Journal of Clinical Medicine最新文献

{"title":"Timing of First Systemic Antibiotic Administration and Risk of Deep Infection in Adults with Open Long-Bone Fractures: A Systematic Review and Threshold-Specific Evidence Synthesis.","authors":"Nguyen The Diep, Nguyen Minh Chau, Phan Thanh Nam, Tien Van Nguyen","doi":"10.3390/jcm15197689","DOIUrl":"10.3390/jcm15197689","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Early systemic antibiotics are central to open-fracture care, but a 60 min operational target does not establish a biological infection threshold. We examined how time origin, cutoff, and outcome definition affect interpretation of reported associations. <b>Methods:</b> Evidence was reconstructed from two preserved bibliographic inventories containing 24 entries. Complete database-search exports were unavailable, and selection, extraction, ROBINS-E, and GRADE were not independently duplicated. The protocol was archived retrospectively on OSF (doi:10.17605/OSF.IO/7J8QN). Estimates were described separately by time origin, cutoff, adjustment, outcome, and follow-up for a target population aged at least 18 years. No pooled estimate was retained. <b>Results:</b> The historical evidence map contained 16 reports, including contextual reports that did not establish applicability to the target population. This is not a verified final included-study count. Within the preserved inventory, no threshold-by-time-origin group supplied two compatible adjusted estimates. A 191-patient cohort reported an adjusted odds ratio of 1.02 (95% CI 0.39-2.68) at 60 min after emergency-department arrival. Recorded appraisals indicated predominantly high or very high risk of bias and very low certainty; these judgements were not independently verified. <b>Conclusions:</b> Distinguishing care-process targets from causal thresholds improves interpretation of the available reports. However, incomplete searching and single-investigator assessment limit the reliability and completeness of this synthesis. The observational associations establish neither causal thresholds nor the safety of delay and do not justify postponing indicated prophylaxis.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194423","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 PRCI-Based Individualized Risk Prediction Model for Potentially Inappropriate Medication in Older Outpatients.","authors":"Zhaoyan Chen, Congjun Zhou, Yongfei Dong, Cairong Zhu","doi":"10.3390/jcm15197675","DOIUrl":"10.3390/jcm15197675","url":null,"abstract":"<p><p><b>Objectives</b>: Potentially inappropriate medication (PIM) use remains highly prevalent among older outpatients, yet individualized risk prediction tools are limited. This study aimed to develop and validate a PIM risk prediction model incorporating a novel disease-weighted index. <b>Methods</b>: A multicenter cross-sectional study was conducted using 131,894 outpatient prescriptions from 59 medical institutions in China. Diagnoses were mapped to ICD-10 codes. A PIM Risk-Related Comorbidity Index (PRCI) was developed using multivariable logistic regression and coefficient-weighted scoring. A prediction model was constructed and internally validated using a 6:4 split-sample approach. Discrimination, calibration, and clinical utility were assessed using ROC curves, calibration plots, and decision curve analysis. <b>Results</b>: The proportion of prescriptions containing at least one PIM was 29.0%. Polypharmacy showed a strong dose-response relationship with PIM risk. The PRCI was independently associated with PIM (OR = 1.07 per unit increase). The final model demonstrated good discrimination (AUC = 0.775 in training and 0.773 in validation), satisfactory calibration, and favorable clinical utility. A cutoff probability of 0.304 stratified prescriptions into high- and low-risk groups. <b>Conclusions</b>: The PRCI-based model provides an individualized and clinically applicable tool for identifying older outpatient prescriptions at high risk of containing PIMs, supporting proactive medication safety management.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193874","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":"Longitudinal Visual Recovery and Exploratory Neuroimaging Findings in Pediatric Deprivation Amblyopia Following Unilateral Congenital Cataract Extraction: A Prospective Cohort Study.","authors":"Shuhua Ni, Xiaoli Tang, Meng Li, Jing Li, Fei Leng, Panpan Zheng, Wei Shi, Li Li","doi":"10.3390/jcm15197696","DOIUrl":"10.3390/jcm15197696","url":null,"abstract":"<p><p><b>Objectives</b>: Visual outcomes after unilateral congenital cataract (UCC) extraction remain variable, and the neuroanatomical changes accompanying subsequent visual improvement are poorly understood. This study characterized longitudinal changes in visual function and explored hemispheric asymmetry, longitudinal neuroimaging changes, and their associations with visual recovery in children after UCC extraction. <b>Methods</b>: This prospective observational cohort study enrolled 55 children aged 5 to <9 years with unilateral deprivation amblyopia receiving optical correction, passive occlusion, and dichoptic training. We analyzed 6-month changes in central visual field (CVF; mean sensitivity [MS], mean defect [MD]) and corrected distance visual acuity (CDVA). To assess structural alterations along the posterior visual pathways, a strictly controlled, exploratory subgroup of 18 right-handed patients (aged 5 to <8 years) with left-eye amblyopia underwent 3-Tesla (3T) MRI. Multiple comparisons in the neuroimaging and structure-function analyses were controlled using the Benjamini-Hochberg false discovery rate (FDR) procedure. <b>Results</b>: At 6 months, CDVA and CVF improved significantly from baseline across all amblyopia severity groups (all <i>p</i> < 0.05). Greater CDVA improvement was associated with larger increases in MS (β = 3.36, 95% CI, 1.37 to 5.35; <i>p</i> = 0.001) and greater reductions in MD (β = -2.80, 95% CI, -4.82 to -0.79; <i>p</i> = 0.007). Exploratory longitudinal neuroimaging analyses showed decreases in ipsilateral secondary visual cortex (V2) volume (Cohen's d = -0.75, P_FDR = 0.042) and cortical thickness (Cohen's d = -0.77, P_FDR = 0.042). Interhemispheric differences in V2 and middle temporal visual area (MT) cortical thickness were also observed at the 6-month follow-up (all |Cohen's d| > 0.75, P_FDR < 0.05). Nominal structure-function associations were observed for CVF and CDVA changes (all |r| > 0.54, all <i>p</i> < 0.05). No serious adverse events were observed. <b>Conclusions:</b> Children with unilateral deprivation amblyopia following UCC extraction showed improvements in CDVA and CVF over 6 months of routine care. CVF perimetry may provide complementary functional information during longitudinal assessment. Exploratory neuroimaging findings suggested potentially distinct structural correlates of CDVA and CVF recovery, requiring validation in larger controlled longitudinal studies to clarify the clinical significance of CVF and its associated neuroimaging changes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193942","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":"Functional Mitral Regurgitation Trajectories in CRT-Treated HFrEF During Medical Therapy Optimization: Association with Reverse Remodeling.","authors":"Oana Pătru, Silvia Luca, Dragoș Cozma, Bogdan Enache, Liviu Cirin, Mirela Virtosu, Maria-Laura Crăciun, Constantin-Tudor Luca, Simona Ruxanda Drăgan","doi":"10.3390/jcm15197688","DOIUrl":"10.3390/jcm15197688","url":null,"abstract":"<p><p><b>Background:</b> Functional mitral regurgitation (MR) is common in patients with heart failure with reduced ejection fraction (HFrEF) and may persist despite cardiac resynchronization therapy (CRT). Sacubitril/valsartan is associated with reverse remodeling in HFrEF, but MR dynamics in CRT-treated patients receiving sacubitril/valsartan remain insufficiently characterized. We aimed to characterize longitudinal changes in MR severity and assess their association with ventricular reverse remodeling in CRT-treated patients with HFrEF receiving sacubitril/valsartan. <b>Methods:</b> This retrospective cohort study included 188 patients with HFrEF previously treated with CRT who subsequently initiated sacubitril/valsartan. Clinical and echocardiographic assessments were performed at baseline and 10-14 months. The primary endpoint was MR improvement, defined a priori as a reduction of at least one MR grade. Changes in paired MR grade distribution were assessed using Bowker's test of symmetry. Associations between MR improvement and changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left atrial volume (LAV) were evaluated. Multivariable logistic regression was used to identify factors independently associated with MR improvement. <b>Results:</b> MR improvement occurred in 116 patients (62%), while 72 (38%) had unchanged grades; no worsening was documented in the paired assessments. A significant shift toward lower MR grades was observed between baseline and follow-up (χ² = 116.0, df = 5, <i>p</i> < 0.001). The proportion meeting the endpoint increased from 0% in baseline grade I to 51.2%, 80.0%, and 100% in grades II, III, and IV, respectively. Patients with MR improvement had greater increases in LVEF (9.0 vs. 7.0 percentage points, <i>p</i> = 0.006) and larger reductions in LVEDV (-45.7 vs. -28.6 mL, <i>p</i> = 0.004) and LAV (-20.4 vs. -4.2 mL, <i>p</i> < 0.001). The correlation between changes in LVEDV and MR grade was statistically significant but modest (<i>r</i> = 0.22, <i>p</i> = 0.002). Non-ischemic etiology and greater baseline LVEDV were independently associated with MR improvement, whereas baseline LVEF was not. The strong association with baseline MR grade partly reflects the endpoint's inherent dependence on initial severity. <b>Conclusions:</b> In patients with HFrEF treated with CRT who also received sacubitril/valsartan, lower MR grades were observed at follow-up and were associated with greater longitudinal changes in LVEF, LVEDV, and LAV. These findings describe parallel longitudinal changes in MR severity and cardiac structure within a combined device- and pharmacological-treatment setting. The observed changes cannot be disentangled from ongoing CRT-mediated remodeling, concomitant GDMT, changes in loading conditions, or other time-dependent factors and cannot be attributed specifically to sacubitril/valsartan.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194365","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":"Blood Pressure-Lowering Effects of Finerenone: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Gaetano Marino, Stefania Angela Di Fusco, Elvira Graziano, Sara Corradetti, Stefano Aquilani, Silvio Fedele, Federico Nardi, Domenico Gabrielli, Carmine Savoia, Furio Colivicchi","doi":"10.3390/jcm15197694","DOIUrl":"10.3390/jcm15197694","url":null,"abstract":"<p><p><b>Background:</b> Optimal blood pressure (BP) control remains elusive for millions of patients worldwide, often leading to resistant or secondary hypertension. Overactivation of the mineralocorticoid receptor (MR) drives this systemic pathology. While steroidal mineralocorticoid receptor antagonists (MRAs) are effective, their clinical utility is limited by poor cross-selectivity and risk of hyperkalemia. Finerenone, a novel non-steroidal MRA, offers high selectivity and potent target-organ protection, but a comprehensive pooling of its direct impact on BP is still needed. <b>Methods:</b> Following the PRISMA guidelines, a systematic search was conducted across PubMed, Embase, and ClinicalTrials.gov up to August 2026 for randomized controlled trials (RCTs) comparing finerenone versus placebo and reporting BP outcomes. The primary outcome was office systolic blood pressure (SBP). <b>Results:</b> Six RCTs involving 19,609 patients were included. Finerenone demonstrated a statistically significant but modest reduction in both office SBP (LSM difference: -2.83 mmHg; 95% CI: -3.15 to -2.51; <i>p</i> < 0.001) and office diastolic blood pressure (DBP) (LSM difference: -1.04 mmHg; 95% CI: -1.37 to -0.70; <i>p</i> < 0.001) compared with the placebo, with an absence of statistical heterogeneity (I² = 0.00%). Subgroup analysis confirmed office SBP-lowering efficacy across different clinical phenotypes, including chronic kidney disease and heart failure (<i>p</i> for interaction = 0.18). In a small subset of patients, finerenone reduced 24-h ambulatory SBP (LSM difference: -7.88 mmHg; 95% CI: -10.94 to -4.82; <i>p</i> < 0.001), though these exploratory findings warrant caution due to the limited sample size; no significant reduction was observed for 24-h ambulatory DBP. <b>Conclusions:</b> Finerenone is associated with a modest but statistically significant reduction in systemic SBP.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193836","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":"Nutritional Screening in Hospitalized Patients with Acute Pancreatitis: A Comparative Study in Mexico.","authors":"Mariana Chávez-Tostado, Gabino Cervantes-Guevara, Francisco Álvarez-López, Diana Mercedes Hernández-Corona, Alejandro González-Ojeda, Clotilde Fuentes-Orozco, Miriam Elizabeth Hernández-Franco, María Fernanda Isadora Corona-Meraz, Milton Omar Guzmán-Ornelas, Miriam Méndez-Del Villar, Tonatiuh González-Heredia, Enrique Cervantes-Pérez, Guillermo Cervantes-Cardona, Verónica Chávez-Tostado, Judith Martín-Del Campo Cervantes","doi":"10.3390/jcm15197674","DOIUrl":"10.3390/jcm15197674","url":null,"abstract":"<p><p><b>Background:</b> Acute pancreatitis (AP) is an acute inflammatory condition with high metabolic demands; however, early detection of nutritional risk is underestimated and there is no universal consensus on which is most effective for predicting nutritional risk. <b>Objectives:</b> To compare the level of agreement of nutritional screening methods with subjective global assessment (SGA) in identifying nutritional risk in patients with AP. <b>Methods:</b> This study was conducted as a prospective observational cohort in hospitalized patients diagnosed with mild or moderate AP. Screening tools: nutritional risk screening-2002 (NRS-2002), malnutrition universal screening tool (MUST), short nutritional assessment questionnaire (SNAQ), malnutrition screening tool (MST) and clinical assessment via SGA were performed. <b>Results:</b> Nutritional risk was found in 55.3% patients via SGA assessment, 43.2% in MST, and 38.6% in NRS-2002 and SNAQ and 10.6% in MUST scales. Patients without nutritional risk exhibited a significantly higher mean BMI than at-risk patients (<i>p</i> = 0.026). Patients with moderate AP exhibited a 3.93 increased risk of nutritional risk compared to those with mil AP (<i>p</i> = 0.02). The NRS-2002 and SNAQ scales achieved the highest agreement compared with SGA. <b>Conclusions:</b> Nutritional risk is highly prevalent in patients with mild and moderate AP, showing a significant increase as clinical severity progresses. The NRS-2002 and SNAQ scales had more agreement and better performance when compared with SGA.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194221","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":"Orofacial Myofunctional Therapy to Treat Residual Obstructive Sleep Apnoea in Children Treated with Adenotonsillectomy and Maxillary Expansion: An Interventional Study.","authors":"Derek Mahony, Niroj Bhattarai, Peter Petocz, Peter Borbély, Krisztina Kárpáti","doi":"10.3390/jcm15197676","DOIUrl":"10.3390/jcm15197676","url":null,"abstract":"<p><p><b>Background:</b> In children with residual obstructive sleep apnoea (OSA) despite combined adenotonsillectomy (TA) and semi-rapid maxillary expansion (SRME), the optimal further management remains unclear. This study evaluated the effect of a 12-month programme of orofacial myofunctional therapy (OMFT) on residual OSA in this population. <b>Materials and Methods:</b> In this retrospective cohort study, 80 children (aged 7-9 years) with polysomnography-confirmed residual OSA (respiratory disturbance index [RDI] ≥ 1 event/h) after combined TA and SRME were followed for 12 months. Forty-one children completed a 12-month course of OMFT, and 39 did not, due to compliance concerns, cost/access barriers, or parental preference. RDI at 12-month follow-up (RDIfinal) was compared between groups by <i>t</i>-test and by a covariate-adjusted general linear model. <b>Results:</b> Mean baseline RDI did not differ between groups (<i>p</i> = 0.21). At follow-up, mean RDIfinal was 0.49 events/hour in the OMT group versus 5.26 in controls (<i>p</i> < 0.001; Cohen's <i>d</i> = 3.64), a difference that persisted after adjustment for treatment order, sex, age, race, and BMI (<i>p</i> < 0.001). <b>Conclusions:</b> A 12-month OMT programme was associated with near-normal respiratory indices in children with residual OSA after combined TA and SRME, while untreated residual OSA showed mild deterioration. Given the non-randomised design, this should be interpreted as a strong association rather than a confirmed causal effect, and a randomised trial is warranted.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194321","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":"Autologous Pericardial Cusps Within a Tubularized Bovine Pericardial Conduit for Right Ventricular Outflow Tract Reconstruction During the Modified Ross Procedure: A Technical Note.","authors":"Tomáš Toporcer, Lukáš Vajda, Anton Bereš, Jaroslav Benedík, Marián Homola, Michal Trebišovský, Peter Šafár, Štefan Lukačín, Vilém Rohn, Adrián Kolesár","doi":"10.3390/jcm15197684","DOIUrl":"10.3390/jcm15197684","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Limited availability of pulmonary homografts may restrict right ventricular outflow tract reconstruction after the Ross procedure. This technical note describes the geometric construction of a valved conduit composed of autologous pericardial cusps and a tubularized bovine pericardial patch. <b>Methods:</b> Autologous pericardium (approximately 10 × 8 cm) is treated with 0.9% glutaraldehyde for 10 min, and three size-4 cusps with triangular ears are fashioned using a Fehling template. A bovine pericardial patch (14 × 9 cm) is marked with the cusp attachment baseline, the commissural fixation line, and asymmetric tubularization lines. The cusp implantation field is divided into three equal segments, and each cusp is sutured to the mesothelial surface of the patch with a continuous suture, followed by commissural fixation. The patch is then tubularized, and valve competence is assessed by saline testing. <b>Results:</b> The conduit was constructed in approximately 60 min, in parallel with the main operation, and implanted in four patients undergoing a modified Ross procedure in 2025. Echocardiography on the first postoperative day showed no more than trace pulmonary regurgitation and no conduit obstruction. No conduit-related complications occurred; only early postoperative follow-up is available. <b>Conclusions:</b> The technique allows construction of a valved conduit from autologous and bovine pericardium using widely available materials. Currently, it demonstrates technical feasibility only; hemodynamic performance, safety, and durability remain to be established in larger studies with standardized follow-up.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194181","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":"Implementation of a Structured Perioperative Checklist-Based Standardization Process and Early Postoperative Outcomes After Bariatric Surgery: A Single-Center Retrospective Pre-Post Cohort Study.","authors":"Sertaç Ata Güler, Mehmet Fatih Özsaray, Turgay Şimşek, Nuh Zafer Cantürk","doi":"10.3390/jcm15197680","DOIUrl":"10.3390/jcm15197680","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Structured perioperative checklists may standardize bariatric surgical care, but their association with early clinical outcomes remains uncertain. This study compared 30-day postoperative outcomes before and after implementation of a structured perioperative checklist and characterized complications by type and Clavien-Dindo severity. <b>Methods</b>: This single-center retrospective pre-post cohort study included patients undergoing primary bariatric surgery from June 2024 through December 2025. The checklist was prospectively introduced on 29 July 2024. Cohort identification, data extraction, outcome classification, and comparative analyses were performed retrospectively. Forty patients were included in each cohort. The primary outcome was any 30-day postoperative complication; secondary outcomes included complication severity, intensive care unit admission, and length of hospital stay. Checklist implementation was assessed on the basis of documented completion; item-level adherence to individual perioperative measures and corrective actions prompted by checklist responses were not assessed. Accordingly, the intervention evaluated in this study represents implementation of a structured checklist-based documentation and care-standardization process rather than verified adherence to individual checklist components. <b>Results</b>: Complications occurred in 4 of 40 patients (10.0%) in the checklist group and 9 of 40 (22.5%) in the non-checklist group (relative risk, 0.44; 95% confidence interval, 0.15-1.33; <i>p</i> = 0.13). Minor complications occurred in 7.5% and 15.0%, respectively, and major complications in 2.5% and 7.5%, respectively. The study was underpowered to reliably detect a between-group difference in the observed magnitude in 30-day complication rates; therefore, this comparison should be interpreted as exploratory. Median hospital stay was shorter in the checklist group (3 days; interquartile range, 2.5-4.0) than in the non-checklist group (4 days; interquartile range, 3.0-6.0; Mann-Whitney U = 398; <i>p</i> < 0.001). Intensive care unit admission occurred in 7.5% and 17.5%, respectively (<i>p</i> = 0.31). Given the sequential, non-overlapping study periods, the observed difference in length of stay cannot be separated from secular changes in clinical practice, discharge processes, institutional factors, or surgical-team experience. <b>Conclusions</b>: Checklist implementation was temporally associated with a shorter postoperative length of stay, whereas the observed reduction in 30-day complications did not reach statistical significance. Because the cohorts were treated during sequential, non-overlapping periods, these differences cannot be attributed independently to checklist implementation. The findings should therefore be considered exploratory and hypothesis-generating.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194299","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 of Surgical Approach with Intraoperative Femoral Fracture Patterns During Cementless Hemiarthroplasty for Femoral Neck Fracture.","authors":"Ali Tecirli, Seyyid Serif Unsal, Tugrul Yildirim, Alp Karacoban","doi":"10.3390/jcm15197666","DOIUrl":"10.3390/jcm15197666","url":null,"abstract":"<p><p><b>Background/Objective</b>: Intraoperative femoral fractures during cementless hemiarthroplasty may present with distinct anatomical patterns. We examined whether surgical approach was associated with greater trochanteric versus stem-stable periprosthetic fracture patterns in older patients with osteoporotic-type femoral morphology; stem geometry was evaluated as an additional implant-related factor. <b>Methods</b>: We retrospectively reviewed 292 patients aged ≥75 years who underwent cementless bipolar hemiarthroplasty for low-energy displaced femoral neck fractures at a tertiary referral trauma center between January 2019 and July 2023. Patients were grouped according to stem geometry (fit-and-fill or tapered-wedge) and surgical approach (lateral or posterior). Associations were assessed using multivariable logistic regression, Firth-penalized regression, and stabilized inverse probability of treatment weighting (IPTW). <b>Results</b>: Intraoperative fractures occurred more frequently with the lateral approach than with the posterior approach (23.7% vs. 12.2%; <i>p</i> = 0.015), primarily because of greater trochanteric fractures (9.5% vs. 2.4%; <i>p</i> = 0.016). Periprosthetic fracture rates did not differ significantly between the approaches (14.2% vs. 9.8%; <i>p</i> = 0.284). In the Firth model, the posterior approach was associated with lower odds of greater trochanteric fracture (OR 0.25, 95% CI 0.08-0.80; <i>p</i> = 0.019); after IPTW, the corresponding estimate was OR 0.19 (95% CI 0.05-0.76; <i>p</i> = 0.019). <b>Conclusions</b>: The surgical approach was primarily associated with greater trochanteric fractures, whereas no independent association was observed with stem geometry. Pattern-specific analysis may provide a clearer characterization of intraoperative fracture associations in this setting.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"15 19","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13666352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194043","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}