Journal of Clinical Medicine最新文献

{"title":"Minimally Invasive Revision Surgery Combining Endoscopic Double-Row Reinsertion and Flexor Hallucis Longus Transfer for Insertional Achilles Tendon Re-Rupture in a Semi-Professional Rugby Player: A Case Report.","authors":"André Santos-Moreira, Marine Riou, Pierre Wagner, Ronny Lopes","doi":"10.3390/jcm15197725","DOIUrl":"10.3390/jcm15197725","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Acute insertional Achilles tendon rupture (A-IATR) is a rare, often season-ending injury in athletes. Revision after a failed repair is particularly challenging, and return to sport (RTS) after such surgery is rarely documented. We report one such case. <b>Methods</b>: A 32-year-old semi-professional rugby prop forward sustained an insertional re-rupture eighteen months after open transosseous reinsertion without suture anchors. MRI showed complete detachment with 15 mm of retraction and no residual tendon on the footprint. A single-stage procedure combining endoscopic double-row (SpeedBridge™) reinsertion and flexor hallucis longus (FHL) transfer was performed, followed by six weeks of non-weight-bearing cast immobilization and criteria-based rehabilitation, with Ankle-GO™-guided return to play. <b>Results</b>: At three months, MRI showed tendon continuity without re-rupture. Return to play was authorized at 8.2 months (Ankle-GO™ 16/25); the patient returned to official competition at 9.4 months and was still competing approximately 17 months after surgery. At 15 months, the Achilles Tendon Total Rupture Score was 84 and the AOFAS score 90. No complication occurred. <b>Conclusions</b>: To our knowledge, this is the first report of RTS after this combined endoscopic revision technique. This single case suggests that this approach may be a feasible revision option in high-demand athletes; comparative 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/PMC13665799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194432","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":"Magnesium in Diabetes Mellitus and Diabetic Kidney Disease.","authors":"Guido Gembillo, Luca Visconti, Luca Soraci, Lorenzo Lo Cicero, Manuel Scapellato, Concetto Sessa, Walter Morale, Antonino Catalano, Andrea Corsonello, Alberto La Spada, Ankit Sharma, Michele Provenzano, Domenico Santoro","doi":"10.3390/jcm15197723","DOIUrl":"10.3390/jcm15197723","url":null,"abstract":"<p><p>Magnesium is a cofactor in cellular energy metabolism and insulin signaling, with recognized effects on vascular tone and cardiac electrophysiology. Hypomagnesemia affects roughly one-third of people with type 2 diabetes mellitus (T2DM) in pooled observational data and becomes more frequent in diabetic kidney disease (DKD). Reduced dietary intake accounts for part of the deficit; renal magnesium wasting linked to attenuated insulin signaling and reduced TRPM6 activity at the distal convoluted tubule is a plausible mechanism for the remainder, characterized mainly in cellular and experimental systems. In observational cohorts, lower serum magnesium accompanies poorer glycemic control and an excess of cardiovascular and microvascular events, and in DKD it independently predicts progression to kidney failure. Prescribed oral repletion has been associated with fewer cardiovascular events in hypomagnesemic patients, with no corresponding association in normomagnesemic ones, in propensity-matched data that cannot substitute for randomized confirmation. Mendelian randomization offers suggestive evidence for coronary artery disease and none for incident T2DM, a dissociation compatible with insulin resistance acting upstream of renal magnesium wasting, although instrument limitations leave other readings open. Hypomagnesemia is substantially less frequent in adult type 1 diabetes, where the association with glycemic control concentrates among patients with the highest insulin requirements. SGLT2 inhibitors raise serum magnesium modestly, whereas thiazide and loop diuretics and proton-pump inhibitors lower it. Randomized trials have shown modest effects on glycemic intermediates, larger in patients with documented deficiency, and no trial has yet tested renal progression. Magnesium status is a reproducible prognostic marker in T2DM and DKD; its value as a therapeutic target awaits randomized trials with clinical endpoints.</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/PMC13666300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194316","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 Serum 25-Hydroxyvitamin D Status and Long-Term Marginal Bone Loss Around Dental Implants.","authors":"Okan Özen, Vesile Elif Toy","doi":"10.3390/jcm15197719","DOIUrl":"10.3390/jcm15197719","url":null,"abstract":"<p><p><b>Background and Objectives:</b> The objective was to evaluate the association between serum 25-hydroxyvitamin D [25(OH)D] measured before functional loading and long-term peri-implant marginal bone loss (MBL). <b>Materials and Methods:</b> This retrospective study included 60 systemically healthy patients with 136 implants. Patients were classified as vitamin D-deficient (<20 ng/mL; <i>n</i> = 30) or -sufficient (≥20 ng/mL; <i>n</i> = 30). MBL was calculated from periapical radiographs obtained at prosthetic delivery and final follow-up (mean, 39.46 months; range, 34-48 months). Clinical parameters and implant loss were secondary outcomes. Between-group comparisons used the Mann-Whitney U and Fisher's exact tests; associations were examined using Spearman's rank correlation. <b>Results:</b> MBL was greater in the deficient group than in the sufficient group (0.98 ± 0.25 mm vs. 0.42 ± 0.32 mm; <i>p</i> < 0.001). Serum 25(OH)D was inversely correlated with MBL in the deficient group (r_s = -0.720), sufficient group (r_s = -0.604), and overall sample (r_s = -0.862; all <i>p</i> < 0.001). No statistically significant between-group differences were detected in the clinical parameters (all <i>p</i> > 0.05). <b>Conclusions:</b> Lower baseline serum 25(OH)D was associated with greater long-term MBL, while clinical parameters and patient-level implant loss did not differ between groups.</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/PMC13666258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193854","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":"Parent-Reported History of Traumatic Dental Injuries and Current Sports Participation Among Paediatric Dental Patients in Central Poland: A Cross-Sectional Study.","authors":"Karolina Spodzieja, Dorota Olczak-Kowalczyk","doi":"10.3390/jcm15197720","DOIUrl":"10.3390/jcm15197720","url":null,"abstract":"<p><p><b>Background:</b> Traumatic dental injuries (TDIs) are among the most common oral health problems in children and adolescents and may significantly affect quality of life and long-term oral health outcomes. Participation in sports activities has been identified as an important risk factor for dental trauma; however, epidemiological data concerning Polish paediatric populations remain limited. <b>Objective:</b> The aim of the present study was to assess the proportion and characteristics of parent-reported traumatic dental injuries among children attending a university paediatric dental clinic in the Mazowieckie Voivodeship and to evaluate the associations between a parent-reported history of dental trauma, current sports participation, and selected demographic characteristics. <b>Materials and Methods:</b> A cross-sectional questionnaire-based study was conducted among parents and legal guardians of children aged 7-15 years attending the Department of Paediatric Dentistry at the Medical University of Warsaw. Participants were recruited using convenience sampling during routine dental visits between 2023 and 2025. The questionnaire included items concerning demographic characteristics, current sports participation, and the child's history of traumatic dental injuries. Statistical analyses included chi-square tests, Fisher's exact tests, Mann-Whitney U tests, and logistic regression analysis. <b>Results:</b> A total of 735 questionnaires were included in the analysis. Traumatic dental injuries were reported in 42.9% of children. A history of TDI was reported for 47.7% of boys and 37.3% of girls (<i>p</i> = 0.006). A reported history of dental trauma was more common among children currently participating in sports than among non-participants (49.7% vs. 31.3%; <i>p</i> < 0.001). Football participation was associated with a higher occurrence of reported TDI. Rural residence and lower parental education level were also associated with a higher occurrence of reported TDI. In the fitted logistic regression model, current sports participation was associated with higher odds of a reported TDI history (OR = 2.33; 95% CI: 1.69-3.21). <b>Conclusions:</b> A history of traumatic dental injuries was frequently reported among children attending a university paediatric dental clinic in the Mazowieckie Voivodeship and was associated with sports participation and selected demographic characteristics. Owing to the clinic-based convenience sampling, these findings should not be interpreted as population-level prevalence estimates for children in Central Poland.</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/PMC13665782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194306","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":"Foot Dysfunction and Its Associations with Kinesiophobia and Concern About Falling in Adults with Fibromyalgia Syndrome: A Cross-Sectional Study.","authors":"Coral Moya-Cuenca, Ana López-González, Hayla Pérez-Matilla, Alba Gracia-Sánchez, África Lozano-Espinosa, Silvia García-Lázaro, Esther Chicharro-Luna, Sara Zúnica-García","doi":"10.3390/jcm15197718","DOIUrl":"10.3390/jcm15197718","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Foot problems are common in fibromyalgia syndrome (FMS) and may be related to pain, kinesiophobia, and concern about falling. This study examined associations between foot function, kinesiophobia, and concern about falling in adults with FMS and identified factors independently associated with worse foot function. <b>Methods:</b> Adults with clinically diagnosed FMS were assessed between December 2024 and April 2025 in this cross-sectional study. Foot function was evaluated using the Foot Function Index (FFI), kinesiophobia with the Tampa Scale for Kinesiophobia-11 (TSK-11), and concern about falling with the Falls Efficacy Scale-International (FES-I). Multivariable linear regression identified factors independently associated with total FFI score. <b>Results:</b> Among 444 participants, 95.3% were women. The mean FFI score was 52.28 ± 23.24/100, with pain showing the greatest impairment. The mean TSK-11 and FES-I scores were 29.21 ± 7.91 and 39.73 ± 12.41, respectively. FFI scores were associated with both TSK-11 and FES-I scores in bivariate analyses (<i>p</i> < 0.001). In multivariable analysis (adjusted R² = 0.366), older age was associated with lower FFI scores, whereas higher BMI, smoking history, rheumatoid arthritis, and higher FES-I scores were independently associated with worse foot function. <b>Conclusions:</b> Foot dysfunction in FMS was associated with kinesiophobia and concern about falling, but only concern about falling remained independently associated after adjustment. Higher BMI, smoking history, and rheumatoid arthritis were also associated with worse foot function. Assessment of concern about falling may provide complementary information when evaluating foot-related functional impairment in individuals with FMS.</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/PMC13666124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194367","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":"Comorbidity Burden in Frontal Fibrosing Alopecia and Lichen Planopilaris: A Systematic Review and Prevalence Meta-Analysis.","authors":"Juan Luis Sanz-Cabanillas, Francisco José Gómez-García, Elena Beatriz Sanz-Cabanillas, Jesús Gay-Mimbrera, Antonio José Vélez García-Nieto, Beatriz Isla-Tejera, Juan Ruano","doi":"10.3390/jcm15197728","DOIUrl":"10.3390/jcm15197728","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Frontal fibrosing alopecia (FFA) and lichen planopilaris (LPP) are primary lymphocytic cicatricial alopecias with frequently reported systemic and dermatological comorbidities, although their prevalence and consistency across studies remain uncertain. <b>Methods:</b> We conducted a systematic review and random-effects prevalence meta-analysis following PRISMA 2020 and Joanna Briggs Institute guidance, prospectively registered in PROSPERO (CRD420250656067). MEDLINE, Embase, ClinicalTrials.gov, preprint sources, and reference lists were searched from inception to 18 June 2025 for observational studies reporting comorbidity prevalence in FFA and/or LPP. <b>Results:</b> Sixty studies comprising 4499 patients with FFA and 1370 with LPP were included. In FFA, the highest pooled prevalences among commonly reported conditions included androgenetic alopecia (31.9%), hypertension (23.6%), thyroid disorders (22.2%), hypothyroidism (20.6%), lichen planus pigmentosus (19.6%), and dyslipidemia (17.9%). In LPP, androgenetic alopecia (27.2%), hypertension (21.2%), hypothyroidism (18.7%), vitamin D deficiency (18.3%), dyslipidemia (16.0%), and thyroid disorders (14.5%) were prominent. Several estimates showed substantial between-study heterogeneity. Exploratory subgroup analyses identified study-level sources of heterogeneity for selected outcomes, whereas no meta-regression association remained significant after false-discovery-rate correction. <b>Conclusions:</b> These findings provide a quantitative map of comorbidity burden in FFA and LPP and support targeted, individualized clinical assessment. Because this analysis estimates prevalence within affected populations rather than comparative risk against controls, the findings should not be interpreted as evidence of excess risk or causal relationships.</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/PMC13666100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194039","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 Rare Case of Benign-Appearing Myoepithelial Carcinoma of the Hard Palate in an Adolescent.","authors":"Eun Young Lee, Baljinnyam Altangerel, Kang Hee Yu","doi":"10.3390/jcm15197708","DOIUrl":"10.3390/jcm15197708","url":null,"abstract":"<p><p>Myoepithelial carcinoma is a rare malignant salivary gland tumor that is particularly uncommon in pediatric patients. A 14-year-old girl presented with a painless, slowly enlarging hard palate mass that had been present for 2 years. Clinically, the lesion closely resembled a benign tumor due to its young presentation age, well-encapsulated state, absence of mucosal ulceration, and lack of lymphadenopathy, leading to an initial diagnosis of pleomorphic adenoma. Complete surgical excision with superficial mucosa preservation was initially performed. However, histopathological examination revealed myoepithelial carcinoma with infiltrative growth despite its well-circumscribed appearance. Consequently, a second-stage wide local excision was performed to achieve adequate safety margins. The patient recovered uneventfully without functional impairment, with preservation of oral mucosal mobility. No evidence of recurrence was observed during 18 months of follow-up. This case demonstrates that myoepithelial carcinoma may present as a clinically benign, well-circumscribed palatal mass even in pediatric patients, emphasizing that benign clinical features and a negative intraoperative frozen-section result do not exclude malignancy and highlighting the importance of careful permanent histopathological examination and long-term postoperative surveillance.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193865","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":"Chlorhexidine Versus Iodine-Based Skin Preparation Was Not Associated with a Significant Difference in 90-Day Infection Risk After Instrumented Degenerative Cervical or Lumbar Spine Surgery: A Propensity Score-Matched Analysis.","authors":"Firas Batrash, Fahad Jamal, Siddharth Jasti, James A Belanger, Timothy A Reiad, Tasif Mahmoud, Ahmed Iqbal, Artin Allahverdian, Bassel G Diebo, Bryce A Basques, Alan H Daniels","doi":"10.3390/jcm15197714","DOIUrl":"10.3390/jcm15197714","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Chlorhexidine and iodine-based preparations are both widely used, and the existing literature suggests a possible advantage of chlorhexidine in clean elective surgery. Whether this extends to instrumented degenerative spine surgery is unknown. We asked whether chlorhexidine-based skin preparation reduces 90-day postoperative infection compared with iodine-based preparation after instrumented degenerative cervical or lumbar spine surgery. <b>Methods:</b> A retrospective TriNetX cohort study was performed among adults undergoing instrumented degenerative cervical or lumbar spine surgery. Patients were stratified by anatomic region and by preoperative preparation exposure: chlorhexidine-based versus iodine-based. Moreover, 1:1 propensity-score matching was performed within each anatomic stratum on demographics, Charlson Comorbidity Index (CCI), diabetes, smoking, obesity and BMI, immunosuppression, methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) carrier status, and index procedure codes. The primary outcome was 90-day postoperative infection. Secondary outcomes were superficial and deep surgical site infection, MRSA infection, incision and drainage, debridement, sepsis, urinary tract infection, and pneumonia. <b>Results:</b> After matching, the cervical cohort included 3528 patients per group and the lumbar cohort 4164 per group. Postoperative infection did not differ in the cervical cohort (1.76% vs. 1.59%; risk ratio [RR] 1.11, 95% confidence interval [CI] 0.77-1.58; <i>p</i> = 0.578) or the lumbar cohort (3.17% vs. 3.29%; RR 0.96, 95% CI 0.76-1.22; <i>p</i> = 0.757). Superficial and deep infection, MRSA infection, debridement, sepsis, urinary tract infection, and pneumonia did not differ significantly in either cohort. <b>Conclusions:</b> No statistically significant difference in 90-day postoperative infection was found between chlorhexidine-based and iodine-based skin preparation after instrumented degenerative cervical or lumbar spine surgery.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194131","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":"Percussive Vibration Therapy as an Adjunct to Conventional Physiotherapy in Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial.","authors":"Elif Esma Bayraktar, Ömer Şevgin, Ainaz Vahedi, Ertuğrul Safran","doi":"10.3390/jcm15197711","DOIUrl":"10.3390/jcm15197711","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Hand-held percussive vibration therapy (PVT) is widely used in musculoskeletal rehabilitation, yet its incremental benefit beyond an active physiotherapy program for chronic non-specific low back pain (CNLBP) is unclear. We investigated whether PVT added to conventional physiotherapy (CPT) improves disability, sleep quality, and pain. <b>Methods:</b> This single-center, parallel-group, assessor-blinded randomized trial enrolled 50 adults aged 18-65 years with CNLBP and baseline visual analogue scale (VAS) pain ≥4/10. Participants were allocated equally to PVT + CPT or CPT alone and attended three sessions weekly for eight weeks. The Oswestry Disability Index (ODI) was the primary outcome; Pittsburgh Sleep Quality Index (PSQI) and VAS scores were secondary outcomes. Week-8 scores were analyzed with baseline-adjusted ANCOVA using HC3 robust standard errors. <b>Results:</b> Follow-up data were complete for all participants. The adjusted ODI score at week 8 was 2.59 points higher with PVT + CPT than with CPT (95% confidence interval [CI], 0.47 to 4.71; <i>p</i> = 0.017), a statistically significant difference in favor of CPT. PSQI scores did not differ between groups (adjusted difference, 0.25; 95% CI, -0.40 to 0.90; <i>p</i> = 0.451). VAS scores were lower with PVT + CPT (adjusted difference, -1.15; 95% CI, -1.45 to -0.85; <i>p</i> < 0.001). <b>Conclusions:</b> PVT did not provide an additional benefit for disability and did not improve sleep quality when added to CPT. The pain difference was a secondary, exploratory finding of uncertain clinical relevance.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194309","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":"Recurrent Revascularization Failure in a Patient with Complex Coronary Substrate.","authors":"Nicoleta-Monica Popa-Fotea, Mircea Bajdechi, Radu-Gabriel Vătășescu, Cristina Madalina Pascu, Lucian Dorobanţu, Lucian Câlmâc","doi":"10.3390/jcm15197710","DOIUrl":"10.3390/jcm15197710","url":null,"abstract":"<p><p><b>Background:</b> In-stent restenosis (ISR) remains a major limitation of contemporary percutaneous coronary intervention (PCI), particularly in patients with diabetes mellitus and complex coronary anatomy. In addition to anatomical and metabolic factors, inappropriate lesion selection and preparation may contribute to adverse outcomes and repeated revascularization. <b>Case Summary:</b> A 44-year-old man with insulin-treated type 2 diabetes mellitus, arterial hypertension, and dyslipidemia presented with non-ST-segment elevation myocardial infarction. His recent cardiovascular history included multiple PCI procedures with drug-eluting stent (DES) implantation in the left anterior descending and circumflex arteries. Early recurrent ISR developed and progressed to involve the left main coronary artery (LMCA) bifurcation, with rapid evolution toward multilayer restenosis despite repeat drug-coated balloon (DCB) angioplasty and additional stent implantation. Given the complex coronary anatomy (residual SYNTAX score 32) and repeated PCI failure, the Heart Team recommended coronary artery bypass grafting. However, early graft degeneration and progression of native coronary disease led to recurrent angina. Subsequent intravascular ultrasound (IVUS)-guided PCI using a hybrid strategy (DCB and DES) resulted in favorable short-term outcomes, with no significant restenosis at 6- and 12-month follow-up. <b>Conclusions</b>: This case illustrates how recurrent restenosis may develop despite ischemia-supported PCI when complex bifurcation anatomy and mechanical factors such as stent underexpansion remain insufficiently characterized. In complex coronary disease, systematic use of intracoronary imaging and mechanism-based revascularization are essential to prevent repeated target lesion failure.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194468","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}