Clinics and Practice最新文献

{"title":"Indications, Causes, and Patient Risk Factors for Revision After Total Ankle Arthroplasty: A Descriptive Cross-Registry Analysis of the NJR, AOANJRR, and SwedAnkle Registries.","authors":"Sedeek Mosaid, Yousif Jihad, Mostafa Jihad, Ashok Marudanayagam, Paul Lee","doi":"10.3390/clinpract16070133","DOIUrl":"10.3390/clinpract16070133","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Total ankle arthroplasty (TAA) is increasingly used to treat end-stage ankle arthritis, but comprehensive cross-registry data on revision patterns remain limited. This study describes indications, causes, and patient risk factors for revisions using three national registries. <b>Methods:</b> Aggregate data were extracted from the UK National Joint Registry (NJR; 22nd Annual Report 2025; <i>n</i> = 11,321), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR; 2025 Ankle Supplementary Report; <i>n</i> = 5379), and the Swedish Ankle Registry (SwedAnkle; Annual Report 2024; <i>n</i> = 1852; survival estimates from a published sub-cohort, <i>n</i> = 1226). Metrics were compared descriptively without inferential pooling. <b>Results:</b> Across registries, 18,552 primary TAAs were identified. Ten-year cumulative per cent revision (CPR) was 9.54% (95% confidence interval [CI], 8.75-10.39) in the NJR, 13.5% (95% CI, 12.1-15.1) in the AOANJRR osteoarthritis sub-cohort, and approximately 26% (author-derived from Kaplan-Meier curves; see Methods) in SwedAnkle (1993 onwards implants). Aseptic loosening was the predominant cause of revision in all three registries; the rank of subsequent causes differed between registries (infection was second in the NJR and AOANJRR; in SwedAnkle, infection ranked below insert wear/breakage at 11.5%). AOANJRR Cox analysis identified younger age (hazard ratios (HRs), 2.00 for <55 vs. ≥75 years; 95% CI, 1.30-3.07; <i>p</i> = 0.001), earlier surgical era (HR, 1.91 for pre-2015 vs. 2015-2024; 95% CI, 1.53-2.38; <i>p</i> < 0.001), and obesity (HR, 1.52 for body mass index (BMI) ≥ 30; 95% CI, 1.06-2.19; <i>p</i> = 0.023) as significant independent predictors in AOANJRR Cox proportional hazards models (osteoarthritis sub-cohort for age, sex, BMI and ASA; all-diagnoses primary cohort for surgical era). Sex and American Society of Anesthesiologists (ASA) scores were not significant. <b>Conclusions:</b> Aseptic loosening was the predominant cause of revision in all three registries. The rank of subsequent causes differed: in the NJR and AOANJRR, infection was the second most frequent cause; in SwedAnkle, infection ranked below insert wear/breakage. Younger age, obesity, and earlier surgical era were independent predictors of revision in AOANJRR Cox proportional hazards models. The post-2015 era was associated with approximately 48% lower revision hazard; this association cannot be interpreted causally, as the independent contributions of implant design, surgical technique, patient selection, and other secular changes cannot be isolated from registry data. These findings may inform preoperative counselling, implant selection, and registry harmonisation efforts.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic Assessment of Fetal Anatomy in the First Trimester: A Comparative Study of Visualization Rates Using Two- and Three-Dimensional Ultrasound.","authors":"Savoia Fabiana, La Verde Marco, Giudicepietro Antonia, Minnella Gian Piero, Fantasia Ilaria, Sarno Laura, Quaresima Paola, Gerbino Martina, Volpe Grazia, Dall'Asta Andrea, Morlando Maddalena","doi":"10.3390/clinpract16070132","DOIUrl":"10.3390/clinpract16070132","url":null,"abstract":"<p><p><b>Background/Objectives</b>: This study aimed to compare the visualization rates of fetal anatomical structures with standard 2D ultrasound examination versus a single 3D volume acquired during the first trimester. <b>Methods:</b> This multicenter prospective study was performed in nine tertiary referral centers, by experienced sonographers. A standard protocol was adopted in both 2D and 3D modalities to assess the 17 anatomical structures listed in the national and international guidelines. The included cases were non-anomalous fetuses from women booked for combined screening test between 11 + 0 and 13 + 6 weeks. <b>Results:</b> Two hundred and thirty-nine women were included in the study. The mean gestational age at ultrasound examination was 12 weeks ± 5 days (±5.4 SD). All the 17 structures were seen in 155/239 fetuses (64.85%) at 2D evaluation and in 84/239 (35.15%) at 3D evaluation (<i>p</i> = 0.001). Comparing 2D and 3D visualization, the following anatomical structures showed a statistical difference: posterior fossa (92% vs. 74%, <i>p</i> < 0.005); neck (94.2% vs. 87.2%, <i>p</i> < 0.001); orbits (93% vs. 85.6%, <i>p</i> < 0.001); nasal bone (93% vs. 88.8%, <i>p</i> = 0.016); lung fields (99.5% vs 96.7%, <i>p</i> = 0.046); cardiac axis (99.5% vs. 83.9%; <i>p</i> < 0.001); bladder (97.5% vs. 91.7%, <i>p</i> < 0.001); abdominal wall (98.7% vs. 94.2%, <i>p</i> < 0.001). For the other anatomical portion, no statistically significant differences were found. <b>Conclusions:</b> Our study demonstrates that a full assessment of fetal anatomy is best performed using 2D ultrasound, while 3D ultrasound showed lower overall visualization rates, with comparable performance for selected structures, suggesting a potential supplementary use in specific clinical contexts.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Risk Stratification of Delirium in Intermediate Care Units and Its Impact on 30-Day Mortality: A Decision-Tree Analysis.","authors":"Fabrizio Lucente, Lucia Filippi, Arian Zaboli, Alessandra Eugenia Bionda, Michael Maggi, Marta Parodi, Alice Bresolin, Arianna Pretto, Martina Da Meda, Silvia Greselin, Francesca Fulghesu, Gianni Turcato","doi":"10.3390/clinpract16070131","DOIUrl":"10.3390/clinpract16070131","url":null,"abstract":"<p><strong>Background: </strong>Delirium is an under-recognized complication in hospitalized acute care patients, associated with worse outcomes including increased length of stay, higher ICU admission rates and greater mortality. Although screening tools exist for early diagnosis, the absence of admission-based tools limits early risk stratification and timely prevention strategies.</p><p><strong>Aim: </strong>To identify early risk factors for delirium development in IMCU patients and quantify its prognostic role on 30-day mortality.</p><p><strong>Methods: </strong>In this prospective single-center study, 651 consecutive IMCU patients without delirium at admission were enrolled. Admission variables were analyzed using multivariable logistic regression and Classification and Regression Tree (CART) analysis to identify clinically relevant risk phenotypes. The association between delirium and 30-day mortality was assessed in adjusted models.</p><p><strong>Results: </strong>Delirium developed in 18.6% of patients within 96 h. Key independent risk factors included age (OR 1.04), male sex (OR 1.75), alcohol use disorder (OR 3.59), cognitive impairment (OR 3.35), COPD (OR 1.68), NEWS (OR 1.18), and need for NIV (OR 3.83). CART analysis identified NIV as the dominant early discriminator, followed by cognitive vulnerability and acute severity. 30-day mortality was significantly higher in patients with delirium (22.3% vs. 9.8%, <i>p</i> = 0.001). Delirium remained an independent risk factor after adjustment (OR 2.53). CART analysis further corroborates delirium as a significant determinant, enhancing prognostic stratification beyond its role as a mere surrogate of disease severity.</p><p><strong>Conclusions: </strong>Admission-level clinical variables and exploratory CART analysis identified clinically interpretable delirium risk phenotypes in IMCU patients. Delirium was independently associated with increased 30-day mortality. These findings provide a preliminary framework for future validation studies and development of IMCU-specific risk-stratification approaches.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness of Dental Professionals of the Relationship Between Prosthetic Pressure Lesions and Infective Endocarditis: A Cross-Sectional Observational Study.","authors":"Francesco Saverio Ludovichetti, Serena Zanatta, Davide Scettri, Valentina Brun, Sergio Mazzoleni, Edoardo Stellini, Christian Bacci","doi":"10.3390/clinpract16070129","DOIUrl":"10.3390/clinpract16070129","url":null,"abstract":"<p><p><b>Background</b>: Infective endocarditis is a serious disease affecting cardiac tissues and may arise following episodes of transient bacteremia. Oral prosthetic pressure lesions, characterized by mucosal ulcerations, may facilitate the entry of pathogenic microorganisms into the systemic circulation. In predisposed individuals, the presence of such lesions may therefore contribute to the development of infective endocarditis. The objective of this study was to assess dental professionals' knowledge, awareness, and self-reported clinical practices related to the possible relationship between oral prosthetic pressure lesions and infective endocarditis. <b>Materials and Methods</b>: A cross-sectional observational study was conducted using an anonymous online questionnaire specifically developed for this study and subjected to preliminary content validation and pilot assessment before administration. The survey was distributed online to oral health professionals working in the Italian public and private sectors; for the present analysis, only complete responses provided by licensed dental professionals practicing in Italy were included. <b>Results</b>: Among the 268 dental professionals analyzed, an overall limited awareness of the possible relationship between oral prosthetic pressure lesions and infective endocarditis emerged. Only 16.8% of participants reported being familiar with the most recent guidelines for the prevention of infective endocarditis. <b>Conclusions</b>: The findings suggest the need to strengthen continuing education, improve familiarity with current infective endocarditis prevention guidelines, and promote more structured clinical protocols for the assessment and management of prosthetic pressure lesions in patients at risk.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitudes, and Perceptions of Midwives and Obstetricians/Gynecologists on Sexual Activity During Pregnancy: A Cross-Sectional Study in Greece.","authors":"Eleni Charitopoulou, Angeliki Bolou, Vikentia Harizopoulou, Antigoni Sarantaki, Athina Diamanti, Irene Athina Avramidou, Giannoula Kyrkou","doi":"10.3390/clinpract16070130","DOIUrl":"10.3390/clinpract16070130","url":null,"abstract":"<p><p><b>Background:</b> Sexual health is a key component of quality of life and an essential aspect of holistic maternity care. During pregnancy, changes in sexual function are often accompanied by fears and misconceptions, which are influenced by healthcare professionals' counseling. <b>Objectives</b>: The present study aimed to investigate the knowledge, attitudes, and perceptions of midwives and obstetricians/gynecologists in Greece regarding sexual activity during pregnancy. <b>Methods</b>: A cross-sectional study was conducted using an anonymous, self-administered questionnaire. Participants included 121 healthcare professionals (73 midwives and 48 obstetricians/gynecologists). Data were analyzed using appropriate non-parametric statistical tests and multiple linear regression analysis. <b>Results</b>: The majority of participants (97.5%) considered sexual activity during pregnancy to be beneficial. Midwives demonstrated significantly higher scores on the knowledge assessment compared to obstetricians/gynecologists (67.7 ± 18.0 vs. 54.8 ± 24.2, <i>p</i> = 0.001) and more frequently selected the questionnaire response indicating benefits for both the couple and the fetus (46.6% vs. 27.1%, <i>p</i> = 0.031). A higher proportion of midwives perceived that pregnant women do not receive adequate information regarding their sexual health (93.2% vs. 68.8%, <i>p</i> < 0.001). Obstetricians/gynecologists were more likely to recommend restrictions even in low-risk pregnancies. <b>Conclusions</b>: The findings highlight the need for improved education and standardized counseling protocols on sexual health during pregnancy, with particular emphasis on strengthening the role of midwives in delivering holistic, woman-centered care.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Patterns and Determinants of Subclinical and Overt Hypothyroidism in a Clinical Cohort from the Hail Region, Saudi Arabia: A Retrospective Cross-Sectional and Cluster Analysis Study.","authors":"Tareq Nafea Alharby, Sultan Almuntashiri, Majd Habib Alshammari, Shahad Hassan Alshammari, Ahad Fhaid Alzabni, Asyah Awad Alnomassi, Hanadi Saleh Alrashidi, Saleh Alghamdi, Nafees Ahemad, Sirajudheen Anwar","doi":"10.3390/clinpract16070128","DOIUrl":"10.3390/clinpract16070128","url":null,"abstract":"<p><p><b>Background</b>: Hypothyroidism is a globally prevalent disorder with variations in its occurrence. However, few studies have reported its prevalence in Saudi Arabia. This study aimed to establish the prevalence, characteristics, and predictors of subclinical and overt hypothyroidism in a clinical cohort from the Hail region of Saudi Arabia. <b>Methods</b>: A retrospective cross-sectional design was used. Electronic medical records of adults (aged ≥18 years) who underwent thyroid function testing (TSH, FT4, and FT3) at the study institution were reviewed. Participants with missing laboratory or demographic data and those with hyperthyroidism (TSH < 0.4 mIU/L) were excluded. Hypothyroidism was classified biochemically using internationally accepted TSH and FT4 thresholds. The final analysis cohort comprised 724 participants. <b>Results</b>: Of 724 participants, 471 (65.1%) were euthyroid, 234 (32.3%) had subclinical hypothyroidism, and 19 (2.6%) had overt hypothyroidism, yielding a total biochemical hypothyroidism prevalence of 34.9% (<i>n</i> = 253). Women were over-represented (89.6%), and obesity was prevalent (69%). The biochemical results confirmed that overt hypothyroidism showed significantly elevated TSH and decreased FT4 compared to subclinical hypothyroidism. There were non-significant associations between gender, BMI, and hypertension with thyroid status. Age was an independent predictor of hypothyroid status (OR = 0.983, 95% CI: 0.970-0.995, <i>p</i> = 0.008), and systolic blood pressure was also independently associated (OR = 1.011, 95% CI: 1.002-1.019, <i>p</i> = 0.016). Multiple regression showed age, hypertension, gonarthrosis, and chest pain were independently associated with TSH levels. Hierarchical clustering suggested potential regional patterns in hypothyroidism prevalence. <b>Conclusions</b>: Hypothyroidism, mostly subclinical, was prevalent in this clinical cohort. Age and systolic blood pressure were independent predictors, while BMI and gender were not. Biochemical assessment is essential for detection, and larger prospective studies are recommended.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Manifestations of Sinonasal Osteomas: A Narrative Review.","authors":"Spyridon Lygeros, Alkmini Gatsounia, Ioanna Athanasiadou, Aris I Giotakis, Foteini Tsapardoni, Gerasimos Danielides","doi":"10.3390/clinpract16070126","DOIUrl":"10.3390/clinpract16070126","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Sinonasal osteomas are benign, slow-growing tumors that are typically asymptomatic and incidentally detected. However, in rare cases, they may present with atypical and potentially serious complications involving other sinonasal, orbital, or intracranial structures. This review aims to synthesize these unusual manifestations and to highlight the underlying mechanisms, diagnostic challenges, and management implications. <b>Methods</b>: A narrative review of the literature was conducted, focusing on reported cases of sinonasal osteomas with rare or complicated presentations. Studies were analyzed with emphasis on clinical features, imaging findings, pathophysiological mechanisms, and treatment strategies. <b>Results</b>: Unusual presentations of sinonasal osteomas are primarily driven by sinus obstruction, progressive expansion, and skull-base erosion. These processes may result in complications such as pneumocephalus, intracranial mucoceles, cerebrospinal fluid leaks, orbital compression, and secondary infections. Clinical manifestations are often nonspecific, including headache, seizures, visual disturbances, or focal neurological deficits, which may delay diagnosis. High-resolution computed tomography is essential for identifying the osseous lesion and associated bone changes, while magnetic resonance imaging is critical for assessing soft-tissue involvement and intracranial extension. Management is individualized, with surgical resection indicated in most symptomatic or complicated cases, using endoscopic, open, or combined approaches. <b>Conclusions</b>: Although rare, atypical manifestations of sinonasal osteomas can result in significant morbidity. A mechanism-based understanding, supported by appropriate imaging, is essential for accurate diagnosis and timely management. Increased clinical awareness is crucial to improving outcomes in these uncommon but clinically significant cases.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond National Averages: Spatial and Temporal Patterns in Type 2 Diabetes Dynamics in Romania-A 10-Year Time Series Study.","authors":"Cristina Gena Dascalu, Diana Tatarciuc, Magda Ecaterina Antohe","doi":"10.3390/clinpract16070127","DOIUrl":"10.3390/clinpract16070127","url":null,"abstract":"<p><strong>Background/objectives: </strong>This study analyzes the temporal and spatial evolution of type 2 diabetes prevalence in Romanian counties over a 10-year period (2012-2021), based on the time series autocorrelation and cross-correlation coefficients.</p><p><strong>Methods: </strong>The autocorrelation coefficients were calculated within each county's data series, in order to identify the internal temporal dependencies, and the cross-correlation coefficients were calculated on administrative regions, in order to identify epidemiological patterns.</p><p><strong>Results: </strong>The type 2 diabetes prevalence rates in most counties follow autoregressive series, with significant positive correlations at lag 1, indicating cyclical fluctuations. Cross-correlation analysis revealed 3 regional patterns: North-East and West regions showed highly synchronized dynamics with cross-correlations exceeding 0.9, South-East and South regions showed mixed synchronization, with temporal lags of 1-2 years between counties, while the other regions (Center, South-West and North-West) revealed a synchronized core and an isolated county, with atypical dynamics (e.g., Cluj, Alba, Mehedinți, Ialomița).</p><p><strong>Conclusions: </strong>These findings highlight the utility of time series analysis in understanding the specificity of such data and their practical applicability in customizing the required public health interventions.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb Salvage After Chronic Nonunion Following Deformity Correction in Congenital Fibular Deficiency: A Cautionary 12-Year Follow-Up Case Highlighting Biological and Mechanical Reconstructive Challenges.","authors":"Koji Nozaka, Shohei Murata, Naohisa Miyakoshi","doi":"10.3390/clinpract16070125","DOIUrl":"10.3390/clinpract16070125","url":null,"abstract":"<p><p><b>Background</b>: Congenital fibular deficiency is a rare longitudinal deficiency of the lower extremity associated with limb-length discrepancy, ankle and foot deformity, soft-tissue imbalance, and functional impairment. Reconstruction may be challenging because bone healing, regenerate maturation, and mechanical stability can be less predictable in selected patients. <b>Case Presentation</b>: A man with congenital fibular deficiency developed chronic distal tibial nonunion after corrective osteotomy at another institution. The nonunion persisted for four years, and the patient presented to our hospital with inability to bear weight and wheelchair dependence. A comprehensive salvage strategy was performed, including Achilles tendon lengthening using the Vulpius technique, removal of retained fixation material, debridement and refreshment of the nonunion site, negative bacteriological cultures, autologous cancellous iliac bone grafting, acute shortening and compression of the docking site, circular external fixation, proximal tibial osteotomy, and gradual lengthening. Low-intensity pulsed ultrasound was applied postoperatively as an adjunctive biological stimulus. <b>Results</b>: Bone union was achieved, and the external fixator was removed approximately one year after surgery. A total lengthening of 78 mm was achieved. At 12-year follow-up, the AOFAS ankle-hindfoot score was 90, ankle range of motion was 5° dorsiflexion and 40° plantarflexion, and the JOA knee score was 95. The patient walked independently without assistive devices and continued to work. Mild residual varus deformity of the proximal tibia was present, but the patient reported no knee pain, ankle pain, or ankle instability, and radiographs showed no progressive osteoarthritic changes. <b>Conclusions</b>: In selected patients with congenital fibular deficiency and chronic nonunion after previous treatment, durable limb salvage may be achieved using an individualized strategy that addresses both biological and mechanical factors.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum or Plasma Oncostatin M for Predicting Primary Non-Response to Tumor Necrosis Factor-α Antagonist Therapy in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Maxwell A Barffour, Elizabeth Karanja, Mustafa Gandhi, Susan S Kais, Saurabh Kapur, Yezaz A Ghouri","doi":"10.3390/clinpract16070124","DOIUrl":"10.3390/clinpract16070124","url":null,"abstract":"<p><p><b>Background</b>: Over 30% of patients with inflammatory bowel disease (IBD) experience primary non-response to tumor necrosis factor-α antagonists (anti-TNFs). Oncostatin M (OSM), a TNF-α-independent pro-inflammatory signaling cytokine, is emerging as a potential predictive biomarker of treatment response. Through a systematic review and meta-analysis, we assessed the utility of baseline serum or plasma OSM for predicting anti-TNF response in IBD patients. <b>Methods</b>: We searched PubMed, Embase, Cochrane Library, and Web of Science through March 2026 for studies reporting associations between baseline serum/plasma OSM and endoscopic or clinical response to anti-TNF therapy in adult IBD patients. We used a bivariate random-effects model to estimate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the receiver operating characteristic (ROC) curve (AUC). Quality was assessed using QUADAS-2. <b>Results</b>: Data from four studies (<i>n</i> = 441 patients) were pooled. We estimated a pooled sensitivity of 82.8% (95% CI 71.4-90.3%) and a specificity of 88.4% (95% CI 82.7-92.4%) for predicting anti-TNF non-response. The pooled AUC was 0.899 (95% CI 0.858-0.940), with low heterogeneity (I² = 16.0%). The pooled DOR was 36.7 (95% CI 15.7-85.8), with a positive likelihood ratio of 7.1 and a negative likelihood ratio of 0.19. Risk of bias was low across the studies. <b>Conclusions</b>: Higher serum OSM was associated with treatment failure in IBD patients receiving anti-TNF therapy, with a pooled AUC of 0.899 in assay-stratified analysis and 0.820 when all studies were included. However, the small number of available studies, substantial variability in OSM cutoffs (14-233.6 pg/mL) and assay heterogeneity limit the robustness and generalizability and call for additional prospective data to more-robustly characterize the clinical utility of OSM.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"16 7","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}