Journal of Clinical Medicine最新文献

{"title":"Serial TAPSE and Subsequent 60-Day Mortality Among Critically Ill Adults with Reduced Baseline TAPSE: A MIMIC-IV-ECHO Cohort Study.","authors":"Shanshan Zhai, Dezhi Ren, Yongyi Chen, Hui Wang, Jun Duan","doi":"10.3390/jcm15197753","DOIUrl":"10.3390/jcm15197753","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Tricuspid annular plane systolic excursion (TAPSE) is routinely available in critical-care echocardiography, but the prognostic relevance of serial change is uncertain. We examined serial TAPSE and subsequent mortality among critically ill adults with reduced baseline TAPSE. <b>Methods:</b> This retrospective MIMIC-IV-ECHO cohort included adults with at least two TAPSE measurements and baseline TAPSE < 1.7 cm. Serial TAPSE status was classified as improved (increase >0.2 cm) or non-improved (change ≤0.2 cm). Cox regression evaluated 60-day mortality from the follow-up echocardiogram. <b>Results:</b> Among 227 patients, 101 (44.5%) were improved and 126 (55.5%) non-improved over a median interval of 10 days. Non-improved status was associated with higher subsequent mortality (adjusted hazard ratio 1.72, 95% confidence interval 1.06-2.80; <i>p</i> = 0.028). After adjustment for follow-up TAPSE, neither binary status nor continuous change was significantly associated with mortality. <b>Conclusions:</b> In this exploratory study, non-improved serial TAPSE was associated with higher 60-day mortality. Added prognostic value beyond follow-up TAPSE was not demonstrated.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194424","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 External Oblique Intercostal Plane Block and Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia After Open Radical Gastrectomy: A Single-Blind Randomized Trial.","authors":"Uson Mamasaliev, Ahmet Taşar, Ersin Sönmez, Gamze Talih, Ayşe Ülgey","doi":"10.3390/jcm15197736","DOIUrl":"10.3390/jcm15197736","url":null,"abstract":"<p><p><b>Background:</b> Ultrasound-guided fascial plane blocks are increasingly incorporated into multimodal analgesia for upper abdominal surgery. Although both the external oblique intercostal plane (EOIP) block and the subcostal transversus abdominis plane (scTAP) block have been used for postoperative analgesia, evidence directly comparing their efficacy after open radical gastrectomy is lacking. We compared the postoperative analgesic efficacy of bilateral EOIP and bilateral scTAP blocks in patients undergoing open radical gastrectomy. <b>Methods:</b> In this prospective, single-center, randomized, patient-blinded trial, 60 adults undergoing elective open radical gastrectomy were randomly assigned to receive either a bilateral ultrasound-guided EOIP block or a bilateral scTAP block. The primary outcome was cumulative morphine consumption during the first 24 postoperative hours. Secondary outcomes included postoperative Numeric Rating Scale (NRS) scores, rescue analgesic requirements, postoperative nausea and vomiting (PONV), and length of hospital stay. <b>Results:</b> Thirty patients were analyzed in each group. 24 h cumulative morphine consumption did not differ significantly between the EOIP and scTAP groups (24.3 ± 11.4 mg vs. 22.4 ± 8.8 mg, respectively; mean difference 1.9 mg, 95% confidence interval -3.10 to 6.97; <i>p</i> = 0.47). Morphine consumption at 2, 6, and 12 h also showed no statistically significant differences. Postoperative NRS scores showed no significant differences at any time point. Rescue analgesic requirements and the proportion of patients experiencing PONV episodes did not differ significantly between the groups. No complications were observed. <b>Conclusions:</b> Among patients undergoing open radical gastrectomy, no statistically significant differences were detected between bilateral EOIP and bilateral scTAP blocks in postoperative opioid consumption, pain scores, rescue analgesic requirements, or PONV. These findings do not establish equivalence or efficacy relative to standard care without a block and warrant confirmation in larger multicenter trials.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194234","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":"Long-Term Follow-Up After Testicular Tissue Cryopreservation in Boys Facing Gonadotoxic Therapies: Safety, Pubertal Development, Reproductive Outcomes, and Clinical Implications.","authors":"Lucia Paolini, Vittorio Ferrari, Umberto Cattini, Elisa Bortolamedi, Marcello Lanari, Federico Baronio","doi":"10.3390/jcm15197759","DOIUrl":"10.3390/jcm15197759","url":null,"abstract":"<p><p>Testicular tissue cryopreservation is increasingly offered to boys facing gonadotoxic therapies. Yet, its long-term clinical significance depends not only on future fertility-restoration technologies but also on how these patients evolve. This narrative review aims to synthesizes the available follow-up literature on boys who underwent testicular tissue cryopreservation, focusing on procedural safety, testicular growth, pubertal progression, endocrine function, semen outcomes in patients reaching adulthood, and the emerging question of whether cryopreserved tissue may ultimately be needed in all cases. We will compare follow-up strategies across centers, highlight the lack of standardized endpoints, and discuss how survivorship data may refine counseling, re-consent, and future management of cryopreserved tissue. The aim is to provide a clinically oriented overview of what current longitudinal cohorts can already tell us, while identifying the key evidence gaps that still limit harmonized follow-up protocols.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194239","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":"Pathogen and Testing Profiles in Post-Infectious Irritable Bowel Syndrome Across the COVID-19 Public Health Emergency: A Retrospective Case Series.","authors":"Erhan Bozkurt, Osman Sağlam, Alper Sarı, Murat Ay, Oğuzhan Köse, Alper Emre Kurt, Ali Arda Demir, Mesut Çeliker","doi":"10.3390/jcm15197729","DOIUrl":"10.3390/jcm15197729","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The COVID-19 public health emergency altered enteric infection surveillance, diagnostic testing, and antibiotic prescribing. We compared pathogen/testing composition among post-infectious irritable bowel syndrome (PI-IBS) cases stratified by whether index gastroenteritis occurred before, during, or after the emergency. <b>Methods:</b> This single-centre retrospective case series included 138 adults with clinician-diagnosed PI-IBS classified as Rome IV-compatible by chart adjudication. Index gastroenteritis occurred from January 2019 to December 2024; existing clinical records were reviewed retrospectively. The primary comparison was a five-category pathogen/testing profile. <b>Results:</b> The profile differed across pre-pandemic (<i>n</i> = 30), pandemic (<i>n</i> = 39), and post-emergency (<i>n</i> = 69) periods (χ² = 35.56, <i>p</i> < 0.001; Cramér V = 0.36, 95% CI 0.30-0.48). Bacterial/protozoal cases represented 63.3%, 7.7%, and 33.3%, respectively; SARS-CoV-2-associated cases represented 0%, 35.9%, and 13.0%. Antibiotic exposure was 56.7%, 12.8%, and 33.3%. In an exploratory adjusted model, confirmed enteric pathogens were associated with antibiotic exposure (OR 16.28, 95% CI 3.03-87.35), whereas period was not. Sensitivity analyses excluding SARS-CoV-2 cases and period-crossing diagnoses were concordant. <b>Conclusions:</b> Pathogen/testing and antibiotic-exposure profiles differed across periods among diagnosed PI-IBS cases. These data describe case composition, not incidence or causal risk, and cannot separate infection ecology from diagnostic behaviour.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194329","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":"Validating Type 2 Diabetes Diagnoses Across the Madrid Hospital Network: Evidence for Secondary Use of the CMBD in the European Health Data Space.","authors":"Rafael Gómez-Coronado-Martín, Ana Chacón-García, Ana López-de-Andrés, Miguel A Salinero-Fort, Daniala L Weir, Carmen de Burgos-Lunar","doi":"10.3390/jcm15197717","DOIUrl":"10.3390/jcm15197717","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Hospital discharge data are increasingly reused for research and within health data spaces, but their value depends on accurate diagnostic coding. The validity of type 2 diabetes mellitus (T2DM) coding in the Spanish hospital discharge database (CMBD) had not been assessed across a whole regional network. We aimed to quantify the precision and completeness of E11 coding across the public hospital network of the Region of Madrid. <b>Methods:</b> We conducted a retrospective validation study in the public hospitals of the Region of Madrid (2016-2025). In each of four hospital complexity groups, we selected admissions with and without an ICD-10-ES E11 code, matched by age and sex (787 and 781 analysed). The reference standard was the American Diabetes Association criteria, checked in health records. Predictive values were estimated directly; sensitivity, specificity and prevalence were reconstructed for the whole population, adjusting for sex and age. <b>Results:</b> Of 4,707,924 discharges, 918,797 (19.5%) had a T2DM code. The positive predictive value was 94.2% (95% CI: 92.1-96.0), the negative predictive value 94.0% (91.3-96.3), specificity 98.5% (98.0-99.0) and sensitivity 79.3% (72.4-86.2), a lower bound. The estimated prevalence of T2DM among discharges was 23.2%, against 19.5% coded; about 226,000 admissions with T2DM had no code. Only the positive predictive value differed between hospital groups (<i>p</i> = 0.006). <b>Conclusions:</b> The E11 code is highly precise but incomplete: it is reliable for building cohorts, whereas counts based on it underestimate the number of cases by about one in five.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194207","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":"Long-Term Speech Outcomes After Primary Palatoplasty: A Comparison of Minimal-Incision Intravelar and Modified Veau-Wardill-Kilner Techniques.","authors":"Kostadin Gigov, Ivan Ginev, Petra Kavradzhieva, Mariya Miteva","doi":"10.3390/jcm15197727","DOIUrl":"10.3390/jcm15197727","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Speech outcome is a major functional endpoint following primary palatoplasty. This study compared long-term speech outcomes after closed intravelar minimal-incision palatoplasty and the modified Veau-Wardill-Kilner procedure. <b>Methods:</b> This retrospective observational study evaluated speech using a standardized perceptual protocol adapted to the Bulgarian phonetic system across eight domains. Outcomes were compared between surgical groups, with additional analyses stratified by age and cleft type. <b>Results:</b> The minimal-incision group showed higher unadjusted proportions of normal speech intelligibility (29.4% vs. 17.6%, <i>p</i> = 0.020), normal resonance (73.2% vs. 54.9%, <i>p</i> = 0.001), and normal consonant articulation (37.8% vs. 19.0%, <i>p</i> < 0.001), whereas compensatory articulation was less frequent (49.6% vs. 65.5%, <i>p</i> = 0.008). Hypernasality, voice quality, and vowel articulation were comparable between groups. After adjustment for cleft type and age group, no significant association was observed between surgical technique and normal speech intelligibility (aOR 1.33, 95% CI 0.73-2.43; <i>p</i> = 0.357), whereas the minimal-incision technique was associated with higher odds of normal consonant articulation (aOR 1.79, 95% CI 1.01-3.18; <i>p</i> = 0.047) and normal resonance (aOR 1.73, 95% CI 1.02-2.94; <i>p</i> = 0.043). <b>Conclusions:</b> Both techniques were associated with broadly comparable long-term functional speech outcomes across most evaluated domains. After adjustment for cleft type and age group, differences remained in normal consonant articulation and normal resonance, whereas no significant adjusted association was observed for normal speech intelligibility. These findings should be interpreted cautiously given the historical treatment patterns, non-random distribution of cleft type between groups, and potential residual confounding.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194209","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":"Changes in Symptoms and Lung Function During Three Months of Individually Tailored Inhaled Therapy in Chronic Obstructive Pulmonary Disease: A Prospective Observational Cohort Study.","authors":"Bektas Isik, Hilmi Erdem Sumbul, Huseyin Ali Ozturk, Begum Seyda Avci, Erdinc Gulumsek, Merve Sumbul, Irfan Alisan, Ahmet Gazi Mustan, Fatih Necip Arici, Cisem Yilmaz, Cahit Dincer, Okan Pirinci, Ramazan Azim Okyay","doi":"10.3390/jcm15197722","DOIUrl":"10.3390/jcm15197722","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Randomised controlled trials have established what individual inhaled regimens can achieve in chronic obstructive pulmonary disease (COPD) under controlled conditions, but they recruit selected populations and enforce protocol-driven follow-up. How patients fare on regimens chosen individually for them in everyday care is less well characterised. &lt;b&gt;Objective.&lt;/b&gt; To assess the change in symptoms and lung function over three months in a prospective cohort of patients with COPD whose inhaled treatment was tailored to the individual by the attending physician. &lt;b&gt;Methods.&lt;/b&gt; Consecutive adults with stable, spirometrically confirmed COPD attending a single internal-medicine clinic were assessed at baseline and reassessed approximately three months later. Baseline regimens were short-acting beta&lt;sub&gt;2&lt;/sub&gt;-agonist/short-acting muscarinic antagonist (SABA/SAMA), long-acting muscarinic antagonist (LAMA), long-acting beta&lt;sub&gt;2&lt;/sub&gt;-agonist (LABA), LABA plus inhaled corticosteroid (ICS), LABA plus LAMA, or LABA plus LAMA plus ICS. The primary outcomes were the within-participant change in COPD Assessment Test (CAT) score and in forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;) % predicted. Secondary outcomes were the proportion achieving the CAT minimal clinically important difference (MCID, defined as a reduction of at least two points), the proportion achieving a six-minute walk distance (6MWD) improvement of at least 30 m, change in modified Medical Research Council (mMRC) dyspnoea grade, body mass index-airflow obstruction-dyspnoea-exercise capacity (BODE) and age-dyspnoea-obstruction (ADO) indices, and clinical events. Paired changes were analysed with paired &lt;i&gt;t&lt;/i&gt;-tests or Wilcoxon signed-rank tests and are reported with 95% confidence intervals (CIs). &lt;b&gt;Results.&lt;/b&gt; Three hundred participants were enrolled. Recorded GOLD groups were A (&lt;i&gt;n&lt;/i&gt; = 69), B (n = 158) and E (n = 73). Paired CAT and FEV&lt;sub&gt;1&lt;/sub&gt; data were available for 276 (92.0%) and 257 (85.7%) participants, all of whom were reassessed between 84 and 98 days after baseline (median 91 days). Across the cohort, mean CAT fell by 3.93 points (95% CI -4.43 to -3.44) and mean FEV&lt;sub&gt;1&lt;/sub&gt; rose by 2.20 percentage points (95% CI 1.78 to 2.63); one hundred and ninety-five of 276 participants (70.7%) reached the CAT MCID and 98 of 244 (40.2%) achieved a 6MWD gain of at least 30 m. Improvement was observed with every long-acting regimen. Participants receiving LABA + ICS improved by 4.18 CAT points (95% CI -5.24 to -3.12; &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and 3.06 FEV&lt;sub&gt;1&lt;/sub&gt; percentage points (95% CI 2.16 to 3.95; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with 82.1% reaching the CAT MCID-a magnitude similar to that observed on LABA+LAMA. Participants on SABA/SAMA alone showed no improvement in either outcome. Sixty-three exacerbations, eleven hospitalisations and four cases of pneumonia occurred. &lt;b&gt;Conclusions.&lt;/b&gt; During a reassessment interval of 84 to 98 days, patients with COPD ","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194117","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":"Adjunctive Immersive Virtual Reality for Urinary Incontinence-Related Quality of Life in Postmenopausal Women with Urinary Incontinence: A Non-Randomized Controlled Pilot Trial.","authors":"Gabriela Kołodyńska, Błażej Cieślik, Aleksandra Piątek, Maciej Zalewski, Joanna Szczepańska-Gieracha, Waldemar Andrzejewski","doi":"10.3390/jcm15197726","DOIUrl":"10.3390/jcm15197726","url":null,"abstract":"<p><p><b>Background/Objectives:</b> This study examined whether adding relaxation-oriented immersive virtual reality (VR) to pelvic floor muscle electrostimulation with electromyographic (EMG) biofeedback was associated with additional improvement in incontinence-related quality of life among postmenopausal women. <b>Methods:</b> In this exploratory non-randomized controlled pilot trial, 40 postmenopausal women received electrostimulation with EMG biofeedback alone (ES; <i>n</i> = 20) or the same intervention preceded by VR (VR + ES; <i>n</i> = 20). Participants completed eight sessions over 2 weeks and were assessed at baseline (T0), post-intervention (T1), and 2-week follow-up (T2); T1 was the prespecified primary assessment. The primary outcome was the Incontinence Quality of Life Questionnaire (I-QOL) total score. Secondary outcomes included pelvic floor EMG, bladder-diary variables, other quality-of-life measures, perceived stress, and self-esteem. Baseline-adjusted linear mixed models were used. The registry record was submitted before enrollment (NCT07070063). <b>Results:</b> Thirty-six participants contributed to the primary analysis. The adjusted between-group difference in I-QOL was -1.65 points at T1 (95% CI, -10.03 to 6.74; <i>p</i> = 0.70) and -4.00 points at T2 (95% CI, -12.38 to 4.39; <i>p</i> = 0.35). Adjusted contrasts were non-significant for the remaining questionnaire and EMG outcomes. Selected bladder-diary outcomes differed between groups, but these analyses were exploratory, unadjusted for multiple comparisons, and did not directly quantify urinary leakage. <b>Conclusions:</b> The study did not detect a statistically significant additional improvement in incontinence-related quality of life with adjunctive VR. Confidence intervals remained compatible with potentially meaningful effects in either direction. Given the small sample and non-randomized design, the findings are preliminary and hypothesis-generating.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193947","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":"High Satisfaction, Modest Differences: A Comparative Cohort Study of Robotic-Assisted and Conventional Total Hip Arthroplasty.","authors":"David González-Martín, Alejandro Herrera-Rodríguez, José María Lomo-Garrote, Juan José González-Álvarez, Francisco Del Canto-Iglesias, Andrés Saldaña-Díaz, José Luis Pais-Brito","doi":"10.3390/jcm15197721","DOIUrl":"10.3390/jcm15197721","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Robotic-assisted total hip arthroplasty (raTHA) improves the accuracy and reproducibility of acetabular component positioning compared with conventional THA (cTHA), but whether this translates into superior patient-reported outcomes and satisfaction remains debated. <b>Methods:</b> A retrospective comparative cohort study was performed, including all patients who underwent primary raTHA with the Mako system at our institution (September 2024-May 2025) and an equal-sized control group recruited consecutively from an alphabetically ordered list of 172 eligible cTHAs, starting from a randomly selected letter (August 2022-January 2025), with a minimum follow-up of one year. Treatment allocation was determined by insurance coverage. The postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was the primary outcome; the Visual Analog Scale (VAS), modified Harris Hip Score (mHHS) and Forgotten Joint Score-12 (FJS-12) were secondary outcomes, and an overall satisfaction rating and willingness to undergo the surgery again were also recorded. <b>Results:</b> Ninety-three raTHA and 93 cTHA patients were analyzed. Follow-up was longer in the cTHA group (35.6 vs. 15.5 months; <i>p</i> < 0.001). Postoperative WOMAC (10.5 vs. 14.4; mean difference -3.8 points, 95% CI -7.4 to -0.2) and mHHS (86.9 vs. 84.7; mean difference 2.2 points, 95% CI -0.9 to 5.4) differed in rank-based comparisons, favoring raTHA (Mann-Whitney U test, <i>p</i> = 0.020 and <i>p</i> = 0.030, respectively). Point estimates were below the selected clinical-relevance thresholds, but the confidence intervals did not exclude clinically relevant differences; improvement from baseline did not differ between groups. There were no significant differences in VAS, FJS-12, overall satisfaction (9.32 vs. 9.31) or willingness to undergo surgery again (96.8% vs. 97.8%). <b>Conclusions:</b> Given insurance-based allocation, unequal follow-up and unadjusted analyses, robotic-assisted THA was associated with small differences in postoperative WOMAC and mHHS, whose point estimates were below the selected thresholds, although clinically relevant differences cannot be excluded; there were no differences in improvement, pain, joint awareness or satisfaction, which was very high in both groups. These findings do not establish a causal effect of robotic assistance; prospective randomized studies are needed.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193770","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":"Urethral Stricture with a Miniaturised (22 Fr) Versus Standard (26 Fr) Resectoscope Sheath During Thulium Fibre Laser Enucleation of the Prostate: A Prospective, Two-Centre Comparative Cohort Study.","authors":"İbrahim Buldu, Mustafa Bilal Hamarat, Burak Yılmaz, Taha Emre Aydın, Hakan Hakkı Taşkapu","doi":"10.3390/jcm15197724","DOIUrl":"10.3390/jcm15197724","url":null,"abstract":"<p><p><b>Objectives:</b> We aimed to compare the observed rates of postoperative urethral stricture between patients undergoing thulium fibre laser enucleation of the prostate (ThuFLEP) using a 22 Fr miniaturised instrument strategy and those treated using a standard 26 Fr strategy. <b>Methods:</b> This prospective, two-centre comparative cohort study included 208 patients with benign prostatic hyperplasia and a prostate volume of less than 150 mL who underwent thulium fibre laser enucleation of the prostate (ThuFLEP) between 2024 and 2026. Patients were grouped according to the resectoscope sheath used at each centre: Group 1 comprised 99 patients treated with a 22 Fr miniaturised sheath and Group 2 comprised 109 patients treated with a standard 26 Fr sheath. The primary endpoint was the development of postoperative urethral stricture. Patient demographics and preoperative and postoperative clinical outcomes were also recorded. <b>Results:</b> Demographic and operative parameters were comparable between the groups. No significant difference was observed in mean prostate volumes (68.8 ± 34.1 vs. 70.8 ± 25.7 mL). Although the enucleation efficiency (g/min) was numerically higher in Group 1, the difference did not reach statistical significance (2.2 ± 1.1 vs. 1.8 ± 0.6; <i>p</i> = 0.082). Postoperative urethral stricture was observed in 2 patients (2.0%) in Group 1 and in 10 patients (9.2%) in Group 2. The incidence of stricture was significantly higher in Group 2 (<i>p</i> = 0.036). <b>Conclusions:</b> The 22 Fr ThuFLEP strategy was associated with a lower observed urethral stricture rate. However, the independent effect of sheath diameter could not be separated from centre- and surgeon-related factors. Further randomised studies are required to confirm these findings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193932","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}