Journal of Clinical Medicine最新文献

{"title":"Vitrectomy for Epiretinal Membrane Peeling in Patients with Diabetic Retinopathy-Functional and Morphological Outcome.","authors":"Patricia Hülse, Sarah Janott, Verena Schöneberger, Claudia Brockmann, Thomas A Fuchsluger, Friederike Schaub","doi":"10.3390/jcm14145128","DOIUrl":"10.3390/jcm14145128","url":null,"abstract":"<p><p><b>Background</b>: Secondary epiretinal membrane (ERM) is a common complication of diabetic retinopathy, but data on surgical outcome is limited. The aim of this study was to evaluate anatomical and functional outcomes after pars plana vitrectomy with ERM peeling in eyes with diabetic retinopathy. <b>Methods</b>: A retrospective analysis was conducted on 87 eyes of 87 consecutive patients with diabetic retinopathy who underwent ERM peeling over a ten-year period (04/2013-11/2022). Collected data included demographics, best-corrected visual acuity (BCVA), stage of diabetic retinopathy, and optical coherence tomography parameters such as central subfield retinal thickness (CSRT), macular volume (MV), and presence of hyperreflective foci, subretinal fluid, and intraretinal fluid. Statistical analyses were performed using a paired <i>t</i>-test and the Wilcoxon test. <b>Results</b>: The majority of patients had type 2 diabetes (96.6%), and 69.0% presented with diabetic macular edema (DME). The mean follow-up was 2.2 ± 2.0 years. Significant postoperative reductions were observed in CSRT (from 377.20 ± 99.28 µm to 337.99 ± 113.834 µm; <i>p</i> = 0.008) and MV (from 10.11 ± 1.46 mm³ to 99.28 ± 1.07 mm³; <i>p</i> < 0.001). No significant changes in BCVA were observed across the entire study cohort. ERM recurrence was rare (2.3%), and no major complications occurred. <b>Conclusions</b>: ERM peeling in diabetic eyes leads to significant anatomical improvement, especially in advanced diabetic retinopathy and DME, but with limited functional gains. The surgical indication should be carefully considered.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731534","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":"Clinical Scores of Peripartum Patients Admitted to Maternity Wards Compared to the ICU: A Systematic Review and Meta-Analysis.","authors":"Jennifer A Walker, Natalie Jackson, Sudha Ramakrishnan, Claire Perry, Anandita Gaur, Anna Shaw, Saad Pirzada, Quincy K Tran","doi":"10.3390/jcm14145113","DOIUrl":"10.3390/jcm14145113","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Hospitalized peripartum patients who later decompensate and require an upgrade to the intensive care unit (ICU) may have an increased risk for poor outcomes. Most of the literature regarding the need for ICU involves Modified Early Warning Scores in already hospitalized patients or the evaluation of specific comorbid conditions or diagnoses. This systematic review and meta-analysis aimed to assess the differences in clinical scores at admission among adult peripartum patients to identify the later need for ICU. <b>Methods</b>: We systematically searched Ovid-Medline, PubMed, EMBASE, Web of Science and Google Scholar for randomized and observational studies of adult patients ≥18 years of age who were ≥20 weeks pregnant or up to 40 days post-partum, were admitted to the wards from the emergency department and later required critical care services. The primary outcome was the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included other clinical scores, the hospital length of stay (HLOS) and mortality. The Newcastle-Ottawa Scale was utilized to grade quality. Descriptive analyses were performed to report demographic data, with means (±standard deviation [SD]) for continuous data and percentages for categorical data. Random-effects meta-analyses were performed for all outcomes when at least two studies reported a common outcome. <b>Results</b>: Seven studies met the criteria, with a total of 1813 peripartum patients. The mean age was 27.2 (±2.36). Patients with ICU upgrades were associated with larger differences in mean SOFA scores. The pooled difference in means was 2.76 (95% CI 1.07-4.46, <i>p</i> < 0.001). There were statistically significant increases in Sepsis in Obstetrics Scores, APACHE II scores, and HLOS in ICU upgrade patients. There was a non-significantly increased risk of mortality in ICU upgrade patients. There was high overall heterogeneity between patient characteristics and management in our included studies. <b>Conclusions</b>: This systematic review and meta-analysis demonstrated higher SOFA or other physiologic scores in ICU upgrade patients compared to those who remained on the wards. ICU upgrade patients were also associated with a longer HLOS and higher mortality compared with control patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731273","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":"Declining Myocarditis Mortality in the United States and the Impact of the COVID-19 Pandemic.","authors":"Ali Bin Abdul Jabbar, Daniyal Ali Khan, John Osborne, William Thomson, Ameya Chinawalkar, Mason Klisares, Kyle Gilkeson, Ahmed Aboeata","doi":"10.3390/jcm14145116","DOIUrl":"10.3390/jcm14145116","url":null,"abstract":"<p><p><b>Background:</b> Myocarditis is associated with increased mortality due to complications such as cardiogenic shock and arrhythmia. Trends of myocarditis-related mortality in the United States, along with demographic and regional disparities and changes during the COVID-19 pandemic, are unknown. <b>Methods:</b> We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to extract data for myocarditis deaths from 1999 to 2023. The Joinpoint Regression Program was used to analyze long-term trends in mortality, and R Studio (version 4.4.1) was used to calculate expected and excess mortality for 2020 to 2023. <b>Results:</b> There were 33,016 myocarditis-related deaths from 1999 to 2023. The age-adjusted mortality rate (AAMR) of myocarditis deaths decreased by 46.08% from 7.40 (95% CI: 7.04-7.76) in 1999 to 3.99 (95% CI: 3.74-4.23) in 2019, with an APC of -2.59 (95% CI: -2.97 to -2.24). From 2019 to 2021, the AAMR increased by 46.62% to 5.85 (95% CI: 5.56-6.14) by 2021 (2019-2021 APC 22.3%*), reversing the gains of the previous two decades. By 2023, the AAMR recovered to 4.33 (95% CI: 4.09 to 4.58), though mortality was still higher than expected from pre-pandemic trends. From 2020 to 2023, there were 40.12% more deaths than expected, with 54.94% higher mortality in 2021. Briefly, 70.33% of excess myocarditis-related deaths also had COVID-19, with a peak of 76.15% of excess myocarditis deaths in 2021 being reported as involving COVID-19 infection. Significant disparities in mortality trends persisted, with males, NH Black or African Americans, and the elderly having higher mortality rates. <b>Conclusions:</b> Myocarditis mortality decreased in the United States from 1999 to 2019 but significantly increased during the COVID-19 pandemic years 2020 and 2021. At the height of the pandemic, COVID-19 infection contributed to almost three-quarters of excess myocarditis mortality. Significant disparities in myocarditis mortality persisted from 1999 to 2023.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731299","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":"Exploring the Proteomic Landscape of Cochlear Implant Trauma: An iTRAQ-Based Quantitative Analysis Utilizing an Ex Vivo Model.","authors":"Jake Langlie, Rahul Mittal, David H Elisha, Jaimee Cooper, Hannah Marwede, Julian Purrinos, Maria-Pia Tuset, Keelin McKenna, Max Zalta, Jeenu Mittal, Adrien A Eshraghi","doi":"10.3390/jcm14145115","DOIUrl":"10.3390/jcm14145115","url":null,"abstract":"<p><p><b>Background:</b> Cochlear implantation is widely used to provide auditory rehabilitation to individuals with severe-to-profound sensorineural hearing loss. However, electrode insertion during cochlear implantation leads to inner ear trauma, damage to sensory structures, and consequently, loss of residual hearing. There is very limited information regarding the target proteins involved in electrode insertion trauma (EIT) following cochlear implantation. <b>Methods:</b> The aim of our study was to identify target proteins and host molecular pathways involved in cochlear damage following EIT utilizing the iTRAQ™ (isobaric tags for relative and absolute quantification) technique using our ex vivo model. The organ of Corti (OC) explants were dissected from postnatal day 3 rats and subjected to EIT or left untreated (control). The proteins were extracted, labelled, and subjected to ultra-high performance liquid chromatography-tandem mass spectrometry. <b>Results:</b> We identified distinct molecular pathways involved in EIT-induced cochlear damage. Confocal microscopy confirmed the expression of these identified proteins in OC explants subjected to EIT. By separating the apical, middle, and basal cochlear turns, we deciphered a topographic array of host molecular pathways that extend from the base to the apex of the cochlea, which are activated post-trauma following cochlear implantation. <b>Conclusions:</b> The identification of target proteins involved in cochlear damage will provide novel therapeutic targets for the development of effective treatment modalities for the preservation of residual hearing in implanted individuals.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731301","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":"Genetic Susceptibility to Glomerulonephritis in Children: Analysis of Structural Kidney Genes and Immune System Genes.","authors":"Marina Peric, Aleksandra Anicin, Marija Brankovic, Natasa Stajic, Jovana Putnik, Aleksandra Paripovic, Milena Jankovic, Ivo Bozovic, Vladimir Perovic, Ivana Novakovic, Vladislav Vukomanovic, Emina Milosevic","doi":"10.3390/jcm14145119","DOIUrl":"10.3390/jcm14145119","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Glomerulonephritis (GNs) is a heterogeneous group of inflammatory kidney diseases. Novel genetic methods have revealed some disease-causing and susceptibility genes underlying primary and secondary GNs. We aimed to investigate the presence of the single nucleotide polymorphisms (SNPs) rs12917707, found in the <i>UMOD</i> gene, and rs17319721, found in the <i>SHROOM3</i> gene, as well as different polymorphisms in immune system genes in a group of children with GN. <b>Method</b>: The study included 71 children with GN (40 with primary and 31 with secondary GN) and 119 healthy children (HC). SNPs of the <i>UMOD</i> (rs12917707), <i>SHROOM3</i> (rs17319721), <i>IL10</i> (rs1800871 and rs3024505), <i>IL6</i> (rs1800795), <i>IL12B</i> (rs3212227), <i>IL23R</i> (rs11209026 and rs1800896), and <i>TNF</i> (rs361525 and rs1800629) genes were genotyped. <b>Results</b>: The median age of the patients was 8 years at the onset of GN and 14 years at sampling. Allele A for rs1800629 in the <i>TNF</i> gene was more common in patients with GN in comparison to HCs (<i>p</i> = 0.009), followed by the difference in genotype distributions (<i>p</i> = 0.021), where AA and GA genotypes were more prevalent in patients. We found a statistically significant difference in haplotype distributions between patients and HCs for TNF, with GN patients having the GGAG haplotype more frequently and HCs having GGGG (<i>p</i> < 0.05). No correlation between the investigated SNPs and patient clinical characteristics (disease onset, primary or secondary GN, severity of disease, occurrence of remission, and presence of hypertension) was observed. <b>Conclusions</b>: An association between the <i>TNF</i> gene and different types of GN was noticed in children with GN. This may help us to understand the pathogenesis of these disorders and develop new treatments to cover the unmet needs of children with GN.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731324","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":"Reverse Total Shoulder Arthroplasty for Proximal Humerus Nonunion.","authors":"James Tyler Frix, Maria Kammire, Nainisha Chintalapudi, Patrick Connor","doi":"10.3390/jcm14145130","DOIUrl":"10.3390/jcm14145130","url":null,"abstract":"<p><p><b>Background:</b> Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. <b>Methods:</b> We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. <b>Results:</b> The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. <b>Conclusions:</b> In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731504","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":"Fragility Fractures of the Pelvis-Current Understanding and Open Questions.","authors":"Amber Gordon, Michela Saracco, Peter V Giannoudis, Nikolaos K Kanakaris","doi":"10.3390/jcm14145122","DOIUrl":"10.3390/jcm14145122","url":null,"abstract":"<p><p>Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon's experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731308","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":"Effectiveness of Ozone Therapy in Non-Surgical Periodontal Treatment: A Meta-Analysis of Topical Applications.","authors":"Alessia Pardo, Annarita Signoriello, Gabriele Brancato, Raffaele Brancato, Elena Messina, Paolo Faccioni, Stefano Marcoccia, Gianna Maria Nardi, Giorgio Lombardo","doi":"10.3390/jcm14145124","DOIUrl":"10.3390/jcm14145124","url":null,"abstract":"<p><p><b>Background:</b> Additional therapies (e.g., laser, photodynamic therapy, and ozone) have been reported to improve mechanical instrumentation and immune response in non-surgical periodontal therapy (NSPT). With this systematic review we evaluated the effectiveness of ozone therapy in reducing inflammation and progression of periodontal disease. <b>Methods:</b> Three electronic databases (PubMed, Scopus, and Cochrane Library) were searched for randomized and clinical trials on ozone therapy (gas, liquid, gel/oil) combined with NSPT. The study design followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and the risk of bias was assessed using the RoB-2 tool. <b>Results:</b> Eight of the twenty-two studies reviewed reported on gaseous ozone, nine on ozone water, and five on ozonated oil/gel as an adjunct to mechanical periodontal instrumentation, often with scaling and root planing (SRP). Ozone was found to be more effective than SRP alone in treating inflammation, as measured with the gingival index (VMD -0.32; 95% confidence interval (CI) (-0.41; -0.24); <i>p</i> < 0.00001) and compared to chlorhexidine (CHX) (ozone gel; VMD -0.10; 95% CI (-0.20; -0.01); <i>p</i> = 0.03). The study findings were inconsistent, however, with several reporting clinical and microbiological benefit while others observed no marked improvement with the addition of ozone therapy to NSPT. <b>Conclusions:</b> While ozone therapy may represent a useful adjunct to NSPT, further research with larger study groups is warranted to determine its effectiveness.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12294910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731333","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":"Impact of Perioperative Antibiotic Prophylaxis in Caesarean Section on the Maternal Gut Microbiome: A Systematic Review.","authors":"Elisabeth Al Feles, Claudio Neidhöfer, Christina Wessels, Rosalie Gruber, Frauke Mattner","doi":"10.3390/jcm14145104","DOIUrl":"10.3390/jcm14145104","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain underexplored. This systematic review synthesizes current evidence on how antibiotic prophylaxis during CS affects maternal gut microbiome composition and diversity-an underrepresented, but clinically relevant aspect of maternal-fetal medicine. <b>Methods:</b> A systematic literature search was conducted in Medline (PubMed), the Cochrane Library, and the WHO International Clinical Trials Registry Platform (ICTRP) through November 2024. Inclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies used molecular techniques to report maternal gut microbiome outcomes (alpha- and beta-diversity). The search concentrated on beta-lactam antibiotics. Reference lists were screened, but no additional grey literature was searched. Synthesis followed the Synthesis Without meta-analysis (SWiM) approach. No review protocol was registered. The review received no external funding. <b>Results:</b> Out of 1011 records, three studies (total 286 mothers) met the inclusion criteria. All reported maternal microbiome outcomes secondarily to infant-focused research. Only one study provided pre- and post-birth stool samples. Applied antibiotic regimens, sequencing methods, and reported microbiome metrics for alpha- and beta-diversity varied considerably, thus limiting comparability of results. Due to high heterogeneity, no formal risk of bias was assessed. While taxonomic diversity changes were inconsistent, significant shifts in functional diversity metrics were observed postpartum. <b>Conclusions:</b> Evidence on maternal microbiome disruption following perioperative antibiotic prophylaxis in CS is methodologically fragmented and limited by small sample sizes and inconsistent antibiotic protocols. Nonetheless, functional diversity appears sensitive to antibiotic exposure. To improve clinical understanding and safety, maternal-focused studies using standardized protocols are urgently needed. The maternal microbiome may play a key role in both recovery and shaping the newborn's early microbial environment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731377","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 Impact of Spring Ligament Injuries on Flatfoot Deformity: An Exploratory Study of Morphological and Radiographic Changes in 198 Patients.","authors":"Roxa Ruiz, Roman Susdorf, Beat Hintermann","doi":"10.3390/jcm14145109","DOIUrl":"10.3390/jcm14145109","url":null,"abstract":"<p><p><b>Background</b>: Spring ligament (SL) injuries are primarily associated with progressive collapsing flatfoot deformity, but can also occur due to trauma. It remains unclear whether the morphological changes following trauma differ from those caused by chronic overload. The aim of this study was (1) to analyze whether a relationship exists between the injury pattern and foot deformity and (2) to evaluate whether there is a distinction between trauma-related and non-trauma-related injuries. <b>Method</b>: We prospectively enrolled 198 patients with a median age of 57 years (range, 13 to 86 years; female, 127 (64%); male, 71 (36%)) who had a clinically diagnosed, surgically confirmed, and classified SL injury. We used weight-bearing standard X-rays to assess foot deformity. The control group consisted of 30 patients (median age 51 years, range, 44-66; female, 21 (70.0%); male, 9 (30.0%)) with no foot deformities or prior foot surgeries. <b>Results</b>: A 41.9% incidence of trauma was identified as the cause of these injuries, accounting for 16 (20.8%) of isolated injuries to the SL, 30 (42.9%) of SL injury accompanied by a posterior tibial (PT) tendon avulsion, and 37 (72.5%) of SL injury alongside a bony avulsion at the navicular injuries. The odds of being post-traumatic decreased with each year of age by a factor of 0.97 (95% CI: 0.95-0.99). <b>Conclusions</b>: While all radiographic measurements for flatfoot deformity became pathological after an injury to the SL, they did not accurately predict the injury patterns of the SL and distal PT tendon. Generally, post-traumatic cases exhibited lower severity of foot deformity, suggesting that other structures beyond the SL may contribute to the development of flatfoot deformity.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731553","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}