Journal of Clinical Medicine最新文献

{"title":"Electrophysiological Changes in Children with Isolated Persistent Left Superior Vena Cava: A Case-Control Study.","authors":"Sule Arici, Ozlem Surekli Karakus, Gulperi Yagar Keskin, Erkan Tas, Fatih Alparslan Genc, Sezin Bayraktar, Metin Sungur, Ayse Inci Yildirim","doi":"10.3390/jcm15166494","DOIUrl":"10.3390/jcm15166494","url":null,"abstract":"<p><p><b>Background:</b> Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the thoracic venous system and is generally considered a benign variant. This study aimed to evaluate arrhythmia-related electrocardiographic parameters in children with isolated PLSVC and to assess the relationship with coronary sinus dimensions. <b>Methods:</b> This retrospective cross-sectional study included 26 children with isolated PLSVC and 26 age- and sex-matched healthy controls. All participants underwent transthoracic echocardiography and electrocardiographic analysis. Coronary sinus diameters were measured and indexed to body surface area. Electrocardiographic parameters reflecting atrial conduction and ventricular repolarization heterogeneity, including P-wave dispersion, QTc dispersion, Tp-e interval, and indices of cardiac electrophysiological balance (QT/QRS and QTc/QRS), were evaluated. <b>Results:</b> P-wave dispersion (62.15 ± 14.78 vs. 35.59 ± 10.02 ms, <i>p</i> < 0.001), QTc dispersion (99.66 ± 30.10 vs. 40.45 ± 10.78 ms, <i>p</i> < 0.001), and Tp-e dispersion (67.29 ± 19.10 vs. 38.42 ± 7.13 ms, <i>p</i> < 0.001) were significantly higher in the PLSVC group. QT/QRS (4.33 ± 0.59 vs. 3.78 ± 0.36, <i>p</i> < 0.001) and QTc/QRS (5.48 ± 0.91 vs. 4.61 ± 0.36, <i>p</i> < 0.001) ratios were also increased. Coronary sinus measurements showed weak and inconsistent correlations with electrocardiographic parameters. <b>Conclusions:</b> Children with isolated PLSVC exhibit significant electrocardiographic alterations reflecting atrial and ventricular electrical heterogeneity. These findings suggest that PLSVC may be associated with subclinical electrophysiological abnormalities beyond a benign anatomical variant. Accordingly, increasing clinical awareness of potential arrhythmic risk during follow-up and considering this aspect in patient evaluation may be appropriate.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828825","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 Sufficiently Effective and Low-Risk Plane Block: A Randomized Controlled Trial Evaluating the Modified Parasternal Block in Off-Pump Coronary Artery Bypass Grafting with Sternotomy.","authors":"Xiaoxian Feng, Rongtian Kang, Lining Huang, Fang Yan, Dongqi Yao, Xuze Li","doi":"10.3390/jcm15166472","DOIUrl":"10.3390/jcm15166472","url":null,"abstract":"<p><p><b>Background</b>: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). <b>Methods</b>: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. <b>Results</b>: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0-167.5] μg vs. 280.0 [IQR, 192.5-327.5] μg; <i>p</i> < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. <b>Conclusions</b>: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828874","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 Functional Movement Screen Scores and Joint Stability Tests with Non-Contact Lower-Limb Injury Burden in Collegiate Athletes.","authors":"Adam Eckart, Pragya Sharma-Ghimire","doi":"10.3390/jcm15166466","DOIUrl":"10.3390/jcm15166466","url":null,"abstract":"<p><p><b>Background:</b> The ability of preseason screening to identify athletes at risk for non-contact lower-limb injury remains uncertain. <b>Purpose:</b> To determine whether knee and ankle joint tests, body mass index (BMI), prior lower-limb injury, and Functional Movement Screen (FMS) scores were associated with injury and improved discrimination. <b>Methods:</b> Prospectively collected data from 381 collegiate athletes across 11 sports were retrospectively analyzed. Preseason assessments included BMI, injury history, FMS composite and subtest scores, and knee and ankle special tests summarized regionally. The primary outcome was two or more non-contact lower-limb injuries during the subsequent season; at least one injury was secondary. Hierarchical multivariable logistic regression, sex-stratified and sensitivity analyses, and cross-validated ridge logistic regression were performed. <b>Results:</b> Eighty athletes (21.0%) sustained at least one injury and 41 (10.8%) sustained two or more. Prior injury was associated with ≥2 injuries in Models 1 and 2 (odds ratios = 2.03 and 2.00, respectively) and remained the most consistent correlate across sensitivity analyses. Knee and ankle test findings and FMS composite scores were not consistently associated with injury in primary analyses. Exploratory subgroup associations included female BMI, In-Line Lunge, female Deep Squat, and male ankle instability without prior injury. For the primary outcome, apparent AUC was 0.621-0.649 and cross-validated AUC was 0.535-0.562; adding FMS variables did not improve cross-validated discrimination. <b>Conclusions:</b> Prior injury history was the most consistent risk marker, but the preseason battery showed limited generalizable predictive value. FMS and joint-test measures should not be used alone to predict individual injury risk.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828924","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":"Endoscopic Activity Prediction in Ulcerative Colitis Using Hemogram-Derived Inflammatory Indices: Impact of Azathioprine Use on Diagnostic Performance.","authors":"Muhammed Kaya, Gökhan Evren, İbrahim Durak, Tolga Düzenli, Hüseyin Köseoğlu, Mustafa Sadeçolak","doi":"10.3390/jcm15166464","DOIUrl":"10.3390/jcm15166464","url":null,"abstract":"<p><p><b>Objective:</b> In ulcerative colitis (UC), endoscopic assessment remains central to disease monitoring, but repeated colonoscopy is invasive and resource-intensive. This study evaluated the association and discriminatory performance of the systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte) and the hemoglobin-albumin-lymphocyte-platelet (HALP; hemoglobin × albumin × lymphocyte/platelet) score for endoscopic activity in UC and explored whether azathioprine use modified these associations. <b>Methods:</b> Among 428 retrospectively reviewed patients with UC, 218 met the inclusion criteria. Mayo-defined activity (endoscopic score ≥ 2) and Rachmilewitz EAI-defined activity (score ≥ 4) were analyzed as separate outcomes. Laboratory parameters were compared between active disease and remission groups. Receiver operating characteristic (ROC) analyses, multivariable logistic regression, sensitivity analyses accounting for disease duration and treatment category, and azathioprine interaction analyses were performed. <b>Results:</b> According to the Mayo and Rachmilewitz EAI definitions, 80 (36.7%) and 150 (68.8%) patients, respectively, had active disease. For Mayo-defined activity, CRP showed the highest discrimination (AUC = 0.720), followed by SII (AUC = 0.692), whereas HALP showed limited discrimination (AUC = 0.598). In the primary multivariable Mayo model, CRP, SII, younger age, and male sex were independently associated with activity, whereas HALP and azathioprine use were not. Adding SII to CRP produced only a small numerical increase in AUC (0.720 to 0.752), and adding HALP produced essentially no further change. No significant interaction between azathioprine use and SII or HALP was identified. <b>Conclusion:</b> SII was associated with endoscopic activity but showed only modest discriminatory performance, while HALP had limited discriminatory and independent predictive value. CRP remained the strongest individual biomarker. SII and HALP should therefore be interpreted as adjunctive inflammatory indices rather than substitutes for established biomarkers or endoscopic assessment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828774","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":"Arterial dP/dt_max Response to Fluids and Norepinephrine During Intraoperative Hypotension: A Prospective Physiological Study.","authors":"Andrea Russo, Manuel Ignacio Monge García, Antonio Maria Dell'Anna, Tiziano Torce', Salvatore Silvio Melcore, Giuseppe Romano, Francesco Scialanga, Tiziana Iacobucci, Flaminio Sessa, Tiziana Bove, Massimo Antonelli, Paola Aceto","doi":"10.3390/jcm15166471","DOIUrl":"10.3390/jcm15166471","url":null,"abstract":"<p><p><b>Background:</b> Intraoperative hypotension during major abdominal surgery is common and can result from changes in preload, afterload, or myocardial contractility. Recognising the underlying cause is essential for targeted haemodynamic management. Arterial dP/dt_max has been proposed as a surrogate marker for ventricular systolic function, but its behaviour during fluid and vasopressor administration under general anaesthesia remains not fully understood. This study evaluated changes in radial arterial dP/dt_max following protocol-guided fluid administration and norepinephrine boluses during intraoperative hypotension. <b>Methods:</b> This prospective observational study involved 88 adult patients undergoing elective major abdominal surgery with continuous radial arterial waveform monitoring. Hypotensive episodes were defined as a mean arterial pressure <65 mmHg persisting for at least 60 s and were managed according to a predefined algorithm based on stroke volume variation and dynamic arterial elastance. The primary outcome was the change in arterial dP/dt_max from baseline to 5 min after fluid administration. Linear mixed-effects models were used to account for repeated intervention episodes within patients. <b>Results:</b> A total of 502 protocol-guided intervention episodes contributed by 76 patients were included in the primary analysis: 228 fluid-treated episodes and 274 norepinephrine-treated episodes. Estimated mean arterial dP/dt_max increased from 517 mmHg·s^-1 (95% CI 477-557) at baseline to 631 mmHg·s^-1 (95% CI 591-671) at 5 min during fluid-treated episodes and from 575 mmHg·s^-1 (95% CI 536-615) to 647 mmHg·s^-1 (95% CI 608-686) during norepinephrine-treated episodes (both <i>p</i> < 0.001). A significant intervention-condition-by-time interaction was observed (F = 5.55, <i>p</i> = 0.019), indicating that temporal evolution of arterial dP/dt_max differed between the two algorithm-defined haemodynamic conditions. <b>Conclusions:</b> Radial arterial dP/dt_max increased after both fluid administration and norepinephrine, confirming its sensitivity to haemodynamic loading conditions. It should therefore be interpreted as an integrated haemodynamic variable influenced by ventricular performance, preload, and arterial properties rather than as a direct measure of intrinsic myocardial contractility.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Adherence to a Locally Adapted Enhanced Recovery After Surgery Pathway and Perioperative Outcomes After Open Abdominal Aortic Aneurysm Repair: A Retrospective Cohort Study.","authors":"Zhiyi Yang, Qinghe Wang, Qingfeng Li, Xinyu Cheng, Yutong Liu, Jing Cai, Tong Qiao","doi":"10.3390/jcm15166486","DOIUrl":"10.3390/jcm15166486","url":null,"abstract":"<p><p><b>Objective:</b> Open surgical repair (OSR) remains an important treatment for abdominal aortic aneurysm (AAA), but its invasiveness contributes to substantial perioperative risk. Although Enhanced Recovery After Surgery (ERAS) pathways have improved outcomes across several surgical specialties, evidence supporting their use in open aortic surgery, particularly in Chinese clinical settings, remains limited. We, therefore, evaluated the association between adherence to a locally adapted ERAS pathway and early perioperative outcomes after elective OSR for AAA. <b>Methods:</b> This single-center retrospective cohort study included 182 patients who underwent elective OSR for AAA. Patients who received at least 70% of the 30 ERAS elements were assigned to the ERAS group (<i>n</i> = 93), whereas those who received less than 70% were assigned to the control group (<i>n</i> = 89). A total of 152 patients remained after 1:1 matching of the two groups using propensity score. Quantile regression and logistic regression models were used to evaluate the impact of the ERAS protocol on postoperative length of stay, 30-day mortality, ICU admission rate, hospital cost, major complications, and readmission. <b>Results:</b> After matching, baseline and aneurysm characteristics were generally comparable between groups. The ERAS group demonstrated a significantly reduced risk of major complications (OR = 0.33; 95% CI 0.16-0.71; <i>p</i> = 0.004) and postoperative nausea and vomiting (OR = 0.10; 95% CI 0.01-0.80; <i>p</i> = 0.030). The time to postoperative bowel movement was 1 day earlier in the ERAS group (<i>p</i> < 0.001). The incidence of postoperative cardiac complications was significantly lower in the ERAS group (2.6% vs. 11.8%; <i>p</i> = 0.028). Pulmonary complications were also markedly reduced in the ERAS group (1.3% vs. 19.7%; <i>p</i> < 0.001). The ERAS group was associated with a reduction in postoperative length of hospital stay by 2 days (<i>p</i> < 0.001) and a decrease in hospital cost by 8065 RMB (<i>p</i> < 0.001). <b>Conclusions:</b> Higher adherence to a locally adapted ERAS pathway was associated with fewer major complications, faster bowel recovery, shorter postoperative hospitalization, and lower hospital costs after elective open AAA repair. These findings support prospective multicenter evaluation and further context-specific implementation of ERAS in open aortic surgery.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828806","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 Role of General Practitioners in Actinic Keratosis Management in Europe: A Dermato-Oncologists Initiative.","authors":"Claas Ulrich, Markus V Heppt, Giuseppe Argenziano, Maria Concetta Fargnoli, Carla Ferrándiz-Pulido, Thomas Jouary, Aimilios Lallas, César Martins, Klara Mosterd, Philippe Saiag, Nathalie Bégeault, Alba Crespo-Cruz","doi":"10.3390/jcm15166467","DOIUrl":"10.3390/jcm15166467","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Actinic keratosis (AK) is the key precursor of invasive cutaneous squamous cell carcinoma (cSCC). Rising incidence, ageing populations, and limited dermatologists' availability, particularly in rural and underserved regions, underscore the need for more inclusive care pathways. As in other common diseases such as diabetes or hypertension, general practitioners (GPs) could play a pivotal role in improving access, early recognition, and management of AK, provided that systemic barriers are addressed. <b>Methods</b>: This article synthesises current evidence and expert insights from a European multi-country advisory process, focusing on Italy, France, Germany, Spain, Portugal, the Netherlands, and Greece. The advisory board comprised dermatologists selected based on their clinical expertise and national representativeness, and consensus was reached through structured discussion and iterative review of background materials. <b>Results/Conclusions</b>: The study outlines unmet needs, barriers, and enablers for GPs' involvement and proposes a structured strategy supported by consensus recommendations. It offers a pragmatic model for improving AK care through stronger collaboration between primary care and dermatology. Greater GPs' involvement may support earlier recognition, better triage, improved access to care, and more efficient use of specialist services, while ensuring that complex or high-risk lesions remain under dermatologists' oversight. This may help optimise AK care pathways across Europe.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829103","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":"Comparison of Perioperative, Oncologic, and Functional Outcomes Following Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis.","authors":"Konstantinos Kossenas, Maximos Frountzas, Athanasios Syllaios, Nikolaos Pararas, Panagiotis Kokoropoulos, Dimosthenis Michelakis, Konstantinos Tsimogiannis, Dimitrios Symeonidis, Dimitrios Schizas","doi":"10.3390/jcm15166483","DOIUrl":"10.3390/jcm15166483","url":null,"abstract":"<p><p><b>Background</b>: Intersphincteric resection (ISR) is a technically demanding sphincter-preserving procedure for low rectal cancer. While robotic surgery may offer technical advantages, evidence comparing robotic ISR (R-ISR) and laparoscopic ISR (L-ISR) remains limited. This study aimed to compare perioperative, oncologic, and functional outcomes between R-ISR and L-ISR. <b>Methods</b>: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020. PubMed, Scopus, and Cochrane Library were searched up to 1 March 2026. Comparative studies evaluating R-ISR versus L-ISR in adult patients with low rectal cancer were included. Random-effects models were used to calculate mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I². Subgroup and sensitivity analyses were performed. <b>Results</b>: Seven studies were included. R-ISR was associated with a significantly longer operative duration (MD 34.53 min, 95% CI 7.48 to 61.59; <i>p</i> = 0.02; I² = 81%), a lower rate of overall complications (OR 0.78, 95% CI 0.61 to 0.99; <i>p</i> = 0.04; I² = 0%), a statistically lower Wexner score at 12 months, although the magnitude of the difference was small and its clinical significance uncertain (MD -1.53, 95% CI -2.54 to -0.51; <i>p</i> = 0.02; I² = 0%), and a slightly lower lymph node yield (MD -1.06, 95% CI -2.05 to -0.08; <i>p</i> = 0.04; I² = 65%). No significant differences were observed in blood loss (MD -8.15, 95% CI -23.03 to 6.73; <i>p</i> = 0.20; I² = 37%), conversion to open surgery (OR 0.35, 95% CI 0.02 to 6.02; <i>p</i> = 0.13; I² = 0%), anastomotic leakage (OR 0.92, 95% CI 0.61 to 1.37; <i>p</i> = 0.60; I² = 0%), length of hospital stay (MD -0.48, 95% CI -1.16 to 0.21; <i>p</i> = 0.12; I² = 0%), and CRM positivity (OR 0.93, 95% CI 0.01 to 69.04; <i>p</i> = 0.87; I² = 0%). Subgroup analyses in experienced surgeons and high-volume centers demonstrated no statistically significant differences across outcomes. Sensitivity analyses showed that several results were not robust. <b>Conclusions</b>: Evidence to date does not show superiority of robotic or laparoscopic ISR. Robotic ISR was associated with longer operative time and lower overall complication rates but most perioperative and oncologic outcomes were comparable. After robotic ISR, the 12-month Wexner scores were statistically lower, although the magnitude of this difference was small and the clinical significance uncertain. These results should be interpreted with caution given the limited non-randomized evidence base. PROSPERO Registration: CRD420261359130.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828642","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":"Resin Infiltration in the Conservative Management of Incipient Dental Caries: An Evidence-Based Review.","authors":"Gildo C Santos, Maria Jacinta M C Santos","doi":"10.3390/jcm15166485","DOIUrl":"10.3390/jcm15166485","url":null,"abstract":"<p><p>Dental caries is a biofilm-mediated, non-communicable, multifactorial disease in which the balance between demineralization and remineralization determines whether an initial enamel lesion remains stable, arrests, or progresses toward cavitation. Contemporary caries management prioritizes preservation of tooth structure and emphasizes individualized decisions based on lesion activity, cavitation status, cleansability, radiographic depth, and patient's caries risk. Resin infiltration has emerged as a microinvasive approach positioned between noninvasive preventive strategies and conventional restorative treatment. This evidence-based narrative review summarizes the current literature on resin infiltration for incipient, non-cavitated proximal carious lesions in permanent teeth, with emphasis on diagnosis, case selection, clinical protocol, and current evidence. A structured search of three databases (PubMed, Embase, and the Cochrane Central Register of Controlled Trials) identified randomized clinical trials, observational clinical studies, systematic reviews, narrative reviews, and relevant in vitro investigations. The strongest clinical evidence supports resin infiltration for non-cavitated proximal lesions in permanent teeth, particularly enamel and selected outer dentin lesions, where long-term studies demonstrate reduced radiographic progression. In vitro studies indicate that lesion penetration, enamel hardness, and surface roughness depend on lesion characteristics, pretreatment, and technique, and help explain the caries-arresting effect. Current evidence shows that resin infiltration should be considered a selective microinvasive option for incipient proximal caries, guided by lesion assessment and patient's caries risk rather than a universal substitute for prevention or restoration.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13513741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829086","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":"Explainable Multimodal Machine Learning Predicts 90-Day Treatment Failure in Older Patients with Fragility Fractures of the Pelvis.","authors":"Kangwei Wang, Yulin Cao, Nan Gao, Cong Ma, Jianwen Wang, Zishen Xia, Aiwen Gui, Yong Liu, Yuxiong Weng","doi":"10.3390/jcm15166487","DOIUrl":"10.3390/jcm15166487","url":null,"abstract":"<p><p><b>Background</b>: Fragility fractures of the pelvis (FFP) are increasingly encountered in older adults, yet early deterioration is difficult to anticipate because fracture instability interacts with frailty and systemic vulnerability. We developed and validated an admission-based multimodal framework to predict 90-day treatment failure (TF90) before definitive management. <b>Methods</b>: This multicentre retrospective prediction study included 1684 consecutive patients aged ≥65 years with FFP treated at five tertiary hospitals. TF90 was defined as persistent fracture-related pain or immobility, delayed conversion to operative stabilisation, secondary displacement, FFP-related unplanned readmission, revision or unplanned reoperation, or all-cause mortality within 90 days. Only predictors available within 24 h of admission and before the definitive treatment decision were eligible, including CT-defined fracture morphology, frailty, clinical characteristics and routine laboratory biomarkers; DXA and specialised bone metabolism measurements were evaluated separately in an extended model. Four prespecified models were developed in 985 patients, temporally validated in 520 patients and evaluated in a completely held-out Centre E internal-external validation cohort of 179 patients, with additional leave-one-centre-out internal-external cross-validation. <b>Results</b>: TF90 occurred in 307 patients (18.2%) and increased from 8.1% in FFP I to 37.1% in FFP IV. Higher risk was associated with advanced age, greater frailty, impaired prefracture mobility, bilateral posterior ring injury, greater displacement, systemic inflammation, hypoalbuminaemia and renal dysfunction. In temporal validation, AUROCs were 0.732 for the simple logistic model, 0.763 for the core logistic model, 0.759 for the core random forest and 0.755 for the extended random forest. Neither greater algorithmic complexity nor specialised skeletal measurements provided reproducible incremental value. A development-derived high-risk stratum had a TF90 incidence of 32.2% and contained 70.0% of all events. At the fixed threshold of 0.209, sensitivity was 71.3%, specificity 70.0% and negative predictive value 93.1%. <b>Conclusions</b>: Pretreatment integration of pelvic ring mechanics, frailty and routinely available systemic biomarkers enables clinically relevant enrichment of older patients at risk of TF90. The model is best positioned to support intensified surveillance and structured reassessment rather than determine operative treatment. Independent prospective external validation, recalibration and clinical impact evaluation are required before routine implementation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 16","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13514191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148828814","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}