Journal of Clinical Medicine最新文献

{"title":"Diagnostic Performance of Prenatal Ultrasound to Detect Velamentous Cord Insertion in Twin Pregnancies.","authors":"Kodai Minoura, Hiroyuki Tsuda, Yumiko Itoh, Atsuko Tezuka, Tomoko Ando","doi":"10.3390/jcm15083168","DOIUrl":"10.3390/jcm15083168","url":null,"abstract":"<p><p><b>Objective:</b> We aimed to determine the ability of prenatal ultrasound to detect velamentous cord insertion (VCI) in twin pregnancies and identify factors influencing diagnostic sensitivity. <b>Methods:</b> This single-center retrospective study included twins delivered between April 2018 and March 2024. We excluded monochorionic monoamniotic twins, those without chorionicity or umbilical cord insertion data, and fetuses that died in utero. Umbilical cord insertion sites assessed by second-trimester transabdominal ultrasound (16 + 0 to 21 + 6 weeks of gestation) using color Doppler imaging were classified as normal, marginal, or velamentous. The results of postnatal macroscopic examinations served as reference standards. We calculated accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. The effects of examiner expertise, chorionicity, placental location, ultrasound device, and maternal body mass index (BMI) on diagnostic sensitivity were analyzed in subgroups. <b>Results:</b> We confirmed VCI in 45 (8.8%) of 514 delivered fetuses. Prenatal ultrasound correctly identified 14 VCI cases. Sensitivity, specificity, PPV, and NPV were 31.1% (14/45), 98.9% (464/469), 73.7% (14/19), and 93.7% (464/495), respectively. The overall accuracy was 93.0% (478/514). Sensitivity was significantly higher when ultrasound specialists conducted examinations compared with non-specialists and when twins were monochorionic diamniotic twins than dichorionic. Anterior placental location and high-performance ultrasound equipment were also associated with increased sensitivity, but were not statistically significant. Maternal BMI did not affect diagnostic sensitivity. <b>Conclusions:</b> Prenatal ultrasonographic detection of VCI in twin pregnancies has high specificity but limited sensitivity. Diagnostic performance was influenced by examiners' experience and chorionicity. Routine assessment of cord insertion sites and targeted training might improve detection and support the optimized perinatal management of twin pregnancies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13118110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815907","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":"Short-Term Effects of Structured Physical Activity With or Without Dietary Counselling in Early-Stage Chronic Kidney Disease Managed in Primary Care: A Non-Randomised Controlled Study.","authors":"Lorena Bosnar Zelenika, Dragana Tišma, Tamara Ciko, Pero Hrabač, Ivana Vuković Brinar, Valerija Bralić Lang","doi":"10.3390/jcm15083169","DOIUrl":"10.3390/jcm15083169","url":null,"abstract":"<p><p><b>Background/Objectives:</b> To evaluate the short-term effects of structured physical activity (PA), alone or combined with dietary counselling, in early-stage chronic kidney disease (CKD) patients managed in primary healthcare (PHC). <b>Methods</b>: This non-randomised controlled study was conducted in Croatia from 1 September to 30 November 2025. Ninety adults aged 40-75 years with early-stage CKD were allocated to three groups: structured PA, combined PA and dietary counselling, or control. Interventions included kinesiologist-led PA and, in the combined group, dietitian-led Mediterranean/plant-based counselling. Outcomes included estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (ACR), cardiometabolic risk factors, behavioural measures, quality of life, and sleep quality. Statistical significance was set at <i>p</i> < 0.01. <b>Results:</b> Seventy-eight participants completed follow-up. Changes in eGFR did not differ between groups (<i>p</i> = 0.310). Mean ± standard deviation changes in ACR were -1.10 ± 6.37, -0.86 ± 2.88, and +1.18 ± 3.13 in the PA, combined, and control groups, respectively (<i>p</i> = 0.017, not meeting the prespecified significance threshold). Significant between-group differences were observed for selected patient-reported and PA outcomes, including emotional well-being, energy/fatigue, role limitations due to emotional problems, sedentary time, and total PA (all <i>p</i> ≤ 0.006). <b>Conclusions:</b> Structured PA, with or without dietary counselling, improved PA behaviour and selected patient-reported outcomes in early-stage CKD managed in PHC but did not demonstrate significant short-term effects on kidney-related outcomes. These findings support the feasibility of integrating lifestyle-oriented interventions into PHC as part of integrated CKD care, while larger, longer-term studies are needed.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815938","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":"A Novel Percutaneous Technique for Coaxial Treatment of Large Coronary Vessel Perforations-The RIP (Rip and Inflate in Perforations) Technique.","authors":"Maximilian Will, Konstantin Schwarz, Gregor Leibundgut","doi":"10.3390/jcm15083163","DOIUrl":"10.3390/jcm15083163","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Coronary perforations are infrequent but potentially fatal complications during percutaneous coronary intervention (PCI). Interventional management aims to stop extravasation and restore distal flow to prevent tamponade and cardiogenic shock. In current practice, the ping-pong technique is recommended to ensure sealing of the perforation during covered stent delivery. However, this method is complex, time-consuming, and requires a second vascular access. Therefore, we developed a technique that seals the perforation and enables covered stent implantation using a single guide catheter. <b>Methods</b>: This technical note describes a novel technique in which a guide extension catheter (GEC) can be advanced across a vascular perforation after balloon inflation. The insertion of the GEC is made possible by detachment of the balloon hypotube. To minimize leakage, a regular coronary wire introducer needle is attached to the snapped hypotube after GEC loading and continuously inflated to hold nominal pressure. Advancement of the GEC across the perforation immediately limits hemorrhage and facilitates covered stent deployment via a single vascular access. The technique was first evaluated in bench testing and subsequently applied in three illustrative clinical cases at a tertiary referral center using standard, commercially available devices. <b>Results</b>: Bench testing confirmed the reproducibility of the ripping maneuver and successful ballon inflation over enough time to advance the GEC with the introducer married with the ripped hypotube. In all clinical cases, the GEC was successfully advanced across the perforation, allowing prompt covered stent deployment where necessary using a single guide catheter and access site without technical failure. <b>Conclusions</b>: The RIP (Rip and Inflate in Perforations)-technique is a feasible and reproducible alternative to the ping-pong technique. Bench validation and initial clinical application suggest that it may simplify the management of large-vessel perforations while reducing procedural complexity and the need for additional vascular access.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13118204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815738","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":"Differential Effects of Oral Antidiabetic Drugs on Skeletal Muscle Mass and Hemoglobin Levels in Adults with Type 2 Diabetes Mellitus: A Prospective Real-World Cohort Study.","authors":"Fatma Pınar Ziyadanoğlu, Ece Çiftçi Öztürk, Gamze Şengün, Seher İrem Şahin, Büşra Çetintulum Aydın, Hayriye Esra Ataoğlu","doi":"10.3390/jcm15083172","DOIUrl":"10.3390/jcm15083172","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Beyond glycemic control, oral antidiabetic drugs (OADs) may exert class-specific effects on muscle mass and hematologic parameters. However, real-world evidence comparing these effects across OAD classes remains limited. This study aimed to evaluate the differential effects of commonly prescribed OADs on skeletal muscle mass (SMM) and hemoglobin (Hb) levels in adults with type 2 diabetes mellitus (T2DM). <b>Methods:</b> In this prospective observational cohort study, 60 adults with newly initiated OAD therapy were followed for six months at a tertiary care center in Türkiye. Patients were classified according to the OAD class newly added to their regimen (metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, pioglitazone, or sodium-glucose cotransporter-2 inhibitors [SGLT2-i]). Multi-frequency bioelectrical impedance analysis was used to evaluate body composition, and hematologic parameters including Hb were obtained at both time points. To account for potential confounders-including age, sex, BMI, baseline Hb, and eGFR-binary logistic regression analyses were performed. <b>Results:</b> Patients initiated on pioglitazone (n = 11) demonstrated a borderline within-group increase in SMM in unadjusted analysis (median delta +0.17 kg, IQR -0.55 to +0.50; <i>p</i> = 0.050); however, this association was attenuated and no longer statistically significant after multivariable adjustment (OR 2.16, 95% CI 0.60-7.83; <i>p</i> = 0.240). In contrast, SGLT2-i users (n = 28) showed a significant increase in Hb (median delta +0.10 g/dL, IQR -0.30 to +0.50; <i>p</i> = 0.022), which remained significant after adjustment (OR 4.22, 95% CI 1.32-13.44; <i>p</i> = 0.015). Other OAD classes were not associated with meaningful changes in SMM or Hb. <b>Conclusions:</b> In this real-world prospective cohort, pioglitazone showed a trend toward increased SMM in unadjusted analysis that did not reach significance after adjustment, suggesting a hypothesis-generating signal warranting further investigation. SGLT2 inhibitors were independently associated with increased Hb levels, though the observed median increment was modest in absolute terms. These findings highlight potentially clinically relevant, non-glycemic effects of OAD classes and may inform individualized treatment selection, particularly in patients at risk of sarcopenia or anemia. Adequately powered, prospective studies are needed to validate and extend these preliminary observations.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13116796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815821","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":"Management of Ogilvie's Syndrome: A Network Meta-Analysis.","authors":"Orestis Ioannidis, Christos Chatzakis, Ioannis Mitrogiannis, Elissavet Anestiadou, Aliki Brenta, Savvas Symeonidis, Stefanos Bitsianis, Efstathios Kotidis, Manousos George Pramateftakis, Ioannis Mantzoros, Stamatios Angelopoulos","doi":"10.3390/jcm15083177","DOIUrl":"10.3390/jcm15083177","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Ogilvie's syndrome, or acute colonic pseudo-obstruction (ACPO), is defined by acute colonic dilatation without mechanical obstruction and carries a risk of ischemia and perforation if not promptly managed. Treatment strategies include conservative supportive care, neostigmine administration, colonoscopic decompression, and combinations of these approaches. The aim of this study was to compare the relative effectiveness of these interventions for symptom resolution using a network meta-analysis. <b>Methods:</b> A systematic search of PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and grey literature was conducted from inception in February 2025 to November 2025. Prospective cohort and case-control studies evaluating conservative supportive care, neostigmine, colonoscopic decompression, or their combinations were included. A random-effects network meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS). <b>Results:</b> Four studies comprising 172 patients were included. Compared with supportive care alone, supportive care combined with neostigmine was associated with higher odds of symptom resolution (network OR 13.86, 95% CI 3.06-62.83). Supportive care combined with colonoscopic decompression demonstrated an even greater effect (network OR 65.65, 95% CI 11.70-368.50). Colonoscopic decompression versus neostigmine yielded a network OR of 4.74 (95% CI 1.17-19.25). SUCRA rankings indicated that colonoscopic decompression combined with supportive care had the highest probability of being the most effective strategy. <b>Conclusions:</b> Active interventions, particularly colonoscopic decompression or neostigmine combined with supportive care, were associated with a higher incidence of symptom resolution compared to supportive care alone. Larger comparative studies are needed to confirm these findings and refine treatment selection.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815853","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 Edward, R. Comment on \"Fernandez Martin et al. Analgesia for Upper Abdominal Surgery, a Scoping Review of the Current Fascial Plane Block Techniques. <i>J. Clin. Med.</i> 2025, <i>14</i>, 8632\".","authors":"Maria T Fernandez Martin, Edward R Mariano, Luis F Valdes-Vilches, Servando Lopez Alvarez, Nabil Elkassabany","doi":"10.3390/jcm15083152","DOIUrl":"10.3390/jcm15083152","url":null,"abstract":"<p><p>Dear Editor, [...].</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815994","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":"Ultrasound Characteristics of an Isolated Redundant Foramen Ovale Flap in Fetuses and Its Differential Diagnosis from Aortic Coarctation.","authors":"Liya Li, Yuxin Li, Shijie Zhang, Shaozheng He, Qiuyue Chen, Guorong Lyu","doi":"10.3390/jcm15083166","DOIUrl":"10.3390/jcm15083166","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the potential utility of the ratio of the maximal diameter of the bulging foramen ovale flap to the left atrial diameter (FOFD/LAD) for distinguishing false-positive prenatal suspicion of fetal coarctation of the aorta (CoA), and to examine its association with fetal cardiac structural parameters. <b>Materials and Methods:</b> This retrospective study included a selected referral cohort of 44 fetuses with prenatal suspicion of CoA, who were classified postnatally into the false-positive prenatal suspicion group (<i>n</i> = 29) or the true CoA group (<i>n</i> = 15), along with 50 gestational age-matched controls. FOFD, LAD, atrial and ventricular diameters, great-vessel diameters, and aortic isthmus Z-scores were measured. Associations were assessed using Spearman rank correlation, and intergroup differences were evaluated using the Kruskal-Wallis test with Bonferroni-adjusted Mann-Whitney U tests. <b>Results:</b> FOFD/LAD was significantly higher in the false-positive prenatal suspicion group than in the true CoA and control groups (all <i>p</i> < 0.001), whereas no difference was observed between the true CoA and control groups (<i>p</i> = 0.059). In the false-positive and control groups, FOFD/LAD was positively associated with RAD/LAD, RVD/LVD, and PAD/AoD (all <i>p</i> < 0.001). Both suspected CoA groups showed higher right-to-left cardiac structural ratios and aortic isthmus Z-scores than controls (all <i>p</i> < 0.001), but these indices did not differ between false-positive prenatal suspicion and true CoA cases. <b>Conclusions:</b> In a selected cohort of fetuses with prenatal suspicion of CoA, an increased FOFD/LAD may reflect the presence of a redundant foramen ovale flap and may serve as a promising adjunctive parameter for distinguishing RFOF-related CoA mimicry from true CoA. However, given the limited sample size and moderate reproducibility, these findings should be considered exploratory and require validation in larger independent cohorts.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816078","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":"The Potential Role of Large Language Models in Assisting Patients and Guiding Emergency Care Visits.","authors":"Kristina Gerhardinger, Josina Straub, Julia Lenz, Siegmund Lang, Volker Alt, Borys Frankewycz, Maximilian Kerschbaum, Lisa Klute","doi":"10.3390/jcm15083170","DOIUrl":"10.3390/jcm15083170","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Overcrowding in emergency departments (EDs) remains a critical challenge in modern healthcare systems, driven in part by patient uncertainty regarding symptom urgency and a lack of accessible medical guidance. Recent advances in artificial intelligence, particularly large language models (LLMs), present a novel opportunity to support patient navigation and relieve pressure on ED infrastructures. <b>Methods</b>: A total of 238 unique patient questions were identified through a structured web search. Following deduplication and thematic clustering, 15 representative questions were selected. Each question was submitted to the three LLMs-ChatGPT (v3.5), DeepSeek, and Gemini-using a standardized prompt. Responses were assessed by clinical experts (N = 8) who were blinded to the model source. Reviewers selected the best overall response per question, as well as the individual responses of the three LLMs for each respective question. <b>Results</b>: ChatGPT was selected as the best-performing model in 60% of cases, with DeepSeek and Gemini selected in 23% and 17%, respectively. ChatGPT responses also achieved the highest proportion of \"excellent\" quality ratings and the lowest proportion of \"unsatisfactory\" outputs. Across all models, clarity was the most positively rated domain (79% agreement), followed by empathy (72%), length/detail appropriateness (71%), and completeness (65%). Over two-thirds of raters expressed willingness to integrate LLM-based tools into clinical practice for patient education and pre-triage counseling. <b>Conclusions</b>: Large language models demonstrate promising capabilities in responding to emergency care-related patient queries. Their ability to deliver medically sound and communicatively effective answers positions them as potential digital adjuncts in the management of low-acuity ED presentations and prehospital triage.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13118221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816096","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":"Unexpected Positive Cultures After Failed Proximal Humerus Osteosynthesis: Why a Two-Stage Procedure Could Be Safer.","authors":"Raffaele Garofalo, Nunzio Lassandro, Angelo De Crescenzo, Riccardo Ranieri, Angelo Del Buono, Alberto Fontanarosa","doi":"10.3390/jcm15083162","DOIUrl":"10.3390/jcm15083162","url":null,"abstract":"<p><p><b>Background</b>: Treatment of failed osteosynthesis of fractures of the proximal humerus with one-stage or two-stage surgery is difficult and clinical results are poor. The aim of this work is to evaluate the microbiological positivity of devices removed due to osteosynthesis failure. Furthermore, the clinical outcomes of these patients were evaluated at a follow-up of minimum 6 months, to assess the recovery of range of motion and the reduction in pain. <b>Methods</b>: A retrospective analysis was performed on 15 patients treated from September 2021 to September 2023 for failure of previous proximal humerus synthesis. These treatments included implant removal and arthrolysis. None of these patients showed signs of infection. Demographic data, VAS, ASES, Constant score, and range of motion (ROM) were assessed before surgery and at least 6 months of follow-up. Removed devices were processed in MicroDTTect^® system, to increase the sensitivity of microbiological cultures. The cultural and clinical results of device removal surgery were analyzed. <b>Results</b>: Culture results were positive in eight out of 15 patients. Slow-growing anaerobic bacteria were the most isolated microorganisms, particularly <i>C. acnes</i> (62.5%). Improvement in patients' passive ROM was observed. The patients went from a preoperative VAS of 8.4 (±1.1) to a VAS of 2 (±1.1) at follow-up. Similarly, we observed an increase in ASES from 9 ± 6 to 50.2 ± 2.3 and Constant score from 17 (15-18) to 40.7 ± 3.3 at a follow-up of at least 6 months. <b>Conclusions</b>: Two-stage procedure should always be considered in the context of proximal humerus synthesis failure. Arthrolysis with postoperative physiotherapy prepares the shoulder for definitive prosthesis implantation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815498","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 Antiplatelet Use and Clinical Outcomes in Patients with Advanced Chronic Kidney Disease Following Acute Coronary Syndrome: A Descriptive Cohort Study.","authors":"Lama Alfehaid, Eman Alzahrani, Amani Alsubaie, Majed Almutairi, Mansour Alomran, Saleh Alghadeer","doi":"10.3390/jcm15083167","DOIUrl":"10.3390/jcm15083167","url":null,"abstract":"<p><p><b>Background:</b> Patients with advanced chronic kidney disease (CKD) experience disproportionately high ischemic and bleeding risks following acute coronary syndrome (ACS), yet remain markedly underrepresented in randomized trials of antiplatelet therapy. Consequently, real-world data describing antiplatelet prescribing patterns and clinical outcomes in this population are limited. <b>Objectives:</b> To describe real-world antiplatelet use and 12-month clinical outcomes in patients with advanced CKD and end-stage renal disease (ESRD) following ACS. <b>Methods:</b> We conducted a single-center, retrospective cohort study including adults with advanced CKD (stage 4-5) or dialysis-dependent ESRD hospitalized with ACS and discharged on dual antiplatelet therapy. Baseline characteristics, revascularization strategies, and clinical outcomes were collected. Outcomes of interest included all-cause mortality, recurrent ischemic events (recurrent myocardial infarction, stroke or transient ischemic attack, or repeat revascularization), and bleeding events defined by Thrombolysis in Myocardial Infarction (TIMI) criteria over 12 months. All analyses were descriptive in nature. <b>Results:</b> A total of 222 patients were included; clopidogrel was prescribed in 96.0% of patients and ticagrelor in 4.0%. The cohort was elderly, highly comorbid, and predominantly dialysis-dependent. At 12 months, all-cause mortality occurred in approximately one-third of patients, recurrent ischemic events were frequent, and bleeding complications were common. Most bleeding events occurred in dialysis-dependent individuals. Outcomes among ticagrelor-treated patients are reported descriptively only due to the very small sample size. <b>Conclusions:</b> In this real-world cohort of patients with advanced CKD and ESRD following ACS, a substantial burden of mortality, recurrent ischemic events, and bleeding complications was observed, underscoring the narrow therapeutic window in this high-risk population. These findings are descriptive and hypothesis-generating, supporting the need for individualized antiplatelet strategies and prospective studies specifically enrolling patients with advanced CKD.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 8","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13118201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815931","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}