Journal of Clinical Medicine最新文献

{"title":"Comparative Botulinum Toxin Injection Strategies Beyond the Masseter for Bruxism: A Scoping Review.","authors":"Doungkamol Siri-Archawawat, Arunrat Dumkliang, Chime Eden, Weeratian Tawanwongsri","doi":"10.3390/jcm15197712","DOIUrl":"10.3390/jcm15197712","url":null,"abstract":"<p><p><b>Background:</b> Botulinum toxin type A is used to reduce excessive masticatory muscle activity in bruxism, but whether extending injection beyond the masseter provides additional benefit remains uncertain. This scoping review aimed to map comparative evidence on expanded botulinum toxin muscle targeting for bruxism and assess whether available studies provide evidence of incremental clinical benefit beyond masseter-only injection. <b>Methods:</b> PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform were searched from inception to 3 August 2026. Eligible studies directly compared botulinum toxin injection strategies differing in the muscles targeted. Data were charted and synthesized descriptively. The protocol was prospectively registered with INPLASY (INPLASY202680008). <b>Results:</b> Five small randomized trials involving 133 participants were included, of whom 116 contributed to the comparative analyses. Expanded strategies added the temporalis, anterior digastric, lateral pterygoid, or medial pterygoid. Additional clinical benefit of broader targeting was not clearly demonstrated, although some studies reported greater reductions in activity of the additionally injected muscle. In all studies, the masseter dose was held constant while additional muscles were injected, resulting in higher total toxin doses and preventing separation of anatomical targeting effects from dose escalation. Safety evidence was insufficient because reporting was limited and heterogeneous, and the small overall sample precluded adequate characterization of the safety profile. <b>Conclusions:</b> The available evidence is preliminary and insufficient to determine whether routinely extending botulinum toxin injection beyond the masseter provides additional clinical benefit. Future adequately powered, dose-controlled trials should prioritize patient-important outcomes and distinguish the effects of anatomical targeting from total toxin dose.</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/PMC13665912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194014","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":"Incidence and Factors Associated with Suboptimal Exercise Workload Progression in Cardiac Rehabilitation: A Retrospective Cohort Study.","authors":"Guy Halevi, Oren Caspi, Noa Haimovich, Omer Golan, Noa Rentsler, Barak Zafrir","doi":"10.3390/jcm15197713","DOIUrl":"10.3390/jcm15197713","url":null,"abstract":"<p><p><b>Background:</b> Improving cardiorespiratory fitness is a central goal of cardiac rehabilitation (CR), yet exercise workload progression varies substantially. We aimed to characterize changes in treadmill workload during CR and determine the frequency of, and the factors associated with, suboptimal progression. <b>Methods:</b> This retrospective cohort study included 180 patients enrolled in an outpatient CR program. Treadmill exercise workload was quantified in metabolic equivalents (METs) from recorded speed and grade using estimated oxygen-consumption equations. Using prespecified exploratory thresholds, suboptimal progression was defined as an absolute increase of <1 MET or a relative increase of <30%, determined by comparing mean workloads achieved during the initial and final four sessions. Factors associated with suboptimal progression were assessed using multivariable logistic regression. <b>Results:</b> Median workload increased from 3.07 METs (IQR 2.40-4.01) during the initial four sessions to 3.90 METs (IQR 2.93-5.56) during the final four sessions (<i>p</i> < 0.001), with improvements observed across baseline exercise capacity, age, and sex strata. Nevertheless, 104 patients (57.8%) achieved <1 MET improvement and 97 (53.9%) achieved <30% relative improvement. In the primary multivariable analyses, female sex and higher body mass index were associated with suboptimal progression under both definitions; a history of coronary artery disease was additionally associated with suboptimal absolute progression, and recent smoking with suboptimal relative progression. Among concurrent training-related factors, lower session attendance was associated with both definitions, whereas higher mean perceived exertion was associated with suboptimal relative progression. <b>Conclusions:</b> More than half of participants demonstrated suboptimal treadmill workload progression despite significant overall improvement during CR. Routine monitoring of session-level workload may facilitate identification of patients with limited progression and support individualized adjustment of exercise prescriptions.</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/PMC13665919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194349","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":"Development and Temporal Validation of Staged Prediction Models for Acute Respiratory Distress Syndrome After Thymic Epithelial Tumour Resection.","authors":"Ruize Wang, Siyu Yao, Lifeng Huang, Qiuyue Liu","doi":"10.3390/jcm15197715","DOIUrl":"10.3390/jcm15197715","url":null,"abstract":"<p><p><b>Background/Objectives:</b> To develop and temporally validate staged models for predicting acute respiratory distress syndrome (ARDS) after thymic epithelial tumour resection. <b>Methods:</b> This single-centre retrospective study included 596 adults with pathologically confirmed thymic epithelial tumours. Patients treated in 2005-2020 formed the development cohort (<i>n</i> = 395), and those treated in 2021-2026 formed the temporal validation cohort (<i>n</i> = 201). Postoperative ARDS was adjudicated using the 2024 global definition. A preoperative model and a postoperative landmark model incorporating intraoperative, pathological, and early postoperative variables were developed using least absolute shrinkage and selection operator and multivariable logistic regression. Performance was assessed using discrimination, calibration, Brier score, decision curve analysis, bootstrap internal validation, and temporal validation. <b>Results:</b> ARDS occurred in 116 development patients (29.4%) and 58 validation patients (28.9%). The postoperative landmark model included the preoperative linear predictor, one-lung ventilation duration, Masaoka-Koga stage, perioperative transfusion, and early postoperative glucose, albumin, and C-reactive protein. It achieved higher AUCs than the preoperative model in the development (0.908 vs. 0.693; <i>p</i> < 0.001) and validation cohorts (0.928 vs. 0.655; <i>p</i> < 0.001), with lower Brier scores (0.107 vs. 0.187 and 0.094 vs. 0.192, respectively; both <i>p</i> < 0.001). The optimism-corrected development AUC was 0.898. Calibration and decision curve analyses also favoured the postoperative landmark model. <b>Conclusions:</b> Incorporating perioperative information improved ARDS prediction after thymic epithelial tumour surgery. The staged models may support sequential perioperative risk assessment; however, prospective evaluation and independent multicentre validation are required before implementation.</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/PMC13666171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193817","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":"Automated Regional Detection of Intervortex Venous Anastomosis on Ultra-Widefield Indocyanine Green Angiography Using a Two-Stage Deep Learning Framework.","authors":"Areum Jeong, Min Sagong","doi":"10.3390/jcm15197709","DOIUrl":"10.3390/jcm15197709","url":null,"abstract":"<p><p><b>Objectives:</b> This study aimed to develop and validate a deep learning-based system for automated detection of intervortex venous anastomosis (IVA) on ultra-widefield indocyanine green angiography (UWF-ICGA). <b>Methods</b>: A total of 183 UWF-ICGA images with an original resolution of 3900 × 3072 pixels were included. A two-stage deep learning framework was developed. In the first stage, an object detection model automatically localized four predefined quadrants within each UWF-ICGA image. In the second stage, each extracted quadrant was classified according to the presence or absence of IVA. Quadrants demonstrating definite venous connections between adjacent vortex vein drainage territories were defined as IVA-positive, whereas quadrants without identifiable intervortex venous connections were defined as IVA-negative. Brightness normalization was applied before analysis, and images were resized to 512 × 512 pixels using linear interpolation. The object detection model was trained using 155 images and tested using 28 images. The 183 original images generated 732 quadrant images, of which 622 were used for training and 110 for testing of the classification model. Model performance was evaluated using accuracy, precision, recall, F1 score, and confusion matrices. <b>Results</b>: The object detection model correctly localized all predefined quadrants in the test dataset, achieving an accuracy, precision, recall, and F1 score of 100.0%. All 112 manually labeled regions from 28 test images were correctly matched by the model. The IVA classification model achieved an accuracy of 93.63%, precision of 95.39%, recall of 91.46%, and F1 score of 93.38%. Among 110 test quadrants, all 69 IVA-negative quadrants were correctly classified, while 34 of 41 IVA-positive quadrants were correctly identified. Seven IVA-positive quadrants were misclassified as negative, whereas no IVA-negative quadrant was classified as positive. When IVA-positive was considered the positive class, the corresponding sensitivity and specificity were 82.9% and 100%, respectively. <b>Conclusions</b>: A two-stage deep learning system enabled automated detection of IVA on UWF-ICGA with high classification performance. Automated assessment of IVA may provide an objective and reproducible approach for evaluating choroidal venous remodeling and may serve as a platform for future quantitative investigations of vortex vein abnormalities.</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/PMC13665899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194128","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":"Diagnostic Accuracy of GPT-5 in Detecting and Localizing Acute Ischemic Stroke on Isolated Diffusion-Weighted Imaging: A Retrospective Case-Control Study.","authors":"Emre Gökçen, Mikail Kuşdoğan, Mustafa Fatih Erkoc, Levent Albayrak, Güneş Seda Albayrak, Deniz Tanrıverdi","doi":"10.3390/jcm15197716","DOIUrl":"10.3390/jcm15197716","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Multimodal large language models are emerging tools for medical image interpretation, but their performance on isolated diffusion-weighted imaging (DWI) for acute ischemic stroke remains largely unexplored. We evaluated GPT-5 for stroke detection and vascular territory classification on preselected representative DWI images using a structured two-step prompting protocol. <b>Methods:</b> This single-center, retrospective, balanced case-control study included 220 cases (110 stroke patients and 110 stroke-negative controls). Four representative axial DWI slices per case were provided without apparent diffusion coefficient maps. Step 1 queried stroke presence and vascular territory; Step 2 queried the middle cerebral artery (MCA) segment-associated territory (M1-M4) following an MCA response. The reference standard was radiologist-neurologist consensus based on full multimodal magnetic resonance imaging, blinded to GPT-5 outputs. Diagnostic performance metrics and Cohen's kappa (κ) were calculated. <b>Results:</b> Stroke detection showed a sensitivity of 100% (95% confidence interval [CI], 96.6-100%), specificity of 83.6% (95% CI, 75.6-89.4%), accuracy of 91.8%, and κ = 0.836. Accuracy was 93.6% for anterior/posterior circulation (κ = 0.838) and 90.9% for vascular territory (κ = 0.799). Conditional MCA segment-associated territory accuracy was 71.6% (53/74; κ = 0.602); end-to-end accuracy was 66.3% (53/80). Exploratory analysis of the 18 false-positive cases identified four overlapping error categories: artifactual and physiologic signal misinterpretation (72.2%), chronic lesion misclassification (27.8%), terminological inconsistency or unsupported report statements (77.8%), and etiological scenarios or unhedged definitive diagnoses (38.9%). <b>Conclusions:</b> GPT-5 achieved high sensitivity and a specificity of 83.6% for stroke classification on preselected representative DWI images using a vascular territory-based diagnostic framework. However, the 16.4% false-positive rate indicates that positive findings require radiologist confirmation. These findings support further evaluation of GPT-5 as a potential clinician-assisted image-interpretation tool but do not establish a clinical decision-support role.</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/PMC13666144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194211","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":"Synchronous Metaplastic Breast Carcinoma with Mesenchymal Differentiation and Triple-Negative Invasive Papillary Carcinoma: A Case Report and Literature Review.","authors":"Vladimir Tvrdisic, Vesna Vulovic, Bojan Stojanovic, Marina Petronijevic, Milica Dimitrijevic, Emilija Subanovic, Nina Radosavljevic, Marko Spasic, Bojan Milosevic, Jasna Gacic","doi":"10.3390/jcm15197705","DOIUrl":"10.3390/jcm15197705","url":null,"abstract":"<p><p><b>Background:</b> Metaplastic breast carcinoma with mesenchymal differentiation is a rare and morphologically heterogeneous malignancy that may show a biphasic epithelial and sarcomatoid pattern historically termed \"carcinosarcoma.\" Its synchronous occurrence with invasive papillary carcinoma is exceptionally uncommon and may create diagnostic and therapeutic difficulties. <b>Methods:</b> We report the clinicopathological course of a premenopausal woman with two synchronous breast malignancies. Clinical, radiological, histopathological, and immunohistochemical findings were reviewed, including PD-L1 assessment using the 22C3 antibody, and interpreted in the context of the relevant literature. <b>Results:</b> Definitive surgical pathology demonstrated a 125-mm metaplastic breast carcinoma with mesenchymal differentiation showing carcinosarcoma morphology and a separate 22-mm high-grade triple-negative invasive papillary carcinoma. Sarcomatoid predominance led to the initial interpretation of malignant phyllodes tumor on core biopsy. Axillary lymph-node metastases showed papillary morphology and a concordant immunophenotype, strongly supporting their relationship to the invasive papillary carcinoma. Later supraclavicular recurrence and pulmonary metastases could not be conclusively attributed to either primary tumor. PD-L1 combined positive scores were 25 in both primary tumors and 35 in the supraclavicular metastasis. Pembrolizumab-based therapy was followed by radiological regression and clinical stability. <b>Conclusions:</b> This case highlights the importance of representative sampling, careful characterization of synchronous tumors, comparison of metastatic deposits with all primary lesions, and biomarker reassessment during progression. The observed response should be interpreted in the context of PD-L1-positive metastatic triple-negative breast cancer rather than as evidence of histology-specific pembrolizumab efficacy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194497","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":"Admission Endothelial Activation and Stress Index in Acute Myocardial Infarction: Incremental Value Beyond the GRACE Score and a Test of the Index Weights.","authors":"Kader Eliz Şahin, Ahmet Berk Duman, Şadiye Nur Dalgıç, Denizhan Karaçimen, Yalçın Dalgıç, Metin Çağdaş, Sedat Avcı, Ayşe Hoşoğlu","doi":"10.3390/jcm15197703","DOIUrl":"10.3390/jcm15197703","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The Endothelial Activation and Stress Index (EASIX), calculated from lactate dehydrogenase, creatinine and platelet count, has been linked to mortality in cardiovascular cohorts. We examined whether admission EASIX adds prognostic information to the Global Registry of Acute Coronary Events (GRACE) score for in-hospital mortality in acute myocardial infarction (AMI), and whether its fixed weights are supported. <b>Methods:</b> We retrospectively studied consecutive adults with AMI undergoing coronary angiography; patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m² were excluded. EASIX was modelled on the log2 scale. Incremental value was assessed against a GRACE model refitted in this cohort and against the published GRACE risk after recalibration, by discrimination, calibration, decision curves and bootstrap validation. <b>Results:</b> In-hospital death occurred in 225 of 4777 patients (4.7%). Each doubling of EASIX was associated with mortality after adjustment for the GRACE score (odds ratio 2.386, 95% confidence interval 2.053-2.774) and after clinical adjustment (2.363, 1.974-2.828). Adding EASIX raised the area under the curve from 0.855 to 0.890 (optimism-corrected increment 0.034, 95% confidence interval 0.025-0.052) and improved the Brier score and net benefit. Added to the recalibrated published GRACE risk, EASIX raised the area under the curve from 0.856 to 0.881 (corrected increment 0.024, 0.012-0.040). Findings were consistent in both infarct types. Freely estimated weights differed from the fixed weights but added little discrimination. <b>Conclusions:</b> Admission EASIX was independently associated with in-hospital mortality in AMI and added discrimination and net benefit to both a refitted and the published GRACE risk. External validation is required before clinical use.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193966","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":"Health-Related Quality of Life and Family Impact in Young Children with Infantile Epileptic Spasms Syndrome: A Cross-Sectional Caregiver-Reported Study.","authors":"Natalia Kasaraba, Anna Rozensztrauch","doi":"10.3390/jcm15197706","DOIUrl":"10.3390/jcm15197706","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objectives:&lt;/b&gt; Infantile epileptic spasms syndrome (IESS) is a developmental and epileptic encephalopathy characterized by epileptic spasms and epileptiform EEG abnormalities. Classical West syndrome represents a phenotype within the IESS spectrum characterized by epileptic spasms, hypsarrhythmia, and developmental plateau or regression. Beyond seizure control, assessment of health-related quality of life (HRQoL) and family impact may provide important information on the long-term burden of the disease. This study aimed to characterize caregiver-reported HRQoL in young children with IESS and family impact and to explore clinical and perinatal factors associated with these outcomes. &lt;b&gt;Methods:&lt;/b&gt; This cross-sectional caregiver-proxy study included 60 parents or primary caregivers of children aged 1 month to 4 years who had previously received a physician-established diagnosis of West syndrome; in the present manuscript, the cohort is described within the broader contemporary IESS framework. Children's HRQoL was assessed using age-appropriate versions of the Pediatric Quality of Life Inventory (PedsQL), while family impact was assessed using the PedsQL Family Impact Module (FIM). Parametric and non-parametric statistical methods were applied as appropriate. All analyses were exploratory, and no adjustment for multiple comparisons or multivariable adjustment for potential confounders was performed. &lt;b&gt;Results:&lt;/b&gt; The mean PedsQL Total Scale Score was 64.53 ± 19.35 among children aged 1-24 months assessed with the PedsQL Infant Scales and 56.34 ± 23.29 among children aged 2-4 years assessed with the PedsQL 4.0 Generic Core Scales. In exploratory pooled analyses, children with additional congenital, genetic, structural, or systemic conditions had lower age-appropriate Total Scale Scores than children without such conditions (52.93 ± 21.55 vs. 64.40 ± 22.08; unadjusted mean difference -11.48 points, 95% CI -22.75 to -0.20; nominal &lt;i&gt;p&lt;/i&gt; = 0.046). Physical health scores were also lower in children with additional conditions (53.78 ± 27.62 vs. 69.60 ± 26.71; nominal &lt;i&gt;p&lt;/i&gt; = 0.012). In the sensitivity analysis restricted to children aged 2-4 years assessed with a single PedsQL instrument, the Total Scale Score difference was similar in direction but did not reach the nominal significance threshold (48.76 ± 20.86 vs. 62.35 ± 23.76; mean difference -13.59 points, 95% CI -27.57 to 0.38; nominal &lt;i&gt;p&lt;/i&gt; = 0.056). Within the FIM, the lowest mean scores were observed for Worry (24.17 ± 21.20) and Daily Activities (35.00 ± 28.57). &lt;b&gt;Conclusions:&lt;/b&gt; Caregiver-reported HRQoL and family impact varied substantially among young children with IESS and their families. Additional congenital, genetic, structural, or systemic conditions were associated with lower scores in selected child HRQoL domains, although these exploratory unadjusted findings may be affected by residual confounding. The findings support the inclusion of child HRQoL a","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194403","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":"Validated Assessment of Ejaculatory and Erectile Function After Unilateral \"Z\"-Shaped Bladder Neck Incision (ZANCLE): A Prospective Study Using the MSHQ-EjD Short Form and IIEF-5.","authors":"Alessandro Calarco, Pietro Morgia, Carlo Maria Scornajenghi, Marianna Paolillo, Pietro Viscuso, Beatrice Filippi, Antonio Tufano","doi":"10.3390/jcm15197699","DOIUrl":"10.3390/jcm15197699","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Preservation of anterograde ejaculation after transurethral incision for primary bladder neck obstruction (PBNO) has traditionally been assessed with unvalidated binary self-report. We prospectively evaluated ejaculatory and erectile function after the ZANCLE (\"Z\" Anatomical Needle Cut Leads Ejaculation) technique using two validated patient-reported outcome instruments, the Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF) and the International Index of Erectile Function-5 (IIEF-5). <b>Methods</b>: Forty consecutive patients undergoing ZANCLE for PBNO at a single institution were prospectively enrolled between June 2024 and July 2025. MSHQ-EjD-SF (ejaculatory function domain, items for force/volume/frequency, independent bother item) and IIEF-5 were administered at baseline and at 1, 6, and 12 months postoperatively, together with the binary anterograde-ejaculation question used in the parent cohort. Voiding parameters (Qmax, IPSS, PVR) are not described here, as they have already been reported for this technique by our group in a previously published series. <b>Results</b>: Median age was 41 years (IQR 35-55). The MSHQ-EjD-SF function domain score was unchanged from baseline to 12 months (10.8 ± 1.3 vs. 11.0 ± 1.1, Δ+0.2, <i>p</i> = 0.52), while the bother item improved significantly (1.1 ± 0.9 vs. 0.5 ± 0.6, Δ-0.6, <i>p</i> = 0.011). IIEF-5 total score remained stable throughout follow-up (20.1 ± 3.0 vs. 20.5 ± 2.8 at 12 months, Δ+0.4, <i>p</i> = 0.58). Anterograde ejaculation was preserved by binary self-report in 100% of evaluable patients at every postoperative timepoint. <b>Conclusions</b>: Validated instruments confirm, with greater granularity than binary self-report, that the ZANCLE technique preserves ejaculatory function domain scores and erectile function while reducing ejaculation-related bother. These preliminary findings support incorporation of MSHQ-EjD-SF and IIEF-5 into future prospective evaluations of ejaculation-sparing bladder neck surgery.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194192","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 Use of the Drospirenone 4 mg-Only Pill in Overweight and Obese Women with Polyendocrine Metabolic Ovarian Syndrome: A Retrospective Cohort Study.","authors":"Klara Hofer, Selina Ebner, Rodrig Marculescu, Magdalena Boegl, Peter Frigo, Robert Krysiak, Johannes Ott","doi":"10.3390/jcm15197701","DOIUrl":"10.3390/jcm15197701","url":null,"abstract":"<p><p><b>Objective</b>: Polycystic ovary syndrome is frequently associated with hyperandrogenemia-related hirsutism, which creates notable cosmetic concerns for many affected women. Although multiple antiandrogenic treatments exist, many patients remain dissatisfied, and combined oral contraceptives are often contraindicated due to metabolic and cardiovascular risk factors. This study evaluates whether a drospirenone-only pill improves hormonal profiles and hirsutism in PMOS compared to cyclic dydrogesterone. <b>Methods</b>: This retrospective cohort study assessed hyperandrogenemia and hirsutism using the modified Ferriman-Gallwey score in 60 overweight or obese women with PMOS who were treated at the Clinical Division of Gynecologic Endocrinology and Reproductive Medicine of the Medical University of Vienna, Austria. Patients underwent follow-up examinations after three and six months of treatment. Thirty women chose treatment with drospirenone-only and were age-matched with 30 women receiving cyclic dydrogesterone. <b>Results</b>: After 3 months, women in the drospirenone group showed significant improvements, including reductions in LH (<i>p</i> < 0.001), FSH (<i>p</i> < 0.001), testosterone (<i>p</i> = 0.001), FAI (<i>p</i> < 0.001) and AMH (<i>p</i> = 0.005). Ferriman-Gallwey scores were significantly lower after 3 months (<i>p</i> < 0.001) and 6 months (<i>p</i> = 0.001). At follow-up, the drospirenone group exhibited lower LH (5.4 vs. 8.8 mIU/mL; <i>p</i> = 0.004) and lower FAI (2.9 vs. 4.0; <i>p</i> = 0.045) compared with controls. Among women with baseline hirsutism (FGS ≥ 8), scores decreased from 14 to 12 (<i>p</i> < 0.001) after 3 months and to 10 (<i>p</i> = 0.002) after 6 months in the drospirenone group. <b>Conclusions</b>: Drospirenone-only treatment resulted in a modest reduction in Ferriman-Gallwey score, with more pronounced improvements observed in women with baseline hirsutism. This was accompanied by hormonal changes, suggesting a potentially beneficial option for women with hyperandrogenic PMOS for whom combined oral contraceptives are not suitable.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194465","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}