Medicine最新文献

{"title":"From kit inserts to daily practice: Six sigma and maximum allowable uncertainty in coagulation analysis.","authors":"Coskun Cavusoglu","doi":"10.1097/MD.0000000000044978","DOIUrl":"10.1097/MD.0000000000044978","url":null,"abstract":"<p><p>Accurate laboratory test results are essential for patient care. While manufacturers provide validated performance metrics such as the coefficient of variation and bias in kit inserts, maintaining such precision in daily laboratory use is often difficult. This study compared the analytical performance of a Sysmex CS-2500 coagulation analyzer in routine use with manufacturer-declared specifications using the Six Sigma and maximum allowable uncertainty methods. Data from June to November 2024 were collected at Ümraniye Training and Research Hospital. Coagulation tests (prothrombin time [PT], International normalized ratio [INR], and aPTT) were assessed using internal quality control and an external quality assessment scheme. Sigma metrics were calculated per CLIA 2024 and maximum allowable uncertainty values were derived using biological variation data. Laboratory results were compared with kit insert values and evaluated according to analytical performance specifications. SigmaLAB scores were ≥ 5 in all months except July due to external quality assessment-related bias, while SigmaMD remained > 6. In Mu analysis, PT (June-August) and INR (August) fell below minimum analytical performance specifications limits in MuLAB, whereas aPTT consistently met desirable limits. MuMD showed PT within minimum, INR borderline minimum, and aPTT borderline optimal limits. Six Sigma provides retrospective insights, while Measurement Uncertainty (Mu) allows continuous performance monitoring. Combining both offers a full picture of analyzer performance. Together, they provide a more complete assessment, revealing that despite excellent manufacturer data, field results showed bias-related limitations.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44978"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and determinants of induced abortion among women migrant workers in an industrial zone in Vietnam: A cross-sectional study.","authors":"Toan Ha, Thien Quy Pham, Nam Nguyen, Roman Shrestha, Stephen L Schensul","doi":"10.1097/MD.0000000000045005","DOIUrl":"10.1097/MD.0000000000045005","url":null,"abstract":"<p><p>Migrant women workers in Vietnam face significant barriers in accessing subsidized sexual and reproductive health services, as these are frequently linked to their official residence status. This lack of access increases their vulnerability to unintended pregnancies and unsafe induced abortions due to limited availability of contraception. This study examined the prevalence of induced abortion and associated factors among sexually active women migrant workers working in the industrial zones (IZs) in Vietnam. A cross-sectional study was conducted from January 2019 to November 2020 among 512 sexually active female migrant workers aged 18 to 29 living in rent clusters and dormitories in Thang Long Industrial Park, Hanoi, Vietnam. The primary outcome was self-reported induced abortion. Multivariable logistic regression identified factors associated with induced abortion. Participants had a mean age of 24.8 years; 42.0% were single, and 85.4% lived in rent clusters. Among 512 sexually active female migrant workers, 10.5% reported having had an induced abortion. Compared to single women, married women had significantly higher odds of abortion (adjusted odds ratio [aOR] = 8.13, 95% confidence interval [CI]: 2.44-27.05). Longer duration since first sexual intercourse (aOR = 1.30, 95% CI: 1.12-1.52), and lower monthly income (aOR = 0.994, 95% CI: 0.99-1.00) were also associated with abortion. In addition, belonging to a non-Kinh ethnic group was associated with lower odds of abortion (aOR = 0.32, 95% CI: 0.16-0.62). This study reveals significant reproductive health challenges, including a high prevalence of abortion, among sexually active women migrant workers in a Vietnamese IZ, particularly for married women. These findings underscore the urgent need for targeted interventions such as accessible contraception, extending service hours into evenings or weekends, offering mobile sexual and reproductive health services near IZs, culturally sensitive comprehensive education, and programs addressing gender inequities to reduce unintended pregnancies and lower abortion rates. For routine practice, prioritize accessible contraception and culturally sensitive sexuality education in Vietnamese IZs. In addition, stronger monitoring and enforcement of regulations for private clinics are needed to ensure the safety and quality of abortion services. Future research should investigate contraceptive use, cohabitation dynamics, and unsafe abortion rates within this population to inform more effective interventions.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e45005"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A global perspective: Trends and insights in premenstrual disorder comorbidity research by bibliometric analysis (1999-2023).","authors":"Xunshu Cheng, Huihao Li, Mingzhou Gao, Xiaoying Liu, Peijuan Wu, Xingping Ni","doi":"10.1097/MD.0000000000045001","DOIUrl":"10.1097/MD.0000000000045001","url":null,"abstract":"<p><strong>Background: </strong>Premenstrual disorders represent a constellation of incapacitating gynecological disorders with numerous coexisting conditions. The identification and comprehension of disease-related comorbidities are of paramount importance in the medical field. This study aims to systematically review existing research and identify potential focus areas through bibliometric analysis.</p><p><strong>Methods: </strong>One hundred forty-nine publications on comorbidity in psychotic mood disorders between 1999 and 2023 were retrieved from the Web of Science Core Collection. The data was analyzed using bibliometric tools such as CiteSpace 6.1.R2 and VOSviewer. Specifically, the study examined the annual publication count, contributions by country and institution and details on journals, authors, citation counts, and keywords.</p><p><strong>Results: </strong>The data were retrieved on August 3, 2023. The annual number of publications showed an upward trend from 1999 to 2023. Globally, the US and Canada presented the highest publication counts and served as core research regions. Meanwhile, McMaster University and Harward University exhibited the highest output and influence by institution. In terms of author, Frey BN (McMaster University, Canada) was the most prolific with leading academic influence, while Lieb R (University of Basel, Switzerland) and Wittchen HU (Technical University Dresden, Germany) were the most cited authors. The American Journal of Psychiatry (impact factor = 17.7, 2023) was the most frequently cited journal. Furthermore, significant overlapping between premenstrual syndrome and premenstrual dysphoric disorder warrants further investigation, and the intrinsic connection between premenstrual dysphoric disorder and bipolar disorder is a rising focus. Temporally, research shifted from prevalence surveys to diagnostic and mechanistic studies.</p><p><strong>Conclusions: </strong>This bibliometric study comprehensively analyzes the current state of research on physical and mental health comorbidities. North America became a prominent leader in contributions from countries, institutions, authors, and journals. Additionally, the study underscores the potential for further exploration of comorbidity between physiological and psychiatric conditions, suggesting a promising avenue for future research efforts.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e45001"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toxoplasmosis in pregnancy; analysis of maternal seropositivity in a large cohort in Turkey and clinical consequences of neonates.","authors":"Bilge Cetinkaya Demir, Oguzhan Yuruk, Yasemin Heper, Hilal Ozkan","doi":"10.1097/MD.0000000000044881","DOIUrl":"10.1097/MD.0000000000044881","url":null,"abstract":"<p><p>Toxoplasmosis infestation during pregnancy is typically asymptomatic however, the risk of vertical transmission increases with advancing gestational age. Due to the absence of overt clinical symptoms in most pregnant women, diagnosis relies on serological testing. Seroprevalence rates vary widely depending on geographical location and cultural practices. In the fetus, toxoplasmosis can result in a spectrum of outcomes, ranging from asymptomatic infection to severe neurological impairment. This study aimed to determine the seroprevalence of Toxoplasma gondii during pregnancy and to evaluate fetal transmission in seropositive pregnant women. For those diagnosed with acute toxoplasmosis, neonatal examination, serological tests, and transfontanel ultrasonography were conducted. This retrospective cohort study evaluated Anti-Toxoplasma IgM, IgG, and IgG avidity results of patients who presented to a tertiary medical center between 2015 and 2020. All maternal serological results, ultrasonographic evaluations, and neonatal data (e.g., serology, transfontanel ultrasonography) from births in the institution were obtained from hospital records. During the study period, 69 out of 2137 women (3.2%) had positive or borderline Toxoplasma IgM results. Seventeen patients were considered to have preconceptional infection, other 46 were suspected as acute toxoplasmosis during pregnancy. Three patients were lost to follow-up, and 5 pregnancies were terminated. Overall, 46 patients (2.1%) were started on spiramycin treatment by a mean gestational age of 14 weeks. Amniocentesis was performed in 14 cases, all of which had negative PCR results. Among neonates with available data, no findings suggestive of congenital toxoplasmosis were detected. The maternal seroprevalence of Toxoplasma gondii observed at our center aligns with findings from similar studies. 2 percent of 2137 women were suspected as acute toxoplasmosis and none of the 38 babies had neonatal intracranial abnormalities. However, the low acceptance rate (30%) for fetal diagnostic testing and the lack of complete neonatal serologic data may contribute to the observed low rate of congenital toxoplasmosis.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44881"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threshold effect of white blood cell count on the risk of refractory Mycoplasma pneumoniae pneumonia in pediatric patients: A retrospective cohort study.","authors":"Lingke Liu, Xuan Wenjie, Yana Wang, Xiaoxian Wang","doi":"10.1097/MD.0000000000044999","DOIUrl":"10.1097/MD.0000000000044999","url":null,"abstract":"<p><p>Refractory Mycoplasma pneumoniae pneumonia (RMPP) remains a major challenge in pediatric respiratory infections, with limited early predictors for disease progression. White blood cell (WBC) count is a widely used biomarker, but its relationship with RMPP risk has not been fully elucidated. This study investigates the threshold effect of WBC count on RMPP development to enhance risk stratification and early intervention strategies. A retrospective cohort study was conducted on pediatric patients diagnosed with MPP. WBC count was analyzed as both a continuous variable and stratified into quartiles to evaluate its association with RMPP risk using multivariable logistic regression. A threshold effect analysis was performed, and model selection was determined by the log-likelihood ratio test (P = .017). Adjustments were made for age, gender, weight, inflammatory markers (C-reactive protein, interleukin-6, γ-IFN), and metabolic indicators (lactate dehydrogenase, lactate, ALT, AST). A nonlinear relationship between WBC count and RMPP risk was identified. A threshold at WBC = 14.3 × 109/L was detected, which serves as a critical diagnostic indicator. When WBC count exceeds this threshold, it strongly suggests the development of RMPP. For WBC levels below 14.3 × 109/L, each 1 × 109/L increase was associated with a 20% higher RMPP risk (OR = 1.2, 95% CI: 1.1-1.2, P < .001), indicating that moderate WBC elevations are a strong predictor of disease progression. The WBC count was associated with the development of refractory RMPP. WBC count could be used as a crucial biomarker for risk stratification and clinical decision-making in pediatric MPP, providing clinicians with a clear threshold for early intervention and close monitoring.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44999"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ellis Jones technique as a cost-effective treatment for chronic peroneal tendon subluxation: A case report.","authors":"The Hung Hoang, Hoang Anh Dang, Tran Canh Tung Nguyen","doi":"10.1097/MD.0000000000045139","DOIUrl":"10.1097/MD.0000000000045139","url":null,"abstract":"<p><strong>Rationale: </strong>Peroneal tendon subluxation is an uncommon injury that is often overlooked during the acute phase, resulting in long-term instability.</p><p><strong>Patient concerns: </strong>We present a case involving a 25-year-old male soldier with a 2-year history of recurrent ankle pain and instability following an initial ankle injury.</p><p><strong>Diagnoses: </strong>Chronic peroneal tendon subluxation was diagnosed based on clinical examination and imaging findings.</p><p><strong>Interventions: </strong>Given the limitations of surgical instruments available at our institution in Vietnam, the patient was treated operatively using the Ellis Jones method, a traditional technique. The superior peroneal retinaculum was reinforced with a part of the Achilles tendon. Postoperatively, the leg was immobilized in a below-knee cast for 6 weeks.</p><p><strong>Outcomes: </strong>The patient experienced an uncomplicated recovery, returning to work without pain or need for braces within 2 months and resuming full physical activity 6 months postoperatively.</p><p><strong>Lessons: </strong>This case highlights that the Ellis Jones method remains a simple, cost-effective, and reliable surgical option for managing chronic peroneal tendon subluxation, particularly in resource-limited settings where specialized implants are unavailable.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e45139"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of knowledge, attitudes, and behaviors of family physicians about testicular cancer and testicular self-examination: An observational study.","authors":"Halil İbrahim Ayaş, Duygu İlke Yildirim","doi":"10.1097/MD.0000000000044610","DOIUrl":"10.1097/MD.0000000000044610","url":null,"abstract":"<p><p>Testicular cancer (TC) is a common malignancy among young men, where early detection greatly improves outcomes. Family physicians are essential in raising awareness and guiding self-care practices such as testicular self-examination (TSE). This cross-sectional study evaluated the knowledge, attitudes, and behaviors of 307 family physicians including specialists, residents, contracted assistant physicians, and general practitioners regarding TC and TSE. Participants included 10.4% family medicine specialists, 67.4% residents, 13.7% contracted assistant physicians, and 8.5% general practitioners, with a mean professional experience of 5.93 ± 5.89 years. While 65.8% felt their knowledge about TC was partially sufficient, 57.7% did not know how to perform TSE and 49.7% of male participants had never performed it. Despite 95.8% believing TSE is beneficial, 71.0% did not recommend it to male patients. Additionally, 53.4% considered TSE important, and 79.2% viewed it as equally important as breast self-examination. Knowledge of risk factors was significantly higher among family medicine specialists. The study highlights significant gaps in physician knowledge and practice regarding TC and TSE. Although not currently a standard screening tool, TSE can aid early detection. Enhancing awareness and education among physicians is crucial to promote patient guidance and improve outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44610"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthritis as a risk factor for cataract: Evidence from NHANES data and Mendelian randomization.","authors":"Minjun Ma, Haoan Yi, Xu Zha, Yanbo Kong, Guojiu Wu, Xinyu Fan, Chuang Yuan, Rui Song, Yuanping Zhang","doi":"10.1097/MD.0000000000044600","DOIUrl":"10.1097/MD.0000000000044600","url":null,"abstract":"<p><p>The relationship between cataract and arthritis remains underexplored, highlighting the need for comprehensive investigation. This study aimed to examine the association between these 2 conditions using data from the National Health and Nutrition Examination Survey and Mendelian randomization (MR) analysis. We utilized National Health and Nutrition Examination Survey data from 1999 to 2008 and applied multiple statistical techniques, including logistic regression, subgroup analysis, and the k-nearest neighbors machine learning algorithm to evaluate associations. For causal inference, we performed MR analysis using inverse variance weighting (a method that combines genetic evidence across variants) to assess causality, with sensitivity analyses (e.g., Steiger filtering) to assess robustness. Arthritis and 11 covariates (e.g., age, gender) differed significantly between cataract and control groups. Logistic regression confirmed arthritis as a risk factor for cataract across adjusted models (odds ratio > 1, P < .05). The k-nearest neighbors model ranked age as the strongest predictor, with arthritis 3rd in predictive importance among 13 variables. MR analysis of 7 arthritis subtypes (including rheumatoid arthritis (RA), osteoarthritis, psoriatic arthritis, gout, lupus-related arthritis, fibromyalgia, and reactive arthritis) revealed a modest but significant causal effect of RA on cataract (odds ratio = 1.025 (1.007-1.044), P < .01). Sensitivity analyses supported robustness. Arthritis, particularly RA, is a novel risk factor for cataract, with implications for early screening and anti-inflammatory strategies in high-risk populations. While the MR effect size is small, this study integrates multi-method evidence (epidemiological, genetic, and machine learning), advancing understanding of systemic inflammation's role in ocular pathology.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44600"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive analysis of metformin-associated lactic acidosis: Insights from the FDA Adverse Event Reporting System (FAERS).","authors":"Jie Jin, Wukun Ge, Aiping Yu, Zhiyong Lan, Shuangli Zhang","doi":"10.1097/MD.0000000000045007","DOIUrl":"10.1097/MD.0000000000045007","url":null,"abstract":"<p><p>The present study aims to evaluate metformin-associated lactic acidosis (MALA) using real-world data from the Food and Drug Administration Adverse Event Reporting System (FAERS), providing reference for rational metformin use in clinical practice. Relevant adverse event data from January 2018 to March 2024 was extracted from the FAERS database. Disproportionality analysis, logistic regression, and time-to-event analysis were performed to assess risk factors, temporal patterns, and potential drug interactions associated with MALA. Among 40,883 metformin-related adverse event reports, 10,370 were MALA cases. Diabetes (adjusted odds ratio [OR]: 2.35, 95% confidence interval [CI]: 2.03-2.74), heart disease (adjusted OR: 1.75, 95% CI: 1.44-2.14), and hypertension (adjusted OR: 1.40, 95% CI: 1.21-1.62) were identified as significant risk factors. Contrast media showed the highest signal strength for drug interactions (reporting odds ratio = 323.7, 95% CI: 226.8-461.99), followed by furosemide and bisoprolol. The median time to lactic acidosis onset was 106 days, significantly longer than the 20 days for other adverse events (P < .0001), with 44.0% occurring within 30 days and 40.4% after 360 days of therapy initiation. Taken together, our comprehensive analysis of the FAERS database enhances understanding of MALA risk factors and temporal patterns, contributing to informed decision-making in metformin's clinical application and facilitating timely management of this potentially life-threatening complication, particularly in patients with cardiovascular comorbidities.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e45007"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive irreparable rotator cuff tear with deltoid tear managed with reverse total shoulder arthroplasty: Case report and review of literature.","authors":"Jianan Liu, Cheng Luo, Yanjuan Chen, Yijun He, Jiongfeng Huang","doi":"10.1097/MD.0000000000044507","DOIUrl":"10.1097/MD.0000000000044507","url":null,"abstract":"<p><strong>Rationale: </strong>Massive irreparable rotator cuff tear (IRCT) with concurrent deltoid tear poses a therapeutic challenge, as the deltoid compensates for lost rotator cuff function. Reverse total shoulder arthroplasty is often contraindicated, but emerging evidence supports its use with deltoid repair, even in patients with prior radiotherapy. This case addresses the knowledge gap in managing such complex cases.</p><p><strong>Patient concerns: </strong>A 67-year-old right-hand dominant male reported chronic right shoulder pain worsening after a fall, with limited range of motion (active flexion 40°, abduction 40°, extension 30°), a palpable middle deltoid gap, and supraspinatus/infraspinatus wasting. History included oral carcinoma resection, chemotherapy, and radiotherapy 3 years prior, without metastasis.</p><p><strong>Diagnoses: </strong>Massive IRCT of supraspinatus, infraspinatus, and subscapularis with retraction (Goutallier grade 3, Hamada 4b); 4-cm retracted middle deltoid tear; rotator cuff tear arthropathy with superior humeral head migration, acromial sclerosis, and glenohumeral degeneration, confirmed by x-ray, computed tomography, and magnetic resonance imaging. Preoperative Constant-Murley score: 27 (pain: 2, activities of daily living: 10, movement: 12, strength: 2).</p><p><strong>Interventions: </strong>One-stage reverse total shoulder arthroplasty with deltoid repair via deltopectoral incision extended along the anterolateral acromion. Deltoid stump reattached to acromion using transosseous sutures. Rehabilitation: 6 weeks immobilization at 90° abduction, followed by passive, active-assisted, and active range of motion exercises.</p><p><strong>Outcomes: </strong>At 1-year follow-up, pain resolved; active abduction/flexion improved to 165°, extension to 30°, with pain-free rotations. Postoperative Constant-Murley score: 93 (pain: 15, activities of daily living: 20, movement: 40, strength: 18). X-rays showed stable prosthesis without loosening or instability.</p><p><strong>Lessons: </strong>Reverse total shoulder arthroplasty with deltoid repair can achieve favorable short-term outcomes in IRCT with deltoid compromise, challenging traditional contraindications. Key factors include preserved anterior/posterior deltoid function, precise surgical techniques, and rehabilitation compliance. Long-term studies are needed for validation.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44507"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}