Adv Clin Exp Med [JOURNAL]
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200 papers
Navigating medication adherence in chronic diseases.
Uchmanowicz I, Jędrzejczyk M, Jakubiak GK … +11 more , Chłopaś-Konowałek A, Iovino P, Aldossary HM, Piwowar A, Uchmanowicz B, Lomper K, Gonos J, Jaros R, Sawczak F, Jaguszewski M, Kołtuniuk A
Adv Clin Exp Med · 2026 Apr · PMID 41945259 · Publisher ↗
Adherence is defined as taking medications as prescribed to achieve a therapeutic outcome. It consists of 3 main components: initiation, implementation, and discontinuation. Methods of assessing adherence can be broadly...
Adherence is defined as taking medications as prescribed to achieve a therapeutic outcome. It consists of 3 main components: initiation, implementation, and discontinuation. Methods of assessing adherence can be broadly classified as direct or indirect. Factors influencing adherence include patient-related, therapy-related, and healthcare system-related variables. Poor adherence in chronic disease management leads to a cascade of negative clinical, economic, and psychosocial outcomes. Evidence consistently demonstrates that non-adherence is not merely a patient-level issue but a systemic healthcare challenge. Effective strategies to improve adherence must therefore be comprehensive, targeting barriers at multiple levels to achieve meaningful improvements in patient outcomes and quality of life. These strategies include supporting the initiation phase, improving implementation, and addressing challenges related to treatment discontinuation. This paper presents key findings from a literature review on adherence and its importance in clinical practice, as well as current and emerging strategies to enhance medication adherence among patients with chronic diseases.
Oxaliplatin-induced peripheral neuropathy in cancer treatment: Mechanisms, risk factors, and management strategies.
Pigońska JA, Banach M, Walkowiak PS … +1 more , Zygulska A
Adv Clin Exp Med · 2026 Apr · PMID 41926777 · Publisher ↗
Oxaliplatin (OXI) is a platinum-based chemotherapeutic agent commonly used in the systemic treatment of colorectal, gastric, pancreatic, and esophageal cancers. Like other cytotoxic agents, OXI is associated with various...
Oxaliplatin (OXI) is a platinum-based chemotherapeutic agent commonly used in the systemic treatment of colorectal, gastric, pancreatic, and esophageal cancers. Like other cytotoxic agents, OXI is associated with various adverse effects; however, OXI-induced peripheral neuropathy (OIPN) represents a particularly challenging clinical problem for both oncologic patients and their clinicians. The severity of neuropathic symptoms may necessitate dose reduction or premature discontinuation of therapy, which can ultimately shorten recurrence-free survival. This paper discusses the symptoms, mechanisms of onset, risk factors, preventive strategies, treatment options, and grading scales associated with OIPN. Both the prevention and treatment of OIPN require further innovative and effective research. It is hoped that the outcomes of ongoing trials will address both chronic and acute OIPN in the near future, as this condition remains a persistent clinical concern for patients with gastrointestinal cancers.
Evaluating weight-adjusted waist index as a risk factor for chronic obstructive pulmonary disease: A cross-sectional analysis of NHANES data.
Li Y, Li B
Adv Clin Exp Med · 2026 Apr · PMID 41926776 · Publisher ↗
BACKGROUND: The weight-adjusted waist index (WWI) shows a significant positive association with chronic obstructive pulmonary disease (COPD) risk, suggesting a potential role in risk stratification and early detection. O...
BACKGROUND: The weight-adjusted waist index (WWI) shows a significant positive association with chronic obstructive pulmonary disease (COPD) risk, suggesting a potential role in risk stratification and early detection. OBJECTIVES: This study examined the relationship between WWI and COPD, with a focus on its clinical implications for COPD risk assessment and management. MATERIAL AND METHODS: Data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2007-2018 were used. We included individuals aged 40 years and older. Weighted logistic regression was used to examine the association between WWI and COPD. Subgroup analyses and interaction tests were performed to assess consistency across demographic and lifestyle factors. A nonlinear regression model was used to evaluate the relationship between WWI and COPD, while receiver operating characteristic (ROC) curve analysis was used to assess the ability of WWI to identify individuals at risk. RESULTS: Among 14,144 participants, WWI was higher in the COPD group than in the control group (p < 0.001). In fully adjusted models, WWI was positively associated with COPD (odds ratio (OR) = 1.50, 95% confidence interval (95% CI): 1.34-1.68). In stratified analyses, participants in the highest WWI quartile had a greater risk of COPD than those in the lowest quartile (OR = 2.13, 95% CI: 1.62-2.80). Subgroup analyses showed a consistent positive association between WWI and COPD across sex, age, and smoking status. The nonlinear model indicated that the risk of COPD increased significantly beyond a certain WWI value. The ROC curve analysis confirmed the utility of WWI as a predictor (area under the curve (AUC) = 0.625, 95% CI: 0.609-0.642). These findings highlight the need to incorporate WWI into routine COPD risk assessment. CONCLUSIONS: This study found a significant and nonlinear positive association between WWI, a marker of central obesity, and COPD risk. Weight-adjusted waist index may be an independent predictor of COPD risk and provide insight into the contribution of obesity to the disease. Given the increasing burden of COPD, integrating WWI into clinical practice could enhance preventive efforts and personalized interventions.
Cardiovascular effects of electronic cigarettes and heated tobacco products: Clinical evidence from a narrative review.
Festinese S, Richter D
Adv Clin Exp Med · 2026 Apr · PMID 41926775 · Publisher ↗
This review critically examines the cardiovascular (CV) implications of switching from combustible cigarettes (CCs) to combustion-free nicotine products, namely heated tobacco products (HTPs) and electronic cigarettes (e...
This review critically examines the cardiovascular (CV) implications of switching from combustible cigarettes (CCs) to combustion-free nicotine products, namely heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes). Noncommunicable diseases, particularly cardiovascular disease (CVD), remain the leading global cause of mortality, with smoking as a major modifiable risk factor. While complete smoking cessation provides the greatest health benefit, many smokers transition to alternative nicotine delivery systems. Evidence from randomized trials, observational studies, and cohort analyses indicates that switching to HTPs or e-cigarettes significantly reduces exposure to harmful and potentially harmful constituents (HPHCs), including carbon monoxide (CO) and carcinogens, with biomarker improvements comparable to those observed after smoking cessation. Short-term studies suggest favorable changes in endothelial function, arterial stiffness, and oxidative stress, although nicotine-containing products may still exert acute CV effects. Long-term data, although limited, indicate a reduced incidence of major adverse cardiovascular events (MACEs) among exclusive users compared with continued smokers. However, heterogeneity in product design, usage patterns, and study methodologies limits the ability to draw definitive conclusions. Overall, current evidence suggests that non-combustible nicotine products may represent a harm reduction strategy for smokers who are unable or unwilling to quit, although they are not risk-free. Further large-scale, long-term studies with clinically relevant endpoints are required to clarify their CV safety profile and to inform evidence-based public health policies.
Cardiofaciocutaneous syndrome type 4: A comprehensive review of the MAP2K2-related clinical features, diagnostics, and management.
Kubiszewski H, Świeca A, Łukasiewicz K … +2 more , Pierpont EI, Szczałuba K
Adv Clin Exp Med · 2026 Mar · PMID 41904990 · Publisher ↗
Cardiofaciocutaneous syndrome type 4 (CFC4) is a rare genetic condition caused by pathogenic variants in the MAP2K2 (MEK2) gene, part of the RAS/MAPK signaling pathway. While the broader phenotype of CFC syndrome has bee...
Cardiofaciocutaneous syndrome type 4 (CFC4) is a rare genetic condition caused by pathogenic variants in the MAP2K2 (MEK2) gene, part of the RAS/MAPK signaling pathway. While the broader phenotype of CFC syndrome has been well described, the features specific to this molecular subtype remain poorly defined due to the limited number of cases and underreporting. We conducted a structured analysis of all available literature on CFC4, focusing on organ-specific manifestations, including cardiac, craniofacial, neurological, integumentary, and gastrointestinal features, as well as developmental outcomes, treatment approaches, imaging findings, and behavioral profiles. Cardiofaciocutaneous syndrome type 4 is associated with a recognizable but variable phenotype. Pulmonary valve stenosis and atrial septal defects (ASDs) are the most common cardiac anomalies. Neurological involvement is nearly universal, often presenting as hypotonia and motor delay, with intellectual disability in a subset of cases. Distinctive craniofacial features and ectodermal abnormalities support clinical recognition. Feeding difficulties, sensory integration disorders, and behavioral challenges are frequently observed. Brain magnetic resonance imaging (MRI) abnormalities such as ventriculomegaly and corpus callosum hypoplasia are also relatively frequent. Notably, some individuals with CFC4 exhibit relatively mild phenotypes, with reports of independent functioning in adulthood and a history of familial transmission. In such cases, only mild learning difficulties were described. Better recognition and understanding of CFC4 require consistent and detailed reporting of new cases. To support this, we propose a concise clinical checklist to standardize case descriptions and support diagnosis.
Risk factors for postoperative complications in Crohn's disease: A systematic review and meta-analysis.
Łosińska J, Lewandowski M, Kawiński A … +2 more , Dziki AJ, Mik M
Adv Clin Exp Med · 2026 Mar · PMID 41904989 · Publisher ↗
BACKGROUND: Crohn's disease (CD) is a non-specific inflammatory bowel disorder for which no definitive cure is available. The primary management strategy is pharmacological treatment aimed at alleviating symptoms. Howeve...
BACKGROUND: Crohn's disease (CD) is a non-specific inflammatory bowel disorder for which no definitive cure is available. The primary management strategy is pharmacological treatment aimed at alleviating symptoms. However, many patients ultimately require surgical intervention to manage complications arising from the disease. OBJECTIVES: The aim of this study was to investigate disease-related factors that may increase the risk of early postoperative complications in patients with CD. MATERIAL AND METHODS: A meta-analysis was conducted based on studies examining early surgical and medical complications following abdominal surgery for CD. The analyzed risk factors included disease duration prior to surgery, history of previous surgeries, presence of concurrent perianal disease, intra-abdominal abscess during surgery, and Montreal classification subtypes A1-3, L1-4, and B1-3. A systematic review was performed using 4 major databases: PubMed, Cochrane Library, Academic Search Ultimate (EBSCO), and Google Scholar. Outcomes were assessed using the odds ratio (OR) and response ratio (R), together with 95% confidence intervals (95% CIs). Egger's test was used to evaluate publication bias. Heterogeneity was assessed using the I2 statistic, with I2 > 50% indicating significant variability. RESULTS: A total of 51 articles met the inclusion criteria. The analysis identified several significant risk-increasing factors: history of previous surgeries (OR = 1.39; 95% CI: 1.23-1.57), Montreal classification group B3 (OR = 1.26; 95% CI: 1.11-1.42), disease duration before surgery (R = 1.10; 95% CI: 1.02-1.18), and group L2 (OR = 1.38; 95% CI: 1.11-1.72). Conversely, factors associated with a reduced risk of postoperative complications included group L1 (OR = 0.81; 95% CI: 0.71-0.92) and group B2 (OR = 0.81; 95% CI: 0.71-0.91). CONCLUSION: This meta-analysis aggregated data from a broad spectrum of patients and treatment settings across multiple institutions worldwide. Although some risk of bias and heterogeneity was observed, the findings nevertheless highlight the importance of considering disease subtype and progression when assessing the likelihood of postoperative complications in patients with CD. This knowledge may be valuable for optimizing treatment strategies.
Brain volumetric variability and artificial intelligence diagnosis: Importance of race/ethnicity-specific reference standards and social determinant adjustment. A scoping review.
Bolla SR, Almazan JU, Satbekov R … +4 more , Abidi SH, Jumadilova D, Mussabekova K, Maharjan S
Adv Clin Exp Med · 2026 May · PMID 41904988 · Publisher ↗
Neuroimaging techniques such as magnetic resonance imaging (MRI) are routinely used in diagnostic radiology to evaluate brain changes associated with neurological and psychiatric conditions. Evidence suggests that imagin...
Neuroimaging techniques such as magnetic resonance imaging (MRI) are routinely used in diagnostic radiology to evaluate brain changes associated with neurological and psychiatric conditions. Evidence suggests that imaging biomarkers predict clinical outcomes with varying accuracy across ethnic groups. Underrepresentation of ethnic diversity in neuroimaging research may result in generalization bias, whereby findings derived from one population are inaccurately applied to others. A scoping review methodology was employed to systematically identify and analyze relevant literature. Searches were conducted across EBSCOhost (including CINAHL and Medline Complete), Elsevier (Scopus), Clarivate (Web of Science), and PubMed. Eligible studies examined ethnicity-related differences in subcortical brain volumes and cortical thickness in healthy adults using neuroimaging. The search yielded 1,013 records, which were screened according to predefined inclusion and exclusion criteria. Fourteen studies met the eligibility criteria and were included in the final analysis. The reviewed studies demonstrated significant variations in cortical thickness and subcortical volumes across diverse populations and socioeconomic groups, underscoring the need for population-sensitive reference standards in neuroimaging to minimize generalization bias. These findings highlight the importance of incorporating ethnic variability into neuroimaging research and developing population-sensitive frameworks for MRI-based diagnostic applications. Additionally, the review identifies key areas for improvement, including the integration of ethnic and socioeconomic diversity in artificial intelligence (AI)-driven neuroimaging models to enhance diagnostic precision and equity.
Modulation of NF-κB and oxidative stress pathways in ethanol-induced gastric injury by a multi-component herbal formula: An in vivo study.
Hou S, Li J
Adv Clin Exp Med · 2026 Apr · PMID 41904987 · Publisher ↗
BACKGROUND: Chronic alcohol consumption can damage the gastric mucosa and increase the risk of severe gastrointestinal disorders, including gastritis, peptic ulcers, and potentially gastric cancer. Modern research has de...
BACKGROUND: Chronic alcohol consumption can damage the gastric mucosa and increase the risk of severe gastrointestinal disorders, including gastritis, peptic ulcers, and potentially gastric cancer. Modern research has demonstrated that Erchen decoction possesses anti-inflammatory, antioxidant, and gastric mucosal protective properties and has been applied in the treatment of various inflammatory conditions. OBJECTIVES: This study aimed to investigate the effects of Erchen decoction on chronic ethanol-induced gastric injury. MATERIAL AND METHODS: Seventy-two male Sprague Dawley rats were randomly assigned to the following groups: Con group (control), Mod group (model), OXY group (oxymatrine, 5 mL/kg), ECDH group (high-dose Erchen decoction, 10 mL/kg), ECDM group (medium-dose Erchen decoction, 5 mL/kg), and ECDL group (low-dose Erchen decoction, 2.5 mL/kg). Gastric histopathological changes were evaluated using hematoxylin and eosin (H&E) staining and transmission electron microscopy (TEM). Proliferation of gastric mucosal cells was assessed using immunohistochemical detection of proliferating cell nuclear antigen (PCNA). Serum levels of tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), superoxide dismutase (SOD), and malondialdehyde (MDA) were measured using enzyme-linked immunosorbent assay (ELISA) and biochemical analysis. Western blot (WB) was used to analyze protein expression associated with inflammatory pathway activation. RESULTS: Compared with the Mod group, Erchen decoction significantly alleviated gastric injury and increased PCNA expression in the gastric mucosa. Its therapeutic efficacy decreased in a dose-dependent manner, with weaker effects observed at lower doses. Erchen decoction significantly reduced serum levels of TNF-α, IL-1β, and MDA while enhancing SOD activity; however, these effects were less pronounced in the ECDL group than in the ECDM and ECDH groups. Importantly, Erchen decoction markedly decreased the expression of toll-like receptor 4 (TLR4), nuclear factor kappa-B (NF-κB), NOD-like receptor protein 3 (NLRP3), apoptosis-associated speck-like protein (ASC), cleaved caspase-1, IL-1β, and interleukin-18 (IL-18). CONCLUSIONS: Erchen decoction alleviates ethanol-induced gastric injury by reducing inflammation, attenuating oxidative stress, preserving cellular structural integrity, and regulating the NF-κB signaling pathway.
Machine learning-based prediction of out-of-hospital births in prehospital emergency care.
Wach J, Lewandowski Ł, Staniczek J … +2 more , Juárez-Vela R, Czapla M
Adv Clin Exp Med · 2026 Mar · PMID 41880214 · Publisher ↗
BACKGROUND: Unplanned out-of-hospital births constitute rare but high-risk obstetric emergencies managed by emergency medical services (EMS). Rapid assessment of labor progression in prehospital settings is challenging d...
BACKGROUND: Unplanned out-of-hospital births constitute rare but high-risk obstetric emergencies managed by emergency medical services (EMS). Rapid assessment of labor progression in prehospital settings is challenging due to limited diagnostic resources and time pressure, increasing the risk of adverse maternal and neonatal outcomes. Machine learning (ML) may support early risk stratification using routinely collected prehospital data. OBJECTIVES: To develop and validate supervised ML models for predicting prehospital birth and to evaluate whether these models reflect clinically intuitive obstetric reasoning. MATERIAL AND METHODS: This retrospective observational study analyzed 3,002 EMS-attended labor cases in Poland (August 2021.January 2022). The outcome was birth occurring before hospital arrival. Candidate predictors included maternal characteristics, obstetric history, stage of labor, vital signs, and intrapartum findings. Penalized logistic regression (elastic net), random forest (RF), support vector classifier with radial basis function kernel (SVC-RBF), Gaussian naive Bayes (GNB), and k-nearest neighbors (kNN) models were trained using stratified fivefold cross-validation. Model performance was evaluated using discrimination metrics (area under the receiver operating characteristic curve (ROC-AUC) and precision-recall AUC (PR-AUC)) and calibration metrics (Brier score and logarithmic loss (log loss)). Nested cross-validation was applied to reduce overfitting. Model interpretability was assessed using standardized coefficients, permutation importance, and Shapley Additive Explanations (SHAP) values. RESULTS: Penalized logistic regression demonstrated robust performance (ROC-AUC: 0.97 }0.01; PR-AUC: 0.81 } 0.04; Brier score: 0.036 }0.015). Random forest and SVC-RBF models achieved comparable discrimination (ROC-AUC up to 0.97), whereas kNN performed less well (ROC-AUC = 0.84). The 2nd stage of labor was the dominant predictor (Ŕ = 1.39), followed by amniotic fluid status (Ŕ = .0.44). Sensitivity analysis excluding the stage of labor reduced model performance but retained moderate discrimination (ROC-AUC . 0.76), indicating that additional clinical variables contributed to prediction. CONCLUSIONS: Machine learning models demonstrated high internal predictive performance for prehospital birth using routinely available EMS data and reproduced clinically intuitive decision patterns. Such tools may support, but not replace, prehospital obstetric decision-making.
iCare quantitative CT shows a higher detection rate of hip osteoporosis compared with Mindways quantitative CT.
Huang J, Huang F, Tang L … +1 more , Ji X
Adv Clin Exp Med · 2026 Apr · PMID 41880213 · Publisher ↗
BACKGROUND: Osteoporosis is a major risk factor for fractures in middle-aged and elderly individuals. Globally, osteoporotic fractures of the hip, spine, and forearm are associated with limited mobility, disability, chro...
BACKGROUND: Osteoporosis is a major risk factor for fractures in middle-aged and elderly individuals. Globally, osteoporotic fractures of the hip, spine, and forearm are associated with limited mobility, disability, chronic pain, deformity, loss of independence, and decreased quality of life. OBJECTIVES: To explore differences in hip bone density measurements between the iCare and Mindways bone densitometers. MATERIAL AND METHODS: The iCare and Mindways quantitative computed tomography (QCT) post-processing software were used to measure high-, medium-, and low-density vertebrae within a European Spine Phantom (ESP) to compare the average values obtained with each QCT software and to assess potential differences. Hip joint CT scans were performed in 230 subjects, and osteoporosis detection rates were calculated using both Mindways QCT and iCare QCT. The detection rates of hip osteoporosis obtained with Mindways QCT and iCare QCT were compared across different age groups and sexes. RESULTS: There were no statistically significant differences (p > 0.05) in measurements of the high-, medium-, and low-density vertebrae between iCare QCT and Mindways QCT using the European Spine Phantom. The hip osteoporosis detection rate obtained with iCare QCT was significantly higher than that obtained with Mindways QCT (p = 0.01). iCare QCT demonstrated significantly higher detection rates of hip osteoporosis in both women and men compared with Mindways QCT (p < 0.05). Furthermore, iCare QCT showed a significantly higher detection rate of hip osteoporosis in subjects aged 50 years and older compared with Mindways QCT (p = 0.02). CONCLUSIONS: iCare QCT provides reliable bone density measurements and demonstrates a superior detection rate for hip osteoporosis compared with Mindways QCT.
Causal links between gut microbiota, metabolites, and diffuse large B-cell lymphoma: Evidence from a Mendelian randomization study.
Feng G, Zhong G, Wang C … +3 more , Kong R, Wang J, Zhou X
Adv Clin Exp Med · 2026 May · PMID 41880212 · Publisher ↗
BACKGROUND: The precise causal relationship between alterations in the gut microbiota, microbiota-derived metabolites, and the development of diffuse large B-cell lymphoma (DLBCL) remains unclear. OBJECTIVES: To investig...
BACKGROUND: The precise causal relationship between alterations in the gut microbiota, microbiota-derived metabolites, and the development of diffuse large B-cell lymphoma (DLBCL) remains unclear. OBJECTIVES: To investigate the potential causal relationships between gut microbiota, microbiota-derived metabolites, and DLBCL. MATERIAL AND METHODS: Genetic data on gut microbiota were obtained from the MiBioGen consortium, while data on microbiota-derived metabolites were sourced from the TwinsUK and KORA studies.Statistics for DLBCL were retrieved from FinnGen. Mendelian randomization (MR) analysis was performed, with inverse-variance weighting (IVW) used as the primary analytical method. Sensitivity analyses included Cochran's Q test, the MR-Egger intercept test, and MR-PRESSO. Reverse MR analysis was conducted to assess potential bidirectional causal relationships between gut microbiota and DLBCL. Bayesian weighted MR (BWMR) was applied for additional validation to enhance the robustness of the findings. RESULTS: Among 196 gut microbial taxa analyzed, Bilophila (odds ratio (OR) = 1.777, 95% confidence interval (95% CI): 1.053-3.000, p = 0.031) was associated with an increased risk of DLBCL. In contrast, Alistipes (OR = 0.521, 95% CI: 0.311-0.873, p = 0.013) and Ruminococcaceae UCG011 (OR = 0.749, 95% CI: 0.574-0.978, p = 0.034) were associated with a reduced risk. Reverse MR analysis demonstrated a positive association between DLBCL risk and the abundance of Anaerofilum (OR = 1.087, 95% CI: 1.008-1.173, p = 0.031). Negative associations were observed between DLBCL risk and the abundance of Deltaproteobacteria (OR = 0.959, 95% CI: 0.922-0.997, p = 0.037), Desulfovibrionales (OR = 0.959, 95% CI: 0.922-0.998, p = 0.041), Oxalobacteraceae (OR = 0.914, 95% CI: 0.843-0.992, p = 0.031), and Oxalobacter (OR = 0.909, 95% CI: 0.837-0.988, p = 0.024). Analysis of microbiota-derived metabolites identified a causal association between indolepropionate (OR = 0.296, 95% CI: 0.131-0.669, p = 0.003) and reduced DLBCL risk, whereas 7-alpha-hydroxy-3-oxo-4-cholestenoate (7-HOCA) (OR = 9.561, 95% CI: 1.426-64.088, p = 0.020) was associated with an increased risk. No evidence of directional pleiotropy or heterogeneity was detected. CONCLUSIONS: This MR study provides evidence that specific gut microbial taxa and microbiota-derived metabolites may causally influence the risk of DLBCL.
Orthobiologics in anterior cruciate ligament (ACL) reconstruction: A narrative review.
Ostojic M, Ragni E, Lovreković B … +9 more , Valcarenghi J, Dzidzishvili L, Ramadanov N, Salzmann M, Rotim C, Prill R, Sabalic S, Becker R, Indelli PF
Adv Clin Exp Med · 2026 Mar · PMID 41841165 · Publisher ↗
Anterior cruciate ligament (ACL) injury is one of the most frequent injuries in sports medicine. Despite advancements in surgical techniques, suboptimal results in terms of delayed graft incorporation into bone tunnels a...
Anterior cruciate ligament (ACL) injury is one of the most frequent injuries in sports medicine. Despite advancements in surgical techniques, suboptimal results in terms of delayed graft incorporation into bone tunnels and ligamentization, as well as inferior clinical outcomes, still present significant challenges in treating these injuries. Orthobiological modalities such as platelet-rich plasma (PRP) and stem cells have emerged as a potential adjunct to ACL treatment, with a theoretical advantage in enhancing local biological processes and subsequent improvements in clinical outcomes. Embase, Cochrane, and PubMed databases were searched for relevant literature. The aim of this narrative review was to summarize the currently available evidence on the efficacy of orthobiologics, or the lack thereof, in ACL repair and reconstruction (ACLR), with emphasis on graft incorporation into bone tunnels, ligamentization, and overall clinical outcomes. These modalities exert their theoretical effect by delivering growth factors, anti-inflammatory cytokines, and regenerative cells to the target site, which enhance local biological processes. Although some research has shown positive effects of orthobiologics in ACLR, clinical outcomes remain inconsistent, without consensus on preparation methods and administration protocols. The lack of homogeneous, high-quality methodology in existing studies limits the possibility of drawing definitive conclusions on the efficacy of orthobiologics in ACLR. Although orthobiological modalities provide theoretical benefits in improving outcomes, until more robust evidence is available regarding their efficacy and optimal application methods, their routine use warrants caution and cannot yet be recommended. Future research should focus on improving and standardizing clinical and research protocols before drawing any definitive conclusions on this matter.
Phase angle from bioelectrical impedance analysis as a reliable marker for malnutrition detection in patients with heart failure.
Popiołek-Kalisz J, Jarosz I
Adv Clin Exp Med · 2026 Mar · PMID 41837468 · Publisher ↗
BACKGROUND: Malnutrition is common among patients with heart failure (HF), yet accurate assessment of nutritional status in this population remains challenging. The phase angle (PhA) derived from bioelectrical impedance...
BACKGROUND: Malnutrition is common among patients with heart failure (HF), yet accurate assessment of nutritional status in this population remains challenging. The phase angle (PhA) derived from bioelectrical impedance analysis (BIA) has been proposed as a marker of nutritional status at the cellular level; however, concerns persist regarding its dependence on hydration status. OBJECTIVES: This study aimed to assess the association between HF and nutritional status, with particular emphasis on phase angle (PhA) measured at 50 kHz, and to evaluate its diagnostic value in comparison with other indices, including the Nutritional Risk Screening 2002 (NRS 2002), body mass index (BMI), and selected laboratory parameters. MATERIAL AND METHODS: In this cross-sectional study, 270 patients with chronic coronary syndrome were evaluated using laboratory tests, anthropometric measurements, the NRS 2002, and BIA. Patients were stratified according to HF status. Statistical analyses included parametric and non-parametric tests, correlation analyses, multivariable logistic regression models, and receiver operating characteristic (ROC) curve analysis. Adjustments were made for age, sex, BMI, estimated glomerular filtration rate (eGFR), hemoglobin, and extracellular fluid percentage (ECF%). RESULTS: Heart failure was present in 91 of 270 patients (33.7%). Patients with HF had significantly lower PhA (median 4.79 vs 5.22; p < 0.001), higher NRS 2002 scores (p = 0.010), and lower eGFR and hemoglobin levels. In multivariable logistic regression analysis, PhA remained independently associated with HF (odds ratio (OR) = 0.62; p = 0.016), whereas NRS 2002 and ECF% were not significant. Inclusion of ECF% did not improve model performance. In ROC analysis, PhA showed modestly higher discriminative ability for HF (area under the curve (AUC) = 0.636) compared with NRS 2002 (AUC = 0.594) and BMI (AUC = 0.598). CONCLUSIONS: Heart failure is associated with impaired nutritional status. Phase angle appears to be a clinically relevant marker that remains independently associated with HF after adjustment for hydration status and may be considered as a complementary tool for routine nutritional screening in this high-risk population.
Postpartum assessment of insulin resistance indicators in mothers with gestational diabetes: A prospective observational case-control study.
Karcz K, Gaweł P, Królak-Olejnik B
Adv Clin Exp Med · 2026 May · PMID 41837467 · Publisher ↗
BACKGROUND: Gestational diabetes mellitus (GDM) is characterized by a higher degree of insulin resistance (IR) than in a normal pregnancy. Several surrogate measures have been proposed to assess insulin sensitivity, incl...
BACKGROUND: Gestational diabetes mellitus (GDM) is characterized by a higher degree of insulin resistance (IR) than in a normal pregnancy. Several surrogate measures have been proposed to assess insulin sensitivity, including glycated hemoglobin, the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and the Quantitative Insulin Sensitivity Check Index (QUICKI). OBJECTIVES: The aim of the study was to determine whether markers of IR in the 1st week postpartum differ between mothers with GDM and healthy controls, and whether mothers with GDM treated with insulin have significantly different levels of IR markers compared with those treated with diet and physical activity. The association between IR markers, pregnancy outcomes, and maternal glucose profiles based on the oral glucose tolerance test (OGTT) was also investigated. MATERIAL AND METHODS: Among the 70 participants, 50 mothers were diagnosed with GDM; 21 were treated with diet and physical activity (GDM G1), while 29 received insulin therapy (GDM G2). The remaining 20 participants constituted a control group with no history of glucose intolerance before or during pregnancy (non-GDM). A range of statistical methods (e.g., analysis of variance (ANOVA), Kruskal-Wallis test, χ2 test, regression analysis, and cluster analysis) were used to compare data between study groups, with a significance level of α = 0.05. RESULTS: The results showed that selected markers of IR in the 1st week after delivery differed significantly between mothers. Mothers with GDM exhibited considerably higher levels of HOMA-IR and HbA1c (p < 0.05), yet no substantially divergent QUICKI (p > 0.05) in the 1st week postpartum. Additionally, they demonstrated elevated glucose levels at 3 OGTT time points in comparison with non-GDM mothers. The GDM G2 group exhibited higher values than the GDM G1 group, except for the 1 h OGTT. Identification of maternal glucose phenotypes confirmed variability in the degree of glucose metabolism disorders among mothers. CONCLUSIONS: Cluster analysis and glucose phenotype stratification in mothers with GDM help identify high-risk groups and support targeted counseling and monitoring to improve pregnancy outcomes.
Assessing the stability of drugs of abuse and pharmaceuticals in postmortem blood samples.
Pelletti G, Mohamed S, Boscolo-Berto R … +5 more , Giampietro A, Giorgetti A, Pascali J, Lenzi J, Pelotti S
Adv Clin Exp Med · 2026 Apr · PMID 41837466 · Publisher ↗
BACKGROUND: Reliable toxicological analysis is crucial for accurate forensic and clinical interpretation; however, pre-analytical factors such as handling and storage can significantly alter drug concentrations in postmo...
BACKGROUND: Reliable toxicological analysis is crucial for accurate forensic and clinical interpretation; however, pre-analytical factors such as handling and storage can significantly alter drug concentrations in postmortem (PM) samples, potentially leading to misinterpretation. Postmortem degradation, influenced by enzymatic and microbial activity, can change drug levels, making it essential to understand drug stability in biological matrices. OBJECTIVES: This preliminary study investigates the long-term stability of drugs of abuse and psychoactive substances in PM blood samples from drug-related deaths stored at -20°C for 29 months. MATERIAL AND METHODS: Postmortem blood samples were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) following the routine methodology currently in use in the forensic toxicology laboratory. Stability was assessed by measuring concentration changes between analyses performed shortly after sample collection and reanalyses conducted after 6-29 months. Regression analyses were used to relate percentage variation in concentration to elapsed time. RESULTS: A strong correlation was found between the percentage reduction in drug concentration and storage time for all tested molecules, including morphine, cocaine, methadone, ketamine, benzodiazepines, antidepressants, antipsychotics, and lidocaine. Regression curve analysis revealed a reduction in concentration beginning within the initial months, with high variability. CONCLUSIONS: The study highlights the significant impact of long-term storage on drug concentrations in PM blood, emphasizing the need for careful consideration of storage intervals when reanalysis of samples is requested for forensic purposes. The findings underscore the importance of understanding degradation patterns for the accurate interpretation of toxicological results in medicolegal investigations.
Effects of peribulbar block and incisionless sub-Tenon's block on sleep quality after cataract surgery.
Kılıç Y, Gürsoy HH, Bilgeç MD … +2 more , Ata AR, Güleç MS
Adv Clin Exp Med · 2026 Apr · PMID 41837465 · Publisher ↗
BACKGROUND: Sleep quality often decreases in patients after surgery and may affect postoperative outcomes. OBJECTIVES: The aim of this study was to compare the effects of peribulbar block and incisionless sub-Tenon's blo...
BACKGROUND: Sleep quality often decreases in patients after surgery and may affect postoperative outcomes. OBJECTIVES: The aim of this study was to compare the effects of peribulbar block and incisionless sub-Tenon's block on postoperative sleep quality. MATERIAL AND METHODS: Patients who underwent cataract surgery under peribulbar block (n = 36) or incisionless sub-Tenon's block (n = 31) were included in the study. The 2 blocks were compared with each other in terms of eyelid and globe movements, corneal sensation, complications, pain, and postoperative sleep quality (evaluated using the Richard-Campbell Sleep Questionnaire (RCSQ) score). RESULTS: Sixty-seven patients with a mean age of 67 years were included in the study. At the 15th minute after the block (p = 0.066) and at the end of surgery (p = 0.098), akinesia was better in the incisionless sub-Tenon's group, with p-values close to the level of statistical significance. Chemosis was found to be significantly lower in the peribulbar block group than in the incisionless sub-Tenon's block group (p = 0.033) 3 h after surgery. All minor complications, including chemosis, subconjunctival petechiae, and subconjunctival hemorrhage, were observed less frequently in the peribulbar block group, although the differences were not statistically significant (p > 0.05). Pain scores were comparable between the groups (p > 0.05). The total RCSQ score (p = 0.396) and overall sleep perception (p = 0.355) were also comparable between the groups. CONCLUSIONS: The incisionless sub-Tenon's block was superior to the peribulbar block in terms of providing akinesia and reducing the need for maintenance anesthetic medications such as sedatives or analgesics. Although chemosis and subconjunctival hemorrhage occurred more frequently in the incisionless sub-Tenon's group, all events were transient and had no serious clinical significance. The 2 regional techniques were similar in terms of postoperative sleep quality and patient satisfaction.
Triglyceride-glucose (TyG) index in cardiovascular risk prediction: Clinical utility, guideline implications, and the need for outcome trials.
Cheng H
Adv Clin Exp Med · 2026 Apr · PMID 41837464 · Publisher ↗
The triglyceride-glucose (TyG) index, a simple surrogate marker integrating insulin resistance and atherogenic dyslipidemia, has attracted growing attention as a potential tool for addressing residual risk in cardiovascu...
The triglyceride-glucose (TyG) index, a simple surrogate marker integrating insulin resistance and atherogenic dyslipidemia, has attracted growing attention as a potential tool for addressing residual risk in cardiovascular disease (CVD) prediction. Robust observational evidence consistently links the TyG index to hard cardiovascular endpoints and subclinical atherosclerosis, positioning it as a strong candidate for clinical translation. However, its adoption in mainstream guidelines is constrained by a critical limitation: the current evidence is exclusively observational and lacks interventional data demonstrating that lowering the TyG index improves clinical outcomes. This editorial argues that, although the TyG index represents a practical and readily available risk-stratification adjunct, it has not yet evolved into a validated therapeutic target. We propose a dual-pathway strategy: provisional recognition within guidelines as a risk-enhancing factor, accompanied by a clear call for dedicated cardiovascular outcome trials. Such an approach would capitalize on its present utility while upholding the evidentiary standards required to inform clinical practice.
Pathway Mutation Accumulate Perturbation Score: A prognostic and predictive biomarker for immunotherapy in advanced gastric cancer.
Zhang Z, Yang G, Xing Y … +2 more , Gao Y, Lu H
Adv Clin Exp Med · 2026 Apr · PMID 41837463 · Publisher ↗
BACKGROUND: Gastric cancer (GC) remains highly lethal, with limited available biomarkers. The Pathway Mutation Accumulation Perturbation Score (PMAPscore), which leverages pathway-level mutations, provides a novel approa...
BACKGROUND: Gastric cancer (GC) remains highly lethal, with limited available biomarkers. The Pathway Mutation Accumulation Perturbation Score (PMAPscore), which leverages pathway-level mutations, provides a novel approach to predicting immunotherapy response and survival outcomes. OBJECTIVES: To evaluate the prognostic and predictive value of the PMAPscore in patients with advanced GC undergoing immunotherapy. MATERIAL AND METHODS: Three cohorts of patients with GC treated with immunotherapy were analyzed: PUCH (Peking University Cancer Hospital; n = 39, training cohort), MSK (Memorial Sloan Kettering; n = 19, validation cohort) and SMC (Samsung Medical Center; n = 43, validation cohort). A PMAPscore-based risk model was developed and validated for survival outcomes. Immune mechanisms in highand low-risk groups were explored using The Cancer Genome Atlas (TCGA) GC data (n = 431). RESULTS: Low-risk patients identified by the PMAPscore model exhibited significantly better progression-free survival (PFS), overall survival (OS) and durable clinical benefit (DCB). In the PUCH cohort, low-risk patients had higher DCB rates (85.7% vs 44.0%, p = 0.02), longer PFS (p < 0.001), and longer OS (p < 0.001). Similar trends were observed in the MSK and SMC cohorts. Multivariate analysis confirmed low-risk status as an independent predictor of improved PFS and OS, outperforming tumor mutation burden (TMB), programmed death-ligand 1 (PD-L1) expression, microsatellite instability (MSI) status, and the gastrointestinal immune prognostic signature (GIPS). The TCGA data indicated enhanced antitumor immune activity in low-risk tumors, with increased human leukocyte antigen (HLA)-related gene expression and greater B-cell and natural killer (NK) cell infiltration. CONCLUSIONS: The PMAPscore-based risk model is a robust tool for predicting survival and immunotherapy responses in patients with advanced GC, supporting its clinical application for treatment stratification.
Updating guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD) in Poland.
Dyląg KA, Klecka M, Borkowska M … +5 more , Palicka I, Okulicz-Kozaryn K, Cichoń-Chojnacka A, Maciejewski T, Śmigiel RS
Adv Clin Exp Med · 2026 Jun · PMID 41784045 · Publisher ↗
BACKGROUND: The prevalence of fetal alcohol spectrum disorders (FASD) in Poland is about 2%, but the prevalence of prenatal alcohol exposure (PAE) is much higher than previously reported. In the absence of a single bioma...
BACKGROUND: The prevalence of fetal alcohol spectrum disorders (FASD) in Poland is about 2%, but the prevalence of prenatal alcohol exposure (PAE) is much higher than previously reported. In the absence of a single biomarker or imaging test that can confirm the diagnosis, the identification of FASD relies on clinical diagnostic criteria; therefore, the first Polish diagnostic standards were developed in 2020. OBJECTIVES: To present the process of updating the national diagnostic guidelines for FASD in Poland and discuss the key revisions made based on clinical implementation feedback. MATERIAL AND METHODS: The work was carried out by the members of the Council for FASD Prevention and Treatment at the National Centre for Addiction Prevention in 4 steps: 1) a pilot implementation study; 2) a structured literature review supporting the update; 3) a formalized expert consensus process; and 4) stakeholder consultation. RESULTS: The updated guidelines include the following sections: Introduction, Methodology, Diagnostic categories, Diagnostic scheme, Ethical considerations, Evaluation of PAE, Evaluation of facial dysmorphism, Evaluation of growth impairment, and Evaluation of the central nervous system (CNS). Appendices containing practical tools useful in the diagnostic procedure are an important element of the recommendations. Key amendments include the introduction of the partial fetal alcohol syndrome (pFAS) diagnostic category; the addition of biomarker analysis as a tool to confirm PAE; simplification of the assessment of facial dysmorphologies; clarification of CNS evaluation; and discussion of the ethical concerns associated with FASD diagnosis. CONCLUSIONS: The updated national guidelines may improve the quality and standardization of FASD diagnosis not only in Poland, but also worldwide. The practical utility of each recommendation should be continuously monitored, validated, and updated.
Social prescribing and health inequalities in LGBT+ populations: A narrative review.
Czapla M, Stefanicka-Wojtas D, Juárez-Vela R … +7 more , Martinez-Sabater A, Lipieta M, Hörmann S, Oeser P, Rezvani F, Sołtysiak A, Kurpas D
Adv Clin Exp Med · 2026 Mar · PMID 41784044 · Publisher ↗
Social prescribing (SP) has gained increasing attention as an approach to addressing non-medical determinants of health by linking individuals to community-based resources. While SP is frequently discussed in the context...
Social prescribing (SP) has gained increasing attention as an approach to addressing non-medical determinants of health by linking individuals to community-based resources. While SP is frequently discussed in the context of health inequalities, its relevance to lesbian, gay, bisexual, transgender, and other sexual and gender minority (LGBT+) populations has not been systematically examined. LGBT+ populations experience multidimensional health challenges shaped by social, structural, and institutional factors, including unmet social needs and barriers within healthcare systems, which may render SP conceptually relevant but empirically uncertain. This narrative review synthesizes and critically examines the international literature on SP with a particular focus on its conceptualization, application, and limitations in the context of LGBT+ health. A structured narrative search of major biomedical databases was conducted, complemented by title-based screening and review of relevant policy and practice sources. Findings were synthesized thematically. The available evidence directly addressing SP in LGBT+ populations is sparse and limited. Existing studies are predominantly descriptive or qualitative, often embedding LGBT+ individuals within broader vulnerable groups without disaggregated analysis. While inclusive SP models and services exist in practice, particularly within the UK, their effectiveness has not been rigorously evaluated. Overall, the literature reveals a substantial gap between the theoretical relevance of SP for LGBT+ health and the availability of robust empirical evidence to inform its implementation.
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