Journal of Clinical Medicine

9 pages, 323 KiB

Open AccessArticle

Long-Term Follow-Up of Gender-Affirming Chest Masculinization: What Have We Learned About Patient Satisfaction and Psychological Well-Being?

by Samuel Kwartin, Ron Skorochod, Liran Shapira and Yoram Wolf

J. Clin. Med. 2025, 14(4), 1249; https://doi.org/10.3390/jcm14041249 - 13 Feb 2025

Abstract

Background: Gender-affirming surgery has become an integral part of the gender transition process that transgender and gender-diverse individuals undergo. Although ample literature exists on the short-term outcomes of gender-affirming surgery, very little is known about the long-term implications the surgery has on the [...] Read more.

Background: Gender-affirming surgery has become an integral part of the gender transition process that transgender and gender-diverse individuals undergo. Although ample literature exists on the short-term outcomes of gender-affirming surgery, very little is known about the long-term implications the surgery has on the psychological well-being of the patients. The purpose was to understand the long-term impact that gender-affirming surgery has on transgender and gender-diverse individuals and gain insight on potential contributors to improved psychological well-being and satisfaction. Methods: All patients who were operated on by a single surgeon during a 20-year period were invited to the clinic for a follow-up appointment. The patients were physically examined, their scars were graded, and NAC sensation was evaluated. BUT (A and B) and BREAST-Q questionnaires were filled out by them and evaluated by the research staff. Results: Satisfaction with pre-operative information provided to the patient was associated with satisfaction with the final appearance of the chest (R = 0.717, p < 0.001), the surgical outcome (R = 0.481, p = 0.037), psychosocial well-being at follow up (R = 0.489, p = 0.034), satisfaction with the surgeon (R = 0.486, p = 0.035), satisfaction with the medical team (R = 0.62, p = 0.005) and satisfaction with the office staff (R = 0.65, p = 0.003). Conclusions: Pre-operative communication between the medical staff and the patients improves the psychological outcomes and satisfaction of the patients over the years. Full article

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

15 pages, 487 KiB

Open AccessArticle

The Burden of Diabetic Foot Ulcers on Hospital Admissions and Costs in Romania

by Adriana Rusu, Gabriela Roman, Bogdan Stancu and Cornelia Bala

J. Clin. Med. 2025, 14(4), 1248; https://doi.org/10.3390/jcm14041248 - 13 Feb 2025

Abstract

Background/Objectives: Diabetic foot ulcers represent an important economic burden for healthcare systems worldwide. We aimed to analyze the costs of care for diabetic foot ulcers (DFUs) associated with peripheral neuropathy (DPN) and peripheral arterial disease (PAD) and their trends in a tertiary-care [...] Read more.

Background/Objectives: Diabetic foot ulcers represent an important economic burden for healthcare systems worldwide. We aimed to analyze the costs of care for diabetic foot ulcers (DFUs) associated with peripheral neuropathy (DPN) and peripheral arterial disease (PAD) and their trends in a tertiary-care hospital. Methods: We used data from the electronic system of the Emergency Clinical County Hospital Cluj-Napoca, Romania. We included all episodes of hospitalization with a discharge date between 1 January 2015 and the 31 December 2018 and a discharge diagnosis of type 1 or type 2 diabetes, DPN, PAD, and foot ulcers. Results: During the analyzed period, 1094 episodes of hospitalization with type 1 or type 2 diabetes and DFUs were recorded. Of these, 25.9% had neuropathic, 47.1% ischemic, and 16.6% neuroischemic DFUs. The median length of hospital stay was 8.0 days, and the median cost per episode of hospitalization was 810.8 EUR, with no significant variations during the analyzed years. The cost per episode of hospitalization was higher in cases with ischemic DFUs than for other etiologies of foot ulcers for 2015–2017 (p < 0.001). In 2018, the costs for ischemic and neuroischemic DFUs were similar and significantly higher compared to neuropathic ones. Predictors of higher costs per episode of hospitalization included the etiology of the DFUs (β = 0.032, p = 0.034) and the length of hospital stay (β = 0.860, p < 0.001). Conclusions: By analyzing data from a tertiary care hospital, we showed higher costs for the care of persons with ischemic DFU. Full article

(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—3rd Edition)

12 pages, 689 KiB

Open AccessArticle

Dynamic Arterial Elastance as a Predictor of Intraoperative Fluid Responsiveness in Elderly Patient over 70 Years of Age Undergoing Spine Surgery in the Prone Position Under General Anesthesia: A Validation Study

by Eun Jung Oh, Eun Ah Cho, Joohyun Jun, Sung Hyun Lee, Seunghyeon Lee and Jin Hee Ahn

J. Clin. Med. 2025, 14(4), 1247; https://doi.org/10.3390/jcm14041247 - 13 Feb 2025

Abstract

Background: Optimizing fluid therapy is critical for maintaining hemodynamic stability in elderly patients undergoing major surgeries. Dynamic arterial elastance (Eadyn), defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV), has been proposed as a predictor of fluid [...] Read more.

Background: Optimizing fluid therapy is critical for maintaining hemodynamic stability in elderly patients undergoing major surgeries. Dynamic arterial elastance (Eadyn), defined as the ratio of pulse pressure variation (PPV) to stroke volume variation (SVV), has been proposed as a predictor of fluid responsiveness, especially in challenging conditions like prone-positioned spine surgery under general anesthesia. Methods: Hemodynamic parameters were measured before and after fluid loading with 500 mL of crystalloid solution. Patients were classified as responders or non-responders based on a ≥15% increase in mean arterial pressure (MAP) post-fluid administration. Predictive performance of these parameters was assessed using receiver operating characteristic (ROC) analysis. Results: Of the 37 patients, 15 were classified as responders and 22 as non-responders. Eadyn demonstrated poor predictive performance (AUC = 0.508). In contrast, SVV (AUC = 0.808), PPV (AUC = 0.738), and C (AUC = 0.741) exhibited moderate to high predictive ability. Responders exhibited significantly higher baseline SVV, PPV, and net arterial compliance compared to non-responders. Conclusions: Dynamic arterial elastance (Eadyn) showed limited predictive ability for fluid responsiveness in elderly patients undergoing spine surgery in the prone position. In contrast, stroke volume variation (SVV), pulse pressure variation (PPV), and net arterial compliance (C) demonstrated superior reliability, with SVV emerging as the most accurate predictor. Full article

(This article belongs to the Section Anesthesiology)

17 pages, 2836 KiB

Open AccessSystematic Review

Exploring the Association Between Dietary Fruit Intake and Endometriosis: A Systematic Review and Meta-Analysis

by Pegah Rashidian, Ehsan Amini-Salehi, Shaghayegh Karami, Camran Nezhat and Farr Nezhat

J. Clin. Med. 2025, 14(4), 1246; https://doi.org/10.3390/jcm14041246 - 13 Feb 2025

Abstract

Background/Objectives: Endometriosis is a chronic gynecological disorder affecting up to 10% of women of reproductive age. The etiology of endometriosis remains unclear; however, there is growing interest in identifying modifiable risk factors, particularly dietary influences. The present study aims to systematically evaluate the [...] Read more.

Background/Objectives: Endometriosis is a chronic gynecological disorder affecting up to 10% of women of reproductive age. The etiology of endometriosis remains unclear; however, there is growing interest in identifying modifiable risk factors, particularly dietary influences. The present study aims to systematically evaluate the association between fruit consumption and the incidence of endometriosis. Methods: A comprehensive systematic search was conducted across PubMed, Embase, Web of Science, and Google Scholar for studies published from 1 January 1990 to 30 September 2024. Relevant data were extracted and categorized, and the methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklists. Additionally, meta-analyses were performed using STATA 18.0 to compare daily and weekly fruit consumption among women with and without endometriosis. Results: The analysis included six studies comprising 3689 women with endometriosis and 1463 controls. The meta-analysis revealed no significant association between daily fruit consumption and the risk of endometriosis (odds ratio (OR): 0.95; 95% confidence interval (CI): 0.90–1.01). Similarly, weekly fruit consumption did not demonstrate a significant link to endometriosis risk (OR 1.03, 95% CI: 0.78–1.35). The assessment of publication bias using Begg’s and Egger’s tests, along with contour-enhanced funnel plots, indicated the absence of publication bias in the data across both analysis groups. Conclusions: This study indicates that fruit consumption does not significantly influence the risk of developing endometriosis. Additional research is necessary to examine preferred dietary interventions for populations affected by this condition. Full article

(This article belongs to the Section Obstetrics & Gynecology)

12 pages, 468 KiB

Open AccessArticle

Coronary Artery Calcium Is Independently Associated with Arterial Stiffness and LDL Cholesterol Burden in Patients with Familial Hypercholesterolemia

by Alessandro Mattina, Antonina Giammanco, Davide Noto, Giulio Geraci, Emilio Nardi, Carlo Maria Barbagallo, Carola Maria Gagliardo, Maria Ausilia Giusti, Francesco D’Ignoto, Francesco Giallauria, Carla Di Benedetto, Antonella Maria Cardella, Patrizia Toia, Ludovico La Grutta, Angelo Baldassare Cefalù and Maurizio Averna

J. Clin. Med. 2025, 14(4), 1245; https://doi.org/10.3390/jcm14041245 - 13 Feb 2025

Abstract

Background: Familial hypercholesterolemia (FH) is a genetic disorder characterized by high plasma levels of low-density lipoprotein cholesterol (LDL-C) and exposing patients to higher risk of early cardiovascular (CV) atherosclerotic diseases. Though the estimated prevalence of heterozygous FH (HeFH) is about 1 in 200, [...] Read more.

Background: Familial hypercholesterolemia (FH) is a genetic disorder characterized by high plasma levels of low-density lipoprotein cholesterol (LDL-C) and exposing patients to higher risk of early cardiovascular (CV) atherosclerotic diseases. Though the estimated prevalence of heterozygous FH (HeFH) is about 1 in 200, FH is still underdiagnosed and undertreated. Coronary artery calcification (CAC) assessment and arterial stiffness measured as pulse wave velocity (PWV) have demonstrated their accuracy in CV risk assessment, but data on HeFH are lacking. This study aims to evaluate CAC and PWV in a population of HeFH patients to improve risk stratification and therapy timing and setting. Methods: One hundred genetically characterized HeFH patients, regularly followed up since diagnosis, were recruited at our outpatient clinic. In all patients, CAC, PWV measurement, and LDL-C burden calculation were assessed. Results: The mean age was 45 ± 16 years. A total of 25% of patients had hypertension, and 15% were in secondary prevention. Through univariate analysis, we found strong positive correlations between CAC and both PWV (r = 0.52 p > 0.0001) and total LDL-C burden (r = 0.52 p < 0.0001). No other associations with lipid parameters were found. Multivariate analysis showed that CAC was independently associated with PWV adjusted for sex, total LDL-C burden, systolic blood pressure, smoking, LDL-C, HDL-C, and statin treatment. Conclusions: Arterial stiffness is strongly associated with CAC in HeFH patients with similar total LDL-C burden and CV risk profiles. Personalized risk assessment based on arterial stiffness and CAC evaluation enhances the stratification and management of cardiovascular risk in FH patients, supporting individualized therapeutic approaches. Full article

(This article belongs to the Special Issue Personalized Medicine for the Management of Non-Communicable Disease (NCDs))

13 pages, 481 KiB

Open AccessArticle

Postpartum Mothers’ Mental Health in a Conflict-Affected Region: A Cross-Sectional Study of Emotion Regulation and Social Support

by Shirly Mor, Yaron Sela and Shahar Lev-Ari

J. Clin. Med. 2025, 14(4), 1244; https://doi.org/10.3390/jcm14041244 - 13 Feb 2025

Abstract

Background: The transition through pregnancy, childbirth, and postpartum significantly impacts maternal mental health, influencing both individual and family well-being. While social support and emotion regulation serve as protective factors generally, their role and impact during periods of conflict remains understudied. Methods: We conducted [...] Read more.

Background: The transition through pregnancy, childbirth, and postpartum significantly impacts maternal mental health, influencing both individual and family well-being. While social support and emotion regulation serve as protective factors generally, their role and impact during periods of conflict remains understudied. Methods: We conducted a cross-sectional study of 400 Jewish mothers (up to two years postpartum) from a representative sample in Israel during a period of conflict. Participants were recruited through the Sekernet platform, a validated online survey tool in Israel. The study population included Jewish mothers up to two years postpartum, aged 18–45, without a history of diagnosed mental health disorders. Inclusion criteria specified mothers aged 18–45 and within two years postpartum, while exclusion criteria included mothers under 18, over 45, more than two years postpartum, or with a history of diagnosed mental illness or psychiatric disorders. Using validated instruments, we assessed psychological well-being (PWB), anxiety (GAD-7), perceived stress (PSS), resilience (CD-RISC), emotion regulation strategies (ERQ), quality of life (WHO-5), social support (MSPSS), and post-traumatic stress symptoms (PCL-5). Additionally, exposure to conflict-related media and direct exposure to war events were measured using self-reported questionnaires evaluating frequency and type of exposure during the conflict period. Results: Cognitive reappraisal and resilience positively correlated with psychological well-being (p < 0.01), while expressive suppression and general stress negatively correlated with both psychological well-being and quality of life (p < 0.01). Mediation analysis revealed that social support significantly mediated the effects of stress on psychological well-being (β = −0.060; p < 0.05) and quality of life (β = −0.05; p < 0.05). Additionally, exposure to conflict-related media and post-traumatic stress symptoms correlated with reduced well-being and increased anxiety. Conclusions: Our findings emphasize the vital roles of social support systems and adaptive emotional regulation strategies during the postpartum period, particularly in conflict settings. Healthcare providers should implement interventions that strengthen social support networks and teach adaptive emotion regulation skills to postpartum mothers in conflict zones. Full article

(This article belongs to the Special Issue Perinatal Mental Health Management)

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9 pages, 1658 KiB

Open AccessArticle

An Evaluation of Prognostic Factors in Cutaneous Squamous Cell Carcinoma: A Single-Center Study of 237 Japanese Cases

by Emi Yamazaki, Taku Fujimura, Manami Takahashi-Watanabe, Ryo Amagai, Erika Tamabuchi, Kenta Oka, Yumi Kambayashi, Akira Hashimoto, Ryoko Omori, Takehiro Takahashi and Yoshihide Asano

J. Clin. Med. 2025, 14(4), 1243; https://doi.org/10.3390/jcm14041243 - 13 Feb 2025

Abstract

Background/Objectives: Cutaneous squamous cell carcinoma (cSCC) is a common cutaneous malignancy with diverse etiologies, including actinic keratosis, burns, and hidradenitis suppurativa (HS). Methods: We reviewed 237 cases diagnosed as cSCC in our department between 2013 and 2023. In addition, we focused on [...] Read more.

Background/Objectives: Cutaneous squamous cell carcinoma (cSCC) is a common cutaneous malignancy with diverse etiologies, including actinic keratosis, burns, and hidradenitis suppurativa (HS). Methods: We reviewed 237 cases diagnosed as cSCC in our department between 2013 and 2023. In addition, we focused on HS as an aggravating factor for cSCC. The mechanism of cSCC progression was investigated with a focus on LL-37, a peptide implicated in the pathogenesis of HS. Relevant gene expression was analyzed comprehensively via RNA sequencing in vitro. Results: The median age of the patients was 82 years (range: 33–101), with 139 males and 98 females. The primary sites were as follows: head and neck (125 cases), trunk (10 cases), vulva (11 cases), extremities (81 cases), and buttocks (10 cases). Among the five cases (2.1%) of buttocks cSSc associated with HS, all cases (100%) had local recurrence or lymph node metastasis at the time of diagnosis, and one case (20%) developed multi-organ metastasis. The incidence of disease progression in cSCC originating from HS-affected buttocks was significantly higher than in other sites (p < 0.05). RNA sequencing revealed the significant amplification of ACTA1, which was confirmed by Western blotting and immunohistochemical staining. Conclusions: These results suggest that HS is a prognostic factor in cSCC and that LL-37 stimulation contributes to tumor progression, partly by enhancing multiple tumor growth factors. Full article

(This article belongs to the Special Issue New Insights into Melanoma and Non-Melanoma Skin Cancers)

12 pages, 1007 KiB

Open AccessReview

Beyond the Lungs: Extrapulmonary Effects of Non-Invasive and Invasive Ventilation Strategies

by Pedro Leme Silva, Davide Chiumello, Tommaso Pozzi and Patricia Rieken Macedo Rocco

J. Clin. Med. 2025, 14(4), 1242; https://doi.org/10.3390/jcm14041242 - 13 Feb 2025

Abstract

Background/Objectives: Non-invasive respiratory support and invasive mechanical ventilation are critical interventions that can induce significant changes not only in the lungs but also in extra-pulmonary organs, which are often overlooked. Understanding the extra-pulmonary effects of non-invasive respiratory support and invasive mechanical ventilation [...] Read more.

Background/Objectives: Non-invasive respiratory support and invasive mechanical ventilation are critical interventions that can induce significant changes not only in the lungs but also in extra-pulmonary organs, which are often overlooked. Understanding the extra-pulmonary effects of non-invasive respiratory support and invasive mechanical ventilation is crucial since it can help prevent or mitigate complications and improve outcomes. This narrative review explores these consequences in detail and highlights areas that require further research. Main Text: Non-invasive respiratory support and invasive mechanical ventilation can significantly impact various extrapulmonary organs. For instance, some ventilation strategies can affect venous return from the brain, which may lead to neurological sequelae. In the heart, regardless of the chosen ventilation method, increased intrathoracic pressure (ITP) can also reduce venous return to the heart. This reduction in turn can decrease cardiac output, resulting in hypotension and diminished perfusion of vital organs. Conversely, in certain situations, both ventilation strategies may enhance cardiac function by decreasing the work of breathing and lowering oxygen consumption. In the kidneys, these ventilation methods can impair renal perfusion and function through various mechanisms, including hemodynamic changes and the release of stress hormones. Such alterations can lead to acute kidney injury or exacerbate pre-existing renal conditions. Conclusions: This review emphasizes the critical importance of understanding the extensive mechanisms by which non-invasive respiratory support and invasive mechanical ventilation affect extrapulmonary organs, including neurological, cardiovascular, and renal systems. Such knowledge is essential for optimizing patient care and improving outcomes in critical care settings. Full article

(This article belongs to the Special Issue Applied Cardiorespiratory Physiology in Critical Care Medicine)

17 pages, 1554 KiB

Open AccessReview

SGLT2 Inhibitors: The First Endothelial-Protector for Diabetic Nephropathy

by Davide Viggiano, Rashmi Joshi, Gianmarco Borriello, Giovanna Cacciola, Annalisa Gonnella, Andrea Gigliotti, Michelangelo Nigro and Giuseppe Gigliotti

J. Clin. Med. 2025, 14(4), 1241; https://doi.org/10.3390/jcm14041241 - 13 Feb 2025

Abstract

Sodium-glucose co-transporter type 2 inhibitors (SGLT2i) have emerged as a class of agents relevant for managing diabetic nephropathy and cardiopathy. In a previous report, we noticed that these drugs share, with other drugs with “nephroprotective” effects, the ability to reduce the glomerular filtration [...] Read more.

Sodium-glucose co-transporter type 2 inhibitors (SGLT2i) have emerged as a class of agents relevant for managing diabetic nephropathy and cardiopathy. In a previous report, we noticed that these drugs share, with other drugs with “nephroprotective” effects, the ability to reduce the glomerular filtration rate (GFR), thus suggesting the kidney hemodynamic effect as a proxy for optimal drug dosage. We also noticed that all known nephroprotective drugs exert cardioprotective functions, suggesting the possibility of activities not mediated by the kidney. Finally, we observe that nephroprotective drugs can be grouped according to their effects on hemoglobin levels, thus suggesting their mechanism of action. While the primary mechanism of SGLT2i involves glycosuria and natriuria, growing evidence suggests broader therapeutic effects beyond hemodynamic modulation. Specifically, the evidence that SGLT2 can be expressed in several atypical regions under pathological conditions, supports the possibility that its inhibition has several extratubular effects. Evidence supports the hypothesis that SGLT2i influence mitochondrial function in various cell types affected by diabetes, particularly in the context of diabetic nephropathy. Notably, in SGLT2i-treated patients, the extent of albumin-creatinine ratio (ACR) reduction post-treatment may be correlated with mitochondrial staining intensity in glomerular endothelial cells. This implies that the anti-proteinuric effects of SGLT2i could involve direct actions on glomerular endothelial cell. Our investigation into the role of SGLT2 inhibitors (SGLT2i) in endothelial function suggests that the aberrant expression of SGLT2 in endothelial cells in T2DM would lead to intracellular accumulation of glucose; therefore, SGLT2i are the first type of endothelial protective drugs available today, with potential implications for ageing-related kidney disease. The review reveals two major novel findings: SGLT2 inhibitors are the first known class of endothelial-protective drugs, due to their ability to prevent glucose accumulation in endothelial cells where SGLT2 is aberrantly expressed in Type 2 Diabetes. Additionally, the research demonstrates that SGLT2 inhibitors share a GFR-reducing effect with other nephroprotective drugs, suggesting both a mechanism for optimal drug dosing and potential broader applications in ageing-related kidney disease through their effects on mitochondrial function and glomerular endothelial cells. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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16 pages, 1933 KiB

Open AccessReview

The Past, Present, and Future Perspective of Photodynamic Therapy for Age-Related Macular Degeneration

by Shigeru Honda

J. Clin. Med. 2025, 14(4), 1240; https://doi.org/10.3390/jcm14041240 - 13 Feb 2025

Abstract

Photodynamic therapy (PDT) has been approved as a therapeutic modality for the management of neovascular age-related macular degeneration (nAMD). PDT can treat macular neovascularization with minimal effects on normal tissue, reducing lesion size and maintaining patients’ visual acuity; consequently, it became the choice [...] Read more.

Photodynamic therapy (PDT) has been approved as a therapeutic modality for the management of neovascular age-related macular degeneration (nAMD). PDT can treat macular neovascularization with minimal effects on normal tissue, reducing lesion size and maintaining patients’ visual acuity; consequently, it became the choice of intervention for nAMD around the year 2000. However, the visual outcomes of PDT are inferior to those of anti-vascular endothelial growth factor therapy. Thus, PDT is no longer favored, except for the management of some specific phenotypes of nAMD (e.g., polypoidal choroidal vasculopathy and pachychoroid neovasculopathy) that are good candidates for PDT. Despite these circumstances, PDT remains an effective treatment modality for several retinal and choroidal diseases and should be considered for further use. This review summarizes the past and present positions of PDT in the field of ophthalmology and discusses the future perspectives on PDT. Full article

(This article belongs to the Section Ophthalmology)

20 pages, 5879 KiB

Open AccessSystematic Review

Evaluating the Role of Vitamin D in Prediabetes Management, Insights from RCTs in the MENA Region: A Comprehensive Systematic Review

by Mohammed A. M. Y. Al-Hetar, Noradliyanti Rusli, Mohd Amir Kamaruzzaman, Husni Al-Goshae, Wan Zurinah Wan Ngah, Shamsul Azhar Shah, Abdullah Mohammed Al-Matary, Qais Mohammed Al-Hetar, Dhya’a Alhaq Mohammed Senan and Norasyikin A. Wahab

J. Clin. Med. 2025, 14(4), 1239; https://doi.org/10.3390/jcm14041239 - 13 Feb 2025

Abstract

Background/Objectives: The association between vitamin D deficiency and prediabetes has been extensively investigated, yet the findings remain inconsistent, with limited data available on the MENA region. This systematic review aims to assess the relationship between vitamin D deficiency and prediabetes in the [...] Read more.

Background/Objectives: The association between vitamin D deficiency and prediabetes has been extensively investigated, yet the findings remain inconsistent, with limited data available on the MENA region. This systematic review aims to assess the relationship between vitamin D deficiency and prediabetes in the Middle East and North Africa (MENA) region, focusing specifically on randomized controlled trials (RCTs). Methods: A comprehensive literature search was performed across four databases, which were Ovid MEDLINE, Cochrane, Scopus, and PubMed. RCTs studies conducted on people with prediabetes aged 15 years and older who live in the MENA region, and receiving vitamin D supplementation were included in the study. Results: From 2194 studies identified from the literature search, only 51 studies were considered eligible for full-text review. Ultimately, seven articles were finalized for inclusion. The findings from these studies showed mixed results, where some studies indicated that vitamin D supplementation had no significant effect on these outcomes. The remaining reported improvements in insulin sensitivity and a reduced risk of progression to type 2 diabetes with vitamin D supplementation. Conclusions: This systematic review examines the complex and contradictory relationship between vitamin D deficiency and prediabetes in the MENA region. Due to the mixed pattern seen in the intervention of vitamin D to prevent the development of type 2 diabetes, further research is necessary to elucidate the underlying mechanisms and potential confounding factors specifically in population of the MENA region. Full article

(This article belongs to the Special Issue Type 2 Diabetes: Advances and Challenges)

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17 pages, 26497 KiB

Open AccessReview

Congenital Stationary Night Blindness (CSNB)—Case Reports and Review of Current Knowledge

by Magdalena Durajczyk and Wojciech Lubiński

J. Clin. Med. 2025, 14(4), 1238; https://doi.org/10.3390/jcm14041238 - 13 Feb 2025

Abstract

Purpose: To present the current state of knowledge and our diagnosed patients with congenital stationary night blindness. Material and methods: Data from the PubMed database on CSNB and the presentation of patients with complete and incomplete forms of this condition. Patients underwent routine [...] Read more.

Purpose: To present the current state of knowledge and our diagnosed patients with congenital stationary night blindness. Material and methods: Data from the PubMed database on CSNB and the presentation of patients with complete and incomplete forms of this condition. Patients underwent routine ophthalmologic examination, optical coherence tomography, and full-field elecroretinogram (ERG-ISCEV), ON-OFF ERG. Results: CSNB is a group of rare, non-progressive retinal diseases characterized by impaired night vision from birth, reduced visual acuity, myopia, nystagmus, and strabismus. Color vision and fundus imaging are most often normal. CSNB is mainly inherited autosomal recessively. Eighteen genes with more than 360 pathogenic variants have been detected in this condition. The effect of gene mutations is to damage the function of rods (Riggs type) and bipolar cells of the retina (Schubert–Bornstein type). The key diagnostic test in CSNB is ERG. In diagnosed cases of complete CSNB the following types have been registered: rod ERG absent, rod–cone response negative (ON bipolar cell defect), and photopic ERG enlarged a-wave. In incomplete CSNB-rod ERG-subnormal, rod-cone response-negative (bipolar cell defect ON, OFF), photopic ERG-subnormal with a double peak in the flicker fusion frequency. Knowledge of the phenotypic changes associated with various gene pathogenic variants is still very limited, hindering the ability to correctly diagnose a patient based on clinical examination and additional ophthalmologic tests. However, some phenotypic features found in our cases were consistent with pathogenic variants previously described in the literature and helped to make a diagnosis that was proven by genetic testing. Conclusions: Congenital stationary night blindness should be considered in the diagnosis of retinal diseases manifesting with impaired night vision. A correct diagnosis is especially important for the patients, as it is nonprogressive, unlike other diseases that should be considered in the differential diagnoses. Full article

(This article belongs to the Collection Recent Advances of Examination and Treatment for Retinal and Choroidal Diseases)

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11 pages, 415 KiB

Open AccessArticle

Expanding the EVAR Pool with Non-IFU Patients: How Important is Subjective Physician Assessment?

by Hasan Iner, Ismail Yurekli, Erturk Karaagac, Ihsan Peker, Nuri Utkan Tunca, Tahsin Murat Tellioglu, Huseyin Durmaz, Hidayet Onur Selcuk and Levent Yilik

J. Clin. Med. 2025, 14(4), 1237; https://doi.org/10.3390/jcm14041237 - 13 Feb 2025

Abstract

Objectives: In order to reduce the abdominal aortic aneurysm (AAA)-related complication rate in endovascular aneurysm repair (EVAR) procedures, manufacturers recommend following the instructions for use (IFU). However, IFU is considered too conservative in many centers. In this context, we present our experience and [...] Read more.

Objectives: In order to reduce the abdominal aortic aneurysm (AAA)-related complication rate in endovascular aneurysm repair (EVAR) procedures, manufacturers recommend following the instructions for use (IFU). However, IFU is considered too conservative in many centers. In this context, we present our experience and patient follow-up data with 248 consecutive patients with or without IFU eligibility. Methods: A total of 248 patients who underwent elective EVAR for AAA between 2014 and 2019 were included. In total, 190 patients were in the IFU group and 58 in the non-IFU group. Patients were evaluated for baseline demographic and anatomic data; unexpected periprocedural intervention; and postoperative data such as development of endoleaks during follow-up, need for re-intervention, development of complications, EVAR patency, and mean 5-year survival rate. Results: The patients did not differ in terms of basic demographic data. The basic anatomical data were suitable for the IFU standard. Intraoperative endoleak development was significantly higher in the non-IFU group. In addition, the development of endoleaks at any time, the need for re-intervention, and the development of complications were higher in the non-IFU group at postoperative follow-up. Survival analysis showed no difference in the mean 5-year follow-up. The EVAR patency rate was higher in the IFU group. Conclusions: We believe that the decision for a non-IFU EVAR should be patient-specific and that the results of the subjective medical assessment should definitely be taken into account. However, we should not forget that EVAR patients, especially non-IFU patients, are susceptible to future changes in the aorta and prone to the development of endoleaks and re-interventions. Full article

(This article belongs to the Special Issue Endovascular Management of Diseases of the Aorta: From the Aortic Valve to the Iliac Arteries)

22 pages, 1892 KiB

Open AccessCase Report

Giant Ovarian Tumors in Young Women: Diagnostic and Treatment Challenges—A Report of Two Cases and Narrative Review of the Recent Literature

by Mariia Melnyk, Andrzej Starczewski, Jolanta Nawrocka-Rutkowska, Amalia Gorzko, Bohdan Melnyk and Iwona Szydłowska

J. Clin. Med. 2025, 14(4), 1236; https://doi.org/10.3390/jcm14041236 - 13 Feb 2025

Abstract

Background: Ovarian cysts (OCs) are a common gynecological issue, with approximately 20% of women developing at least one pelvic mass during their lifetime. The incidence of large ovarian cysts has decreased substantially due to regular gynecological screenings. However, giant ovarian tumors still continue [...] Read more.

Background: Ovarian cysts (OCs) are a common gynecological issue, with approximately 20% of women developing at least one pelvic mass during their lifetime. The incidence of large ovarian cysts has decreased substantially due to regular gynecological screenings. However, giant ovarian tumors still continue to pose significant diagnostic and therapeutic challenges. Methods: We report two cases of giant ovarian tumors (GOTs). Case 1 involves a 17-year-old woman who presented with a 2-year history of gradual abdominal enlargement, accompanied by repeated attempts at weight reduction. A computed tomography (CT) scan revealed a large tumor. It was excised by laparotomy. Histopathologic examination revealed ovarian cystadenofibroma. Case 2 presents a 25-year-old female who had a 3-month history of progressive, severe abdominal distension and weight gain, accompanied by nausea and diarrhea. CT imaging revealed a giant cystic neoplasm. The cyst was removed by laparotomy. The histopathological study revealed the intestinal–endocervical mucinous borderline tumor. In this context, we performed a narrative literature review, including cases of giant ovarian tumors in young women over the past five years. We centered on diagnoses and management in these cases. Results: The surgical management of both cases was successful, with complete tumor excision and favorable postoperative outcomes. hese cases underscore the importance of including giant ovarian tumors in the differential diagnosis of young women presenting with progressive abdominal distension. The narrative review analyzed 39 relevant publications on the management of giant ovarian tumors in young women. Conclusions: It is important to highlight a possible risk of malignancy, and risk of fatal complications during the surgical removal of giant ovarian cysts (GOCs). To ensure safer and more successful outcomes, multidisciplinary care should be provided. The early detection and diagnosis of OCs are challenging, as patients may not seek medical attention until the tumor has become large enough to cause symptoms. It is crucial to raise awareness among family doctors and other primary care providers (PCPs) regarding OCs to ensure optimal diagnostic and therapeutic management and improve the outcomes for patients with OCs. Full article

(This article belongs to the Special Issue Challenges in Diagnosis and Treatment of Gynecological Malignancies in Young Adults)

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8 pages, 186 KiB

Open AccessFeature PaperArticle

Efficacy and Safety of a Regimen for Medical Abortion up to 63 Days of Gestation: A Retrospective Study in Northern Greece

by Vera Kelesidou, Ioannis Tsakiridis, Kyriaki Mitta, Andriana Virgiliou, Georgios Michos, Anna Kougioumtsidou, Apostolos Mamopoulos, Themistoklis Dagklis and Ioannis Kalogiannidis

J. Clin. Med. 2025, 14(4), 1235; https://doi.org/10.3390/jcm14041235 - 13 Feb 2025

Abstract

Background and Objectives: First trimester medical abortion with the combination of mifepristone and misoprostol is highly effective. The aim of this study was to assess the efficacy and safety of a modified medical abortion protocol, offering a structured outpatient approach up to [...] Read more.

Background and Objectives: First trimester medical abortion with the combination of mifepristone and misoprostol is highly effective. The aim of this study was to assess the efficacy and safety of a modified medical abortion protocol, offering a structured outpatient approach up to 9 weeks (63 days) of gestation. This study may contribute to existing evidence by evaluating a slightly altered regimen and its real-world effectiveness in clinical practice. Material and Methods: This was a retrospective cohort study conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, during a two-year period (2022–2024). Women aged 18 years or older with an intrauterine pregnancy ≤63 days confirmed by transvaginal ultrasound were included. Exclusion criteria included ectopic pregnancy, contraindications to study medications, or loss to follow-up. Mifepristone (200 mg) was administered orally on Day 1, and misoprostol (800 mcg) was administered vaginally on Day 3. Serial follow-up visits on Days 8, 15, and 21 were scheduled according to the success of each cycle. Results: In total, 130 women were included in the study. A high success rate of 96.9% (95% CI: 92.3–99.2%) was observed. Success was most frequently observed on Day 8 (60.8%). Success rates were 100% for the age group of 18 to 25 years, approximately 96% for both the groups of 26–35 and 36–45 years, and around 50% for those aged >45 years. With regards to gestational age, success rates were 97.5% for ≤7 weeks (49 days) and 95.9% for >7 weeks (p = 0.63). Side effects were reported by 13.2% of participants (95% CI: 7.8–20.1%) and mainly involved the gastrointestinal system. Pain intensity was reported as moderate; analgesics were used by 75.4% of patients. The satisfaction rate for the medical abortion process was 95.4% (95% CI: 90.2–98.3%). Conclusions: Early-first-trimester medical abortion on an outpatient basis is a feasible, patient-friendly method with high efficacy, exhibiting limited side effects and a high satisfaction rate. Full article

(This article belongs to the Section Obstetrics & Gynecology)

22 pages, 6018 KiB

Open AccessReview

Minimally Invasive Rectal Surgery: Current Status and Future Perspectives in the Era of Digital Surgery

by Marta Goglia, Matteo Pavone, Vito D’Andrea, Veronica De Simone and Gaetano Gallo

J. Clin. Med. 2025, 14(4), 1234; https://doi.org/10.3390/jcm14041234 - 13 Feb 2025

Abstract

Over the past two decades, minimally invasive approaches in rectal surgery have changed the landscape of surgical interventions, impacting both malignant and benign pathologies. The dynamic nature of rectal cancer treatment owes much to innovations in surgical techniques, reflected in the expanding literature [...] Read more.

Over the past two decades, minimally invasive approaches in rectal surgery have changed the landscape of surgical interventions, impacting both malignant and benign pathologies. The dynamic nature of rectal cancer treatment owes much to innovations in surgical techniques, reflected in the expanding literature on available treatment modalities. Local excision, facilitated by minimally invasive surgery, offers curative potential for patients with early T1 rectal cancers and favorable pathologic features. For more complex cases, laparoscopic and robotic surgery have demonstrated significant efficacy and provided precise, durable outcomes while reducing perioperative morbidity and enhancing postoperative recovery. Additionally, advancements in imaging, surgical instrumentation, and enhanced recovery protocols have further optimized patient care. The integration of multidisciplinary care has also emerged as a cornerstone of treatment, emphasizing collaboration among surgeons, oncologists, and radiologists to deliver personalized, evidence-based care. This narrative review aims to elucidate current minimally invasive surgical techniques and approaches for rectal pathologies, spanning benign and malignant conditions, while also exploring future directions in the field, including the potential role of artificial intelligence and next-generation robotic platforms. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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11 pages, 1041 KiB

Open AccessReview

Clear Cell Sarcoma (CCS) of the Soft Tissue: An Update Narrative Review with Emphasis on the Utility of PRAME in Differential Diagnosis

by Gerardo Cazzato, Francesco Piscazzi, Alessandra Filosa, Anna Colagrande, Paolo Del Fiore, Francesca Ambrogio, Chiara Battilotti, Andrea Danese, Serena Federico and Fortunato Cassalia

J. Clin. Med. 2025, 14(4), 1233; https://doi.org/10.3390/jcm14041233 - 13 Feb 2025

Abstract

Clear Cell Sarcoma (CCS) of soft tissue is a rare and highly malignant neoplasm primarily affecting young adults, often presenting in the deep soft tissues of the extremities. Despite morphological and immunophenotypic similarities to melanoma, CCS arises from connective tissues and is characterized [...] Read more.

Clear Cell Sarcoma (CCS) of soft tissue is a rare and highly malignant neoplasm primarily affecting young adults, often presenting in the deep soft tissues of the extremities. Despite morphological and immunophenotypic similarities to melanoma, CCS arises from connective tissues and is characterized by a distinct genetic hallmark: the EWSR1-ATF1 fusion resulting from t(12;22)(q13;q12) translocation. This genetic signature is absent in melanoma, making molecular diagnosis essential for accurate differentiation. Additionally, recent evidence highlights the utility of PRAME as an immunohistochemical marker to distinguish CCS from melanoma and other neoplasms. Clinically, CCS commonly involves tendons and aponeuroses, with metastatic potential leading to poor prognoses despite optimal local disease management. Histologically, CCS features lobular growth, spindle-to-epithelioid cells with clear cytoplasm, and low mitotic activity, often necessitating a multimodal diagnostic approach incorporating histopathology, immunohistochemistry, and molecular testing. Therapeutically, wide surgical excision remains the cornerstone for localized disease, with sentinel lymph node biopsy aiding in staging. Adjuvant radiotherapy is considered in select cases, while chemotherapy has limited efficacy in metastatic settings. Emerging treatments, including targeted therapies focusing on EWSR1-ATF1-driven pathways and immune checkpoint inhibitors, offer hope for improved outcomes. This review synthesizes current knowledge on CCS, emphasizing diagnostic challenges, the role of PRAME, and advancements in therapeutic strategies to enhance patient care. Full article

(This article belongs to the Special Issue Skin Diseases: From Diagnosis to Treatment)

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16 pages, 7083 KiB

Open AccessCase Report

Comprehensive Management of a Giant Left Frontal AVM Coexisting with a Bilobed PComA Aneurysm: A Case Report Highlighting Multidisciplinary Strategies and Advanced Neurosurgical Techniques

by Corneliu Toader, Matei Serban, Razvan-Adrian Covache-Busuioc, Mugurel Petrinel Radoi, Alexandru Vlad Ciurea and Nicolaie Dobrin

J. Clin. Med. 2025, 14(4), 1232; https://doi.org/10.3390/jcm14041232 - 13 Feb 2025

Abstract

Background: Arteriovenous malformations (AVMs) are high-risk cerebrovascular anomalies that can lead to devastating complications, especially when associated with intracranial aneurysms. Their coexistence poses unique challenges in diagnosis and management due to heightened hemodynamic stress and rupture risks. This case presents a 35-year-old woman [...] Read more.

Background: Arteriovenous malformations (AVMs) are high-risk cerebrovascular anomalies that can lead to devastating complications, especially when associated with intracranial aneurysms. Their coexistence poses unique challenges in diagnosis and management due to heightened hemodynamic stress and rupture risks. This case presents a 35-year-old woman with a giant unruptured left frontal AVM and a bilobed posterior communicating artery (PComA) aneurysm, highlighting the critical role of advanced imaging, meticulous surgical planning, and individualized care in addressing complex cerebrovascular conditions. Methods: The patient presented with a generalized tonic–clonic seizure, her first-ever neurological event. Advanced imaging, including digital subtraction angiography and 3D rotational imaging, revealed a 3–4 cm AVM supplied by the left middle and anterior cerebral arteries, with venous drainage into the superior sagittal sinus. Additionally, an unruptured bilobed PComA aneurysm was identified. Given the AVM’s large size, high-flow dynamics, and significant rupture risk, surgical resection was prioritized. The aneurysm, being stable and anatomically distinct, was managed conservatively. Microsurgical techniques were employed to ensure complete AVM resection while preserving critical vascular and neurological structures. Results: Postoperative angiography confirmed the complete removal of the AVM without residual nidus or abnormal vascular connections. The patient recovered without complications, achieving seizure freedom and preserved neurological function. At the three-month follow-up, imaging showed a stable resection cavity and a hemodynamically stable aneurysm. Conclusions: This case demonstrates the power of multidisciplinary care and advanced neurosurgical techniques in achieving curative outcomes for complex cerebrovascular anomalies. It underscores the importance of risk-prioritized strategies and highlights emerging directions for the field, including AI-integrated imaging, hybrid treatment approaches, and long-term studies on hemodynamic stability post-resection. This case contributes valuable insights into optimizing outcomes for patients with coexisting AVMs and aneurysms, offering hope for those facing similarly challenging diagnoses. Full article

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

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12 pages, 753 KiB

Open AccessReview

Diagnostic Challenges in the Management of Aortic Valve Stenosis and the Role of Imaging: A Narrative Review

by Dimitrios Karelas, Evangelos Tatsis, Dimitrios Oikonomidis and Constantinos Hristou Papadopoulos

J. Clin. Med. 2025, 14(4), 1231; https://doi.org/10.3390/jcm14041231 - 13 Feb 2025

Abstract

Aortic valve stenosis (AS) is a prevalent and progressive valvular disease that poses significant diagnostic challenges, particularly in low-flow, low-gradient (LF-LG) states. Accurate assessment of AS severity is crucial for timely intervention and improved clinical outcomes. This narrative review critically evaluates the limitations [...] Read more.

Aortic valve stenosis (AS) is a prevalent and progressive valvular disease that poses significant diagnostic challenges, particularly in low-flow, low-gradient (LF-LG) states. Accurate assessment of AS severity is crucial for timely intervention and improved clinical outcomes. This narrative review critically evaluates the limitations of conventional echocardiographic techniques and explores the role of multimodal imaging—including advanced echocardiography, computed tomography (CT), and cardiac magnetic resonance (CMR)—in enhancing diagnostic accuracy. Special emphasis is placed on the unique challenges of LF-LG AS, where standard Doppler-derived assessments may misclassify disease severity, necessitating a more integrative diagnostic approach. By addressing these key diagnostic uncertainties and proposing a multimodal framework for improved assessment, this review provides a comprehensive update on best practices in AS evaluation, with the goal of optimizing clinical decision making and patient outcomes. Full article

(This article belongs to the Special Issue Current Advances in Aortic Valve Stenosis)

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