Clinics and Practice最新文献

{"title":"Patterns of Enteral Feeding, Feeding Intolerance, and Mortality in Traumatic Brain Injury: An Observational Study.","authors":"Hasan M Al-Dorzi, Abdulaziz R Al-Qwizani, Turki F Al-Saikhan, Yousef Alshahwan, Bandar F Bindayel, Raed Alharthi, Raymond Khan","doi":"10.3390/clinpract16050083","DOIUrl":"10.3390/clinpract16050083","url":null,"abstract":"<p><p><b>Background:</b> Patients with traumatic brain injury (TBI) are often underfed and frequently experience enteral feeding (EF) intolerance. We examined the association between EF timing, caloric intake and EF intolerance, and mortality. <b>Methods:</b> We retrospectively evaluated adult patients with moderate-to-severe TBI in a tertiary-care ICU. In the first 7 days, we recorded daily caloric intake from EF and the occurrence of EF intolerance-defined as a gastric residual volume > 500 mL or >250 mL with vomiting. <b>Results:</b> Among 298 patients, 210 (70.4%) received early EF. The median 7-day cumulative caloric intake was 7766 kcal for the early EF group (64.7% of caloric requirement) and 2783 kcal (23.1% of caloric requirement) for the late (after 48 h) EF group (<i>p</i> < 0.001). EF intolerance occurred in only 24 patients (8.1%), with no significant difference between the early and late groups. Hospital mortality was 13.8% with early EF versus 30.7% with late EF (<i>p</i> = 0.001), 8.5% with caloric intake ≥ 80% of requirement versus 21.3% with lower caloric intake (<i>p</i> = 0.02) and 50% in patients with EF intolerance versus 16.1% in those without intolerance (<i>p</i> < 0.001). In multivariable logistic regression analysis, early EF was associated with lower mortality (odds ratio 0.326; 95% confidence interval 0.165-0.644), whereas EF intolerance was associated with higher mortality (odds ratio 7.451; 95% confidence interval 2.787-19.922). <b>Conclusions:</b> In patients with moderate-to-severe TBI, early EF was associated with higher caloric intake and lower mortality compared to late EF. EF intolerance was uncommon but strongly associated with higher mortality.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13204867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Associations Between Early Cognitive Impairment and Echocardiographic Markers in Middle-Aged Patients with Atrial Fibrillation and Cardiometabolic Comorbidities: A Pilot Study.","authors":"Borislava Atanasova, Mariya Tokmakova, Angel M Dzhambov, Rafiela Chitak, Penka Atanassova","doi":"10.3390/clinpract16050082","DOIUrl":"10.3390/clinpract16050082","url":null,"abstract":"<p><p><b>Objectives</b>: Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, and cardiometabolic comorbidity, have been increasingly associated with cognitive impairment and dementia. These associations, however, remain underexplored and underappreciated in middle-aged individuals with AF. This study aimed to explore the associations of early cognitive impairment with the presence of cardiometabolic comorbidities and potential associations with echocardiographic markers in middle-aged patients with and without AF. <b>Methods</b>: Between 2023-2024, fifty-six consecutive outpatients with a diagnosis of AF aged 45-65 years underwent clinical evaluation, transthoracic echocardiography, and comprehensive neuropsychological assessment using the Montreal Cognitive Assessment (MoCA) and the Consortium to Establish a Registry for Alzheimer's Disease battery (CERAD). A control group of 58 age group-matched individuals without known cardiometabolic disease was included in comparative cognitive analyses. <b>Results</b>: Patients with AF and cardiometabolic comorbidities demonstrated early cognitive deficits, particularly in episodic memory and visuospatial functions, detectable even in individuals with normal MoCA scores, compared with the control group. However, no associations were observed between cognitive performance and conventional echocardiographic parameters in the group with AF. <b>Conclusions</b>: This study corroborated prior evidence of an association between cardiometabolic impairment and subtle cognitive impairment, but did not identify a specific contribution of echocardiography markers. More extensive and sensitive biomarkers of left atrial structure and function may be required to detect harmful associations with subtle cognitive impairment in middle-aged individuals. Further prospective studies, with a more balanced control for comorbidities, are warranted to clarify the clinical relevance of atrial structural remodeling in this context.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13204831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Significance of Serum Protein Electrophoresis in Rapid Progression of Multiple Myeloma: A Case Report.","authors":"Silvia Iannelli, Melania Scarcella, Antonella Cusano, Federica Feleppa, Ylenia Pancione, Luigi Michele Pavone, Pasquale Cocchiaro","doi":"10.3390/clinpract16040081","DOIUrl":"10.3390/clinpract16040081","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Serum protein electrophoresis (SPE) is a widely used laboratory test for the detection and monitoring of monoclonal gammopathies, including multiple myeloma (MM). Although SPE is usually recommended in the presence of specific clinical or laboratory abnormalities, monoclonal gammopathies may occasionally develop rapidly and without typical symptoms. This case report aims to emphasize the diagnostic value of SPE in identifying an unexpected and fast-evolving monoclonal gammopathy. <b>Methods</b>: We report the clinical and laboratory eight-month follow-up of a 58-year-old male who initially underwent SPE for unrelated clinical conditions. Serial SPE analyses were performed using capillary zone electrophoresis. When abnormalities emerged, immunotyping and serum free light chain (FLC) assays were conducted. The diagnostic workup was completed with bone marrow aspiration, flow cytometry, and imaging studies according to current international diagnostic criteria. <b>Results</b>: The initial SPE (November 2023) showed a normal protein profile. After eight months, follow-up SPE revealed a prominent monoclonal spike in the gamma region (2.9 g/dL), associated with increased total serum proteins (91 g/L; range 64-82 g/L), elevated IgA levels (20.0 g/L; range 0.4-3.5 g/L), and a markedly abnormal κ/λ FLC ratio (54.00; range 0.31-1.56). Bone marrow analysis demonstrated >18% plasma cell infiltration, confirming the diagnosis of IgA-κ MM. The patient underwent standard therapy followed by autologous stem cell transplantation, achieving disease remission. <b>Conclusions</b>: This case highlights that clinically relevant monoclonal gammopathies may arise rapidly in the absence of classical diagnostic features. Routine SPE represents a cost-effective and accessible screening tool that can identify subtle protein abnormalities, prompting the timely use of more specific and invasive diagnostic procedures for aggressive plasma cell disorders.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13114651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Physical Activity During Radiation Therapy for Lung Cancer: Study Protocol of the APART-LUNG Study.","authors":"Dirk Rades, Maria Karolin Streubel, Laura Doehring, Stefan Janssen, Sabine Bohnet, Christian F Schulz, Hanne Falk Grauslund, Charlotte Kristiansen","doi":"10.3390/clinpract16040080","DOIUrl":"10.3390/clinpract16040080","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Radiation therapy is a common treatment modality for non-small-cell and small-cell lung cancer that can be associated with considerable side effects, mainly reactions of healthy tissues in the radiation field. Radiation therapy may lead to significant fatigue, which can potentially be mitigated by maintaining or increasing physical activity during treatment. Since achieving this goal may be a challenge for patients, they may benefit from a mobile application reminding them daily to perform a predefined number of steps. Such a reminder app will be investigated prospectively in a phase 2 trial. The current APART-LUNG study (NCT07380815) is a mandatory study for designing the prospective trial. <b>Methods</b>: The main objective of the APART-LUNG (exploratory non-interventional) study is to report patterns of physical activity during radiation therapy for lung cancer patients and generate hypotheses based on our findings. Our primary endpoint is the within-patient difference in weekly average steps per wear hour of the smartphone (week 5 minus week 1 of radiation therapy), and our secondary aim is to estimate differences in operational measures (wear time of the smartphone) between week 5 and week 1. The sample size of approximately 20 patients (full analysis set) allows us to detect a moderate-to-large standardized within-patient difference and is driven by feasibility and the intent to obtain preliminary estimates of effect size and variability. The results of the APART-LUNG study will be very important for appropriately designing a phase 2 trial.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Intracranial Haemorrhage in Patients Taking Direct Oral Anticoagulants or Vitamin K Antagonists: A Seven-Year Single-Centre Retrospective Analysis.","authors":"Mallika Sathitwat, Surat Tanprawate, Atiwat Soontornpun, Chayasak Wantaneeyawong, Chutithep Teekaput, Nopdanai Sirimaharaj, Angkana Nudsasarn, Chatree Chai-Adisaksopha, Kitti Thiankhaw","doi":"10.3390/clinpract16040079","DOIUrl":"10.3390/clinpract16040079","url":null,"abstract":"<p><p><b>Background:</b> The clinical outcomes of patients with intracranial haemorrhage (ICH) whilst using direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) are uncertain. This study aimed to assess outcomes and management in patients receiving DOACs compared with those receiving VKAs. <b>Methods:</b> In this retrospective study, patients hospitalised during the period from 1 January 2017 to 31 December 2023 for traumatic and non-traumatic ICH and using oral anticoagulants (OACs) were included. The primary outcomes were mortality and functional outcomes, as measured by the modified Rankin Scale (mRS) during admission and 90-day follow-up. ICH management and complications were studied and compared between the two OAC groups. <b>Results:</b> A total of 171 eligible patients were included, comprising 24 patients on DOACs and 147 patients on VKAs. Patients receiving DOACs were older (79.1 vs. 66.8, <i>p</i> < 0.001) and had a higher proportion of traumatic ICH (75.0% vs. 46.3%, <i>p</i> = 0.009) than those receiving VKAs. In-hospital and 90-day outcomes were not statistically different between the two groups, with an adjusted odds ratio (aOR) of 1.30 (0.39-4.36) for in-hospital mortality, <i>p</i> = 0.67, and an aOR of 0.89 (0.33-2.41) for mRS 0-2 at 90 days, <i>p</i> = 0.83. In total, 81.3% of patients received at least one reversal agent; fresh frozen plasma was commonly used in the VKA group (78.9% vs. 33.3%, <i>p</i> < 0.001), whereas prothrombin complex concentrate was significantly prescribed in patients with DOAC-associated ICH (29.2% vs. 3.4%, <i>p</i> < 0.001). <b>Conclusions:</b> Patients with DOAC-associated ICH had comparable in-hospital and long-term clinical outcomes to those with VKA use.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review: The Impact of COVID-19 Vaccination on Myocarditis Risk and Recovery.","authors":"Yibo Liu, Christopher Khatchadourian, Luke Sanders, Quincy Eweroke, Cyvannah Warner-McCutcheon, Jackson Lewis, Joaquin Santos, Vishwanath Venketaraman","doi":"10.3390/clinpract16040077","DOIUrl":"10.3390/clinpract16040077","url":null,"abstract":"<p><p><b>Background:</b> Myocarditis is an uncommon but recognized adverse event following mRNA COVID-19 vaccination, with risk varying by age, sex, dose number, and vaccine product. Clarifying the magnitude of risk, clinical course, and recovery-relative to myocarditis following SARS-CoV-2 infection-is essential for risk-benefit assessment and public health guidance. <b>Methods:</b> We performed a systematic PubMed and Embase search (January 2020-December 2024) and synthesized cohort, registry, and surveillance data on myocarditis incidence and outcomes following mRNA COVID-19 vaccination. Outcomes included incidence, observed-to-expected (OE) or incidence rate (IRRs) ratios, hospitalization, and short-term recovery. Study selection followed PRISMA 2020 systematic review guidelines. <b>Results:</b> Myocarditis following mRNA COVID-19 vaccination was identified as a rare adverse event, most commonly occurring after the second dose and in younger male individuals. Across multiple cohort and registry-based studies, cases were generally mild and self-limited, with most patients recovering without complication. In contrast, myocarditis following SARS-CoV-2 infection was consistently associated with more severe outcomes, including higher rates of hospitalization and mortality. <b>Conclusions:</b> Vaccine-associated myocarditis is rare, typically mild, and self-limited, with excellent short-term recovery; vaccinated individuals also exhibit lower odds of in-hospital death and intubation. In contrast, infection-associated myocarditis is more frequent and severe. Overall, the benefit-risk profile of mRNA vaccination remains strongly favorable.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommended Cardiometabolic Screening Guidelines for Unhoused Adults: A Street Medicine Needs Assessment.","authors":"Sanjana Arun, Joaquin Cardozo, Andre Shon Hirakawa, Teresa Anh Tran, Van Dexter Calo, Robert Fauer","doi":"10.3390/clinpract16040078","DOIUrl":"10.3390/clinpract16040078","url":null,"abstract":"<p><p><b>Background:</b> Unhoused individuals face disproportionately high rates of preventable chronic disease due to fragmented access to care and prolonged exposure to environmental stressors. Street medicine programs offer a mobile, low-barrier model to assess and address these unmet needs. Despite well-documented disparities, no publications in the current literature provide numerically specific screening recommendation guidelines tailored to unhoused populations. This study fills that gap using clinical data from Street Medicine Phoenix (SMP), a mobile healthcare initiative serving urban Arizona. <b>Methods:</b> We retrospectively reviewed 1322 clinical encounters recorded by SMP between August 2023 and October 2024. Diagnoses and treatments were manually categorized. Blood pressure (BP) and glucose values were analyzed using descriptive statistics and compared against national norms (CDC 50th percentile and ADA guidelines). Kruskal-Wallis and Dunn's tests assessed age-based differences, while chi-square and Mann-Whitney U tests examined glucose patterns. <b>Results:</b> The mean patient age was 51.4 years; 34.5% identified as female. Cardiovascular issues (39.4%) and routine screenings (39.6%) were most frequently documented. Systolic and diastolic BP values were significantly elevated across all age groups except those 60+, with even the 18-39 group showing median systolic BP above CDC norms (124.0 mmHg). Among 60 patients with fasting glucose data, 41.4% met ADA criteria for diabetes, and 10.7% of those without a known diagnosis had diabetic-range values. <b>Conclusions:</b> Our findings suggest that cardiometabolic disease may emerge earlier and more aggressively among unhoused individuals than in the general U.S. population, reflecting patterns of accelerated biological aging. The elevation of cohort-based BP percentiles suggests that current national benchmarks may underrepresent clinical risk in this group. We propose initiating blood pressure screening at age 18 and fasting glucose screening by age 35 in unhoused individuals-adaptations of existing USPSTF recommendations based on cohort-specific trends. These screening thresholds can be feasibly implemented in street medicine settings to promote earlier detection and improve long-term health outcomes.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13114903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angiogenic Imbalance Defines Multisystem Phenotypes of Preeclampsia: A Phenotype-Oriented Cohort Study.","authors":"Anca Tătaru-Copos, Florin Szasz, Anca Carmen Huniadi, Rodica Georgeta Negrini, Mircea Ioachim Popescu, Paula Trif, Gelu Florin Murvai, Radu Galiș, Cristian Sava, Romina Viorela Murvai","doi":"10.3390/clinpract16040076","DOIUrl":"10.3390/clinpract16040076","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is a heterogeneous multisystem disorder characterized by endothelial dysfunction and angiogenic imbalance. While the sFlt-1/PlGF ratio is widely used for diagnostic purposes, its role in defining biological phenotypes of preeclampsia remains insufficiently explored. This study aimed to investigate whether angiogenic imbalance is associated with distinct multisystem phenotypes of preeclampsia and with perinatal outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study including 320 pregnant women, of whom 68 were diagnosed with preeclampsia. Multisystem phenotypes were defined using laboratory markers reflecting renal, hepatic, and hematologic involvement. The sFlt-1/PlGF ratio was compared across phenotypes. Associations with gestational age at delivery, birth weight, Apgar score, and neonatal intensive care unit (NICU) admission were evaluated. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of the sFlt-1/PlGF ratio for identifying the renal-dominant phenotype.</p><p><strong>Results: </strong>The mean sFlt-1/PlGF ratio was higher in preeclampsia compared to normotensive pregnancies (58.5 ± 20.3 vs. 34.6 ± 15.9). Within preeclampsia, the renal-dominant phenotype showed the highest ratio (66.0 ± 22.5), followed by hepatic (55.9 ± 18.2) and hematologic phenotypes (52.0 ± 16.8). The renal phenotype was associated with earlier delivery (34.6 weeks), lower birth weight (2196 g), higher NICU admission (10.7%), and lower Apgar scores. The sFlt-1/PlGF ratio demonstrated moderate discrimination for the renal phenotype (AUC = 0.69).</p><p><strong>Conclusions: </strong>Angiogenic imbalance varies across multisystem phenotypes of preeclampsia and is associated with meaningful perinatal differences. The sFlt-1/PlGF ratio may contribute to phenotype-based risk stratification, supporting a move toward precision obstetrics. Prospective studies are needed to validate phenotype-oriented classification models.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13114905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Platelet-Rich Plasma in Knee Osteoarthritis: Umbrella Meta-Analysis Based on Clinical Evidence, Methodological Quality and Therapeutic Positioning.","authors":"María Ángeles Ventura-García, Tesifón Parrón-Carreño, David Lozano-Paniagua, Bruno José Nievas-Soriano, Antonio Fernando Murillo-Cancho, Elena María Gázquez-Aguilera, Delia Cristobal-Cañadas","doi":"10.3390/clinpract16040075","DOIUrl":"10.3390/clinpract16040075","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Despite being a standard biological therapy for knee osteoarthritis, inconsistent results across studies-due to varied protocols-have obscured the clinical standing of platelet-rich plasma. This meta-analysis evaluates the efficacy and safety of PRP for pain, function, and adverse events, and examines the potential benefits of combining it with hyaluronic acid. <b>Methods</b>: An umbrella review was conducted following the PRIOR (Preferred Reporting Items for Umbrella Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Meta-analyses evaluating PRP in knee osteoarthritis were included. Quantitative estimates of pain, function, and safety were extracted. Random-effects models were applied when possible. Methodological quality was assessed using AMSTAR 2, and study overlaps were assessed using the CCA method. Publication bias was analyzed using a funnel plot. <b>Results</b>: The meta-analyses included consistently showed the superiority of PRP over hyaluronic acid and placebo in reducing pain and improving function. Pooled estimates indicated clinically relevant improvements, especially in mild-to-moderate osteoarthritis. The combination of PRP and hyaluronic acid demonstrated superior functional recovery and a potential reduction in adverse events compared to PRP monotherapy. The overall safety profile was favorable. <b>Conclusions</b>: PRP is an effective and safe therapy for knee osteoarthritis, with consistent evidence of superiority over conventional intra-articular treatments. Combined PRP and HA administration suggests superior clinical efficacy compared to monotherapy. Standardization of protocols and appropriate patient selection will be key in future clinical guidelines.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13115077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromuscular Characteristics Associated with Knee Instability in Osteoarthritis and After Total Knee Replacement: A Systematic Review and Meta-Analysis.","authors":"Ariane P Lallès, Luisa Cedin, Markus A Wimmer","doi":"10.3390/clinpract16040074","DOIUrl":"10.3390/clinpract16040074","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Knee joint instability is frequently reported in individuals with knee osteoarthritis (OA) and may persist after total knee replacement (TKR), where it represents a leading cause of revision. However, neuromuscular factors associated with knee instability remain poorly understood. This systematic review and meta-analysis aimed to compare neuromuscular characteristics between individuals with stable and unstable knees in OA and TKR populations. <b>Methods</b>: PubMed, CENTRAL, Scopus, and EMBASE were searched from inception to 10 January 2025. Studies comparing neuromuscular outcomes between stable and unstable knees were included. Neuromuscular parameters included: muscle strength, muscle power, muscle activation pattern, and joint stiffness. Where appropriate, pooled standardized mean differences (SMD) were calculated using random-effects models. Certainty of evidence was evaluated using the GRADE approach. <b>Results</b>: Nineteen studies (16 OA, 3 TKR; <i>n</i> = 7369 participants) were included, with eleven studies eligible for meta-analysis. OA individuals with unstable knees demonstrated significantly lower limb muscle strength compared with stable counterparts (SMD = -0.49, 95% CI -0.81 to -0.16, <i>p</i> = 0.003). Muscle co-contraction did not differ significantly between groups (SMD = 0.12, 95% CI -0.70 to 0.94, <i>p</i> = 0.77). The overall certainty of evidence was rated as very low. <b>Conclusions</b>: Knee instability in OA populations is associated with reduced lower limb muscle strength, although evidence quality is limited and findings regarding neuromuscular control strategies remain inconclusive. Evidence in TKR populations is scarce. Future studies should investigate muscle activation patterns and dynamic joint stabilization during functional tasks to clarify the neuromuscular mechanisms underlying knee instability.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 4","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13114445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}