Journal of Clinical Medicine最新文献

{"title":"Neutrophil-to-Lymphocyte Ratio Is Associated with Disease Progression in a Surveillance Cohort of Patients with Branch-Duct IPMN.","authors":"Frederik J Hansen, Peter Ewald, Luis Sorncharoen, Daniel R Quast, Maximilian Stögbauer, Christian Torres Reyes, Renate Schlottmann, Christoph Zeidler, Mousa Ayoub, Bernadette Kaup, Anne Koch, Sarah Schellen, Lisa Weckheuer, Oscar Cahyadi, Alanna Ebigbo","doi":"10.3390/jcm15197758","DOIUrl":"10.3390/jcm15197758","url":null,"abstract":"<p><p><b>Background</b>: A Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are common pancreatic precursor lesions requiring varying duration of surveillance because of their potential for malignant transformation. Current risk stratification relies predominantly on imaging-based criteria defined by the Kyoto guidelines, while reliable blood-based biomarkers are lacking. The neutrophil-to-lymphocyte ratio (NLR) has been associated with invasive IPMN in surgical resected cases, but its role in routine BD-IPMN surveillance has not been investigated. This study investigated the association between NLR and disease progression in a large surveillance cohort of patients with BD-IPMN. <b>Methods</b>: This retrospective two-center study included patients with image-based diagnosis of BD-IPMN who underwent at least one further follow-up endoscopic ultrasound (EUS) examination between 2006 and 2026 and had an available differential blood count. Disease progression was defined as the development of new worrisome features (WFs), high-risk stigmata (HRS), pancreatic resection for progressive disease, or IPMN-associated carcinoma. <b>Results</b>: A total of 285 patients undergoing 2207 EUS examinations were included, with a mean EUS surveillance duration of 4.8 years. During follow-up, 63 patients (22.1%) developed at least one WF, 4 (1.4%) developed HRS, 11 (3.9%) underwent pancreatic resection, and 2 (0.7%) developed IPMN-associated carcinoma. NLR was significantly elevated in patients who developed WFs (<i>p</i> = 0.0023), HRS (<i>p</i> < 0.0001), underwent pancreatic resection (<i>p</i> = 0.0006), or had high-grade dysplasia (<i>p</i> = 0.0002). Baseline continuous NLR showed no significant discriminatory ability for subsequent disease progression (AUC, 0.563; 95% CI, 0.482-0.635; <i>p</i> = 0.136). Patients with an NLR above the cohort median (>2.36) had approximately twofold higher odds of subsequent disease progression (OR, 2.02; 95% CI, 1.02-3.98). Longitudinal analyses demonstrated significant increases in NLR preceding the development of WFs (<i>p</i> < 0.0001), HRS (<i>p</i> = 0.0265), and pancreatic resection (<i>p</i> = 0.0272). Rising NLR was particularly associated with cyst growth, cyst size ≥30 mm, and main pancreatic duct dilation. <b>Conclusions</b>: Elevated and increasing NLR was associated with BD-IPMN progression and correlated with established markers of higher-risk disease. Longitudinal NLR assessment may represent a simple and widely available complementary biomarker for surveillance; however, its modest discriminatory performance warrants prospective validation before clinical implementation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194282","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":"Obstetric Hysterectomy at a Greek Tertiary Referral Center: Differences in Maternal and Neonatal Outcomes Between Elective and Urgent Procedures.","authors":"Stefanos Flindris, Margioula-Siarkou Chrysoula, Konstantinos Christopoulos, Georgia Margioula-Siarkou, Ioannis Chatzikalogiannis, Michail Kalinderis, Alexandros Traianos, Elif Empliouk, Konstantinos Pantazis, Alexandros Sotiriadis, Konstantinos Dinas, Stamatios Petousis","doi":"10.3390/jcm15197738","DOIUrl":"10.3390/jcm15197738","url":null,"abstract":"<p><p><b>Background:</b> Obstetric hysterectomy remains a life-saving intervention for placenta accreta spectrum and uncontrolled obstetric hemorrhage. Evidence regarding the outcomes of planned versus urgent obstetric hysterectomy in contemporary tertiary practice in Greece remains limited. We compared maternal and neonatal outcomes between elective and urgent procedures at a tertiary referral center in Thessaloniki. <b>Methods:</b> We retrospectively reviewed 30 women who underwent obstetric hysterectomy between January 2020 and June 2025. The elective group included women with prenatal PAS diagnosis and planned delivery at ≥34 weeks (n = 17), whereas the urgent group included women requiring unplanned delivery for hemorrhage or active labor without prior surgical preparation (n = 13). Maternal characteristics, intraoperative findings, transfusion requirements, complications, hospital stay, and neonatal outcomes were compared using bivariate statistical tests. <b>Results:</b> Maternal age was similar between groups (36.1 ± 6.1 vs. 37.9 ± 6.8 years; <i>p</i> = 0.44). Elective cases had higher parity (median 3 vs. 1; <i>p</i> = 0.002), had more previous cesarean deliveries (median 2 vs. 0; <i>p</i> = 0.002), and were more frequently diagnosed with placenta previa (<i>p</i> = 0.027). Uterine atony occurred more often in urgent cases (<i>p</i> < 0.001). Bakri balloon tamponade was used only in urgent cases and failed to control hemorrhage (<i>p</i> < 0.001). Operative time, transfusion requirement, hospital stay, and urinary tract injury rates were comparable. No maternal deaths occurred. Birth weight, Apgar scores, and NICU admission rates were also similar. <b>Conclusions:</b> Planned obstetric hysterectomy within a multidisciplinary setting was associated with fewer emergency hemorrhage-control interventions, while major perioperative and neonatal outcomes were comparable between groups.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194215","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":"Reply to de la Barra Ortiz, H.A.; Chamorro Lange, C.H. Comment on \"Alayat et al. The Effectiveness of Photobiomodulation Therapy on Pain and Function in Patients with Patellofemoral Pain Syndrome-A Systematic Review and Meta-Analysis. <i>J. Clin. Med.</i> 2026, <i>15</i>, 20\".","authors":"Mohamed Salaheldien Alayat, Roaa A Sroge, Abdulaziz Awali, Ammar Fadil, Omair Belal Malibari, Raad Hatim Ajawi, Eyad Noor Wali, Suhail Hafiz, Sameer Yamani","doi":"10.3390/jcm15197735","DOIUrl":"10.3390/jcm15197735","url":null,"abstract":"<p><p>Authors would like to sincerely thank the authors of the commentary [...].</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194552","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":"Continuous Infusion Versus Intermittent Bolus Proton Pump Inhibitor Therapy Following Endoscopic Hemostasis for Bleeding Peptic Ulcers: A Systematic Review and Meta-Analysis.","authors":"José Luis Muñoz-Carrillo, Gustavo Bastién-Martínez, Edrei Lopez-Hernandez, Vladimir Guerrero-Toralva, Frida Sofia Ontiveros-Ramos, Alejandra Vargas-Flores, Adair Zabdiel Cortés-Gutiérrez, Francisca Chávez-Ruvalcaba, Natalie Rodríguez-Cortés, Oscar Gutiérrez-Coronado","doi":"10.3390/jcm15197743","DOIUrl":"10.3390/jcm15197743","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Continuous high-dose intravenous proton pump inhibitor (PPI) infusion is commonly used following endoscopic hemostasis for bleeding peptic ulcers, despite uncertainty regarding its clinical advantage over intermittent administration. This systematic review and meta-analysis evaluated whether continuous infusion improves clinically relevant outcomes compared with intermittent intravenous bolus therapy. <b>Methods</b>: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted from inception through to 29 June 2026 to identify randomized controlled trials. Effect estimates were pooled using random-effects models with restricted maximum-likelihood estimation and Hartung-Knapp adjustment. Risk of bias was assessed using RoB 2 and certainty of evidence using GRADE. The protocol was retrospectively registered on OSF. <b>Results</b>: Twelve randomized controlled trials involving 1726 participants were included. Across 11 trials (1621 participants), the pooled estimate did not demonstrate a statistically significant reduction in overall rebleeding with continuous infusion compared with intermittent bolus therapy (RR 0.93, 95% CI 0.65-1.35; I² = 1.4%). Likewise, the pooled estimates did not demonstrate superiority of continuous infusion for rebleeding within 24 h (RR 0.70, 95% CI 0.09-5.64), rebleeding within 7 days (RR 1.07, 95% CI 0.66-1.72), surgery (RR 1.42, 95% CI 0.80-2.53), or mortality (RR 1.76, 95% CI 0.90-3.44). Moderate-certainty evidence indicated little or no clinically important difference in blood units transfused or hospital stay. Certainty was very low for rebleeding outcomes and low for surgery and mortality. <b>Conclusions</b>: Continuous intravenous PPI infusion was not shown to be superior to intermittent intravenous bolus therapy following successful endoscopic hemostasis. However, the very low- to low-certainty evidence for rebleeding, surgery, and mortality establishes neither equivalence nor noninferiority and does not exclude clinically important benefit or harm. The available trials do not identify the optimal intermittent dose or dosing frequency.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194225","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":"IgM- and IgA-Enriched Polyclonal Intravenous Immunoglobulin Therapy in Sepsis: A Single-Center Retrospective Cohort Study.","authors":"Hakan Yılmaz, Melek Tulunay, Ali Abbas Yılmaz","doi":"10.3390/jcm15197731","DOIUrl":"10.3390/jcm15197731","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Evidence for adjunctive intravenous immunoglobulin therapy in sepsis remains conflicting. This study evaluated the association of IgM- and IgA-enriched polyclonal intravenous immunoglobulin (IgGAM) therapy with clinical outcomes, including post hoc analyses according to initial empiric antibiotic therapy (IEAT) appropriateness. <b>Methods</b>: This single-center retrospective cohort study included 50 adults with sepsis or septic shock according to Sepsis-3 criteria, treated between November 2006 and March 2010. Twenty-five patients received adjunctive IgGAM plus standard sepsis management, and 25 received standard management alone. Primary outcomes were 28-day intensive care unit (ICU) mortality, overall ICU mortality, and in-hospital mortality. <b>Results</b>: Overall, 28-day ICU mortality was 28.0% with IgGAM and 32.0% with control (relative risk, 0.88; 95% confidence interval [CI], 0.37-2.05; <i>p</i> = 0.758); other mortality outcomes did not differ significantly. Kaplan-Meier survival distributions also did not differ significantly (log-rank <i>p</i> = 0.208). During the ICU stay, vasopressor therapy was required in 68% of the IgGAM group and 92% of the control group (<i>p</i> = 0.034); corresponding study day 1 requirements were 60% and 76% (<i>p</i> = 0.225). In the complete-case longitudinal analysis (IgGAM group, <i>n</i> = 20; control group, <i>n</i> = 25), SOFA scores decreased significantly over time within the IgGAM group (<i>p</i> = 0.017), whereas no significant within-group change was observed in the control group (<i>p</i> = 0.616). In the post hoc appropriate-IEAT subgroup, 28-day ICU mortality was 0.0% versus 36.8% (<i>p</i> = 0.026), in-hospital mortality was 25.0% versus 63.2% (<i>p</i> = 0.038), and Kaplan-Meier survival distributions differed significantly (log-rank <i>p</i> = 0.004). The 60-day restricted mean survival time was 58.1 versus 38.4 days, with a difference of 19.8 days (95% CI, 11.1-28.4). <b>Conclusions</b>: Adjunctive IgGAM therapy was not associated with significant differences in mortality overall. Findings in the post hoc appropriate-IEAT subgroup were hypothesis-generating and should be interpreted cautiously given potential selection bias, residual confounding, and multiple comparisons. Prospective evaluation within optimized sepsis care is warranted.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194261","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":"From Quiet Asthma to Clinical Remission: Can Optimized Maximal Inhaled Therapy Achieve Biologic-Free Remission in Difficult-to-Treat and Severe Asthma?","authors":"Vitaliano Nicola Quaranta, Silvano Dragonieri, Gianmarco Manzetti, Alessandra Tomasello, Alida Benfante, Nicola Scichilone, Paola Rogliani, Giovanna Elisiana Carpagnano","doi":"10.3390/jcm15197757","DOIUrl":"10.3390/jcm15197757","url":null,"abstract":"<p><p>Clinical remission, defined as sustained multidomain disease stability encompassing symptom control, freedom from exacerbations and from maintenance oral corticosteroid use, and stable or improved lung function, has emerged as a major therapeutic goal in severe asthma, largely driven by the success of biologic therapies. Consequently, remission is often regarded as an outcome primarily achievable through biologic treatment, whereas the potential contribution of optimized inhaled triple therapy has received comparatively less attention. This narrative review examines the evidence supporting biologic-free clinical remission across difficult-to-treat and severe asthma populations and explores the mechanisms that may contribute to sustained multidomain disease stability during optimized inhaled triple therapy. Importantly, we distinguish remission achieved after correction of previously unrecognized modifiable factors-which may reflect successful management of difficult-to-treat asthma-from on-treatment remission occurring in patients in whom severe asthma had already been established after appropriate treatment optimization. We review contemporary remission definitions, the biological rationale for remission achieved during optimized inhaled therapy, and evidence from historical cohorts, national registries, randomized clinical trials, post hoc analyses, and prospective real-world studies. Collectively, these data indicate that optimized inhaled triple therapy can be associated with clinically meaningful multidomain disease-stability states and, when established remission criteria are fulfilled, clinical remission, although the strength of evidence specifically in patients fulfilling current severe-asthma criteria remains more limited. Particular emphasis is placed on the contribution of small-airway dysfunction, the evolution of the quiet asthma concept as a proposed small-airway remission phenotype, and the potential roles of pharmacological synergy, improved peripheral drug deposition, and restoration of distal airway homeostasis. We also discuss the durability of remission, the need for continued multidomain follow-up, and the clinical and health-economic implications of achieving remission without biologic therapy. Current evidence suggests that optimized inhaled triple therapy should be considered not only a key component of severe asthma management but also a potential remission-oriented strategy in appropriately selected patients, including those who may achieve remission without subsequent biologic escalation. Future research should identify the phenotypes most likely to achieve biologic-free remission, clarify the underlying mechanisms, and prospectively validate remission-oriented inhaled treatment strategies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194288","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":"Real-World Evaluation of the Immune Checkpoint Inhibitor Score (IChIS) in Advanced Non-Small Cell Lung Cancer Treated with Immunotherapy.","authors":"İsmail Dilli, Engin Eren Kavak, Mehmetcan Atak, Selahattin Çelik, Özlem Aydın İsak, Esra Zeynelgil, Doğan Yazılıtaş","doi":"10.3390/jcm15197750","DOIUrl":"10.3390/jcm15197750","url":null,"abstract":"<p><p><b>Background:</b> The Immune Checkpoint Inhibitor Score (IChIS), an inflammation-based biomarker incorporating neutrophil and immature granulocyte counts, was recently developed to predict outcomes in patients with advanced non-small cell lung cancer (NSCLC) receiving immune checkpoint inhibitors (ICIs). However, evidence regarding its prognostic performance in independent real-world populations remains limited. We aimed to evaluate the prognostic significance of IChIS in a real-world cohort of patients with advanced NSCLC treated with immunotherapy. <b>Methods:</b> This retrospective single-center cohort study included 169 patients with advanced, recurrent, or metastatic NSCLC who received ICIs with palliative intent between September 2022 and December 2025. IChIS ranged from 0 to 2 and was analyzed as a categorical variable, with IChIS 0 as the reference category. The primary endpoint was progression-free survival (PFS), while overall survival (OS) was evaluated as a secondary exploratory endpoint. Survival outcomes were estimated using the Kaplan-Meier method and evaluated using Cox proportional hazards regression. Multivariable models included ICI treatment line as a clinically relevant potential confounder. <b>Results:</b> A total of 169 patients were included. The median follow-up was 14.1 months. IChIS 0, 1, and 2 were observed in 105 (62.1%), 33 (19.5%), and 31 (18.4%) patients, respectively. Median PFS decreased across increasing IChIS categories. In multivariable Cox regression analysis, compared with IChIS 0, both IChIS 1 (adjusted HR 1.61, 95% CI 1.00-2.59; <i>p</i> = 0.04) and IChIS 2 (adjusted HR 3.63, 95% CI 2.22-5.92; <i>p</i> < 0.001) were independently associated with shorter PFS. For OS, IChIS 1 was not significantly associated with outcome (adjusted HR 1.51, 95% CI 0.86-2.64; <i>p</i> = 0.15), whereas IChIS 2 was independently associated with shorter OS (adjusted HR 4.40, 95% CI 2.53-7.64; <i>p</i> < 0.001). <b>Conclusions:</b> Higher IChIS was independently associated with shorter PFS in patients with advanced NSCLC receiving ICIs, supporting its potential role as a simple and readily available prognostic biomarker. The association with OS was primarily observed in patients with IChIS 2 and should be interpreted cautiously given the relatively short follow-up. Prospective multicenter validation is warranted.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194433","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":"Multidisciplinary Management of Neuroendocrine Neoplasms Beyond Centers of Excellence: Retrospective Real-World Data from a Referral Center in Eastern Europe.","authors":"Irina Sandra, Elena Gabriela Chiorean, Irina Mihaela Cazacu-Croitoru, Vlad Mihai Croitoru, Simona Olimpia Dima, Adrian Goldiș, Carmen Monica Preda, Rucsandra-Ilinca Diculescu, Adina Emilia Croitoru, Mircea Mihai Diculescu","doi":"10.3390/jcm15197762","DOIUrl":"10.3390/jcm15197762","url":null,"abstract":"<p><p><b>Background and Objectives:</b> Neuroendocrine neoplasms (NENs) require multidisciplinary management, yet access to advanced imaging and therapies is uneven across Europe. We aimed to describe real-world management of NENs in an Eastern Europe referral center. <b>Methods:</b> This retrospective single-center study included 192 NEN patients treated between 2011 and 2026 at a national referral center in Romania. <b>Results:</b> Most tumors were well-differentiated (88%), pancreatic primary (59.9%), and non-functioning (77.1%); 51.0% were metastatic at diagnosis. Overall, 30.7% (<i>n</i> = 59) of patients underwent somatostatin receptor imaging, mainly with locally available 99mTc-HYNIC-TOC scintigraphy (<i>n</i> = 56). Among therapeutic modalities, 68.2% of patients underwent conventional systemic therapy and 69.3% had surgery (R0 resection was achieved in 98.9% of curative-intent surgeries; recurrence rate 40%). Peptide receptor radionuclide therapy (PRRT) was performed in 14.6% (19/130) of metastatic NENs and liver-directed therapy (LDT) in 13.6% (16/118) of NENs with liver metastases. Median time to treatment was 78 days for somatostatin analogs, 29 days for chemotherapy in neuroendocrine carcinoma, 30 days for surgery, 62.5 days for LDT, and 144 days for PRRT. <b>Conclusions:</b> This is one of the few reports on real-world management of NENs in an Eastern European tertiary care referral center, which highlights the available multidisciplinary care but also the challenges in diagnostics and therapeutic access for patients with NEN.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194447","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":"How to Complete a Gynecological Robot-Assisted Retroperitoneal Lymph Node Dissection with a High-Quality Experience: 180 Cases in a Single Center.","authors":"Zixi Liu, Lei Dou","doi":"10.3390/jcm15197746","DOIUrl":"10.3390/jcm15197746","url":null,"abstract":"<p><p><b>Background</b>: This study seeks to provide a comprehensive overview of robotic retroperitoneal lymphadenectomy in patients with endometrial cancer, including surgical techniques, quality enhancement, and complication reduction. <b>Methods</b>: A cohort of 180 endometrial cancer patients who underwent retroperitoneal lymphadenectomy with the Da Vinci robotic surgical system in the gynecology department from November 2017 to June 2023 was compared to 195 patients who underwent laparoscopic retroperitoneal lymphadenectomy during the same period as controls. <b>Results</b>: In surgical interventions, the robotic retroperitoneal lymphadenectomy demonstrated superior results compared to laparoscopic surgery, including shorter surgical duration (165 vs. 180 min, <i>p</i> = 0.03), reduced intraoperative bleeding 45 vs. 65 mL, <i>p</i> = 0.04, lower incidence of postoperative complications 19 vs. 33, <i>p</i> = 0.03, and higher rates of complete lymph node resections 25 vs. 20, <i>p</i> = 0.02. Notably, the robotic approach excelled in the retrieval of high para-aortic lymph nodes, particularly in the superior region of the inferior mesenteric artery 5 vs. 3, <i>p</i> = 0.04. In postoperative recovery, the robot group also exhibited significant advantages over the laparoscopic group in various outcomes, including postoperative anal exhaust time 47 vs. 55, <i>p</i> = 0.02, first time out of bed activity time 8 vs. 9, <i>p</i> = 0.04, postoperative hospital stay 2 vs. 4, <i>p</i> = 0.01, and VAS score 4.0 vs. 4.6, <i>p</i> = 0.04, 2.9 vs. 3.4, <i>p</i> = 0.03, 1.1 vs. 1.8, <i>p</i> = 0.04. In surgical outcomes, there was no statistically significant variance observed between the two groups. <b>Conclusions</b>: Robot retroperitoneal lymphadenectomy still follows the classic surgical steps of oncology principles. Summarizing surgical techniques can effectively improve surgical quality and reduce surgical complications.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194193","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":"MRI-Based Morphologic Patterns of the Peroneus Quartus in a Korean Clinical Cohort: An Anatomical Study with an Illustrative Surgical Case.","authors":"Otgonsaikhan Nomkhondorj, Ye-Chan Choi, Jeong-Hyun Park, Hyung-Wook Kwon, Digud Kim, Yu-Jin Choi, Yunil Choe, Kwang-Rak Park, Jaeho Cho","doi":"10.3390/jcm15197732","DOIUrl":"10.3390/jcm15197732","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The peroneus quartus (PQ) is an accessory musculotendinous structure of the lateral leg with variable origin and distal attachment. Although its anatomy has been described in cadaveric and imaging studies, the morphologic patterns encountered on routine ankle MRI remain clinically relevant. This study aimed to characterize MRI-visible PQ morphology in a Korean clinical cohort and to compare the observed patterns with previously reported anatomical variants. An illustrative surgically treated case was also reviewed. <b>Methods:</b> Three hundred ankle MRI examinations obtained between February 2020 and February 2024 were reviewed. After exclusion of 33 examinations in which the peroneal compartment could not be reliably assessed, 267 unique patients were included. Two readers independently evaluated PQ presence and distal attachment using predefined MRI criteria. Interobserver agreement was assessed with Cohen's kappa. The surgically treated case was reviewed separately as an illustrative clinical correlation. <b>Results:</b> A PQ was identified in 41 of 267 ankles (15.4%; 95% CI, 11.5-20.2%). The proximal origin was directly visualized in 32 PQ-positive examinations, arising from the peroneus brevis in 19 and the distal fibula in 13; in nine examinations, the origin was outside the MRI field of view. Thirty-five PQs (85.4%) inserted into the retrotrochlear calcaneal region, whereas six (14.6%) joined the peroneus longus tendon distally. Interobserver agreement was complete for both PQ detection and distal attachment classification (κ = 1.00). In the illustrative case, a symptomatic ganglion was associated with an operatively confirmed degenerative PQ tendon tear. <b>Conclusions:</b> The PQ was identified in 15.4% of ankle MRIs in this selected Korean clinical cohort and showed two predominant MRI-visible distal attachment patterns. Most inserted into the retrotrochlear calcaneal region, whereas a smaller proportion joined the peroneus longus tendon. These findings describe MRI-visible anatomy rather than the full anatomical spectrum. The surgical case further illustrates that symptomatic pathology may involve the PQ tendon and its adjacent sheath.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194408","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}