Journal of Clinical Medicine最新文献

{"title":"More than Rehabilitation: The Role of Contextual Factors in Pain Perception and Recovery: What the Physiotherapy Literature Reports-A Narrative Review with a Systematic Search Strategy.","authors":"Giulia Leonardi, Francesco Bonanno, Angelo Alito, Francesca Cucinotta, Clara Lombardo, Antonio Di Dio, Francesca Sposito, Carmen Cucinotta, Alfio Garofalo, Simona Portaro","doi":"10.3390/jcm15166489","DOIUrl":"10.3390/jcm15166489","url":null,"abstract":"<p><p><b>Background</b>: Pain is a multidimensional experience shaped not only by nociceptive input but also by cognitive, emotional, and social processes. In musculoskeletal (MSK) rehabilitation, outcome variability among patients with similar clinical presentations suggests that determinants beyond tissue pathology may influence pain perception and recovery. Contextual factors (CFs)-communication, therapeutic relationship, patient expectations, and environmental cues-are increasingly recognized yet remain inconsistently integrated into routine practice. <b>Objective</b>: To map how CFs are represented in the physiotherapy literature indexed under that terminology, and to identify where empirical evidence in MSK rehabilitation is present and where it is absent. <b>Methods</b>: A narrative review with a systematic search strategy, reported following SANRA, was conducted in PubMed and Scopus, searched on 31 March 2026. Records were screened against predefined eligibility criteria, including publication from 2006 onwards and English language. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Cochrane RoB2 tool for randomized controlled trials and an adapted Newcastle-Ottawa Scale for observational and cross-sectional studies. Conceptual publications were not formally appraised. Each publication was classified as direct clinical evidence (Tier A), indirect mechanistic or implementation-level evidence (Tier B), or conceptual contribution (Tier C). <b>Results</b>: Eight publications were included: no source provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), five provided indirect mechanistic or implementation-level evidence (Tier B), and three were conceptual contributions (Tier C). The single randomised controlled trial retrieved was conducted in asymptomatic volunteers and was at high risk of bias for the between-group comparisons of all reported outcomes. Findings are organised as contextual domains, mediating mechanisms, and outcomes. No direct clinical evidence was retrieved; claims regarding expectations, therapeutic alliance, non-verbal communication, and the clinical environment rest on indirect or conceptual sources. <b>Conclusions</b>: CFs may contribute to pain and rehabilitation variability through cognitive, emotional, and relational pathways, complementing rather than replacing evidence-based care. The scarcity of direct clinical evidence within the literature indexed under this terminology is itself a finding. Construct-level searches and pragmatic trials are required to clarify the contribution of individual contextual domains.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828818","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":"Association Between Cardiovascular Diseases and Lingual Varices: A Systematic Review and Meta-Analysis.","authors":"Aya El Kanfoud-Ezzarraa, Sonia Egido-Moreno, Ani Mantinyan-Hakobyan, Mónica Blázquez Hinarejos, Beatriz González-Navarro, Anna Oliveras Serrano, Eva Otero-Rey, José López-López","doi":"10.3390/jcm15166495","DOIUrl":"10.3390/jcm15166495","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Early identification of individuals at risk is essential to reduce disease burden. Lingual varices (LV), a common oral vascular condition, have been suggested as a potential non-invasive clinical marker of systemic vascular alterations. This study aimed to evaluate the association between lingual varices and cardiovascular diseases through a systematic review and meta-analysis. <b>Methods</b>: A systematic review was conducted according to PRISMA guidelines and Cochrane recommendations and registered in PROSPERO (CRD420251172737). Electronic searches were performed in PubMed, Web of Science, and Scopus databases. Observational studies assessing the association between lingual varices and cardiovascular diseases in adults were included. Odds ratios (OR) with 95% confidence intervals (CI) were calculated, and meta-analysis was performed using fixed- or random-effects models depending on heterogeneity. <b>Results</b>: Thirteen studies involving 6322 participants were included. The overall prevalence of lingual varices was 34.8%. The meta-analysis demonstrated a significant association between lingual varices and cardiovascular disease (OR = 4.54; 95% CI: 3.35-6.17). Among the cardiovascular conditions evaluated, hypertension also showed a significant association with lingual varices (OR = 4.14; 95% CI: 1.66-10.29). Lingual varices were also significantly associated with smoking (OR = 3.06; 95% CI: 1.61-5.82) and lower extremity varicose veins (OR = 1.64; 95% CI: 1.04-2.58). No significant association was observed with sex (OR = 0.95; 95% CI: 0.67-1.34; <i>p</i> = 0.77). <b>Conclusions</b>: Lingual varices are significantly associated with cardiovascular disease. Although they may represent a readily identifiable oral finding associated with cardiovascular risk profile, the available evidence does not support their use as an independent screening or diagnostic marker. Further prospective studies are required to determine their predictive value and clinical utility.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828832","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":"Acute Ischemic Stroke in 2026: From Time to Penumbra-An Updated Narrative Review of Reperfusion Strategies with a Latin American Implementation Perspective.","authors":"Danilo Alejandro Solarte Ordoñez, Jose Leonel Zambrano Urbano, Harold Enrique Vasquez Ucros, Ana Gabriela Cruz Suarez, Angie Estefanía Arcos Bastidas, Juan David Camacho Bolaños, Darío S López Delgado, Angela Catalina Vallejo Cajigas, Oriana Rivera-Lozada, Cesar Bonilla Asalde, Joshuan J Barboza","doi":"10.3390/jcm15166496","DOIUrl":"10.3390/jcm15166496","url":null,"abstract":"<p><p><b>Background/Objective:</b> The management of acute ischemic stroke (AIS) has evolved from rigid time-based treatment paradigms toward tissue-based selection guided by advanced neuroimaging, thereby expanding eligibility for reperfusion therapies. To provide an updated narrative review of acute ischemic stroke (AIS) classification and management, with emphasis on extended therapeutic windows for intravenous thrombolysis (IVT) and endovascular therapy (EVT), bridging strategies, posterior circulation stroke, and implementation challenges in Latin America and other resource-constrained settings. <b>Methods:</b> A structured narrative review was conducted using the PubMed/MEDLINE, Embase, Scopus, and LILACS databases, covering the period from 2013 to 2025. <b>Results:</b> Sixty-three studies were selected from 412 records and categorized into etiologic classification, extended-window thrombolysis, EVT and bridging therapy, and posterior circulation stroke. Current evidence supports imaging-guided IVT beyond 4.5 h and EVT up to 24 h in selected patients with salvageable brain tissue, including some individuals with large infarct cores. Recent trials also support EVT for basilar artery occlusion. Tenecteplase offers practical workflow advantages in many centers, particularly where transfer delays and limited access to advanced imaging constrain timely reperfusion decisions. <b>Conclusions:</b> Contemporary AIS management is increasingly guided by pathophysiology and imaging rather than strict time thresholds. However, improving outcomes in middle- and low-income settings requires the implementation of adapted clinical algorithms, strengthening of stroke care networks, and optimization of referral pathways.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828930","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":"Reprogramming the Evolution of High-Risk Prostate Cancer: Multidisciplinary Strategies to Delay Castration Resistance.","authors":"Younghun Sim, Jae Won Choi, Dong Seob Kim, Jeong Hyun Kim, Sung Goo Yoon, Jung Ki Jo","doi":"10.3390/jcm15166488","DOIUrl":"10.3390/jcm15166488","url":null,"abstract":"<p><p><b>Background/Objectives</b>: High-risk prostate cancer is a biologically heterogeneous group of tumors carrying a substantial risk of progression to lethal, castration-resistant disease. Although androgen deprivation therapy (ADT) remains the therapeutic backbone, nearly all advanced disease eventually progresses to castration-resistant prostate cancer (CRPC) through Darwinian clonal evolution under sustained therapeutic pressure. This narrative review reframes high-risk prostate cancer management as an effort to reprogram the evolutionary trajectory and delay castration resistance, addressing current risk stratification, androgen receptor (AR)-dependent and AR-independent mechanisms of resistance, and multidisciplinary strategies that modify selective pressure. <b>Methods</b>: A narrative review of the literature was conducted, including peer-reviewed studies, pivotal phase III trial reports, and current clinical practice guidelines indexed in PubMed, Scopus, and Web of Science up to 2026. Sources on high-risk and castration-resistant prostate cancer, the biology of treatment resistance, and multidisciplinary treatment intensification were selected and synthesized. <b>Results</b>: Treatment intensification has been extended to high-risk biochemical recurrence (EMBARK), directed by biomarkers in PTEN-deficient disease (CAPItello-281), and moved earlier through prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (PSMAfore, PSMAddition). In localized disease, effective AR-pathway intensification with abiraterone (STAMPEDE) contrasts with the failure of chemotherapy (PEACE-2) and enzalutamide (ENZARAD). Emerging therapies targeting lineage plasticity exploit its dynamic and potentially reversible biology, raising the prospect of reversing established resistance rather than merely delaying it. CAPItello-281 and PSMAddition have immature overall survival data and are not yet standard of care. <b>Conclusions</b>: Coordinated multidisciplinary care, matched to the disease stage and molecular context, offers a realistic path to delay castration resistance and improve survival.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828995","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":"Risk Factors for Proximal Junctional Kyphosis in Osteoporotic Versus Non-Osteoporotic Patients After Adult Spinal Deformity Surgery.","authors":"Tae Soo Shin, Jin-Sung Park, Dong-Ho Kang, Jun-Seok Oh, Se-Jun Park","doi":"10.3390/jcm15166479","DOIUrl":"10.3390/jcm15166479","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Proximal junctional kyphosis (PJK) is a frequent mechanical complication following adult spinal deformity (ASD) surgery, and osteoporosis is a well-recognized risk factor. However, whether the underlying risk factor profiles for PJK differ according to bone mineral density status remains unclear. This study aimed to identify and compare independent risk factors for PJK between osteoporotic and non-osteoporotic patients following long-segment posterior spinal fusion for ASD. <b>Methods</b>: This retrospective cohort study included 356 patients who underwent ≥5-level posterior fusion to the sacrum or pelvis for ASD with a 2-year follow-up. Patients were stratified into a non-osteoporotic (non-OP; <i>n</i> = 284) and an osteoporotic (OP; <i>n</i> = 72) group based on preoperative dual-energy X-ray absorptiometry (T-score ≤ -2.5). PJK was defined as a proximal junctional angle (PJA) ≥20° with an increase of ≥10° from the preoperative value. Demographic, surgical, and radiographic variables were analyzed separately for each group using univariate and stepwise multivariate logistic regression analyses. Predictive performance was assessed using receiver operating characteristic curve analysis. <b>Results</b>: The overall PJK incidence tended to be higher in the OP group than the non-OP group (36.1% vs. 24.6%, <i>p</i> = 0.055), and fracture-type PJK occurred significantly more frequently in osteoporotic patients (29.2% vs. 15.8%, <i>p</i> = 0.016). The variables that reached statistical significance differed between the two groups. In the non-OP group, lower Hounsfield units at the upper instrumented vertebra (UIV; OR = 0.990, <i>p</i> = 0.011), higher preoperative PJA (OR = 1.098, <i>p</i> < 0.001), and greater L1 pelvic angle (L1PA) offset indicating relative overcorrection (OR = 1.136, <i>p</i> < 0.001) were independent predictors of PJK. In the OP group, higher preoperative PJA (OR = 1.149, <i>p</i> = 0.007) and greater age-adjusted pelvic incidence-lumbar lordosis offset (OR = 1.052, <i>p</i> = 0.039) were identified as independent risk factors. Multivariable models demonstrated acceptable discriminative ability in both groups (area under the curve [AUC] = 0.741, 95% confidence interval [CI] = 0.671-0.804 for the non-OP group; AUC = 0.753, 95% CI = 0.632-0.867 for the OP group; optimism-corrected AUC 0.729 and 0.735 after bootstrap internal validation). <b>Conclusions:</b> The variables associated with PJK differed according to osteoporosis status following ASD surgery. Careful UIV selection avoiding kyphotic junctional alignment may be relevant for both groups. Avoiding overcorrection relative to the age-adjusted target may warrant particular attention in osteoporotic patients, while UIV bone quality and L1PA overcorrection may be relevant to surgical planning in non-osteoporotic patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829075","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":"Comparison of Two Surgical Techniques for Implantation of the Ponto^® Bone Conduction Implant.","authors":"Paulina Podlawska-Nowak, Wojciech Gawęcki, Anna Bartochowska","doi":"10.3390/jcm15166482","DOIUrl":"10.3390/jcm15166482","url":null,"abstract":"<p><p><b>Objectives</b>: The aim of this study was to compare the surgical and postoperative clinical outcomes of punch-only and linear incision techniques for implantation of the Ponto^® bone conduction implant. <b>Methods</b>: Surgical and follow-up data were collected from 101 patients: 46 treated with Minimally Invasive Ponto^® Surgery (MIPS) and 55 with the linear incision technique (LT). The analysis focused on: (1) the surgical procedure, including operative time and intraoperative complications; (2) the healing process; and (3) long-term implant-site outcomes, including implant loss. <b>Results</b>: Median operative time was significantly shorter for MIPS than for LT (30 min vs. 40 min, <i>p</i> < 0.001). No major intraoperative complications were observed in either group. Adverse skin reactions were more frequent in the LT group than in the MIPS group (18.2% vs. 8.7%), but the difference was not statistically significant (<i>p</i> = 0.249). A single implant loss occurred in the LT group 18 months after surgery and was unrelated to failed osseointegration or the surgical technique, being caused by recurrent cholesteatoma. <b>Conclusions</b>: MIPS was associated with a significantly shorter operative time than the LT. Both MIPS and LT appear to be safe techniques. No statistically significant differences were detected between the groups with respect to adverse skin reactions or implant survival during the follow-up period.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828570","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":"Integrated Cranio-Cervical Organization in Adults: Association Between Morphocranial Pattern and Segmental Cervical Alignment After Orthodontic Treatment.","authors":"Marta Serra Alierta, Meritxell Sánchez-Molins, Aroa Casado Rodriguez, Maria Cristina Manzanares Cespedes, Juan Gonzalo Olivieri","doi":"10.3390/jcm15166475","DOIUrl":"10.3390/jcm15166475","url":null,"abstract":"<p><p><b>Objective:</b> This study aimed to examine the association between the study-specific Cl-Na/Cl-Ba cranial-base angle and segmental cervical organization in adults, considering both inclination and sagittal spatial position, and to explore whether longitudinal changes in cervical inclination differed among morphocranial groups over the observed orthodontic treatment interval. <b>Materials and Methods:</b> Pre-treatment and post-treatment lateral cephalograms from 297 adult orthodontic patients obtained in natural head position were analyzed. Cranial-base morphology was operationally classified using the Cl-Na/Cl-Ba angle into brachycephalic (<115°), mesocephalic (115-124°), and dolichocephalic (>124°) groups. Segmental cervical inclination (C2-C5) and horizontal and vertical vertebral coordinates were recorded. Intergroup differences were assessed using Kruskal-Wallis tests with Dunn-Holm post hoc comparisons and effect-size estimates. Associations between the continuous cranial-base angle and cervical variables were evaluated using Spearman correlations. Longitudinal changes in cervical inclination were examined using linear mixed-effects models adjusted for sex, age, cervical segment, and repeated measurements. <b>Results:</b> The continuous cranial-base angle was inversely correlated with all segmental inclination variables (ρ = -0.213 to -0.333; <i>p</i> ≤ 0.002). Spatial coordinates showed larger associations, particularly for vertical positioning (C2 Y: ρ = -0.653; <i>p</i> < 0.001). Morphocranial groups differed in segmental inclination and spatial coordinates, with the largest effect sizes observed for upper cervical vertical variables. In the mixed-effects model, time was significant (<i>p</i> = 0.014), and morphocranial pattern remained independently associated with cervical inclination (<i>p</i> < 0.001). No significant time × morphocranial-pattern interaction was observed (<i>p</i> = 0.184). <b>Conclusions:</b> In this retrospective adult orthodontic sample, the study-specific cranial-base angle was associated with segmental cervical inclination and sagittal spatial coordinates, with the largest associations observed in the upper cervical region. The longitudinal model provided no evidence of differential longitudinal changes in cervical inclination among morphocranial groups over the observed interval. These findings are observational and do not establish a causal cranio-cervical mechanism or a treatment-specific effect. Segmental angular and spatial variables may be complementary descriptive measures when interpreting cranio-cervical cephalograms.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828947","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":"Full-Field Stimulus Threshold: A Key Functional Outcome Measure in Retinal Diseases and Clinical Trials.","authors":"Nathan Macha, Minzhong Yu","doi":"10.3390/jcm15166492","DOIUrl":"10.3390/jcm15166492","url":null,"abstract":"<p><p>Full-field stimulus threshold (FST) testing is a psychophysical method used to assess global retinal function, particularly in patients with severe visual impairment where conventional perimetry is unreliable. This review explores the development, clinical protocols, and applications of FST in retinal diseases, with a focus on its role in inherited retinal dystrophies (IRDs) such as Leber congenital amaurosis (LCA) and retinitis pigmentosa (RP). FST has emerged as a key functional outcome measure in clinical trials, particularly in evaluating novel gene therapies for IRDs. Its fixation-independent nature and ability to detect residual visual function make it valuable for assessing disease progression and treatment efficacy. However, challenges remain regarding standardization and test variability. Ongoing efforts seek to standardize and optimize FST protocols and establish it as a standardized metric in both clinical and research settings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828830","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":"Mechanical Power as a Predictor of Outcomes During Mechanical Ventilation in Coronavirus Disease 2019 (COVID-19): An Updated Systematic Review.","authors":"Camila Vantini Capasso Palamim, Tais Mendes Camargo, Fernando Augusto Lima Marson","doi":"10.3390/jcm15166476","DOIUrl":"10.3390/jcm15166476","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Mechanical power (MP) quantifies the energy delivered to the respiratory system during ventilation and serves as a promising marker for ventilator-induced lung injury (VILI). According to its original definition by Gattinoni, MP reflects the energy transferred from the ventilator to the respiratory system under conditions of deep sedation, passive breathing, neuromuscular blockade, and volume-controlled ventilation. Its role in coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) remains under investigation. This systematic review aimed to synthesize the available evidence on the association between MP and VILI, complications related to mechanical ventilation (MV), and mortality in adult patients with COVID-19 undergoing invasive mechanical ventilation (IMV). <b>Methods</b>: A systematic review was conducted using PubMed-MEDLINE (Medical Literature Analysis and Retrieval System Online) for studies published in recent years, focusing on adult COVID-19 patients undergoing IMV. Inclusion criteria centered on studies reporting MP and its association with VILI, complications, or mortality. Ten studies met eligibility criteria after screening 356 retrieved articles. <b>Results</b>: Most included studies were retrospective and observational, encompassing critically ill COVID-19 patients. Elevated MP was correlated with more severe outcomes, including increased 28-day mortality, prolonged MV, and weaning failure. Franck et al. demonstrated strong correlations between MP and driving pressure, elastance, and positive end-expiratory pressure, emphasizing the importance of calculation methods. González-Castro et al. identified a threshold of 17 J/min, above which mortality risk increased. Stalla et al. highlighted that dynamic MP reductions during prone positioning were associated with survival. Registry-based analyses confirmed that both magnitude and cumulative exposure above 18 J/min increased intensive care unit mortality. Novel indices combining MP with oxygenation parameters improved prognostic accuracy. While absolute MP at initiation provided limited predictive value, temporal trends and individual components were strongly linked to VILI. <b>Conclusions</b>: Higher MP has been associated with adverse clinical outcomes in patients with COVID-19 receiving invasive mechanical ventilation, supporting its potential role as a prognostic indicator. Its dynamic assessment, thresholds, and integration with ventilatory strategies such as prone positioning enhance risk stratification and may guide individualized, lung-protective ventilation. Continuous monitoring and standardized calculation are recommended to optimize clinical decision-making.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828667","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":"Structural and Functional Treatment of Persistent Spinal Pain Syndrome Type 2: A Fibrosis-Stratified Network Meta-Analysis of Epidural Adhesiolysis and Neuromodulation.","authors":"Wolfgang Auffermann, Mohammed Al Jumaily, Alina Auffermann","doi":"10.3390/jcm15166480","DOIUrl":"10.3390/jcm15166480","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Persistent spinal pain syndrome type 2 (PSPS-T2) is treated with two mechanistically distinct interventional families: epidural adhesiolysis (EA), directed at structural epidural pathology, and neuromodulation (NM), directed at modulation of nociceptive signaling. Epidural fibrosis is a biologically plausible candidate for treatment stratification, but whether it independently modifies treatment response remains unproven. This study reviewed the available evidence to determine both the comparative findings and the limitations imposed by the current evidence architecture. <b>Methods</b>: A PROSPERO-registered systematic review and frequentist random-effects network meta-analysis were performed. Studies were classified at the study level, rather than the individual-patient level, as fibrosis-positive (structurally confirmed) or unselected (without confirmed fibrosis). Treatment effects were synthesized separately within each stratum, and an exploratory study-level meta-regression evaluated fibrosis status as a potential moderator. <b>Results:</b> The final dataset comprised 87 studies including 33,504 patients: 40 fibrosis-positive studies (n = 4180) and 47 fibrosis-unselected studies (n = 29,324). Treatment family and fibrosis status were almost completely confounded. EA was evaluated almost exclusively in fibrosis-positive cohorts, whereas NM was evaluated almost exclusively in fibrosis-unselected studies. Although pooled improvements in pain (-0.97 vs. -0.63) and disability (-11.01 vs. -8.46) were greater in fibrosis-positive studies, these differences cannot be attributed independently to fibrosis. Residual heterogeneity remained substantial (I² 71-92%). Peripheral nerve field stimulation and EA protocols incorporating steroid, hyaluronidase, and hypertonic saline achieved the highest probability score for pain relief. All probability scores for the treatments should be interpreted as exploratory. <b>Conclusions:</b> Discordance between EA and NM in PSPS-T2 stems from structurally different populations, precluding pooled comparative classifications or claims that fibrosis modifies treatment effect. While fibrosis remains a promising candidate stratifier, proving it requires prospective trials that stratify randomization to EA versus NM following standardized fibrosis assessment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828606","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}