Journal of Clinical Medicine最新文献

{"title":"Carotid Doppler Imaging as a Marker for Fluid Responsiveness.","authors":"Ankur Srivastava, Christopher Tam, Samir Sethi, Mario Gaudino, Brady Rippon, Joydeep Baidya, Sanya Rastogi, Alexandra Lopes, Avika Kasubhai, Kane Pryor, James Osorio","doi":"10.3390/jcm14186657","DOIUrl":"10.3390/jcm14186657","url":null,"abstract":"<p><p><b>Background/Objective:</b> Identifying fluid-responsive patients is essential in managing hemodynamic instability. Traditional static measures like central venous pressure (CVP) are often unreliable. Prior studies suggest that cardiac ultrasound (US), particularly carotid Doppler point-of-care ultrasound (POCUS), may correlate with pulmonary artery catheter (PAC)-derived cardiac output (CO), offering a noninvasive tool to assess fluid responsiveness. We aimed to evaluate the correlation between carotid ultrasound (US) parameters and pulmonary artery catheter (PAC) derived measurements in post cardiac surgery patients. <b>Methods:</b> We conducted a prospective cohort study on 50 postcardiac surgery patients from 2019 to 2022 in a single cardiothoracic ICU. Carotid US and PAC CO measurements were obtained at four intervals: pre- and post-passive leg raise (fluid challenge) on ICU admission, and one hour later. Fluid responsiveness was defined as a ≥10% increase in carotid blood flow, ≥7 ms increase in corrected flow time (FTc), or ≥10% change in respiratory peak carotid systolic velocity (ΔCDPV). Pearson's correlation and linear regression were used to assess associations between carotid US and PAC changes. Agreement in fluid responsiveness categorization (≥10% CO change) was evaluated using weighted Cohen's kappa. Significance was set at α = 0.05. <b>Results:</b> No significant correlation was found between changes in carotid US parameters and the PAC cardiac index (CI) at baseline or one hour for ΔCDPV, FTc, or carotid blood flow. A moderate correlation was observed between carotid blood flow and FTc at one hour (r = 0.41, <i>p</i> = 0.005). Regression and sensitivity analyses showed no significant associations. <b>Conclusions:</b> The carotid US parameters did not correlate with PAC-derived CO after passive leg raise. Further studies are needed to validate carotid POCUS in this setting.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional Management of Acute Pancreatitis and Its Complications.","authors":"Muaaz Masood, Amar Vedamurthy, Rajesh Krishnamoorthi, Shayan Irani, Mehran Fotoohi, Richard Kozarek","doi":"10.3390/jcm14186683","DOIUrl":"10.3390/jcm14186683","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Acute pancreatitis (AP) is the most common cause of gastrointestinal-related hospitalizations in the United States, with gallstone disease and alcohol as the leading etiologies. Management is determined by disease severity, classified as interstitial edematous pancreatitis or necrotizing pancreatitis, with severity further stratified based on local complications and systemic organ dysfunction. Regardless of etiology, initial treatment involves aggressive intravenous fluid resuscitation with Lactated Ringer's solution, pain and nausea control, early oral feeding in 24 to 48 h, and etiology-directed interventions when indicated. In gallstone pancreatitis, early endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is indicated in the presence of concomitant cholangitis or persistent biliary obstruction, with subsequent laparoscopic cholecystectomy as standard of care for stone clearance. The role of interventional therapy in uncomplicated AP is limited in the acute phase, except for biliary decompression or enteral feeding support with nasojejunal tube placement. However, in severe AP with complications, interventional radiology (IR) and endoscopic approaches play a pivotal role. IR facilitates early percutaneous drainage of symptomatic, acute fluid collections and infected necrosis, particularly in non-endoscopically accessible retroperitoneal or dependent collections, improving outcomes with a step-up approach. IR-guided angiographic embolization is the preferred modality for hemorrhagic complications, including pseudoaneurysms. In the delayed phase, walled-off necrosis (WON) and pancreatic pseudocysts are managed with endoscopic ultrasound (EUS)-guided drainage, with direct endoscopic necrosectomy (DEN) reserved for infected necrosis. Dual-modality drainage (DMD), combining percutaneous and endoscopic drainage, is increasingly utilized in extensive or complex collections, reflecting a collaborative effort between gastroenterology and interventional radiology comparable to that which exists between IR and surgery in institutions that perform video assisted retroperitoneal debridement (VARD). Peripancreatic fluid collections may fistulize into adjacent structures, including the stomach, small intestine, or colon, requiring transpapillary stenting with or without additional closure of the gut leak with over-the-scope clips (OTSC) or suturing devices. Additionally, endoscopic management of pancreatic duct disruptions with transpapillary or transmural stenting plays a key role in cases of disconnected pancreatic duct syndrome (DPDS). Comparative outcomes across interventional techniques-including retroperitoneal, laparoscopic, open surgery, and endoscopic drainage-highlight a shift toward minimally invasive approaches, with decreased morbidity and reduced hospital stay. The integration of endoscopic and interventional radiology-guided techniques has transformed the management of AP complications and multidisciplinary collabo","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activated Complement System's Impact in Antiphospholipid Syndrome Thrombosis: From Pathophysiology to Treatment.","authors":"Sofia Tagara, Serena Valsami, Eleni Gavriilaki, Elias Kyriakou, Elisavet Grouzi, Paschalis Evangelidis, Paraskevi Karvouni, Georgia Kaiafa, Ioannis Papadakis, Aristarchos Poulis, Eleni Petrou, Marianna Politou, Styliani Kokoris","doi":"10.3390/jcm14186672","DOIUrl":"10.3390/jcm14186672","url":null,"abstract":"<p><p>Antiphospholipid syndrome (APS) is the most common acquired form of thrombophilia and is associated with the presence of antiphospholipid antibodies (aPL) in the patient's serum. Until now, the \"double-hit\" hypothesis remains the prevailing theory for APS pathogenesis. According to this model, the presence of aPL (first hit) is insufficient to trigger thrombosis. A secondary event, such as an inflammatory trigger or vascular injury (second hit), is required to initiate immunothrombosis, which ultimately leads to thromboembolism. Although immunothrombosis has a critical role in several mechanisms, such as in defense against pathogens, chronic immune system activation by aPL appears to disrupt its protective function. In the last three decades, the role of the complement system has gained increasing recognition in the pathophysiology of APS. aPL are involved in the dysregulation of multiple components, such as platelets, β2-glycoprotein I, and complement factor H, resulting in excessive activation of the complement system. Thus, the complement system is a key driver of thrombosis in APS and stands as a promising target for the development of future therapeutic strategies. In the current review article, we aim to summarize the ongoing research regarding the role of complement system dysregulation in APS-associated thrombosis development, while recognizing potential therapeutic targets. In the era of precision medicine, more data concerning targeted therapeutics in the field of APS are essential.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of External Carotid Artery Remodeling Following Carotid Artery Stenting.","authors":"Dorota Łyko-Morawska, Michał Serafin, Julia Szostek, Magdalena Mąka, Iga Kania, Wacław Kuczmik","doi":"10.3390/jcm14186682","DOIUrl":"10.3390/jcm14186682","url":null,"abstract":"<p><p><b>Background</b>: Carotid artery stenting (CAS) is a common revascularization approach for carotid artery stenosis. While its impact on the internal carotid artery (ICA) has been extensively studied, the effects on the external carotid artery (ECA)-a key collateral pathway for cerebral perfusion-remain insufficiently explored. This study aimed to assess structural changes in the ECA following CAS and their clinical significance. <b>Methods</b>: A retrospective observational cohort study of 963 patients treated with CAS between 2018 and 2024 was conducted. Demographic data, comorbidities, and procedural characteristics were collected. Pre- and postprocedural ICA and ECA diameters were measured via angiography. Spearman's correlation, regression modeling, and receiver operating curver (ROC) analysis were used to identify predictors of ECA narrowing and occlusion and their relationship with neurological outcomes. <b>Results</b>: The median ECA diameter decreased post-CAS (from 4.7 mm to 3.8 mm, <i>p</i> < 0.001). ECA overstenting occurred in 96.4% of cases, with 71.7% exhibiting diameter reduction. De novo ECA occlusion occurred in 2.5% of patients and was associated with a higher incidence of stroke, transient ischemic attack, and in-stent restenosis (ISR). Multivariate analysis identified preoperative ECA diameter (<i>p</i> < 0.001), ICA diameter (<i>p</i> = 0.001), and second-generation stents (<i>p</i> = 0.02) as independent predictors of ECA narrowing. ROC analysis confirmed that a preoperative ECA diameter ≤ 3.05 mm strongly predicted occlusion (Area under the curve (AUC) = 0.93, <i>p</i> < 0.001). <b>Conclusions</b>: CAS frequently leads to ECA remodeling, including occlusion, compromising collateral perfusion and contributing to adverse ischemic incidences and ISR. Preprocedural ECA assessment may aid in optimizing patient selection and procedural planning.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Surgical Delay on Two-Stage Breast Reconstruction During the COVID-19 Pandemic: A Retrospective Analysis.","authors":"Ferruccio Paganini, Elisa Bascialla, Beatrice Corsini, Chiara Truini, Monica Arcaini, Lorenzo Fresta, Federico Lo Torto, Marco Marcasciano, Sara Matarazzo, Diego Ribuffo, Luigi Valdatta","doi":"10.3390/jcm14186684","DOIUrl":"10.3390/jcm14186684","url":null,"abstract":"<p><p><b>Background:</b> The COVID-19 pandemic caused unprecedented delays in elective surgery, including breast reconstruction, prolonging expander retention beyond recommended timelines. <b>Methods:</b> We retrospectively compared patients who underwent two-stage expander-to-implant reconstruction before the pandemic (2011-2020) and during the pandemic (2020-2022). Clinical outcomes and patient-reported experiences were analyzed, and multivariate regression was used to adjust for confounders. <b>Results:</b> Expander retention was significantly longer in the pandemic cohort (481 vs. 280 days). Capsular contracture around the expander was markedly increased, with pandemic group assignment and prolonged expander retention emerging as independent predictors in multivariate analysis, while overall complication rates were unaffected. Patient-reported outcomes showed more functional limitations but paradoxically higher satisfaction with the definitive implant. <b>Conclusions:</b> Surgical delay selectively increased the risk of expander contracture without raising overall morbidity. Patient-reported findings highlight the dual impact of delay, with both greater burden and a potential \"relief effect\".</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Observational Study of Nintedanib in Managing Idiopathic and Progressive Pulmonary Fibrosis in Routine Practice.","authors":"Alessia Giovanna Andrisano, Nadia Castaldo, Francesco Giuliana, Davide Femia, Giuseppe Morana, Vincenzo Patruno, Giorgio Monteleone, Nicolò Reccardini, Rossella Cifaldi, Michael Hughes, Yukai Wang, Paola Confalonieri, Francesco Salton, Pietro Geri, Marco Confalonieri, Barbara Ruaro","doi":"10.3390/jcm14186665","DOIUrl":"10.3390/jcm14186665","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Idiopathic pulmonary fibrosis (IPF) is the most common form of pulmonary fibrosis (PF) and serves as a key reference for disease severity. Progressive pulmonary fibrosis (PPF), a distinct yet heterogeneous entity arising from various interstitial lung diseases (ILDs), shares similar pathogenetic mechanisms and clinical courses driven by self-perpetuating fibrosis. Antifibrotic therapy, notably nintedanib, can slow disease progression. However, real-world data on antifibrotic therapy's impact on survival, especially in PPF, are limited. This study aims to compare IPF and PPF regarding phenotype, radiological patterns, comorbidities, prognostic factors, and response to nintedanib, focusing on identifying the patient subsets most likely to benefit. Outcomes assessed include safety, survival, and disease progression over one year, considering various prognostic factors. <b>Methods:</b> This retrospective observational study evaluated patients with fibrosing ILD, affected by either IPF or PPF, and treated with nintedanib. Data collected encompassed clinical, radiological, functional, and treatment-related information. Assessments included chest CT, pulmonary function tests, comorbidities, and survival analysis, utilizing standardized methods and statistical tools to interpret outcomes and tolerability. <b>Results:</b> The study population was composed of 97 patients: 64 were diagnosed with IPF and 33 with PPF. The analysis showed that in PPF patients, ongoing antifibrotic treatment resulted in higher survival (71.1 months vs. 27.4 months, <i>p</i> < 0.001), while no statistically significant differences were found in the IPF group (67.4 months vs. 52.5 months, <i>p</i> = 0.216). Nintedanib was generally well tolerated. Gastrointestinal side effects, predominantly diarrhea, were reported in 61% of patients with IPF and 50% of those with PPF. Dose reduction occurred in 43.75% of IPF patients and 36% of PPF patients, while treatment discontinuation was required in 21.87% of IPF and 21% of PPF patients. <b>Conclusions:</b> This study highlights that in PPF patients, antifibrotic therapy with nintedanib can improve survival. This statement underlines that the primary outcome of antifibrotic treatment should focus on improving patients' survival.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence on Non-Invasive Respiratory Support During Flexible Bronchoscopy: A Narrative Review.","authors":"María Hidalgo Sánchez, Manel Luján, Sergio Alcolea Batres, Julia Álvarez Del Vayo, Pablo Mariscal-Aguilar, Carlos Carpio, Rodolfo Álvarez-Sala Walther","doi":"10.3390/jcm14186658","DOIUrl":"10.3390/jcm14186658","url":null,"abstract":"<p><p><b>Background:</b> Flexible bronchoscopy (FB) is a widely used diagnostic and therapeutic procedure in patients with pulmonary disease, many of whom are at risk of gas exchange impairment. FB may exacerbate hypoxaemia due to increased airway resistance, alveolar derecruitment, and haemodynamic fluctuations. <b>Objectives:</b> To assess the effectiveness of non-invasive respiratory support strategies in preventing oxygen desaturation and respiratory complications during FB. <b>Methods:</b> A systematic review and meta-analysis were conducted using PubMed and Cochrane databases, covering studies from 2000 to 2024. Inclusion criteria focused on adult patients undergoing FB with any form of non-invasive oxygen support. Twelve high-quality studies were selected, including randomised trials and prospective cohorts. <b>Results:</b> High-flow therapy (HFT) was more effective than conventional oxygen therapy (COT) in maintaining oxygenation and reducing procedure interruptions, especially in patients with moderate hypoxaemia or risk factors such as obesity and obstructive sleep apnoea. Continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) offered superior oxygenation and ventilatory support in patients with more severe respiratory or cardiac compromise. <b>Conclusions:</b> Non-invasive respiratory support should be individualised based on patient risk and procedural complexity. HFT benefits mild-to-moderate cases, while CPAP or NIV is preferable in more severe conditions. Further multicentre randomised trials are needed to establish formal guidelines.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Trends in Active Smoking Among Adults Living with HCV in the U.S. over the Last Decade: A Population-Level Analysis.","authors":"Mohammad Alabbas, Jingyi Shi, Yuqi Guo, Hongke Wu, Ibukunoluwa Oshobu, Maria Castano, Walaa Mahmoud, Shreya Sengupta, Omar T Sims","doi":"10.3390/jcm14186671","DOIUrl":"10.3390/jcm14186671","url":null,"abstract":"<p><p><b>Background</b>: Smoking in patients with hepatitis C (HCV) amplifies the risk of cirrhosis and hepatocellular carcinoma. We aimed to estimate the prevalence of active smoking over the last decade at the population level among adults living with HCV in the U.S., estimate temporal trends in active smoking, and identify factors associated with active smoking. <b>Methods</b>: We analyzed repeated cross-sectional NHANES data (2007-2018) of adults ≥20 years old with serologic evidence of HCV and complete smoking data (unweighted [n = 621] and weighted [n = 3,620,603] sample size). Temporal trends were evaluated using linear regression and joinpoint regression. Survey-weighted multivariable logistic regression was used to identify factors associated with active smoking. <b>Results</b>: The cumulative prevalence of active smoking was 56.4% (95% CI, 49.2-63.4). Linear trend testing was not significant (<i>p</i> = 0.93). Joinpoint regression suggested a slope change near 2013-2014, but neither segment-specific annual percent changes nor the slope change reached significance. Factors associated with higher odds of active smoking included female sex (aOR = 2.23; 95% CI, 1.17-4.24), low poverty income ratio (aOR = 3.33; 1.41-7.84), lifetime substance use (aOR = 10.63; 3.08-36.70), and depression (aOR = 2.65; 1.29-5.45). Lower odds were observed with >high-school education (aOR = 0.50; 0.26-0.94), obesity (aOR = 0.32; 0.18-0.58), and ≥2 yearly healthcare visits (aOR = 0.27; 0.10-0.68). <b>Conclusions</b>: Smoking appears to be endemic within the HCV population, and rates have remained alarmingly high and stagnant (i.e., unchanged or have not decreased) over the last decade, which consequently can lead to heightened incident cases of HCV-related cirrhosis and hepatocellular carcinoma in the near future.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Checkpoint Inhibitors Beyond Progression in Various Solid Tumors: A Systematic Review and Pooled Analysis.","authors":"Fausto Petrelli, Antonio Ghidini, Maria Chiara Parati, Karen Borgonovo, Mauro Rossitto, Mara Ghilardi, Giuseppina Dognini, Daniela Petro', Irene Angeli, Veronica Lonati, Lorenzo Dottorini, Alessandro Iaculli","doi":"10.3390/jcm14186680","DOIUrl":"10.3390/jcm14186680","url":null,"abstract":"<p><p><b>Background</b>: Immune checkpoint inhibitors (ICIs) have transformed outcomes in advanced cancers; however, the value of continuing treatment after radiologic progression remains uncertain. We systematically assessed the efficacy and safety of ICI continuation beyond progression, focusing on the objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). <b>Methods:</b> PubMed/MEDLINE, Embase, and the Cochrane Library were searched from inception to 31 March 2025. Eligible reports included retrospective cohorts, prospective trials, post hoc analyses, and pooled regulatory reviews that compared outcomes after ICI continuation versus discontinuation or historical controls. Quality was appraised with the Newcastle-Ottawa Scale (observational designs) and the Cochrane Risk-of-Bias tool (randomized trials). <b>Results:</b> Fifty studies involving 8989 patients met the inclusion criteria: 41 retrospective cohorts; 6 post hoc analyses; 2 randomized trials (1 phase III, 1 phase II); and 1 pooled FDA review. Continuing ICIs beyond progression produced ORRs of 9.3-39% in non-small cell lung cancer (n = 5102), 14-100% in melanoma (n = 669), and 8-33% in renal cell carcinoma (n = 458). Median OS ranged from 8.9 to 18.2 months in lung cancer, 12 to 29.9 months in melanoma, and up to 34.8 months in RCC. Modest but clinically meaningful benefits were reported in colorectal, head-and-neck, gastric, liver, and urothelial tumors. <b>Conclusions:</b> Select patients-particularly those with melanoma, lung cancer, RCC, or gastric cancer-may derive sustained benefit from ICI therapy after radiologic progression. Decisions should incorporate tumor biology, performance status, and emerging biomarkers. Prospective, biomarker-driven trials are needed to define optimal patient selection and the duration of post-progression immunotherapy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"HOPE-FIT\" in Action: A Hybrid Effectiveness-Implementation Protocol for Thriving Wellness in Aging Communities.","authors":"Suyoung Hwang, Eun-Surk Yi","doi":"10.3390/jcm14186679","DOIUrl":"10.3390/jcm14186679","url":null,"abstract":"<p><p><b>Background/Objectives:</b> As global aging accelerates, there is a pressing and empirically substantiated demand for integrated and sustainable strategies, as evidenced by the rising prevalence rates of chronic conditions, social isolation, and digital exclusion among older adults worldwide. These factors underscore the urgent need for multidimensional interventions that simultaneously target physical, psychological, and social well-being. The HOPE-FIT (Hybrid Outreach Program for Exercise and Follow-up Integrated Training) model and the SAGE (Senior Active Guided Exercise) program were designed to address this need through a hybrid framework. These programs foster inclusive aging by explicitly bridging digitally underserved groups and mobility-restricted populations into mainstream health promotion systems through tailored exercise, psychosocial support, and smart-home technologies, thereby functioning as a scalable meta-model across healthcare, community, and policy domains. <b>Methods:</b> HOPE-FIT was developed through a formative, multi-phase process grounded in the RE-AIM framework and a Hybrid Type II effectiveness-implementation design. The program combines professional health coaching, home-based and digital exercise routines, Acceptance and Commitment Performance Training (ACPT)-based psychological strategies, and smart-home monitoring technologies. Empirical data from pilot studies, large-scale surveys (N = 1000), and in-depth user evaluations were incorporated to strengthen validity and contextual adaptation. Culturally tailored content and participatory feedback from older adults further informed ecological validity and program refinement. <b>Implementation Strategy/Framework:</b> The theoretical foundation integrates implementation science with behavioral and digital health. The RE-AIM framework guided reach, fidelity, and maintenance planning, while the Hybrid E-I design enabled the concurrent evaluation of effectiveness outcomes and contextual implementation strategies. Institutional partnerships with community centers, public health organizations, and welfare agencies further facilitated the translation of the model into real-world aging contexts. <b>Dissemination Plan:</b> The multi-pronged dissemination strategy includes international symposia, interdisciplinary academic networks, policy briefs, localized community deployment, and secure, authenticated data sharing for reproducibility. This design facilitates evidence-informed policy, empowers practitioners, and advances digital health equity. Ultimately, HOPE-FIT constitutes a scalable and inclusive model that concretely addresses health disparities and promotes active, dignified aging across systems and disciplines.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}