Journal of Clinical Medicine最新文献

{"title":"Autogenous Injections in Temporomandibular Disorders: A Systematic Review.","authors":"Sylwia Orzeszek, Andrzej Malysa, Andrej Jenca, Magdalena Gebska, Katarzyna Sluzalec-Wieckiewicz, Marek Zietek, Piotr Seweryn","doi":"10.3390/jcm14186640","DOIUrl":"10.3390/jcm14186640","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal conditions affecting the temporomandibular joints and masticatory muscles. In recent years, autogenous injections have been investigated as minimally invasive therapeutic options to alleviate pain and improve function. However, the clinical effectiveness of such therapies across different TMD phenotypes remains uncertain. <b>Methods:</b> Electronic searches were performed in MEDLINE, Embase, and Web of Science for articles published between January 2015 and May 2025. Studies involving intra-articular or intra-muscular autogenous injections in TMD patients were included. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Joanna Briggs Institute (JBI) Critical Appraisal Tools. <b>Results</b>: Thirteen studies met the inclusion criteria. Six were randomized controlled trials (RCTs) and seven were non-randomized clinical studies. Ten studies evaluated intra-articular conditions such as disc displacement or Temporomandibular Joint (TMJ) osteoarthritis, while three focused on myofascial pain. Platelet-Rich Plasma (PRP) was the most frequently investigated agent. Most studies reported statistically significant reductions in pain and improvements in mandibular mobility following autogenous injections, with PRP generally outperforming comparators such as hyaluronic acid, corticosteroids, or saline. No serious adverse events were reported. <b>Conclusions</b>: All PRP and Platelet-Rich Fibrin (PRF) injection protocols reviewed were effective in reducing pain and improving mobility in patients with TMD. However, differences in protocols and follow-up times prevented a meta-analysis from being conducted. More standardized RCTs are needed to determine clear clinical guidelines.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175547","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":"Combined Robotic VErticalization and Lower Limb Mobilization in Patients with Severe Acquired Brain Injury: Protocol of a Multicenter Randomized Controlled Trial (VEM-sABI).","authors":"Anna Estraneo, Maria Rosaria Fiorentino, Alfonso Magliacano, Maria Assunta Puopolo, Ilaria Rivetti, Maria Cristina Messa","doi":"10.3390/jcm14186628","DOIUrl":"10.3390/jcm14186628","url":null,"abstract":"<p><p><b>Background</b>: Upright position recovery (i.e., verticalization) is crucial in the rehabilitation of severe acquired brain injury (sABI). VErticalization by tilt table equipped with robotic-assisted lower limbs cyclic Mobilization (VEM) may facilitate a safer adaptation to vertical posture, reducing orthostatic hypotension occurrence. This multicenter randomized controlled trial (RCT) aims at investigating efficacy, safety, and usability of VEM compared to Traditional Verticalization (TV) using a conventional tilt table in cognitive-motor rehabilitation of sABI patients; <b>Methods</b>: a total of 118 sABI patients with or emerged from prolonged Disorder of Consciousness (pDoC and eDoC) will be enrolled in six post-acute Neurorehabilitation Units and randomly allocated to VEM or TV arm (for each arm: total 25 sessions of 30 min daily treatment/5 days/week/5 weeks). Patients will undergo clinical-functional assessment, resting EEG recording and blood sampling, before, at the end of treatment, and after 1 month; <b>Results</b>: we will expect possible differences in safety and usability of verticalization between VEM and TV rehabilitative intervention and in their efficacy to improve clinical-functional findings and brain indices; <b>Conclusions</b>: this RCT will provide new insights for the intensive, tailored and safe neurorehabilitation intervention in patients with sABI.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175575","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":"Fibrosis in Immune-Mediated and Autoimmune Disorders.","authors":"Magdalena Żurawek, Iwona Ziółkowska-Suchanek, Katarzyna Iżykowska","doi":"10.3390/jcm14186636","DOIUrl":"10.3390/jcm14186636","url":null,"abstract":"<p><p>Fibrosis is a pathological process characterized by the excessive accumulation of extracellular matrix (ECM), particularly collagen, leading to tissue scarring, architectural distortion, and organ dysfunction. While fibrosis is a physiological component of wound healing, its persistence and dysregulation can drive chronic tissue damage and organ dysfunction. In autoimmune diseases, fibrosis arises from prolonged inflammation and immune system dysregulation, creating a vicious cycle that exacerbates tissue injury and promotes disease progression. This review provides a comprehensive overview of the fibrotic processes across a range of immune-mediated and autoimmune conditions, including systemic sclerosis (SSc), morphea, autoimmune hepatitis (AIH), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), inflammatory bowel disease (IBD), and rheumatoid arthritis (RA), Finally, we discuss current and emerging antifibrotic strategies aimed at interrupting pathological ECM remodeling and restoring tissue homeostasis.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175805","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":"Diagnostic Biomarkers for Risk Estimation of In-Hospital and Post-Discharge Cardiovascular Mortality in ST-Segment Elevation Myocardial Infarction (STEMI) Patients.","authors":"Kristen Kopp, Michael Lichtenauer, Vera Paar, Uta C Hoppe, Rozana F Rakhimova, Elena A Badykova, Eduard F Agletdinov, Dimitry M Grishaev, Ksenia A Cheremisina, Anastasia V Baraboshkina, Irina A Lakman, Liya R Abzalilova, Naufal S Zagidullin","doi":"10.3390/jcm14186632","DOIUrl":"10.3390/jcm14186632","url":null,"abstract":"<p><p><b>Background</b>: ST-segment-elevation myocardial infarction (STEMI) continues to be associated with substantial short- and long-term cardiovascular (CV) mortality despite advances in treatment. Accurate early risk stratification remains critical for optimizing outcomes. Emerging biomarkers including CRP, sST2, and FABP may enhance predictive precision beyond classical markers. This study aimed to evaluate the prognostic value of these biomarkers for in-hospital and 18-month post-discharge CV mortality in STEMI patients. <b>Methods</b>: In this prospective, single-center study, 179 consecutive STEMI patients admitted September 2020-June 2021 underwent biomarker evaluation upon admission. Serum concentrations of CRP, sST2, and H-FABP were measured by ELISA. Patients were followed for in-hospital outcomes and post-discharge mortality during 18-month follow-up (FU) (last patient, last visit January 2023). ROC analysis was used to determine biomarker cut-off values. Cox regression and Kaplan-Meier analyses assessed associations with mortality. <b>Results</b>: In-hospital mortality was 7.8% (14/179). Elevated CRP (>11 mg/L) was significantly associated with higher in-hospital mortality (21.4% vs. 3.7%, <i>p</i> < 0.01). sST2 and H-FABP showed trends toward worse outcomes at higher levels, although their independent predictive value was less robust. Cox regression identified CRP > 11 mg/L (HR = 4.93, <i>p</i> < 0.01), admission glucose, and reduced GFR as independent predictors of in-hospital mortality. During FU, 18 of 165 discharged patients (10.1%) experienced CV death. Higher sST2 levels were significantly associated with post-discharge mortality in midterm FU (<i>p</i> = 0.041). <b>Conclusions</b>: We could show that CRP > 11 mg/L is a strong predictor of in-hospital mortality while elevated sST2 is associated with CV mortality during midterm FU in STEMI patients. Incorporating these biomarkers into clinical risk models may enhance early risk prediction and identify patients at higher risk for post-discharge events.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176035","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":"Comparative Analysis of Root Canal Microbiota in Patients with Diabetes and Systemically Healthy Individuals: A Pilot Next-Generation Sequencing Study.","authors":"Nazife Maide Dayıcan, Sevinç Aktemur Türker","doi":"10.3390/jcm14186643","DOIUrl":"10.3390/jcm14186643","url":null,"abstract":"<p><p><b>Objectives:</b> The aim of this study is to assess the influence of diabetes mellitus on the microbial flora involved in root canal infections through a comparative analysis with that of systemically healthy individuals. <b>Methods:</b> A total of 39 participants, including 21 patients with diabetes mellitus and 18 systemically healthy individuals (controls), were enrolled in the study. In the diabetic group, 12 teeth were diagnosed with secondary/persistent endodontic infections (SEIs) and 9 with primary endodontic infections (PEIs). In the healthy group, 12 teeth presented with SEIs and 6 with PEIs. Root canal samples were obtained using sterile paper points. The V3-V4 hypervariable regions of 16S rDNA from both sample types were amplified and sequenced using the Illumina MiSeq platform. Microbial richness and diversity were assessed using alpha diversity indices and beta diversity metrics. <b>Results:</b> Faith's Phylogenetic Diversity showed a significant difference between diabetic patients with SEIs and healthy individuals with PEIs (<i>p</i> = 0.02). Both weighted and unweighted UniFrac beta diversity analyses indicated significant differences in microbial composition and phylogenetic structure between diabetic patients with SEIs and healthy individuals with PEIs (<i>p</i> = 0.01 and <i>p</i> = 0.02, respectively). Within the diabetic patient group, significant differences were observed between SEI and PEI groups based on alpha (Fisher's alpha, <i>p</i> = 0.04) and beta diversity analyses (Bray-Curtis and Weighted UniFrac <i>p</i> = 0.02 and <i>p</i> = 0.01, respectively). <b>Conclusions:</b> Diabetic patients showed different microbial profiles compared to healthy individuals.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175596","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":"Spontaneous Multiple Cervical Artery Dissections Detected with High-Resolution MRI: A Prospective, Case-Series Study.","authors":"Aikaterini Foska, Aikaterini Theodorou, Maria Chondrogianni, Georgios Velonakis, Stefanos Lachanis, Eleni Bakola, Georgia Papagiannopoulou, Alexandra Akrivaki, Stella Fanouraki, Christos Moschovos, Panagiota-Eleni Tsalouchidou, Ermioni Papageorgiou, Athina Andrikopoulou, Klearchos Psychogios, Odysseas Kargiotis, Apostolοs Safouris, Effrosyni Koutsouraki, Georgios Magoufis, Dimos-Dimitrios Mitsikostas, Sotirios Giannopoulos, Lina Palaiodimou, Georgios Tsivgoulis","doi":"10.3390/jcm14186635","DOIUrl":"10.3390/jcm14186635","url":null,"abstract":"<p><p><b>Background</b>: Cervical artery dissection (CAD) is a leading cause of acute ischemic stroke among young and middle-aged patients. Currently, the growing availability of high-resolution magnetic resonance imaging (MRI), particularly fat-saturated T1-weighted black-blood SPACE sequences, allows the non-invasive, rapid, and reliable diagnosis of multiple arterial dissections. <b>Methods</b>: We reported our experience from two tertiary stroke centers of patients diagnosed with spontaneous multiple cervical artery dissections, detected with high-resolution MRI, during a three-year period (2022-2025). <b>Results</b>: Among 95 consecutive patients with CAD, 11 patients (mean age: 48 ± 9 years, 6 (55%) females) were diagnosed with multiple symptomatic or asymptomatic CADs, whereas in 84 patients (mean age: 49 ± 11 years, 32 (38%) females) a single CAD was detected. In all patients, high-resolution MRI and MR-angiography were performed, whereas digital subtraction angiography (DSA) with simultaneous evaluation of renal arteries was conducted in nine patients. A history of trauma or chiropractic manipulations, intense physical exercise prior to symptom onset, recent influenza-like illness, and recent childbirth in a young female patient were reported as predisposing risk factors. Cervicocranial pain, cerebral infarctions leading to focal neurological signs, and Horner's syndrome were among the most commonly documented symptoms. Characteristic findings in the high-resolution 3D T1 SPACE sequence were detected in all patients. Fibromuscular dysplasia and Eagle syndrome were detected in four patients and one patient, respectively. Eight patients were treated with antiplatelets, whereas three patients received anticoagulation with low-molecular-weight heparin. There was only one case of stroke recurrence during a mean follow-up period of 9 ± 4 months. <b>Conclusions:</b> This case series highlights the utility of specific high-resolution MRI sequences as a very promising method for detecting multiple CADs in young patients. The systematic use of these sequences could enhance the sensitivity of detecting multiple cervical CADs, affecting also the thorough investigation for underlying connective tissue vasculopathies, stratifying the risk for first-ever or recurrent ischemic stroke, and influencing acute reperfusion and secondary prevention therapeutic strategies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175880","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 of Scene Time Interval and Field Arrival to Epinephrine Administration Time with Outcomes in Cardiac Arrest.","authors":"Yohei Okada, Ki Jeong Hong, Marcus Eng Hock Ong, Sang Do Shin, Kyoung Jun Song, Jeong Ho Park, Young Sun Ro, Nur Shahidah, Shir Lynn Lim, Fahad Javaid Siddiqui","doi":"10.3390/jcm14186645","DOIUrl":"10.3390/jcm14186645","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The association of scene time interval (STI) and field arrival to epinephrine administration time (FET) with outcomes in out-of-hospital cardiac arrest (OHCA) is unknown. The goal of this investigation is to assess the association of STI and FET with outcomes in OHCA. <b>Methods</b>: All adult OHCA cases with prehospital epinephrine administration in South Korea and Singapore were included. STI was divided into short and long stay based on the median value of each country. FET was categorized into early (<10 min) and late groups. We performed multivariable logistic regression for survival to discharge and good neurological recovery. Cases were grouped into short stay early epinephrine (SS-EE), short stay late epinephrine (SS-LE), long stay early epinephrine (LS-EE), and long stay late epinephrine (LS-LE) (reference). Interaction analysis with STI and FET for outcomes was conducted. <b>Results:</b> A total of 18,867 cases from South Korea and 4184 cases from Singapore were included. Adjusted odds ratio (AOR) for survival to discharge was 2.14 (95% CI: 1.18-2.25) in SS-EE, 1.15 (0.94-1.40) in SS-LE, and 1.82 (1.45-2.28) in LS-EE compared to LS-LE in South Korea with similar results for Singapore. SS-EE and LS-EE were also associated with good neurologic recovery. Interaction analysis showed that early epinephrine injection in short stay and long stay was associated with better outcomes. But short STI was not associated with better outcomes in early and late epinephrine groups. <b>Conclusions:</b> Early epinephrine administration was associated with higher survival to discharge irrespective of the scene time interval.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175465","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":"Age-Related Patterns in Pediatric Road Traffic Injuries in Romania.","authors":"Ștefan Popa, Carmen Iulia Ciongradi, Adrian Onisim Surd, Ioan Sârbu, Iuliana-Laura Candussi, Irene Paula Popa","doi":"10.3390/jcm14186633","DOIUrl":"10.3390/jcm14186633","url":null,"abstract":"<p><p><b>Background:</b> Pediatric road traffic injuries (RTIs) represent a significant public health concern, particularly in countries like Romania, where road infrastructure and safety remain challenges. Despite recent economic reclassification, Romania continues to report high rates of pediatric traffic-related injuries. Non-fatal RTIs often result in long-term physical and psychological harm. This study aims to assess age- and gender-specific injury patterns and mechanisms of non-fatal RTIs in children and adolescents, using data from \"St. Mary's\" Emergency Clinical Hospital for Children in Iași over a ten-year period to inform targeted prevention strategies. <b>Methods:</b> This 10-year retrospective study (2015-2024) was conducted at \"St. Mary's\" Emergency Clinical Hospital for Children in Iași, Romania, a regional referral center. Data from 1074 pediatric patients (aged 1 month-17 years, 11 months) with RTIs were analyzed using ICD-10 codes and verified manually. Variables included demographics, injury type, mechanism, and treatment. Patients were stratified into four age groups. Statistical analysis was performed using IBM SPSS Statistics 25, with significance set at <i>p</i> < 0.05. <b>Results:</b> The highest incidence was observed among boys (77.7%) and children aged 10-14 years. Car passengers and cyclists constituted the most frequently affected groups, with only 11% of passengers appropriately restrained and 78% of cyclists not wearing helmets. Common injuries included excoriations, thoracic contusions, and abdominal trauma, with notable variations by age and sex. Thoracic injuries were more frequent among girls, whereas younger children exhibited a higher incidence of abdominal trauma. <b>Conclusions:</b> The findings emphasize critical safety gaps in child restraint and helmet use and highlight the urgent need for targeted, age-specific road safety interventions and improved public health education.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175711","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":"Dinutuximab Beta for the Treatment of High-Risk Neuroblastoma: Data from the Hungarian Pediatric Oncology Network.","authors":"Márk Hernádfői, Márton Szabados, Edit Brückner, Ágnes Varga, Péter Hauser, Gábor Ottóffy, Ágnes Vojcek, Krisztina Csanádi, Gabriella Kertész, Zsuzsanna Jakab, Gergely Agócs, Miklós Garami","doi":"10.3390/jcm14186641","DOIUrl":"10.3390/jcm14186641","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The anti-GD2 monoclonal antibody dinutuximab beta has become standard of care maintenance therapy for high-risk neuroblastoma (HR-NB) in the first-line setting and is also approved in the relapsed/refractory setting. We present a retrospective review of 37 children with HR-NB included in the Hungarian Childhood Cancer Registry who received dinutuximab beta (first-line maintenance therapy, n = 31; relapsed/refractory, n = 6). <b>Methods:</b> All patients received dinutuximab beta continuously over the first 10 days of each 35-day cycle, with dosing based on body surface area/weight. Five cycles were planned, with further cycles administered at the treating physician's discretion. <b>Results:</b> At data cutoff, the overall disease control rate was 54.1% (20/37) (complete response, 51.4% (19/37); partial response, 0.0% (0/37), stable disease, 2.7% [1/37]); two patients (5.4%) had progressive disease, and 15 patients (40.5%) had died. The 5-year overall survival (OS) and event-free survival (EFS) rates in the overall population were 63.3% (95% confidence interval, 49.1-81.7) and 56.2% (95% confidence interval, 42.1-75.0), respectively. Grade 3 or 4 adverse events (including blood and lymphatic system disorders, hypoxia, hypotension, and capillary leak syndrome) were generally consistent with dinutuximab beta's known safety profile. <b>Conclusions:</b> Dinutuximab beta was an effective immunotherapy for patients with HR-NB in routine clinical practice, with a generally manageable side effect profile.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175233","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":"Framing Surgical Decisions in Elderly Patients: Minimally Invasive Partial Versus Radical Nephrectomy for Stage I Renal Cell Carcinoma at Mid-Term Follow-Up.","authors":"Umberto Anceschi, Antonio Tufano, Rocco Simone Flammia, Eugenio Bologna, Riccardo Mastroianni, Leslie Claire Licari, Aldo Brassetti, Maria Consiglia Ferriero, Alfredo Maria Bove, Gabriele Tuderti, Simone D'Annunzio, Maddalena Iori, Silvia Cartolano, Marco Pula, Costantino Leonardo, Giuseppe Simone","doi":"10.3390/jcm14186634","DOIUrl":"10.3390/jcm14186634","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The optimal surgical approach for stage I renal cell carcinoma (RCC) in ultra-octogenarians remains debated, especially when balancing oncologic control, renal preservation, and procedural safety. While ablative techniques and active surveillance are often favored in frail patients, robust comparative evidence supporting nephron-sparing surgery in this age group is limited. <b>Methods</b>: We retrospectively reviewed consecutive patients aged ≥80 years who underwent minimally invasive surgery for cT1 clear cell RCC at a high-volume tertiary-care center between July 2001 and August 2025. Patients were stratified into two cohorts: minimally invasive partial nephrectomy (MIPN, <i>n</i> = 51) and radical nephrectomy (MIRN, n = 26). All MIPNs were performed using an off-clamp approach. Baseline, perioperative, functional, and oncologic outcomes were compared. Kaplan-Meier analysis estimated overall survival (OS), cancer-specific survival (CSS), and progression to significant chronic kidney disease (sCKD, defined as CKD stage ≥ 3b). <b>Results</b>: Groups were comparable in age, comorbidities, and ASA score. MIRN patients exhibited higher tumor complexity (RENAL score: 9 vs. 7, <i>p</i> = 0.01) and a greater proportion of pT1b lesions (77% vs. 37.3%, <i>p</i> = 0.01). Perioperative transfusions occurred exclusively in the MIRN group (<i>p</i> = 0.01), whereas complication rates were low and similar between groups. MIPN was associated with significantly higher eGFR at follow-up (48 vs. 30.9 mL/min/1.73 m², <i>p</i> = 0.01) and a delayed progression to sCKD (<i>p</i> = 0.01), with no differences in OS or CSS at a median follow-up of 30.5 months. <b>Conclusions</b>: In this real-world series of ultra-octogenarians with cT1 clear cell RCC, off-clamp minimally invasive partial nephrectomy ensured superior renal function preservation and delayed progression to sCKD, without compromising oncologic control at mid-term follow-up. Beyond statistical outcomes, these results underscore the importance of tailoring surgical strategies to protect long-term functional autonomy and preserve physiological resilience in elderly patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175835","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}