosalpingography (HSG) is pivotal in delineating tubal pathology, but is associated with pain and exposure to ionizing radiation. This study investigated which reproductive factors predict HSG-identified tubal pathology. Methods: From May 2016 to August 2023, 3322 infertile females with HSG (mean age 33.9 ± 4.3 years) were assessed for fallopian tube status. Results: HSG indicated that 2764 had patent tubes while 558 (16.8%) had non-patent tubes. Unilateral and bilateral absence of free contrast spillage occurred in 377 (11.3%) and 181 (5.4%) cases, respectively. Non-spillage, denoted as non-patency, was seen in 148 (4.5%) and 153 (4.6%) right and left cases, respectively. Tubal occlusion was observed in 181 (5.4%) and 159 (5.4%) right and left cases, respectively. Hydrosalpinx was found in 37 (1.2%) right and 58 (1.7%) left cases. Multivariate logistic regression revealed CT-IgG positivity (odds ratio [OR]: 1.57), endometrioma (OR: 1.64), and fibroids (OR: 1.58) as independent factors for increased non-patency. CT-IgG positivity (OR: 1.92) and fibroids (OR: 1.88) were significant risk factors for occlusion. Painful defecation (OR: 2.79), CT-IgA positivity (OR: 2.09), CT-IgG positivity (OR: 2.07), and endometrioma (OR: 3.11) were significant risk factors for hydrosalpinx. Conclusions: In females with painful defecation, CT-IgG positivity, endometrioma, and fibroids, HSG may be used as a second-line investigation, with laparoscopy as the preferred assessment tool. Full article

(This article belongs to the Special Issue The Changing Landscape of Fertility Diagnosis and Treatment)

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10 pages, 2536 KiB

Open AccessArticle

Gross Motor Development by Age and Functional Level in Children with Cerebral Palsy from 6 Months to 17 Years—A Norwegian Population-Based Registry Study

by Reidun Birgitta Jahnsen, Harald Weedon-Fekjar, Gerd Myklebust and Gunfrid Vinje Storvold

J. Clin. Med. 2025, 14(1), 178; https://doi.org/10.3390/jcm14010178 - 31 Dec 2024

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Abstract

Background: Cerebral palsy is a complex lifespan disability caused by a lesion to the immature brain. Evaluation of interventions for children with cerebral palsy requires valid and reliable outcome measures. Motor development curves and reference percentiles for The Gross Motor Function Measure (GMFM-66) [...] Read more.

Background: Cerebral palsy is a complex lifespan disability caused by a lesion to the immature brain. Evaluation of interventions for children with cerebral palsy requires valid and reliable outcome measures. Motor development curves and reference percentiles for The Gross Motor Function Measure (GMFM-66) are valuable tools for following, predicting, comparing, and evaluating changes in gross motor skills. The aims of this study were to create motor development curves with reference percentiles based on Norwegian data and compare them with published counterparts for Canadian children aged 2–21 years. Method: Prospective population-based cohort data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP) for 1206 children with 3612 GMFM-66 tests between 0.5 and 17.3 years of age. Median development by Gross Motor Function Classification System (GMFCS) levels was estimated using a generalized additive regression model with smoothed parameters for location, scale, and shape (based on the R GAMLSS library). To adjust for repeated individual measurements, we report the median curve of 100 random samples with only one observation per observed child. Results: The Norwegian motor development curves for GMFCS levels I–IV increase up to 7 years of age before flattening off, while GMFCS level V curves are relatively flat. Overall, both motor development curves and GMFM-66 percentiles are very similar to Canadian counterparts. Conclusions: The existing Canadian reference curves are valid also for Norway, working well for both clinical and research applications. However, Norwegian percentiles can be used from an earlier age. Full article

(This article belongs to the Special Issue Early Clinical Diagnosis of and Intervention in Pediatric Cerebral Palsy)

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14 pages, 5551 KiB

Open AccessArticle

Surgical Treatment of Early-Onset Scoliosis: Traditional Growing Rod vs. Magnetically Controlled Growing Rod vs. Vertical Expandable Prosthesis Titanium Ribs

by Bruna Maccaferri, Francesco Vommaro, Chiara Cini, Giuseppe Filardo, Luca Boriani and Alessandro Gasbarrini

J. Clin. Med. 2025, 14(1), 177; https://doi.org/10.3390/jcm14010177 - 31 Dec 2024

Viewed by 183

Abstract

Objectives: Severe early-onset scoliosis (EOS) can be addressed by different growth-friendly approaches, although the indications of each technique remain controversial. The aim of this study was to compare, in a large series of patients, the potential and limitations of the different distraction-based surgical [...] Read more.

Objectives: Severe early-onset scoliosis (EOS) can be addressed by different growth-friendly approaches, although the indications of each technique remain controversial. The aim of this study was to compare, in a large series of patients, the potential and limitations of the different distraction-based surgical techniques to establish the most suitable surgical approach to treat EOS. Methods: We conducted a retrospective observational cohort study evaluating 62 EOS cases treated between January 2002 and December 2021 with a traditional growing rod (TGR), a magnetically controlled growing rod (MCGR) and vertical expandable prosthesis titanium ribs (VEPTR) at IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy. The patients included had a mean age of 7 years and a mean follow-up of 36 months. The COBB angle was measured on x-rays at preoperative, early postoperative, and end of follow-up, and complications were recorded. Results: in our cohort, VEPTR was mainly used in congenital scoliosis (50% vs. a mean value of 25.8%) and syndromic scoliosis (42.9% vs. a mean value of 25.8%). MCGR was mainly used in idiopathic scoliosis (73.9% vs. an average value of 41.9%). TGR was mostly used in muscular neurology EOS (16% vs. an average value of 6.5%). The collected data show a similar deformity correction rate in growing-rod implants in VEPTR, TGR, and MCGR. The mean curve reduction was 25.8 95% CI (21.8–29.8) (p < 0.0005). Compared with preoperative measurements, significant differences in curve magnitude correction between subgroups occurred at the final treatment measurements, when patients with MCGR had a significantly larger correction (53.2° ± 20.84 in %33.9 con DS ± 14.27) than VEPTR (27.12°± 19.13 in %19.7° ± 13.7). Conclusions: Different growing-rod techniques are applied based on EOS etiology. While all EOS etiologies benefited from this surgical approach, congenital EOS had poorer results. Overall, MCGR has been the preferred option for idiopathic EOS and appears to be the most effective in correcting the primary curve. Full article

(This article belongs to the Section Orthopedics)

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20 pages, 279 KiB

Open AccessArticle

Effects of Intensive Impairment-Oriented Arm Rehabilitation for Chronic Stroke Survivors: An Observational Cohort Study

by Thomas Platz, Katharina Kaiser, Tina Laborn and Michael Laborn

J. Clin. Med. 2025, 14(1), 176; https://doi.org/10.3390/jcm14010176 - 31 Dec 2024

Viewed by 193

Abstract

Objective: To assess the effects of a two-week course of intensive impairment-oriented arm rehabilitation for chronic stroke survivors on motor function. Methods: An observational cohort study that enrolled chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis, [...] Read more.

Objective: To assess the effects of a two-week course of intensive impairment-oriented arm rehabilitation for chronic stroke survivors on motor function. Methods: An observational cohort study that enrolled chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis, who received a two-week course of impairment-oriented and technology-supported arm rehabilitation (1:1 participant–therapist setting), which was carried out daily (five days a week) for four hours. The outcome measures were as follows: the primary outcome was the arm motor function of the affected arm (mild paresis: BBT, NHPT; severe paresis: Fugl-Meyer arm motor score). The secondary outcomes were measures of finger strength, active ROM, spasticity, joint mobility/pain, somatosensation, emotional distress, quality of life, acceptability, and adverse events. Results: One hundred chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis were recruited. The training was acceptable (drop-out rate 3%; 3/100). The clinical assessment indicated improved motor function (SMD 0.42, 95% CI 0.36–0.49; n = 97), reduced spasticity/resistance to passive movement, and slightly improved joint mobility/pain and somatosensation. The technology-based objective measures corroborated the improved active range of motion for arm and finger joints, reduced finger spasticity/resistance to passive movement, and the increased amount of use in daily life, but there was no effect on finger strength. The patient’s emotional well-being and quality of life were positively influenced. Adverse events were reported by the majority of participants (51%, 49/97) and were mild. Conclusions: Structured intensive impairment-oriented and technology-supported arm rehabilitation can promote motor function among chronic stroke survivors with mild to severe arm paresis and is an acceptable and tolerable form of treatment when supervised and adjusted by therapists. Full article

(This article belongs to the Special Issue Rehabilitation and Management of Stroke)

14 pages, 219 KiB

Open AccessArticle

The Role of Modern Radiological Procedures in Diagnosing Blunt Liver Injuries Manifested by Upper Gastrointestinal Bleeding

by Piotr Tomasz Arkuszewski, Maciej Adam Rybicki, Bartłomiej Białas and Konrad Szymczyk

J. Clin. Med. 2025, 14(1), 175; https://doi.org/10.3390/jcm14010175 - 31 Dec 2024

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Abstract

Objectives: Posttraumatic upper gastrointestinal bleeding (UGIB) is a very rare consequence of blunt liver trauma. It can be quite a diagnostic challenge for clinicians, as it can clinically manifest many weeks after the trauma or be scantily symptomatic. Methods: The following article would [...] Read more.

Objectives: Posttraumatic upper gastrointestinal bleeding (UGIB) is a very rare consequence of blunt liver trauma. It can be quite a diagnostic challenge for clinicians, as it can clinically manifest many weeks after the trauma or be scantily symptomatic. Methods: The following article would like to provide an analysis of clinical cases of 13 patients following blunt liver injuries, the main symptoms of which was bleeding into the gastrointestinal tract through the biliary tree. The article is research of the published literature concentrating on the influence of modern diagnostic methods (scintigraphy, USG and CT) on the diagnosis and long-term survival of patients with haemobilia caused by blunt liver trauma. In each patient, the condition was presented with UGIB symptoms following blunt trauma, before initiation of operative treatment or before death. The cases were divided into 2 groups: prior to and after introduction of modern diagnostic procedures, and then compared together. Results: The study indicates that liver damage can cause symptoms of UGIB, even after minor abdominal trauma and with delayed and uncharacteristic symptoms. Conclusions: Modern diagnostic methods, such as ultrasound, scintigraphy and CT, make it easier to identify these injuries and choose appropriate treatment, reducing the risk of death. Full article

(This article belongs to the Special Issue Advances in Trauma Treatment)

15 pages, 2860 KiB

Open AccessArticle

Eight Weeks of Resistance Training Is Not a Sufficient Stimulus to Improve Body Composition in Post-COVID-19 Elderly Adults

by Katarzyna Kaczmarczyk, Kamila Płoszczyca, Karol Jaskulski and Miłosz Czuba

J. Clin. Med. 2025, 14(1), 174; https://doi.org/10.3390/jcm14010174 - 31 Dec 2024

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Abstract

Background: This study sought to assess how body mass (BM) and body composition in post-COVID-19 elderly adults were affected by 8 weeks of resistance training. An additional goal was to determine the agreement between Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray [...] Read more.

Background: This study sought to assess how body mass (BM) and body composition in post-COVID-19 elderly adults were affected by 8 weeks of resistance training. An additional goal was to determine the agreement between Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA) in elderly people. Methods: Participants were randomly assigned to an intervention Group, which engaged in 8 weeks of resistance training, and a Control Group, which was advised to maintain their usual activity levels. Before and after the intervention, the body composition was analyzed via the BIA and DXA methods. Results: We found no statistically significant changes in BM or body composition following resistance training. BIA was found to overestimate the participants’ baseline BM and fat-free mass (FFM) and to underestimate the fat mass (FM), compared to the DXA method. There were no significant differences in intervention-induced changes in FM and FFM measured by BIA and DXA. Conclusions: Moderate intensity resistance training lasting 8 weeks was not found to be a sufficient stimulus to improve BM and body composition in post-COVID-19 elderly adults. We also conclude that BIA may serve as a viable alternative to DXA for measuring longitudinal changes in body composition in elderly people. Full article

(This article belongs to the Special Issue Physical Activity, Exercise and Health: Clinical Management and Research)

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15 pages, 904 KiB

Open AccessArticle

Large Unstained Cells (LUC): A Novel Predictor of CDK4/6 Inhibitor Outcomes in HR+ HER2-Negative Metastatic Breast Cancer

by Furkan Ceylan, Mirmehdi Mehdiyev, Didem Şener Dede, Safa Can Efil, Ateş Kutay Tenekeci, Burak Bilgin, Şebnem Yücel, Hayriye Tatlı Doğan, Mehmet Ali Nahit Şendur, Muhammed Bülent Akıncı, Doğan Uncu and Bülent Yalçın

J. Clin. Med. 2025, 14(1), 173; https://doi.org/10.3390/jcm14010173 - 31 Dec 2024

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Abstract

Background: Although CDK4/6 inhibitors combined with endocrine therapies have improved outcomes in HR+ HER2-negative metastatic breast cancer, predictive biomarkers for treatment response and adverse effects remain limited. This study assessed the prognostic and predictive value of large unstained cells (LUC), a subset [...] Read more.

Background: Although CDK4/6 inhibitors combined with endocrine therapies have improved outcomes in HR+ HER2-negative metastatic breast cancer, predictive biomarkers for treatment response and adverse effects remain limited. This study assessed the prognostic and predictive value of large unstained cells (LUC), a subset of white blood cells that may reflect immune status or treatment response. Methods: A retrospective analysis of 210 patients with HR+ HER2-negative metastatic breast cancer treated with CDK 4/6 inhibitors between 2021 and 2024 was conducted. Clinical data, including demographics, tumor characteristics, and treatment regimens, were analyzed. Based on LUC levels, progression-free survival (PFS), overall survival (OS), and adverse events were evaluated. Results: The cohort had a median age of 57, of which 78% were postmenopausal. Common metastatic sites included bone (67%) and liver (24%). At a median follow-up of 18.5 months, the PFS and OS rates were 65% and 83%. Patients with low LUC levels had significantly shorter PFS (OR: 1.91; p = 0.014) and OS (OR: 2.39; p = 0.012), while high LUC levels correlated with a lower incidence of grade 3 neutropenia (OR: 0.49; p = 0.017). Liver metastasis and prior treatments were also linked to shorter survival. Conclusions: LUC levels emerge as a promising biomarker for predicting survival outcomes and the risk of neutropenia in HR+ HER2-negative metastatic breast cancer patients treated with CDK 4/6 inhibitors and endocrine therapy, showing their potential to guide personalized treatment approaches. Full article

(This article belongs to the Special Issue Clinical Application of Biomarkers in Cancers)

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17 pages, 1724 KiB

Open AccessArticle

Validation of an Eye–Foot Coordination Assessment Tool for Children in Dual-Task Condition

by Karina Elizabeth Andrade-Lara, Víctor Serrano Huete, Eva Atero Mata, Juan Antonio Párraga Montilla, Julio Herrador Sánchez, Asensio Moreno Marín, Melchor Martínez Redondo, Daniel Manjón Pozas, Jesús Salas Sánchez, Manuel Lucena Zurita, José Carlos Cabrera Linares and Pedro Ángel Latorre Román

J. Clin. Med. 2025, 14(1), 172; https://doi.org/10.3390/jcm14010172 - 31 Dec 2024

Viewed by 189

Abstract

Background/Objectives: Eye–foot coordination is essential in sports and daily life, enabling the synchronization of vision and movement for tasks like ball control or crossing obstacles. This study aimed to examine both the validity and reliability of an innovative eye–foot coordination (EFC) test [...] Read more.

Background/Objectives: Eye–foot coordination is essential in sports and daily life, enabling the synchronization of vision and movement for tasks like ball control or crossing obstacles. This study aimed to examine both the validity and reliability of an innovative eye–foot coordination (EFC) test in a dual-task paradigm in children aged 6–11 years and the capacity of this test to discriminate between sex and age. Methods: A total of 440 schoolchildren aged 6–11 years participated in this cross-sectional study. A ball control test, involving kicking and catching, was used to assess EFC. The assessment included three conditions: without interference (WI), with auditory interference (AI), and with visual interference (VI). Results: The ICCs per the EFC test scores were 0.975 for foot successes (95% CI = 0.961–0.983; p < 0.001) and 0.747 for foot mistakes (95% CI = 0.611–0.835; p < 0.001). The SEM for the standing successes was 3.082 (10.81%), and the MDC was 4.860 (17.05%). For the standing mistakes, the SEM was 1.551 (19.33%) and the MDC was 3.452 (43.04%). Moreover, boys had a significantly higher number of successes in the WI, AI, and VI conditions (p < 0.001, respectively) than girls, although girls had more mistakes than boys only in the VI condition (p = 0.025). Conclusions: The EFC test showed adequate reliability and validity. Also, the EFC test showed that performance worsened with interference regardless of sex and age, especially in girls in the VI condition. Full article

(This article belongs to the Section Clinical Pediatrics)

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J. Clin. Med., Volume 14, Issue 1 (January-1 2025) – 201 articles

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