Journal of Clinical Medicine最新文献

{"title":"Quantitative Spinal Cord Deformation Is Associated with Neurologic Status in High-Grade Thoracic Metastatic Epidural Spinal Cord Compression: A Retrospective Surgical Cohort.","authors":"Ilhan Yilmaz, Baran Taskala, Muhammed Bayindir, Aydin Talat Baydar","doi":"10.3390/jcm15197702","DOIUrl":"10.3390/jcm15197702","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Neurologic presentation varies among patients with high-grade metastatic epidural spinal cord compression (MESCC), even within Bilsky grades 2-3. We examined whether quantitative preservation of spinal cord caliber is associated with neurologic intactness at presentation. <b>Methods:</b> We retrospectively studied 73 adults who underwent surgery for thoracic Bilsky grade 2-3 MESCC between June 2020 and December 2025. Preoperative neurologic status was classified as Frankel E versus Frankel A-D. Blinded observers measured anteroposterior and transverse cord diameters at maximal compression and at the first tumor-free cranial and caudal pedicle levels. A normalized two-adjacent cord compression ratio (CCR) was available in 71 patients. Modified Poisson regression estimated prevalence ratios for Frankel-E status, adjusted for Bilsky grade; logistic, Firth, and cranial-reference analyses were used as sensitivity analyses. <b>Results:</b> Twenty-two patients (30.1%) were Frankel E. Two-adjacent CCR was higher in Frankel-E than Frankel A-D patients (median 0.521 vs. 0.439; <i>p</i> = 0.013). Each 0.10 increase in CCR was associated with greater prevalence of Frankel-E status after Bilsky adjustment (PR 1.23, 95% CI 1.04-1.47; <i>p</i> = 0.018). Logistic, Firth, and cranial-reference analyses were generally consistent in direction; the solid-tumor-only estimate also remained positive but was less precise and included the null. Interobserver agreement for CCR was acceptable but imprecise (ICC[A,1] = 0.758, 95% CI 0.433-0.911). <b>Conclusions</b>: In this surgically selected cohort, normalized cord-caliber preservation was associated with neurologic intactness after accounting for Bilsky grade. CCR should be regarded as a research phenotype rather than an individual-patient predictor or treatment threshold, pending prospective validation in broader surgical and nonsurgical populations.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194404","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":"Trends in Hospitalizations of Patients with Idiopathic Inflammatory Myopathies: Long-Term Observational Study, 2010-2024.","authors":"Maria Dutsch-Wicherek, Bartłomiej Wieleba, Katarzyna Lewtak, Krzysztof Kanecki, Jakub Stokwiszewski, Małgorzata Wisłowska","doi":"10.3390/jcm15197707","DOIUrl":"10.3390/jcm15197707","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Idiopathic inflammatory myopathies (IIMs) are very rare, chronic, immune-mediated diseases that clinically manifest with myositis symptoms and extramuscular manifestations. The rarity of the disease makes it difficult to conduct double-blind studies, and large population-based studies are needed to improve our knowledge of them. This study aims to analyze the hospitalization rates and trends of IIMs between 2010 and 2024. Additionally, a characterization of the IIM patient population in Poland was conducted. <b>Methods</b>: A retrospective study using data from the Nationwide General Hospital Morbidity Study (NGHMS) between 2010 and 2024 was conducted. Data included demographic characteristics, principal diagnosis, hospitalization, and in-hospital mortality. Classification in accordance with ICD-10 was applied. A total of 7139 patients were included. Appropriate descriptive analyses, comparative tests, Poisson regression for incidence trends, and logistic regression for mortality predictors were performed, with <i>p</i> < 0.05 considered statistically significant. <b>Results:</b> The median IIM incidence in the Polish population was 1.209 per 100,000 per year. The overall female-to-male ratio was 1.68. Hospitalization and mortality trends for IIM were stable over the time period. The incidence among voivodeships in Poland was comparable. <b>Conclusions</b>: Nationwide, comprehensive data are an extremely valuable tool for researching and understanding diseases as rare as IIMs. The incidence, hospitalization, and mortality rates of IIMs in Poland were stable between 2010 and 2024.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194565","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":"Cell-Based and Cell-Derived Therapies Delivered During Ex Vivo Machine Perfusion for Solid Organ Reconditioning Prior to Transplantation: A Systematic Review.","authors":"Mariam Alemi, Zara Edwards, Vassilios Papalois","doi":"10.3390/jcm15197698","DOIUrl":"10.3390/jcm15197698","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Organ shortage is a major barrier to transplantation, leading to the emergence of marginal donor organs and extended criteria donor grafts and, alongside these, machine perfusion as a platform for reconditioning grafts to meet transplantation standards. Despite functioning as a reconditioning platform in its own right, machine perfusion also allows for the delivery of therapeutic agents directly to grafts prior to transplant. Cell-based and cell-derived therapies have been increasingly explored for delivery during this window, although evidence is fragmented across individual organ systems, and whether ex vivo benefit is confirmed post-transplant remains unclear. This systematic review aimed to synthesise the evidence from both perfusion-phase findings and post-transplant findings across solid organ machine perfusion, evaluating the concordance between the two. <b>Methods</b>: This review was prospectively registered on PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Included studies delivered cell-based or cell-derived therapies during ex vivo machine perfusion of a solid organ. The SYRCLE tool was used across all studies to assess risk of bias, and given substantial heterogeneity in cell type, protocol, and organ models, findings were synthesised narratively, with a sensitivity analysis restricted to the subset of studies incorporating a transplantation phase. <b>Results</b>: Thirty-one studies met inclusion criteria, spanning kidney (<i>n</i> = 10), liver (<i>n</i> = 11), lung (<i>n</i> = 9), and heart (<i>n</i> = 1). Mechanisms converged largely on immunomodulatory and metabolic pathways, most consistently reported across organs, alongside a less consistent but notable cross-organ parallel in regenerative progenitor activation between liver and kidney. Benefit was reported more consistently at the molecular and histological levels rather than the physiological level. Eight of the studies proceeded to transplantation, of which half showed a beneficial post-transplant result, and half showed mixed results. <b>Conclusions</b>: Cell-based and cell-derived therapies are best understood as adjuncts to the existing reconditioning capacity of machine perfusion. Molecular and mechanistic benefit was consistently reported; however, confirmation beyond the perfusion phase remained incomplete across organ systems. Mechanisms supported by direct interventional evidence represent priority candidates for further preclinical validation and independent replication.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194019","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":"Between-Session Reliability and Agreement of Body-Plethysmographic Lung Volumes in a Legacy Pulmonary Function Cohort.","authors":"Carmine Izzo, Alessandro Izzo, Pasquale Mone, Simona Musto, Michele Ciccarelli, Francesco Giallauria","doi":"10.3390/jcm15197704","DOIUrl":"10.3390/jcm15197704","url":null,"abstract":"<p><p><b>Background:</b> Serial interpretation of lung volumes requires assessing both reliability and agreement. We examined these properties in a historical clinical dataset. <b>Methods:</b> This retrospective secondary analysis included 72 participants, excluding seven same-session pre/post-bronchodilator pairs. The primary analysis used 19 separately dated pairs labelled pre-bronchodilator at both examinations; the expanded 65-pair analysis was exploratory. Documented intervals were two to three days; the investigator retrospectively confirmed separate-day examinations within six days for all 65 pairs. Total lung capacity (TLC) and residual volume (RV) were principal outcomes; functional residual capacity was secondary and available in the same 19 participants. Analyses included two-way mixed-effects, absolute-agreement, single-measure intraclass correlation coefficients (ICCs), Lin's concordance correlation coefficient, Gaussian reference limits, empirical difference quantiles, and leave-one-out analyses. <b>Results:</b> Fourteen primary participants had recorded chronic obstructive pulmonary disease labels without independently verified diagnostic post-bronchodilator spirometry. Primary TLC and RV ICCs were 0.947 (95% bootstrap confidence interval 0.838-0.988) and 0.940 (0.818-0.974), respectively. Mean second-minus-first differences were -0.033 and -0.015 L, with Gaussian reference limits of -0.964 to 0.898 L and -0.934 to 0.904 L, respectively. Corresponding empirical 2.5th-97.5th percentiles were -1.122 to 0.641 L and -0.875 to 0.803 L. Removing one observation reduced the standard deviation of paired differences by up to 28.8% for TLC and 14.8% for RV. <b>Conclusions:</b> High reliability estimates coexisted with appreciable paired variation. Unverified technical quality and clinical stability preclude attributing this variation solely to measurement error or establishing clinical response thresholds.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194122","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":"Comorbidity Burden and Cumulative Anti-HER2 Exposure Associated with Cardiac Dysfunction in Breast Cancer: A Real-World Cardio-Oncology Cohort.","authors":"Andrea Sonaglioni, Emanuela Fossile, Maria Adelaide Pessi, Maria Gemelli, Massimo Baravelli, Michele Lombardo, Gian Luigi Nicolosi, Barbara Bassani, Antonino Bruno, Paola Muti","doi":"10.3390/jcm15197700","DOIUrl":"10.3390/jcm15197700","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Cancer-therapy-related cardiac dysfunction (CTRCD) remains an important complication of human epidermal growth factor receptor 2 (HER2)-targeted therapy in patients with breast cancer. Although conventional cardiovascular risk factors and serial cardiac imaging are routinely incorporated into cardio-oncology surveillance, the potential contribution of global comorbidity burden and cumulative anti-HER2 treatment exposure remains incompletely characterized. We investigated the occurrence, clinical course, and factors associated with CTRCD in a large real-world population of patients with breast cancer receiving HER2-targeted therapy. &lt;b&gt;Methods:&lt;/b&gt; Adult patients with breast cancer exposed to HER2-targeted therapy and undergoing longitudinal cardio-oncology surveillance at a single tertiary center were retrospectively identified over a 10-year accrual period (January 2014-December 2024). Mean individual follow-up was approximately 2.0 years (range, 0.5-9.0 years). CTRCD was defined according to the harmonized International Cardio-Oncology Society (IC-OS) definitions incorporated into the 2022 ESC Guidelines on cardio-oncology, integrating left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV-GLS), and cardiac biomarkers when available. Baseline comorbidity burden was quantified using the Charlson Comorbidity Index (CCI), while cumulative anti-HER2 exposure was quantified according to the total number of treatment cycles. Factors associated with CTRCD were investigated using univariable and parsimonious multivariable logistic regression. &lt;b&gt;Results:&lt;/b&gt; A total of 850 patients with breast cancer receiving anti-HER2 therapy were included. CTRCD occurred in 179 patients (21.1%) and was predominantly mild, whereas clinically overt heart failure occurred in 2.9%. LVEF and LV-GLS deteriorated at nadir and subsequently showed substantial recovery during follow-up. Conventional cardiovascular risk factors, previous anthracycline exposure, tumor grade, baseline LVEF, and baseline LV-GLS were not significantly associated with CTRCD. In multivariable analysis, increasing CCI (adjusted OR 1.35 per one-point increase, 95% CI 1.12-1.63; &lt;i&gt;p&lt;/i&gt; = 0.002) and cumulative anti-HER2 exposure (adjusted OR 1.41 per five additional cycles, 95% CI 1.10-1.80; &lt;i&gt;p&lt;/i&gt; = 0.006) remained associated with CTRCD after mutual adjustment. Progressively higher observed proportions of CTRCD were found across increasing CCI categories and cumulative anti-HER2 exposure levels. &lt;b&gt;Conclusions:&lt;/b&gt; In this large real-world cohort assembled over a 10-year accrual period, CTRCD was relatively frequent but predominantly mild and reversible. Greater global comorbidity burden and cumulative anti-HER2 exposure were associated with a higher occurrence of CTRCD. However, the association with cumulative anti-HER2 exposure should be considered hypothesis-generating rather than causal because of potential time-dependent and reverse-","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193980","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":"Pharmacokinetic/Pharmacodynamic Optimization and Therapeutic Drug Monitoring of Beta-Lactam Antibiotics in Abdominal Sepsis: Current Evidence, Challenges, and Clinical Perspectives-A Narrative Review.","authors":"Roberto Giurazza, Gianluigi Cosenza, Marco Fiore, Salvatore Notaro, Pasquale Sansone, Vincenzo Pota, Francesco Coppolino, Francesca Piccialli, Maria Caterina Pace","doi":"10.3390/jcm15197697","DOIUrl":"10.3390/jcm15197697","url":null,"abstract":"<p><p><b>Background:</b> Abdominal sepsis is associated with profound pharmacokinetic (PK) alterations that make standard beta-lactam dosing regimens potentially inadequate in critically ill patients. Increased volume of distribution, hypoalbuminemia, augmented renal clearance (ARC), acute kidney injury (AKI) and the PK complexity of the peritoneal compartment collectively impair the ability of conventional dosing to achieve pharmacodynamic (PD) targets. These PK derangements are clinically relevant but incompletely characterized in intra-abdominal infections (IAI)- specific cohorts, as most available data derive from broader critically ill populations. Beta-lactam antibiotics, the cornerstone therapy in IAIs, are particularly susceptible to these alterations, especially in the context of multidrug-resistant (MDR) pathogens. <b>Methods:</b> We conducted a structured narrative review of the literature published between 2010 and 2026, searching PubMed and Embase using terms related to pharmacokinetics, pharmacodynamics, therapeutic drug monitoring, beta-lactam antibiotics, abdominal sepsis, and intra-abdominal infection in critically ill patients. Additional references were identified through manual bibliography screening, including seminal studies predating the search window. No formal systematic review methodology was applied. <b>Results:</b> PK/PD optimization in abdominal sepsis can be organized around four proposed domains: extended or continuous infusion of beta-lactams to maximize the time above the minimum inhibitory concentration; therapeutic drug monitoring (TDM) to guide individualized dose adjustment in the presence of ARC, AKI, or continuous renal replacement therapy (CRRT); tailored dose optimization during CRRT; and target attainment analysis against MDR organisms. Extended and continuous infusions improve PD target attainment and are associated with improved outcomes in some observational studies, although prospective IAI-specific evidence is lacking and the evidence supporting these strategies derives largely from broader intensive care unit populations. <b>Conclusions:</b> In abdominal sepsis, integrating PK/PD principles and TDM-guided dosing represents a pharmacologically rational strategy to optimize beta-lactam exposure and improve target attainment against MDR pathogens. Rigorous IAI-specific prospective studies are needed to establish definitive TDM-guided dosing protocols and translate these pharmacological strategies in this high-acuity setting.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194375","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 Senior Dance Participation with Mental Well-Being and Functional Performance in Older Women: A Cross-Sectional Study.","authors":"Brigitta Lakó, András Simon, Anna Zsófia Kubik, Zsigmond Gyombolai, Éva Kovács","doi":"10.3390/jcm15197687","DOIUrl":"10.3390/jcm15197687","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Community-based activities supporting physical function and mental well-being are increasingly relevant in later life. This cross-sectional study compared mental well-being and physical outcomes among older women participating in senior dance only, senior dance plus additional regular physical activity, and physically inactive older groups; a younger inactive group provided exploratory age-related context. A secondary aim was to examine correlations with participation duration. <b>Methods</b>: Participants were 160 women: 66 in senior dance only (SD), 34 in senior dance plus additional regular physical activity (SD+PA), 30 physically inactive older women, and 30 physically inactive younger women aged 25-40 years. Mental well-being was assessed with the Hungarian four-response five-item Well-Being Index (WBI-5), together with seven physical outcomes. Welch's ANOVA and prespecified Welch-Satterthwaite contrasts with Benjamini-Hochberg correction were used; duration analyses used partial Spearman correlations adjusted for weekly attendance and age. <b>Results</b>: Overall group differences were observed for all outcomes (all <i>p</i> ≤ 0.002). Seven outcomes remained significant in Contrast 1, which did not isolate a dance-specific association. No SD versus SD+PA difference remained significant after correction. Within SD, participation duration correlated with more favorable Timed Up and Go (r_s = -0.428), 30-Second Chair Stand (r_s = 0.425), and 2-Minute Step Test performance (r_s = 0.423; all q = 0.0013). The adjusted WBI-5 correlation did not remain significant after FDR correction (r_s = 0.271; q = 0.061). <b>Conclusions</b>: Participation duration was most consistently correlated with integrated functional performance. Prospective studies are required; causal effects cannot be inferred. ClinicalTrials.gov: NCT07170241.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194053","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 Associated with Spinal Cord Stimulation Failure in Patients with Chronic Pain: A Single-Center Retrospective Cohort Study.","authors":"Ahmed Osailan, Ahmed Najjar, Marie-Pierre Fournier-Gosselin, Francois Fugere","doi":"10.3390/jcm15197681","DOIUrl":"10.3390/jcm15197681","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Spinal cord stimulation (SCS) can provide long-term relief for selected patients with refractory chronic pain, but treatment failure may occur without device explantation. This study examined patient-, clinical-, and device-related factors associated with SCS failure after permanent implantation. <b>Methods:</b> This retrospective, single-center cohort study included 108 adults who underwent permanent SCS implantation at the Centre Hospitalier de l'Université de Montréal between 2007 and 2022. Failure was defined as completed or planned explantation, inadequate pain relief accompanied by a desire or plan for removal, or documented device non-use. Associations were evaluated using univariable categorical tests. Paired pain intensity and morphine milligram equivalent (MME) doses were compared using Wilcoxon signed-rank tests. <b>Results:</b> At the most recent documented assessment, composite SCS failure occurred in 40/108 patients (37.0%), and completed explantation occurred in 25/108 (23.1%); these proportions were not adjusted for unequal follow-up duration. The leading reasons for explantation were loss of efficacy (36.0%), paresthesia or dysesthesia (28.0%), and patient request (24.0%). In exploratory univariable analysis, smoking was associated with documented failure (RR = 1.70, 95% CI 1.05-2.75; <i>p</i> = 0.032). Failure differed across comorbidity-count categories (Cramér's V = 0.34, 95% CI 0.00-0.48; <i>p</i> = 0.019), although the pattern was nonmonotonic. Neither association remained statistically significant after Benjamini-Hochberg correction across 26 comparisons (both <i>q</i> = 0.416). Sex, psychiatric history, pain duration, implantation approach, generator type, and generator location were not significantly associated with failure. The median within-patient reduction in pain intensity was 2.50 points (IQR, 1.00-5.00; <i>p</i> < 0.001), whereas the median paired MME change was 0 MME/day (IQR, -60 to 40; <i>p</i> = 0.649). <b>Conclusions:</b> A composite outcome identified a higher prevalence of clinically unsuccessful SCS treatment than completed explantation alone. Smoking showed an unadjusted association with documented failure; however, this finding may reflect confounding or chance arising from multiple comparisons and should be considered hypothesis-generating. Pain intensity improved without a corresponding significant reduction in opioid exposure. These findings require confirmation through prospective, prespecified multivariable and time-to-event analyses.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194245","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":"Beyond Symptom Control: Remission as a Depth-Stratified Treatment Goal in Severe Asthma.","authors":"Martina Votto, Fabio Manzo, Mauro Maniscalco, Giorgio Castellana, Giuseppe Cascone, Agostino Buonauro, Antimo Papa, Roberto Formisano, Christian Basile, Guido Grassi, Pasquale Ambrosino","doi":"10.3390/jcm15197686","DOIUrl":"10.3390/jcm15197686","url":null,"abstract":"<p><p>The management of severe asthma has shifted from symptom control to the ambition of remission, a goal borrowed from rheumatology. Biologics targeting immunoglobulin E, interleukin-5 and its receptor, the interleukin-4 receptor alpha subunit, and thymic stromal lymphopoietin have made sustained quiescence realistic for many patients, yet estimates that roughly one-third achieve remission shift by tens of percentage points depending on the definition used. This narrative review advances two linked arguments. First, that the heterogeneity of definitions, not any shortage of effective agents, is the central obstacle to using remission as a treatment target. Second, that remission is best read as a multidimensional construct in which clinical, functional and biological quiescence are distinct axes, reached independently and often discordantly, with complete remission denoting their convergence rather than the last step of a sequence. Where each biologic acts within the type 2 cascade determines which biomarkers move under treatment and, only hypothetically, how deep remission can reach. Structural remodeling and the fact that current agents suppress rather than reset inflammation cap that depth, so remission remains a pharmacologically maintained state on treatment. Concomitant chronic rhinosinusitis with nasal polyps is treated as a modifier of asthma remission rather than a separate endpoint. The framework is conceptual and unvalidated. The priority is a harmonized, depth-resolved definition, explicit about treatment burden and patient-centered outcomes, against which any therapy can be judged.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194090","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":"AI-Assisted Analysis of Sentiment Changes Among Repeat Users of Digital Peer Support: A Retrospective Longitudinal Study.","authors":"Farbod Sedaghati, Anya Stetsenko, Ilayda Ozsan McMillan, Zara Dana, Harpreet Nagra","doi":"10.3390/jcm15197677","DOIUrl":"10.3390/jcm15197677","url":null,"abstract":"<p><p><b>Background</b>: Digital peer support (DPS) is a scalable tool to provide emotional support across diverse user populations. Previous studies were limited to single-session outcomes, while the impact of repeated DPS sessions is not well understood. <b>Objectives</b>: This study evaluated sentiment trajectories among repeat users of a 24/7, anonymous, real-time moderated DPS service and examined whether DPS engagement across repeated sessions was associated with changes in negative sentiments (depression, loneliness, despair, grief, and work-related stress). User engagement patterns across different conversation topics, and topic-specific differences in DPS use were also explored. <b>Methods</b>: We conducted a retrospective analysis of 13,686 anonymous live DPS chat sessions (January 2023 to December 2024) from 8084 distinct Supportiv DPS users. Of these, 4099 chat sessions from 596 unique repeat users met the predefined inclusion criteria of at least two sessions with a sentiment score ≥5, representing at least moderate expression of the negative sentiment of interest, and a minimum of three scored messages per session. Sessions were categorized into mental health topics using a large language model, GPT-4o-mini. For each topic (depression, grief, loneliness, suicidality, and work-related), relevant sentiment intensity scores were generated by using a few-shot approach based on scale definitions. Individual message-level sentiment trajectories were descriptively characterized for each user using ordinary least squares (OLS) regression across accumulated conversation time. User engagement patterns, session characteristics, and self-reported demographics were compared using nonparametric tests. <b>Results</b>: Over the two-year study period of repeat DPS users, among user-level trajectories with statistically significant OLS slopes, the proportion with negative slopes was 90.9% for despair, 86.1% for depression, 85.7% for grief, 82.4% for work-related stress, and 72.7% for loneliness. Approximately 40-55% of all negative trajectories reached statistical significance. Suicidality-related sessions were ~20% longer and shared ~35% more resources, while loneliness sessions included 14% more resources than other topics. Users focusing on loneliness and suicidality had longer return intervals (11.8 and 18.6 days, respectively) compared to the average (10.4 days). <b>Conclusions</b>: Analyses showed that some users demonstrated downward message-level sentiment across accumulated conversation time. Given its accessibility and scalability, DPS is a promising mental health support tool. Prospective controlled studies are needed to determine whether repeated DPS use produces sustained benefits.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193902","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}