Journal of Clinical Medicine最新文献

{"title":"Association of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture.","authors":"Ali Tecirli, Seyyid Serif Unsal, Tugrul Yildirim, Alp Karacoban","doi":"10.3390/jcm15197666","DOIUrl":"10.3390/jcm15197666","url":null,"abstract":"<p><p><b>Background/Objective</b>: Intraoperative femoral fractures during cementless hemiarthroplasty may present with distinct anatomical patterns. We examined whether surgical approach was associated with greater trochanteric versus stem-stable periprosthetic fracture patterns in older patients with osteoporotic-type femoral morphology; stem geometry was evaluated as an additional implant-related factor. <b>Methods</b>: We retrospectively reviewed 292 patients aged ≥75 years who underwent cementless bipolar hemiarthroplasty for low-energy displaced femoral neck fractures at a tertiary referral trauma center between January 2019 and July 2023. Patients were grouped according to stem geometry (fit-and-fill or tapered-wedge) and surgical approach (lateral or posterior). Associations were assessed using multivariable logistic regression, Firth-penalized regression, and stabilized inverse probability of treatment weighting (IPTW). <b>Results</b>: Intraoperative fractures occurred more frequently with the lateral approach than with the posterior approach (23.7% vs. 12.2%; <i>p</i> = 0.015), primarily because of greater trochanteric fractures (9.5% vs. 2.4%; <i>p</i> = 0.016). Periprosthetic fracture rates did not differ significantly between the approaches (14.2% vs. 9.8%; <i>p</i> = 0.284). In the Firth model, the posterior approach was associated with lower odds of greater trochanteric fracture (OR 0.25, 95% CI 0.08-0.80; <i>p</i> = 0.019); after IPTW, the corresponding estimate was OR 0.19 (95% CI 0.05-0.76; <i>p</i> = 0.019). <b>Conclusions</b>: The surgical approach was primarily associated with greater trochanteric fractures, whereas no independent association was observed with stem geometry. Pattern-specific analysis may provide a clearer characterization of intraoperative fracture associations in this setting.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194043","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":"Preoperative HALP Profiles in Serous and Mucinous Epithelial Ovarian Tumors: Positioning Borderline Tumors on the Benign-Malignant Spectrum.","authors":"Hanne Bulat Cim, Nisan Helin Dönmez, Melis Altuğ Inan, Fatma Ceren Gurel, Başak Cantürk Murt, Neslişah Ar, Ergül Demircivi, Abdulkadir Turgut","doi":"10.3390/jcm15197662","DOIUrl":"10.3390/jcm15197662","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Borderline ovarian tumors can overlap with benign and malignant adnexal masses in their preoperative features. The hemoglobin-albumin-lymphocyte-platelet (HALP) score reflects inflammatory and immunonutritional status. We compared HALP profiles across benign, borderline, and malignant epithelial ovarian tumors and secondarily explored their contribution beyond the risk of malignancy index (RMI). <b>Methods:</b> This retrospective single-center study included 464 women treated surgically for serous or mucinous epithelial ovarian tumors between 2015 and 2025: 164 benign cystadenomas, 78 borderline tumors, and 222 invasive carcinomas. HALP was compared among groups with additional adjustment for age and menopausal status. Regression and model-performance analyses were performed only in the borderline and malignant groups (<i>n</i> = 300). <b>Results:</b> Median HALP was lower in malignant tumors [28.6 (IQR 22.4)] than in benign [38.3 (23.8)] and borderline tumors [40.5 (21.4)] (both <i>p</i> < 0.001), whereas benign and borderline tumors were similar (<i>p</i> = 0.948). After adjustment, HALP remained lower in malignant tumors than in benign (adjusted median difference, -10.49; 95% CI, -15.47 to -4.55) and borderline tumors (-11.86; 95% CI, -18.63 to -5.84). In exploratory malignant-versus-borderline modeling, HALP was associated with malignant histology alone, but this association was attenuated after accounting for age and log-transformed RMI; adding HALP did not significantly improve model fit or discrimination. <b>Conclusions:</b> Preoperative HALP was consistently lower in malignant tumors, while borderline tumors resembled benign lesions. HALP may reflect systemic immunonutritional differences across pathological groups. Its incremental predictive role beyond established preoperative measures remains uncertain and requires external validation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194294","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":"Temporary Mechanical Circulatory Support in Acute Myocardial Infarction-Related Cardiogenic Shock: Lessons from Contemporary Randomized Trials.","authors":"Osama Odeh, Mariam Al-Bayati, Ali Abdulrazzaq, Ala W Abdallah, Kanval Shah","doi":"10.3390/jcm15197664","DOIUrl":"10.3390/jcm15197664","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Acute myocardial infarction-related cardiogenic shock (AMI-CS) remains associated with high mortality despite advances in revascularization, critical care, and temporary mechanical circulatory support (MCS). Recent randomized trials have challenged the concept of routine device-based therapy and highlighted the importance of matching MCS strategy to shock phenotype, timing, and patient risk profile. &lt;b&gt;Methods:&lt;/b&gt; We reviewed contemporary randomized clinical trials and prespecified or post hoc analyses evaluating temporary MCS strategies in adult patients with AMI-CS. PubMed was searched for English-language studies published from January 2021 through June 2026, focusing on intra-aortic balloon pump (IABP), microaxial flow pumps, and venoarterial extracorporeal membrane oxygenation (VA-ECMO/ECLS). Outcomes of interest included mortality, hemodynamic recovery, end-organ outcomes, and device-related complications. &lt;b&gt;Results:&lt;/b&gt; Recent randomized evidence demonstrates that no temporary MCS device provides universal benefit across the heterogeneous AMI-CS population. Routine IABP use has not been associated with improved survival and is now reserved for selected patients requiring modest circulatory support, bridge-to-decision strategies, or specific mechanical complications. The DanGer Shock trial provided the strongest contemporary randomized evidence supporting temporary MCS, demonstrating reduced 180-day mortality with routine Impella CP support in carefully selected patients with STEMI-related cardiogenic shock. However, this benefit was accompanied by increased major bleeding, limb ischemia, acute kidney injury, and renal replacement therapy. Prespecified secondary and exploratory post hoc analyses have generated hypotheses that treatment response may vary according to age, baseline hemodynamics, timing of support, and shock phenotype; however, these findings require prospective validation and should not be interpreted as established treatment-selection criteria. In contrast, ECLS-SHOCK, ECMO-CS, EURO SHOCK, and randomized meta-analytic data did not demonstrate a survival benefit for routine early VA-ECMO in broad AMI-CS populations and consistently identified higher rates of bleeding and vascular complications. Strategies for routine early left ventricular unloading during VA-ECMO have improved physiologic parameters but have not demonstrated a mortality benefit. &lt;b&gt;Conclusions:&lt;/b&gt; Contemporary randomized trials have shifted the role of temporary MCS in AMI-CS from routine device deployment toward individualized, phenotype-guided therapy. Impella CP, as evaluated in the DanGer Shock trial, currently provides the strongest randomized survival signal but should be applied selectively in patients with predominantly left ventricular failure treated within experienced shock systems. VA-ECMO remains an important rescue option in carefully selected patients with refractory circulatory collapse, severe hypoxemia, cardiac a","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194522","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":"Associations of Total, Leisure, Occupational, and Commuting Sedentary Behavior with Overweight/Obesity Among Adults in Saudi Arabia.","authors":"Abdullah Bandar Alansare","doi":"10.3390/jcm15197670","DOIUrl":"10.3390/jcm15197670","url":null,"abstract":"<p><p><b>Objectives:</b> To examine the associations of total, leisure, occupational, and commuting sedentary behavior (SB) with overweight/obesity among adults in Saudi Arabia and explore whether these associations differ by SB patterns (weekdays vs. weekends) and sex (men vs. women). <b>Methods:</b> This secondary analysis of a web-based, cross-sectional survey included 948 adults living in Saudi Arabia (mean age 29.7 years; 52.1% women; 55.4% with overweight/obesity). Total and domain-specific SB were estimated using the Arabic version of the Sedentary Behavior Questionnaire. Overweight/obesity was assessed using body mass index calculated from self-reported height and weight. Adjusted logistic regression models examined the associations of total and domain-specific SB with the odds of overweight/obesity, with analyses conducted across the week and separately for week-days and weekends and stratified by sex. <b>Results:</b> Higher total and leisure SB across the week and on weekdays were associated with 3.9% to 12.3% higher odds of overweight/obesity, particularly among men (<i>p</i> < 0.05 for all). However, occupational and commuting SB were not associated with the odds of overweight/obesity (<i>p</i> > 0.05 for all). Associations were not statistically significant among women (<i>p</i> > 0.05 for all). <b>Conclusions:</b> These findings highlight the potential importance of considering the domain and temporal pattern of SB, as well as sex, when examining its associations with overweight/obesity among adults in Saudi Arabia. Further longitudinal and intervention studies are needed to establish temporal and causal relationships between the domains of SB and overweight/obesity in this population.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194063","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":"Retinal Structural and Microvascular Findings During Novel NPR-B-Targeted Vosoritide Therapy in Children with Achondroplasia.","authors":"Anıl Ağaçkesen, Hasan Karakaş, Hande Turan, Elvan Bayramoğlu, Olcay Evliyaoğlu","doi":"10.3390/jcm15197661","DOIUrl":"10.3390/jcm15197661","url":null,"abstract":"<p><p><b>Background:</b> The aim of this study was to evaluate the short-term ocular findings during vosoritide therapy in children with achondroplasia using optical coherence tomography (OCT) and OCT angiography (OCTA). <b>Methods:</b> In this study, pediatric patients with genetically confirmed achondroplasia underwent standardised ophthalmologic examination, OCT, and OCTA imaging at baseline and after 12 months of vosoritide treatment. Structural parameters, including macular thickness and peripapillary retinal nerve fiber layer (RNFL), as well as vascular densities of the superficial and deep capillary plexuses and choriocapillaris, were analysed. Findings were compared longitudinally and with age- and sex-matched healthy controls. <b>Results:</b> A total of 12 patients and 12 controls were included. During the 12-month follow-up, nominal increases were observed in nasal parafoveal thickness and in average, superior, and nasal RNFL thickness (<i>p</i> < 0.05); however, none remained significant after false-discovery-rate correction. No significant longitudinal changes were detected in OCTA-derived vascular densities. However, vascular density was significantly lower in specific regions in the achondroplasia group compared to controls both before and after treatment. No clinically relevant ocular pathology was identified. <b>Conclusions:</b> No clinically apparent ocular abnormalities or statistically robust longitudinal changes in retinal structure or microvascular perfusion were identified over one year of vosoritide treatment in this small, preliminary cohort.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194190","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":"Hemodynamic and Metabolic Predictors of Unsuccessful Electrical Cardioversion or Early Atrial Fibrillation Recurrence After Electrical Cardioversion.","authors":"Paulina Skalska, Małgorzata Kurpaska, Beata Uziębło-Życzkowska, Paweł Krzesiński","doi":"10.3390/jcm15197667","DOIUrl":"10.3390/jcm15197667","url":null,"abstract":"<p><p><b>Background:</b> Rhythm control remains a cornerstone in the management of atrial fibrillation (AF). Although electrical cardioversion (ECV) effectively restores sinus rhythm (SR), its short-term durability is limited. <b>Aims</b>: This study aimed to evaluate the short-term rhythm outcomes after ECV and to identify predictors of failure to achieve or maintain SR within 30 days after ECV, with particular emphasis on the hemodynamic profile of patients with persistent AF. <b>Methods:</b> Ninety-four consecutive patients with persistent AF undergoing elective ECV were prospectively enrolled. Cardiac rhythm was assessed immediately after ECV, at ~24 h, and ~30 days. Laboratory testing, echocardiography, and impedance cardiography (ICG) were performed before ECV. Logistic regression analysis was used to identify predictors of failure to achieve or maintain SR within 30 days after ECV. <b>Results:</b> ECV was initially successful in 80 patients (85.1%), with SR maintained in 76 (80.8%) at 24 h. At 30 days, SR persisted in 49 patients (52.1%), while 43 patients (45.7%) failed to achieve or maintain SR, including 14 patients in whom ECV was unsuccessful and 29 patients who experienced AF recurrence after initially successful ECV; two patients were lost to follow-up. In multivariable analysis, T2DM was independently associated with higher odds of failure to achieve or maintain SR within 30 days after ECV (OR 3.26; 95% CI 1.183-8.978; <i>p</i> = 0.022). Higher TFC values were also independently associated with increased odds of this outcome (OR 1.15; 95% CI 1.017-1.291; <i>p</i> = 0.025). In contrast, the presence of hypertension was associated with lower odds of this outcome (OR 0.30; 95% CI 0.094-0.947; <i>p</i> = 0.040). Among hemodynamic parameters, only TFC was independently associated with the outcome, whereas echocardiographic parameters did not differ between groups. <b>Conclusions:</b> Even in a relatively low-risk population without advanced comorbidity burden, failure to achieve or maintain SR after ECV remains frequent. T2DM and elevated TFC were independently associated with failure to achieve or maintain SR, while hypertension was associated with a lower risk. These findings suggest that metabolic and hemodynamic abnormalities may provide prognostic information beyond that captured by conventional echocardiography.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194461","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":"Interocular Differences in Visual Acuity and Refractive Status Between Unilateral Early and Late Age-Related Macular Degeneration: A Nationwide Population-Based Study.","authors":"Chang Gu Kang, Su Kang Kim, Hyungoo Kang, Sang-Il Park","doi":"10.3390/jcm15197672","DOIUrl":"10.3390/jcm15197672","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Age-related macular degeneration (AMD) may affect the two eyes asymmetrically, but visual impairment is commonly classified by visual acuity (VA) in the better-seeing eye. We compared interocular-presenting VA differences in unilateral early versus late AMD, assessed the association between late AMD and worse VA in the AMD-affected eye, and compared refractive status between the affected and fellow eyes. <b>Methods:</b> We analyzed 1112 adults aged ≥40 years with unilateral AMD (1049 early and 63 late) from the 2017-2020 Korea National Health and Nutrition Examination Survey. Interocular VA difference was calculated as the logMAR VA of the AMD-affected eye minus that of the fellow eye. Survey-weighted modified Poisson regression estimated prevalence ratios (PRs), adjusting for age, sex, anisometropia, and the interocular difference in absolute spherical equivalent refraction. Exploratory analyses examined neovascular AMD and geographic atrophy separately, and sensitivity analyses assessed alternative model specifications. <b>Results:</b> Mean interocular differences were -0.004 logMAR (95% confidence interval [CI], -0.016 to 0.008) in early AMD and 0.184 logMAR (95% CI, 0.077 to 0.291) in late AMD. The weighted proportions with VA ≥ 0.2 logMAR worse in the AMD-affected eye were 10.15% and 58.31%, respectively. The adjusted PR for this outcome was 4.95 (95% CI, 3.46-7.09; <i>p</i> < 0.001) for late versus early AMD. Exploratory subtype-specific analyses showed similar associations for neovascular AMD and geographic atrophy. No statistically significant interocular differences in refractive status or astigmatism severity were detected; however, the wide 95% CIs, particularly in the late AMD group, precluded conclusions of equivalence. <b>Conclusions</b>: Unilateral late AMD was associated with greater interocular presenting VA asymmetry than early AMD, and the association remained consistent across sensitivity analyses. However, these cross-sectional findings do not establish longitudinal progression or directly demonstrate implications for spectacle prescribing or binocular visual function.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194292","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":"Macular Holes Secondary to Macular Telangiectasia Type 2: Pathogenesis, Clinical Features, Imaging and Surgical Management.","authors":"Lihteh Wu, Genesis Chen-Li","doi":"10.3390/jcm15197673","DOIUrl":"10.3390/jcm15197673","url":null,"abstract":"<p><p>Full-thickness macular holes (FTMHs) are a rare but recognized complication of macular telangiectasia type 2 (MacTel2). Unlike idiopathic FTMHs, which are primarily driven by vitreofoveal traction, MacTel2-associated holes appear to arise predominantly from progressive neurodegenerative changes. Müller cell dysfunction, intraretinal cavitation, and outer retinal atrophy progressively compromise foveal architecture, ultimately predisposing to tissue dehiscence and full-thickness defects. Although vitreofoveal traction may contribute in individual cases, it is unlikely to be the principal mechanism in most affected eyes. Surgical treatment remains challenging, as current evidence is limited to case reports and small case series. Internal limiting membrane (ILM) flap techniques and, in selected cases, retinal graft or amniotic membrane transplant procedures have yielded encouraging anatomical closure rates, whereas conventional ILM peeling alone appears less predictable. Importantly, restoration of foveal continuity does not necessarily result in meaningful visual improvement, particularly in eyes with established photoreceptor and outer retinal damage. The durability of anatomical repair may be further compromised by continued disease progression. Persistent Müller cell dysfunction, intraretinal cavitation, and progressive outer retinal atrophy can undermine foveal support and lead to recurrent architectural disruption, including reopening of a previously closed hole. Although late recurrence has been documented, its incidence and determinants remain poorly defined because of the limited size and heterogeneity of the available literature. Visual prognosis appears to be determined largely by the amount of structurally and functionally viable retinal tissue remaining at the time of intervention. Smaller defects, less extensive cavitation, and preservation of the external limiting membrane and ellipsoid zone are associated with greater potential for visual recovery. In contrast, extensive cavitation, advanced outer retinal atrophy, and substantial Müller cell or photoreceptor loss are associated with limited functional improvement and may compromise long-term anatomical stability. Overall, a FTMH secondary to MacTel2 should be regarded as a distinct form of macular hole in which surgical repair occurs against a background of ongoing macular neurodegeneration. Preoperative evaluation of hole dimensions, foveal cavitation, and outer retinal integrity may assist in prognostication and in identifying eyes with the greatest likelihood of achieving durable anatomical closure and meaningful visual recovery.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194308","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":"Partitioning All-Cause Pre-Analytical Laboratory Rejections: A 25-Month Retrospective Audit of Specimen Quality Failures with Six Sigma, IFCC, and Pareto Analysis.","authors":"Shoukat Ali Arain, Abdullah Naji Alhawil, Shahid Akhtar Akhund, Mahnoor Ali, Salman Aldosari, Abdulwahab Z Binjomah","doi":"10.3390/jcm15197663","DOIUrl":"10.3390/jcm15197663","url":null,"abstract":"<p><p><b>Objectives:</b> Aggregate pre-analytical rejection rates conflate specimen-quality failures and administrative events, which require distinct mitigation protocols. We disaggregated rejection events to isolate specimen-quality failures and benchmarked them against global frameworks. <b>Methods:</b> We conducted a 25-month retrospective audit (July 2023 to August 2025) of test orders received by the Al Rass General Hospital laboratory. Using an AI-assisted classification protocol, we isolated pre-analytical Specimen Quality Failures from operational and administrative events. We mapped Specimen Quality Failure causes into IFCC WG-LEPS Quality Indicators (QIs) and evaluated via Six Sigma metrics, IFCC benchmarks, and Pareto analysis-stratified by laboratory section, sample type, priority, and work shift. <b>Results:</b> Of 905,018 test orders received, 35,476 were rejected (overall rejection rate 3.92%). However, the specimen-quality failures were 2.21% (σ = 3.51), with 15,495 entries excluded as operational events. Clotted samples (26.2%), hemolysis (23.0%), wrong sample type (20.2%), sample not received (7.8%), and insufficient volume (7.1%) together accounted for 84.3% of specimen quality failures (the Vital Few). Most individual categories scored Good (≥4.0) on Sigma, despite a pooled Sigma of 3.51 (Acceptable). Benchmarking against IFCC WG-LEPS targets showed that 6 of 13 quality indicators, including clotted sample, wrong sample type, and insufficient volume, fell Below Minimum, demonstrating divergent absolute internal process capability metrics and population-relative external benchmark performance signals. STAT samples had a lower specimen quality failure rate than Routine samples (1.25% vs. 2.51%). Although the morning shift accounted for 80.98% of total rejections, only 53.4% represented true specimen quality failures. <b>Conclusions:</b> Headline laboratory rejection rates are inflated by operational and administrative events, necessitating partitioned reporting models. While individual Westgard Sigma scores demonstrate satisfactory absolute process capability across most specimen quality failure categories, cross-referencing against population-relative IFCC targets contextualizes these results and identifies areas performing in the lower international quartiles. Quality improvement strategies require structural changes and workforce training.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194332","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":"Epidural Abscess in Routine Preoperative MRI Reports Versus Documented Operative Findings, and Exploratory Mortality Risk Factors in Surgically Treated Spondylodiscitis: A Retrospective Single-Centre Study.","authors":"Bahadır Balkanlı, Enver İpek, Mehmet Alp Yüksel, Oğuzhan Nayman, Yusuf Sülek, Mehmet Ali Talmaç","doi":"10.3390/jcm15197665","DOIUrl":"10.3390/jcm15197665","url":null,"abstract":"<p><p><b>Background:</b> Surgical decisions in spondylodiscitis rely on the preoperative magnetic resonance imaging (MRI) report, and postoperative mortality remains high. We examined how often routine MRI reports described an epidural abscess later documented at surgery and explored factors associated with mortality. <b>Methods:</b> Twenty-seven adults operated on for pyogenic or fungal spondylodiscitis at one centre (2017-2025) were studied retrospectively. Findings were abstracted from routine MRI reports and operative notes, with epidural pus documented at surgery as the reference. Mortality was explored with univariable Cox and receiver operating characteristic analyses. <b>Results:</b> Epidural pus was documented in 11 patients; none of their MRI reports described an epidural abscess (sensitivity 0%, 95% confidence interval [CI] 0-28.5%), although six reported paraspinal soft-tissue involvement. Eleven patients (40.7%) died during a median follow-up of 2.5 months. Age (hazard ratio 1.14 per year, 95% CI 1.00-1.30) and the age-adjusted Charlson Comorbidity Index (1.54 per point, 1.05-2.28) were associated with mortality and discriminated similarly (areas under the curve 0.741 and 0.736); the unadjusted index and the Pola, Homagk, Spinal Instability Neoplastic Score, and Spinal Instability Spondylodiscitis Score classifications were not. <b>Conclusions:</b> In this small retrospective cohort, routine MRI reports named no epidural abscess among patients in whom one was documented at surgery. Mortality was associated with age and age-adjusted comorbidity burden. These exploratory findings require prospective validation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194422","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}