Journal of Clinical Medicine最新文献

{"title":"Open Fractures on the Field: Two Decades of Pediatric Sports Injuries in a Level 1 Trauma Cohort.","authors":"Britta Chocholka, Lara Marie Bogensperger, Iryna Yegorova, Vanessa Groß, Manuela Jaindl, Bikash Parajuli, Sanika Rapole, Thomas Manfred Tiefenboeck, Stephan Payr","doi":"10.3390/jcm14186667","DOIUrl":"10.3390/jcm14186667","url":null,"abstract":"<p><p><b>Background</b>: Open fractures in pediatric patients are uncommon but clinically relevant, often resulting from high-energy trauma or sports-related incidents. This study analyzes the demographic patterns, types of sports, injury mechanisms, treatment strategies, and outcomes in children and adolescents with sports-related open fractures. <b>Methods</b>: In this retrospective study, 74 pediatric patients with sports-related open fractures treated at a level 1 trauma center between 2002 and 2023 were documented. Parameters such as age, sex, fracture location, sport type, treatment modality, complications, and outcomes were evaluated. <b>Results</b>: The cohort included 74 patients, with a mean age of 13 ± 3.6 years. Open fractures of the upper extremity were most common (seen in 34 patients). Moreover, 10 open craniofacial and 27 open nasal fractures represented 50.0% of injuries, mainly in male athletes involved in contact sports. Soccer was the leading injury-related sport (n = 14; 18.9%). Surgical treatment was required in 28 patients (37.8%), most frequently using elastic stable intramedullary nailing, Kirschner wire fixation in the upper extremities or nasal bone reduction. Antibiotics were administered in 46 patients (62.2%), with a mean documented duration of 2.7 ± 3.1 days. An excellent outcome was documented in 95%. <b>Conclusions</b>: Sports-related open fractures in children primarily affect male adolescents in contact sports and involve the upper extremities and facial region. Conservative management is effective in stable, non-displaced and low-grade injuries. Surgical treatment is frequently indicated in open forearm fractures. The implementation of a structured trauma care protocol, incorporating early debridement, definitive treatment, and antibiotics, has been demonstrated to yield a safe and effective treatment outcome with a favorable prognosis for sports-related open fractures in children.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175888","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":"Tenascin-C and Thrombospondin-1 as a Potential Link Between Sleep Bruxism and Cardiovascular Diseases-A Case-Control Study.","authors":"Helena Martynowicz, Monika Kosacka, Piotr Macek, Gabriella Lachowicz, Rafal Poręba, Agnieszka Kusnerz, Aleksandra Jaremków, Cyryl Daroszewski, Agnieszka Bronowicka-Szydełko, Katarzyna Madziarska, Paweł Gać","doi":"10.3390/jcm14186669","DOIUrl":"10.3390/jcm14186669","url":null,"abstract":"<p><p><b>Background</b>: Sleep bruxism (SB), a sleep behavior, is one of the most common sleep pathologies. Tenascin-C (TnC) and thrombospondin-1 (TSP-1) are involved in the pathogenesis of cardiovascular disease. The aim of our study was to assess the relationship between SB and TSP-1 and TnC. <b>Methods</b>: A total of 80 participants, who were hospitalized in the Sleep Laboratory of the Department of Internal Medicine, Occupational Diseases, Hypertension, and Clinical Oncology at Wroclaw Medical University, were enrolled in the study. Polysomnographic examination was conducted following the standard sleep evaluation criteria set by the American Academy of Sleep Medicine, utilizing the Nox-A1 device. Serum TnC and TSP-1 concentrations were determined using Elisa Kits. <b>Results</b>: The study showed an increased concentration of TnC in the group of patients with a BEI (bruxism episode index) >10.3, compared to <10.3 (6786.79 ± 5655.62 vs. 1585.16 ± 2526.56). In regression analysis, higher values of phasic bruxism, smoking, and older age were independently associated with increased concentrations of TnC in the serum. Moreover, higher values of tonic bruxism, as well as smoking, were independently associated with TSP-1. <b>Conclusions</b>: Since tenascin-C and thrombospondin-1 levels are associated with sleep bruxism, atherosclerosis may be a potential consequence of SB. This relationship is especially noticeable in severe bruxism. Therefore, monitoring for clinical signs of atherosclerosis should be considered in patients with severe bruxism.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175949","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":"Rethinking the Diabetes-Cardiovascular Disease Continuum: Toward Integrated Care.","authors":"Alfredo Caturano, Cassandra Morciano, Katarzyna Zielińska, Vincenzo Russo, Marco Alfonso Perrone, Cesare Celeste Berra, Caterina Conte","doi":"10.3390/jcm14186678","DOIUrl":"10.3390/jcm14186678","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD) are not merely coexisting epidemics but co-evolving manifestations of a shared cardiometabolic continuum. Despite advances in glycemic, lipid, and blood pressure control, residual cardiovascular risk remains high, underscoring the limitations of siloed approaches. In this perspective, we argue for reframing T2D and CVD as interconnected conditions driven by inflammation, adipose tissue dysfunction, and organ crosstalk. Beyond metformin, which remains foundational, several glucose-lowering drug classes are now evaluated not only for glycemic control but also for their cardiovascular and renal impact. Landmark trials and recent meta-analyses confirm that sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists improve cardiorenal outcomes. More recently, tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist, has shown unprecedented efficacy in weight and glucose management, with potential to further transform cardiometabolic risk reduction. Yet enthusiasm for these therapies must be tempered by heterogeneity of response, treatment costs, and inequitable access. Integrated care models, supported by multidisciplinary teams, digital health tools, and value-based reimbursement, are essential to close the gap between trial efficacy and real-world outcomes. Attention to sex, age, ethnicity, and comorbidity profiles is critical to ensure equity, as is the adaptation of strategies to low- and middle-income countries where the burden of cardiometabolic disease is rapidly rising. Ultimately, advancing cardiometabolic medicine requires not only novel therapies but also a unifying framework that integrates biology, behavior, economics, and health systems to deliver the right treatment to the right patient at the right time.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175969","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":"What Cardiologists Should Know About Amyloidosis.","authors":"Rama Alashqar, Ahmad Alkhatib, Ala W Abdallah, Mahmoud Odeh, Mustafa Al-Taei, Own Khraisat, Mohammed Al-Hiari, Hazem Taifour, Amer Hammad, Ahmed Sami Abuzaid","doi":"10.3390/jcm14186668","DOIUrl":"10.3390/jcm14186668","url":null,"abstract":"<p><p><b>Background:</b> Cardiac amyloidosis (CA) is an increasingly recognized but historically underdiagnosed cause of restrictive cardiomyopathy and heart failure with preserved ejection fraction (HFpEF). It results from the extracellular deposition of misfolded protein fibrils, most commonly transthyretin (ATTR) or immunoglobulin light chains (AL), leading to progressive myocardial dysfunction and multi-organ involvement. <b>Objective:</b> This review provides a comprehensive, cardiology-centered overview of cardiac amyloidosis, with an emphasis on early recognition, diagnostic strategies, subtype differentiation, and the evolving therapies. <b>Content:</b> We summarize the epidemiology, pathophysiology, and clinical manifestations of both ATTR and AL subtypes. Key diagnostic tools, including echocardiography, cardiac magnetic resonance imaging, bone scintigraphy, monoclonal protein screening, and endomyocardial biopsy, are reviewed in the context of a stepwise diagnostic approach. Special attention is given to clinical presentation, electrocardiographic and imaging \"red flags,\" and to differentiating CA from mimickers such as hypertrophic cardiomyopathy, hypertension-induced left ventricular hypertrophy, and aortic stenosis. Staging systems are detailed, highlighting the prognostic role of cardiac biomarkers. Therapeutic strategies are explored, including subtype-specific regimens (e.g., daratumumab-based therapy for AL; tafamidis and gene silencers for ATTR), the judicious use of conventional heart failure medications, and emerging therapies such as CRISPR-based gene editing. <b>Conclusions:</b> Timely recognition and accurate diagnosis of cardiac amyloidosis are critical to improving outcomes. As diagnostic tools and disease-modifying therapies evolve rapidly, cardiologists must remain at the forefront of multidisciplinary care. A structured biomarker- and imaging-guided approach can enhance diagnostic yield, inform prognosis, and optimize patient-specific management.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176061","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":"Assessing the Reliability of Compliance with the General Treatment Recommendations by Patients Treated for Temporomandibular Disorders.","authors":"Małgorzata Pihut, Wojciech Maga, Andrzej Gala","doi":"10.3390/jcm14186674","DOIUrl":"10.3390/jcm14186674","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The aim of this study was to assess the accuracy of TMD patients' adherence to treatment recommendations, given in writing, based on an anonymous survey. <b>Methods:</b> The study material included a group of 80 patients of both sexes, aged 21 to 45 years, who came for prosthetic treatment due to symptoms of TMD at the Department of Prosthetics and Orthodontics, Jagiellonian University Medical College in Krakow. Axis I of the DC/TMD was used in the diagnosis of dysfunction. The study used an anonymous questionnaire survey, which asked specific questions regarding the reliability of the implementation of the therapeutic recommendations contained in the written treatment instructions, given to patients at the first diagnostic visit. The questionnaire survey was completed by patients once, at the second visit, which was routinely made after 4 weeks. <b>Results:</b> The analysis showed that the most frequent adherence of respondents was to physiotherapy treatments. The same number of patients (57.5% each) used sleep hygiene, stress management, and maintenance of dental arch dislocation during the day. More than half of the subjects used orthopaedic pillows during sleep and performed daily relaxation exercises. Less than half of the subjects (46.3-47.5%) used hot compresses on the masticatory muscles, took prescribed supplements, controlled the position of the jaw, and used an occlusal splint at the required time. <b>Conclusions:</b> The results of the study indicate a low percentage of adherence to the recommendations made by the doctor.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175752","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":"Nurse Specialising Consultation in Heart Failure: Impact on Drug Titration and Cardiovascular Events in Patients with Heart Failure and Reduced Ejection Fraction.","authors":"Jose Lopez-Aguilera, Jorge Perea-Armijo, Ana Belen Muñoz-Villarreal, Antonia Cepas-Sosa, Luisa Maria Luque-Serrano, Nerea Aguayo-Caño, Gloria Maria Heredia-Campos, Juan Diego Martin-Diaz, Rafael Gonzalez-Manzanares, Juan Carlos Castillo-Dominguez, Manuel Crespin-Crespin, Monica Delgado-Ortega, Martin Ruiz-Ortiz, Dolores Mesa-Rubio, Manuel Pan-Alvarez Osorio, Manuel Anguita-Sanchez","doi":"10.3390/jcm14186681","DOIUrl":"10.3390/jcm14186681","url":null,"abstract":"<p><p><b>Introduction:</b> The increasingly active role of nurses in the management of heart failure (HF) has become important in HF units (HCUs). This study aims to determine the effect of opening a specialised HF nursing (NSHF) consultation in a tertiary hospital on drug titration, and its subsequent impact on cardiac remodelling and prognosis. <b>Methods:</b> A retrospective cohort study was conducted on patients with HF with reduced ejection fraction (HFrEF) who were treated between 2017 and 2020. Patients who were followed by the NSHF were compared with those who underwent conventional clinical follow-up (non-NSHF), focusing on drug optimisation, echocardiographic parameters, biomarkers, and clinical outcomes in terms of mortality and hospital readmissions for HF. <b>Results:</b> A total of 411 patients were analysed, 85 of whom (20.7%) were treated with NSHF. There were hardly any differences in baseline characteristics. At the end of follow-up, the NSHF group had a higher prescription rate of angiotensin receptor-neprilysin inhibitor (+31.7% vs. +23.3%; <i>p</i> < 0.001), beta-blockers (+2.4% vs. -5.8%; <i>p</i> < 0.001), and sodium glucose co-transporter type 2 inhibitors (+24.7% vs. +17.8%; <i>p</i> < 0.001). There was also a higher rate of loop diuretic withdrawal (-16.7% vs. -6.7%; <i>p</i> < 0.001). However, no improvement in reverse remodelling or neurohormonal response was observed. Patients treated with NSHF had a lower probability of dying from HF (88.6% vs. 63.3%; <i>p</i> = 0.006), but this did not reduce hospital admissions for HF. <b>Conclusions:</b> Patients with HFrEF who are cared for through NSHF are more likely to be prescribed drugs that modify the prognosis of the disease. This has an impact on their mortality.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175806","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":"Risk-Stratifying Pituitary Adenoma Treatment: A Cohort Analysis and Risk Prediction of Hypopituitarism.","authors":"Adnan Agha, Shriram Dorairaj Gunasekaran, Entessor Mohammed Noor, Khaled Mohammed Asad Al Dahmani","doi":"10.3390/jcm14186656","DOIUrl":"10.3390/jcm14186656","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The management of pituitary adenomas involves balancing treatment efficacy with the risk of long-term morbidity, particularly treatment-induced hypopituitarism. While risk factors are qualitatively recognized, quantitative, individualized risk prediction tools for clinical practice are lacking. This study aims to evaluate and characterize the clinical features, hormonal profiles, and treatment outcomes of pituitary adenomas, and to develop and validate a pragmatic clinical prediction model for new-onset hypopituitarism. <b>Methods</b>: We conducted a retrospective cohort study of 215 patients diagnosed with pituitary adenomas, selected from 647 sellar lesions screened at a tertiary referral center between January 2010 and December 2020. Primary outcomes included adenoma size control, hormonal remission in functioning adenomas, and the development of new-onset hypopituitarism. A multivariable logistic regression model was developed to identify independent predictors of new-onset hypopituitarism, and its performance was assessed for discrimination and calibration. <b>Results</b>: The cohort consisted of 107 prolactinomas (49.8%), 77 non-functioning adenomas (35.8%), 18 GH-secreting (8.4%), and 8 ACTH-secreting (3.7%) adenomas, with a mean age of 43.2 ± 14.1 years and a female predominance (59.1%). At a median follow-up of 4.8 years, overall adenoma control was 92.1%. Radiotherapy achieved 100% adenoma control but was associated with the highest incidence of new hypopituitarism at 5 years (34.3%), significantly greater than medical therapy (5.6%, <i>p</i> < 0.001) and surgery (13.0%, <i>p</i> < 0.01). The final risk prediction model, incorporating treatment modality, baseline hypopituitarism, macroadenoma, age >50 years, and cavernous sinus invasion, demonstrated good discrimination (C-statistic = 0.82; 95% CI: 0.76-0.88) and excellent calibration (Hosmer-Lemeshow <i>p</i> = 0.42). <b>Conclusions</b>: Treatment modalities for pituitary adenomas have distinct risk-benefit profiles. Our validated, points-based risk model provides a transparent and clinically applicable tool to quantify an individual patient's risk of developing hypopituitarism. This model can be integrated into clinical practice to facilitate shared decision-making and guide personalized surveillance strategies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175501","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":"Post-Heroin Post-Traumatic Stress Disorder Spectrum: Heroin Addiction as a Generator of Trauma Sensitisation in Everyday Life: A Perspective Review.","authors":"Icro Maremmani, Filippo Della Rocca, Manuel Glauco Carbone, Angelo Giovanni Icro Maremmani","doi":"10.3390/jcm14186662","DOIUrl":"10.3390/jcm14186662","url":null,"abstract":"<p><p><b>Background:</b> Heroin addiction is associated with profound dysregulation of the endogenous opioid and stress response systems, yet current diagnostic frameworks may inadequately capture the traumatising aspects of this condition. This perspective proposes the concept of post-heroin post-traumatic stress spectrum (pH-PTSD/S) as a clinical syndrome emerging from chronic opioid-induced neurobiological and psychosocial dysregulation, even in the absence of Criterion A trauma. <b>Methods:</b> The authors review evidence from neuroendocrinology, behavioural neuroscience, and clinical psychopathology to support a sensitisation-based model of trauma vulnerability in heroin use disorder (HUD). <b>Results:</b> Findings suggest that HUD patients frequently exhibit PTSD-spectrum symptoms, including hyperarousal, avoidance, emotional dysregulation, and altered stress reactivity. Opioid agonist treatment (OAT) may mitigate these symptoms by stabilising HPA axis function and reducing exposure to trauma-related contexts. The pH-PTSD/S construct, measured through a dedicated instrument, identifies patients with subthreshold trauma-related symptoms and greater psychopathological burden. <b>Conclusions:</b> Heroin dependence may constitute a traumatising condition, requiring dimensional diagnostic tools and trauma-informed treatment strategies. Further research is needed to validate the nosological status of pH-PTSD/S, clarify its distinction from protracted withdrawal or complex PTSD, and determine its implications for OAT duration and integrated care pathways.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175710","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 Value of Early Active Rehabilitation on Long-Term Functional Outcomes in Neer Type-4 Valgus Impacted Proximal Humeral Fractures Treated with Open Reduction and Internal Fixation: A Retrospective Cohort Study.","authors":"Haiyan Zhou, Liming Cheng","doi":"10.3390/jcm14186660","DOIUrl":"10.3390/jcm14186660","url":null,"abstract":"<p><p><b>Objectives:</b> The optimal rehabilitation protocol following open reduction and internal fixation (ORIF) for Neer type-4 valgus impacted proximal humeral fractures (VIPHF) remains controversial. This study aimed to compare the long-term efficacy and safety of early active mobilization versus conventional rehabilitation in these patients. <b>Methods:</b> We conducted a retrospective cohort study at a single tertiary hospital involving 128 patients who underwent ORIF for Neer type-4 VIPHF between January 2018 and December 2022. Participants were divided into two groups based on the rehabilitation protocol received: the Early Active Activation (EAA) group (<i>n</i> = 64), which initiated controlled active exercises on postoperative day 1, and the Conventional Rehabilitation (CR) group (<i>n</i> = 64), which followed a delayed protocol. The primary outcome was the Constant-Murley score at 24 months. Secondary outcomes included scores at 3, 6, and 12 months, pain VAS scores, active range of motion, fracture healing time, and complications. <b>Results:</b> The EAA group demonstrated significantly superior outcomes, including a higher 24-month Constant-Murley score (88.7 ± 6.5 vs. 75.3 ± 9.2, <i>p</i> < 0.001), lower VAS scores at all time points (<i>p</i> < 0.001), greater range of motion (<i>p</i> < 0.001), and shorter fracture healing time (10.2 ± 1.8 vs. 12.5 ± 2.3 weeks, <i>p</i> < 0.001). Complication rates did not differ significantly (4.7% vs. 6.3%, <i>p</i> = 0.718). <b>Conclusions:</b> For patients with surgically stabilized Neer type-4 VIPHF, early active rehabilitation initiated on postoperative day 1 was associated with significantly improved functional outcomes, accelerated recovery, and a favorable safety profile. However, these findings should be interpreted with caution due to the retrospective design, single-center setting, and potential residual confounding. Further validation through prospective, multicenter studies is recommended.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175894","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":"Endo-Periodontal Lesions Without Root Damage: Recommendations for Clinical Management.","authors":"Susana Aranda Verdú, Antonio Pallarés Sabater, Antonio Pallarés Serrano, Jorge Rubio Climent, Alberto Casino Alegre","doi":"10.3390/jcm14186655","DOIUrl":"10.3390/jcm14186655","url":null,"abstract":"<p><p><b>Background:</b> Endo-periodontal lesions (EPLs) are defined by a pathological connection between the pulp and the periodontium in a specific tooth. Although the identification of EPL etiology is of paramount importance for a correct treatment plan, it may be impossible at times to pinpoint the primary cause prospectively. A critical aspect of treatment planning involves assessing the necessity of root canal treatment in periodontal patients presenting with EPLs, evaluating the indication for periodontal intervention in cases of endodontic origin and determining whether splinting of the affected tooth is required. The aim of this article is to provide a concise perspective on the management of EPLs without root damage. <b>Methods:</b> A clinical decision-making flowchart was created based on current classification systems to guide treatment strategies for EPLs. <b>Results:</b> A flowchart of the treatment of EPLs based on possible decision pathways with a starting point in the diagnosis of the periodontitis or non-periodontitis patient that can prove particularly useful in cases where the initial etiology remains uncertain. <b>Conclusions:</b> EPLs are infections that represent a significant clinical challenge. This article summarizes key diagnostic considerations and therapeutic steps, offering practical guidance for clinicians managing these lesions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175803","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}