Medicina[JOURNAL]
Sun
200 papers
Post-Translational Modifications Modulate the HLA-DR3 Restricted Epitope Landscape of Sjögren's Associated Autoantigens.
Li D, Voigt A, Nguyen CQ
Medicina (Kaunas) · 2026 May · PMID 42356043 · Full text
: Sjögren's disease (SjD) is a chronic autoimmune disorder in which the immune system attacks the glands that produce tears and saliva, leading to symptoms such as dry eyes and dry mouth. If left untreated, SjD can also...
: Sjögren's disease (SjD) is a chronic autoimmune disorder in which the immune system attacks the glands that produce tears and saliva, leading to symptoms such as dry eyes and dry mouth. If left untreated, SjD can also cause inflammation and damage to other parts of the body, including the skin, lungs, kidneys, and nervous system, and increase the risk of developing lymphoma. The human leukocyte antigen (HLA) class II molecule HLA-DR3 is strongly associated with SjD. : To investigate how post-translational modifications (PTMs) influence the presentation of SjD-associated autoantigens by HLA-DR3, we employed a computational framework to determine the binding of PTM-mimic peptides to HLA-DR3. We further supported the in-silico results with in-vitro experiments. : Our analysis revealed that PTM-mimic substitutions at canonical anchor positions rarely improved predicted binding affinity using the Stabilized Matrix Method, with most modifications resulting in reduced affinity. However, a comprehensive analysis of full-length SjD-associated autoantigen sequences (Ro60, Ro52, La) identified discrete regions with high densities of PTM-eligible anchor sites, specifically, the Ro60 HEAT solenoid, Ro52 RING/B-box/PRY-SPRY modules, and the La motif-RRM1 region, suggesting that PTMs may alter epitope presentation in a sequence-dependent manner. Experimental validation of selected PTM-mimic peptides showed enhanced T cell responses, which were associated with increased binding affinity to HLA-DR3. Structural modeling of a representative complex revealed that PTM-mimic peptides adopt a slightly shifted backbone orientation and altered side-chain positioning, leading to a larger peptide-DR3 interaction interface. : These findings provide new insights into the role of PTMs in shaping the immunogenicity of SjD-associated autoantigens and highlight the potential for PTM-mimic peptides to modulate T cell responses in SjD.
Clinical Importance of the Inflammatory Prognostic Index in Patients with Sepsis.
Bingol Tanriverdi T, Yazar V, Aslanparcasi R … +3 more , Sengul A, Ayhan Z, Karahan MA
Medicina (Kaunas) · 2026 May · PMID 42356042 · Full text
: Sepsis is a life-threating organ dysfunction condition caused by the body's uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients'...
: Sepsis is a life-threating organ dysfunction condition caused by the body's uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients' sepsis. The inflammatory prognostic index (IPI) is also a novel marker of inflammation. As there are no studies examining the association of the IPI with in-hospital mortality in patients with sepsis nor its performance compared with other inflammatory markers, we aimed to investigate the clinical importance of the IPI for predicting in-hospital mortality in sepsis patients. : A total of 157 consecutive patients diagnosed with sepsis were retrospectively included in this study. The systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte), the systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte), the aggregate index of systemic inflammation (AISI; neutrophil × platelet × monocyte/lymphocyte) and the IPI (C-reactive protein × neutrophil-to-lymphocyte ratio [NLR]/albumin) were calculated for all patients. Patients were divided into two groups: survivors (n = 81) and non-survivors (n = 76). : Non-survivor patients had significantly higher SII ( = 0.002), SIRI ( < 0.001), AISI ( = 0.002) and IPI ( < 0.001) than survivors. The AUC of the IPI was significantly higher than those of the SII (0.751 vs. 0.645; = 0.010) and the AISI (0.751 vs. 0.648; = 0.021) and tended to be higher than that of the SIRI (0.751 vs. 0.687; = 0.091). Based on logistic regression analysis, the IPI was found to be an independent predictor of mortality (OR: 1.007, 95%CI: 1.002-1.012, = 0.006). : The IPI is a novel combined inflammatory marker that can be easily obtained from laboratory parameters. We determined that the IPI had moderately higher discriminatory ability than the SII and the AISI in patients with sepsis, which indicates that it may be used for risk stratification in this population.
Changing Epidemiology, Healthcare-Associated Infections, and Outcomes in Infective Endocarditis: A Five-Year Retrospective Study from a Tertiary Cardiovascular Center.
Matei A, Tinică G, Bacușcă A … +5 more , Enache M, Țăruș A, Luca MC, Jugănariu G, Azoicăi D
Medicina (Kaunas) · 2026 May · PMID 42356041 · Full text
: Infective endocarditis (IE) remains a major clinical challenge. It carries high morbidity and mortality, despite advances in diagnostic and therapeutic methods. This study aimed to evaluate the epidemiological profile,...
: Infective endocarditis (IE) remains a major clinical challenge. It carries high morbidity and mortality, despite advances in diagnostic and therapeutic methods. This study aimed to evaluate the epidemiological profile, microbiological characteristics, complications, and predictors of adverse outcomes among patients with IE treated at a tertiary cardiovascular center in Romania over 5 years. : We conducted a retrospective study including 156 patients diagnosed with IE between January 2020 and December 2024. We analyzed demographic data, comorbidities, microbiological findings, treatment strategies, complications, and in-hospital outcomes. The cohort was predominantly male (76.3%), with a mean age of 58.5 years. Native valve endocarditis was the most frequent form (80.1%). Streptococci were the most commonly identified pathogens, followed by enterococci and staphylococci. Complications occurred in 74.4% of patients. Heart failure (70.5%), acute kidney injury (37.2%), and embolic events (32.7%) were most frequent. Healthcare-associated infective endocarditis (HAIE) was seen in 10.3% of patients. Additional healthcare-associated infections (HAIs) occurred in 26.9% of patients and were associated with longer hospital stays (21.7 vs. 13.5 days; < 0.001). Use of a central venous catheter independently predicted HAI development (adjusted OR, 3.89; 95% CI, 1.08-14.06; = 0.038). The in-hospital mortality rate was 16.7%. Acute kidney injury and sepsis were the strongest factors associated with in-hospital mortality. : IE remains associated with a high burden of complications and in-hospital mortality. HAIs complicate the clinical course and are closely linked to invasive device use. Mortality is mainly driven by systemic disease severity, especially acute kidney injury and sepsis. These findings highlight the importance of infection prevention, prompt risk stratification, and coordinated multidisciplinary care to improve outcomes in patients with IE.
Prognostic Value of the Inflammatory Burden Index (IBI) in Metastatic Urothelial Carcinoma Prior to First-Line Therapy.
Bilgetekin I, Demir N, Eraslan E … +4 more , Akdagcik Z, Deliktas Onur I, Ates O, Demirci U
Medicina (Kaunas) · 2026 May · PMID 42356040 · Full text
: The systemic inflammatory response is important in cancer prognosis and progression. The inflammatory burden index (IBI) provides information about both inflammation and the immune response. Urothelial carcinomas are i...
: The systemic inflammatory response is important in cancer prognosis and progression. The inflammatory burden index (IBI) provides information about both inflammation and the immune response. Urothelial carcinomas are immunogenic; therefore, it has been suggested that inflammatory indices may predict disease prognosis. The aim of this study was to investigate the effects of systemic inflammatory indices, particularly the inflammatory burden index, on disease progression and overall survival in patients with metastatic urothelial cancer (affecting the bladder and upper urinary system) before first-line treatment and to demonstrate their prognostic importance. : Within the scope of the study, the medical records of 130 patients who received systemic treatment for metastatic urothelial carcinoma at the medical oncology clinic were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold values for IBI. Survival rates were calculated using the Kaplan-Meier method, and survival differences between groups were compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model to evaluate prognostic factors. : A total of 130 patients were included in the study. The median age was 64.9 years (IQR: 57.2-70.5). The primary tumor location was the bladder in 84.6% of patients, while the remaining 15.4% originated from the ureter and renal pelvis. In first-line systemic treatment, patients received a median of 4 cycles (IQR: 3-6). The median number of total treatment lines administered for metastatic disease was 1 (IQR: 1-2). In progression-free survival (PFS) analyses, the median PFS was 9.20 (95% CI 6.55-11.85) months in the IBI-low group ( = 47) and 5.82 (95% CI 4.56-7.07) months in the IBI-high group ( = 83) ( < 0.001). The median OS was calculated to be 18.96 (95% CI 16.61-21.30) months in the IBI-low group ( = 47), while it was found to be 9.50 (95% CI 7.70-11.29) months in the IBI-high group ( = 83) ( < 0.001). In multivariate analysis, high IBI and the presence of brain metastasis were found to be associated with the risk of progression. In terms of overall survival, the presence of brain metastasis, the presence of visceral metastasis, ECOG PS status, receipt of maintenance therapy, LMR, and the IBI score showed statistically significant prognostic effects. : In metastatic urothelial carcinoma, the IBI was identified as an independent prognostic factor associated with progression-free and overall survival. These findings suggest that the IBI may have potential utility as a prognostic biomarker; however, larger, multicenter, and prospective studies are required to further validate its clinical applicability.
Pain Scores Associated with Lidocaine-Tetracaine Versus Lidocaine-Prilocaine Topical Anesthesia During Facial and Cervical Microneedling: A Retrospective Single-Center Observational Analysis.
Majewska L, Dorosz K, Paciepnik I … +1 more , Budzyńska A
Medicina (Kaunas) · 2026 May · PMID 42356039 · Full text
Effective topical anesthesia is essential to patient comfort and adherence during minimally invasive esthetic procedures. We retrospectively reviewed pain scores recorded after microneedling in a single private clinic wh...
Effective topical anesthesia is essential to patient comfort and adherence during minimally invasive esthetic procedures. We retrospectively reviewed pain scores recorded after microneedling in a single private clinic where two topical anesthetic formulations-lidocaine 7%/tetracaine 7% (Pliaglis) and lidocaine 2.5%/prilocaine 2.5% (Anesderm)-were used as part of standard clinical practice on different anatomical sites and under different application protocols. Records were reviewed from 26 healthy female patients (mean age 42 ± 4 years; range 34-48) who underwent microneedling on the face and neck during 2024 in a single private clinic. According to the established clinic protocol, which was not modified for research purposes, Pliaglis was applied to the face without additional occlusion (self-occlusive peel-off film, in accordance with the manufacturer's recommendation) and Anesderm was applied to the neck under plastic-film occlusion (also in accordance with the manufacturer's recommendation), both for 45 min prior to microneedling at a fixed depth of 1.25 mm. Treatment allocation was determined by clinic workflow; patients and the operator were not blinded, and the order of the two products within each session was not randomized. Post-procedural pain was recorded using a Visual Analog Scale (VAS, 0-10), with one decimal precision, separately for each anatomical site. Within-patient differences were analyzed using a paired-sample t-test, with a Wilcoxon signed-rank test as a non-parametric sensitivity analysis. Pain scores were lower at the facial site (Pliaglis, no occlusion) than at the cervical site (Anesderm, occlusion): mean VAS 3.00 ± 0.63 vs. 5.38 ± 0.75; mean within-patient difference 2.38 points, 95% CI 1.97-2.80; paired t(25) = 11.87, < 0.0001; Cohen's d = 2.33. The Wilcoxon signed-rank test produced a concordant result ( < 0.0001). A within-patient pain reduction of at least 30% on the facial site relative to the cervical site was observed in 81% of patients (21/26). Both products were well tolerated, with only mild transient erythema reported. In this retrospective, non-randomized, non-blinded single-center analysis, lower pain scores were observed at the facial site (treated with lidocaine-tetracaine 7%/7% without additional occlusion, per manufacturer instructions) than at the cervical site (treated with lidocaine-prilocaine 2.5%/2.5% under occlusion, per manufacturer instructions) within the same patients. Because formulation, active-drug concentration, anatomical site, and the manufacturer-mandated occlusion technique co-varied between the two conditions, the observed difference cannot be attributed to formulation alone. These findings should be regarded as hypothesis-generating and require confirmation in prospective, randomized, split-region or split-face studies that disentangle formulation effects from site- and protocol-related factors.
Effects of Knee Flexion Angle on Gluteus Medius Activation and Activation Ratios During the Modified Clamshell Exercise.
Lee HY, Zhang YH, Kim KC … +1 more , Lim HW
Medicina (Kaunas) · 2026 May · PMID 42356038 · Full text
: The gluteus medius plays a key role in hip stabilization and lower extremity alignment. However, the influence of knee flexion angle during the modified clamshell exercise on muscle activation patterns remains unclear....
: The gluteus medius plays a key role in hip stabilization and lower extremity alignment. However, the influence of knee flexion angle during the modified clamshell exercise on muscle activation patterns remains unclear. This study aimed to examine the effects of different knee flexion angles on gluteus medius activity and relative muscle activation patterns during the modified clamshell exercise. : Thirty healthy women aged 20-30 years performed the modified clamshell exercise at three knee flexion angles (60°, 90°, and 110°). Muscle activity was recorded using surface electromyography and normalized to maximal voluntary isometric contraction (%MVIC). Relative muscle activation was assessed using muscle activation ratios (GMed/TFL, GMed/QL, GMed/Sar, and GMed/GMax). Differences among conditions were analyzed using repeated-measures ANOVA or the Friedman test, as appropriate. : Gluteus medius activation ( < 0.001, Kendall's W = 0.57) and superior gluteus maximus activation ( < 0.001, ηp = 0.34) increased significantly with greater knee flexion angle, whereas tensor fasciae latae and quadratus lumborum activation decreased. The GMed/TFL ( < 0.001, ηp = 0.45) and GMed/QL ( < 0.001, Kendall's W = 0.47) ratios also increased significantly, while the GMed/GMax ratio did not differ significantly. No meaningful differences were observed between 90° and 110°. : Knee flexion angle influenced muscle activation patterns during the modified clamshell exercise. Compared with 60°, knee flexion angles of 90° and 110° were associated with greater gluteus medius activity and more favorable relative activation patterns; however, no additional benefit was observed beyond 90°. Given the low absolute activation levels, these findings reflect low-load motor control characteristics rather than strengthening effects. The results may be relevant for early-phase rehabilitation under controlled conditions, but their clinical applicability remains limited.
Atrial Fibrillation in Infiltrative Cardiomyopathies: From Atrial Cardiomyopathy Imaging to Targeted Management-A Narrative Review.
Brusamolino M, Catagnano F, Lo Monaco M … +10 more , Malara S, De Carli M, Licastro M, Rossi V, Maranzano G, Frascaro F, Frittella S, Nicoli F, Mollace R, Bertella E
Medicina (Kaunas) · 2026 May · PMID 42356037 · Full text
Infiltrative cardiomyopathies comprise a heterogeneous spectrum of hereditary and acquired diseases characterised by the accumulation of pathological substrates within the myocardium, ultimately resulting in progressive...
Infiltrative cardiomyopathies comprise a heterogeneous spectrum of hereditary and acquired diseases characterised by the accumulation of pathological substrates within the myocardium, ultimately resulting in progressive impairment of cardiac function and the development of heart failure. Across these conditions, atrial fibrillation is a frequent and clinically relevant complication, contributing to symptom burden, heart failure progression, and thromboembolic risk. Structural, functional, and electrical atrial remodelling, collectively referred to as atrial cardiomyopathy, emerges as a common pathophysiological substrate linking myocardial infiltration to atrial fibrillation and adverse cardiovascular outcomes. Multi-modality cardiac imaging enables comprehensive assessment of atrial cardiomyopathy, offering mechanistic insights into the atrial substrate of atrial fibrillation, with potential impact on the clinical management of this group of diseases. This review summarises contemporary evidence on atrial fibrillation in infiltrative cardiomyopathies, with a particular focus on the role of non-invasive multimodal imaging in the evaluation of atrial cardiomyopathy.
Tissue Eosinophilia of the Colonic Mucosa as a Potential Early Predictor of Failure to Achieve Clinical Remission in Ulcerative Colitis.
Pak I, Tashmetov E, Tolegen K … +3 more , Askarov M, Klyuyev D, Kamyshanskiy Y
Medicina (Kaunas) · 2026 May · PMID 42356036 · Full text
: Eosinophilic infiltration is frequently observed in ulcerative colitis (UC), but its impact on disease course remains incompletely understood. This study aimed to assess eosinophilic infiltration of the colonic mucosa...
: Eosinophilic infiltration is frequently observed in ulcerative colitis (UC), but its impact on disease course remains incompletely understood. This study aimed to assess eosinophilic infiltration of the colonic mucosa in patients with newly diagnosed UC and to investigate its association with the achievement of clinical remission during the first year of follow-up. : A retrospective study was conducted in patients with newly diagnosed UC. Patients were stratified into two groups according to clinical outcome during the first year of follow-up: clinical remission ( = 30) and non-remission ( = 30). Clinical and laboratory data were extracted from an integrated medical information system database. Archived colonic mucosal biopsy specimens were independently evaluated by two pathologists. Mean eosinophil density across five high-power fields and peak eosinophil count were assessed. : In primary biopsy specimens, the median eosinophil density was 19 (11 to 27) cells in the clinical remission group and 33 (23 to 51) cells in the non-remission group. Logistic regression analysis showed that an increased eosinophil count (OR 6.48; 95% CI 1.76 to 23.88; = 0.005) and the presence of extraintestinal manifestations (OR 5.78; 95% CI 1.17 to 28.6; = 0.031) were associated with failure to achieve clinical remission during the first year of treatment. : In adult patients with ulcerative colitis, a higher density of eosinophils in the colonic mucosa at the time of initial diagnosis is associated with failure to achieve clinical remission during the first year of treatment. These results should be considered hypothesis-generating and require confirmation in larger prospective studies to further clarify the potential prognostic significance of tissue eosinophilia in ulcerative colitis.
HPV Status and Genotype Associations with Nodal Involvement and Treatment Strategy in Bulgarian Patients with Head and Neck Squamous Cell Carcinoma: A Prospective Multicenter Observational Study.
Deliverska E, Raykova V, Neichev D … +6 more , Yordanov S, Markov D, Slavkov S, Aleksandrova M, Lenkov V, Pashova-Tasseva Z
Medicina (Kaunas) · 2026 May · PMID 42356035 · Full text
: Head and neck squamous cell carcinoma (HNSCC) is a biologically heterogeneous malignancy with variable clinical behavior and prognosis. Human papillomavirus (HPV)-associated tumors represent a distinct subgroup; howeve...
: Head and neck squamous cell carcinoma (HNSCC) is a biologically heterogeneous malignancy with variable clinical behavior and prognosis. Human papillomavirus (HPV)-associated tumors represent a distinct subgroup; however, data from Eastern European populations remain limited. This study aimed to evaluate the association between HPV DNA status and nodal involvement in a Bulgarian HNSCC cohort and to explore whether HPV genotype distribution is related to nodal involvement and therapeutic strategy. : A prospective multicenter observational study with a cross-sectional analytical endpoint was conducted. Fifty patients with histologically confirmed HNSCC were included. Clinical and pathological data were collected, and HPV detection and genotyping were performed using molecular-based methods. Associations between HPV-related variables, nodal status (N0 vs. N+), and treatment strategy were evaluated using univariate tests. HPV status reflects DNA detection only and does not confirm transcriptionally active infection. : HPV DNA positivity was identified in 15/50 patients (30.0%). A higher proportion of nodal involvement was observed among HPV-positive patients compared with HPV-negative patients (46.7% vs. 17.1%, = 0.040; crude OR = 4.23); however, this finding may be influenced by anatomical site distribution. In unadjusted analysis, HPV DNA positivity showed a relationship with nodal involvement (crude OR = 4.23; = 0.040), although this should be interpreted cautiously. Multivariable analysis was not performed due to the limited number of outcome events. Differences in treatment allocation were observed between HPV-positive and HPV-negative patients; however, this finding may be confounded by anatomical site distribution and likely reflects differences in tumor localization rather than HPV-specific effects. Genotype analysis revealed heterogeneity, including multiple HPV types. : HPV DNA positivity was observed in relation to nodal involvement in unadjusted analysis; however, this finding may be confounded by anatomical site and should be considered exploratory.
Feasibility and Preliminary Outcomes of a Machine-Based Pilates Program on Quality of Life and Low Back Pain in Aged Adults: A Mixed-Methods Approach.
Azul J, Silva C, Salvador R … +3 more , Antunes R, Duarte-Mendes P, Rodrigues F
Medicina (Kaunas) · 2026 May · PMID 42356034 · Full text
: The aging process impacts physical function and quality of life, often exacerbated by chronic conditions such as low back pain. This pilot study explored the feasibility and preliminary outcomes of a 12-week machine-ba...
: The aging process impacts physical function and quality of life, often exacerbated by chronic conditions such as low back pain. This pilot study explored the feasibility and preliminary outcomes of a 12-week machine-based Classical Pilates program on quality of life and low back pain in older adults. : An exploratory mixed-methods approach was used. The quantitative phase included 13 participants (Mage = 64.76 ± 4.71) to evaluate quality of life. All 13 participants were assessed for low back pain and quality of life, and 4 females participated in a focus group for a qualitative analysis of perceived benefits. The intervention consisted of two individual sessions per week. : Preliminary quantitative analysis revealed an increase in the physical domain of quality of life ( < 0.05). There was a reduction in pain intensity and global pain values ( < 0.05). Qualitative data provided context for these preliminary findings, with participants reporting perceived improvements in mobility, body awareness, pain management, and sleep quality, alongside notable psychosocial benefits. : Preliminary findings suggest that a 12-week individual machine-based Pilates program is feasible and may be associated with improvements in the physical domain of quality of life and perceived low back pain in active older adults. Due to the complete absence of a control group and the very small sample size, it is impossible to isolate the intervention's efficacy from natural progression or placebo effects. Consequently, these results are strictly exploratory and hypothesis-generating. The mixed-methods approach highlights that individualized machine-based Pilates may provide self-reported psychosocial and daily living benefits, supporting the need for future well-powered randomized controlled trials.
Excess Mortality as the Primary Mediator of COVID-19's Impact on Life Expectancy in Europe: A Multilevel Longitudinal Analysis of Regional Disparities.
Țarcă V, Roșu ST, Cojocaru E … +6 more , Butnariu LI, Roca IC, Lupu A, Mindru DE, Popovici P, Țarcă E
Medicina (Kaunas) · 2026 May · PMID 42356033 · Full text
The COVID-19 pandemic caused unprecedented mortality shocks worldwide, but its differential impact across European regions and the mediating mechanisms remain inadequately quantified. We conducted a longitudinal multile...
The COVID-19 pandemic caused unprecedented mortality shocks worldwide, but its differential impact across European regions and the mediating mechanisms remain inadequately quantified. We conducted a longitudinal multilevel analysis using data from 29 European countries (2015-2023; = 261 country-years). Linear mixed models estimated the impact of the pandemic on life expectancy, controlling for regional differences, vaccination rates, healthcare expenditures, gross domestic product, and excess mortality. The primary outcome was national life expectancy at birth. The pandemic period was associated with an average reduction of 1.12 years in life expectancy (95% CI: 0.95 to 1.49, < 0.001) after adjusting for pre-existing trends. Eastern Europe experienced 56% greater impact than Western Europe (interaction β = -0.623, = 0.002). Excess mortality emerged as the primary mediator, explaining 79% of the pandemic effect. Each 1% increase in excess mortality reduced life expectancy by 0.091 years ( < 0.001). Healthcare expenditures showed protective effects (β = 0.000327 per purchasing power standards (PPS), = 0.049), while vaccination rates, as a direct predictor, were not significantly associated with life expectancy in multivariate models. This critical finding on vaccination rates does not imply biological inefficacy but rather suggests a misspecification of its role. Excess mortality, rather than its direct component, COVID-19-specific mortality, appears to mediate most of the pandemic's impact on life expectancy. Regional disparities reflect structural differences in healthcare systems and socioeconomic conditions more than differential vaccination uptake. The protective effect of vaccination on life expectancy operates entirely through the reduction in excess mortality. Consequently, health policies should prioritize strengthening resilient health systems as well as disease-specific interventions.
Real-World Two-Year Outcomes of Diffractive Implantable Phakic Contact Lenses in Presbyopic Myopes: Functional Vision, Anatomical Findings, and Environmental Context.
Pérez-Silguero D, Pérez-Silguero MÁ, Encinas-Pisa P … +4 more , Mayoral-Álvarez M, Gil AV, Perez-Silguero Jimenez S, Bernal-Blasco I
Medicina (Kaunas) · 2026 May · PMID 42356032 · Full text
: To evaluate two-year functional, anatomical, and patient-reported outcomes after bilateral implantation of a diffractive implantable phakic contact lens (IPCL) for presbyopia correction in myopic patients within a high...
: To evaluate two-year functional, anatomical, and patient-reported outcomes after bilateral implantation of a diffractive implantable phakic contact lens (IPCL) for presbyopia correction in myopic patients within a high-solar-radiation Atlantic island environment. This retrospective observational study included 11 presbyopic myopic patients aged 40-50 years (22 eyes) who underwent bilateral diffractive IPCL implantation and completed a 2-year follow-up. Monocular defocus curves were recorded from +3.0 to -5.0 D and converted to logMAR. Functional visual range and area under the defocus curve (AUC) were calculated. Anatomical stability was assessed by central vault, pupil diameter, and crystalline lens rise measurements. Safety evaluation included slit-lamp examination for crystalline lens transparency and corneal integrity. Patient-reported outcomes were measured using the Quality of Vision (QoV) and Catquest-9SF questionnaires. Environmental parameters during implantation and follow-up were characterized using regional meteorological data. Mean visual acuity remained ≤0.14 logMAR up to -2.5 D of defocus, with functional vision (≤0.2 logMAR) extending to approximately -3.0 D in about half of the eyes. Median vault at 2 years was 546 µm (IQR 361.5-667.3 µm). No cases of clinically significant cataract or corneal compromise were observed. QoV scores were low (1.41 ± 0.43) and Catquest-9SF scores high (3.70 ± 0.18), with no strong correlations between subjective and anatomical metrics. Visual performance remained stable within a consistent high-solar-radiation and atmospheric light-scattering environment. Diffractive IPCL implantation was associated with stable anatomical positioning, sustained functional visual performance across distances, and favorable patient-reported outcomes at 2 years. Within a consistent real-world environmental context, these findings provide a descriptive framework for understanding diffractive IPCL performance, while larger prospective studies are warranted.
Serum Galectin-3 Levels Correlate with Reduced Vascular Reactivity in Patients with Coronary Artery Disease.
Huang PY, Hsieh MH, Wang JH … +2 more , Tsai JP, Hsu BG
Medicina (Kaunas) · 2026 May · PMID 42356031 · Full text
: Endothelial dysfunction is essential in the development and progression of coronary artery disease (CAD) and its complications. Galectin-3 mediates inflammation and organ fibrosis and promotes endothelial dysfunction....
: Endothelial dysfunction is essential in the development and progression of coronary artery disease (CAD) and its complications. Galectin-3 mediates inflammation and organ fibrosis and promotes endothelial dysfunction. Meanwhile, the vascular reactivity index (VRI) reflects endothelial function. The purpose of this research was to evaluate the association between serum galectin-3 levels and VRI in patients diagnosed with CAD. : One hundred and eighteen patients with CAD were enrolled. Endothelial function was noninvasively evaluated using digital thermal monitoring, and VRIs were obtained. According to VRI values, patients were classified into good (≥2.0), intermediate (1.0-1.9), and poor (<1.0) subgroups. Galectin-3 levels were quantified using an enzyme-linked immunosorbent assay. : Patients with poor vascular reactivity were older in age ( = 0.028) and had higher serum total cholesterol ( = 0.003), low-density lipoprotein cholesterol ( = 0.005), and galectin-3 ( < 0.001) levels. Multivariable stepwise linear regression analysis revealed galectin-3 as an independently associated factor of lower VRIs (β = -0.488; < 0.001). Logistic regression model confirmed that galectin-3 independently was associated with higher odds of vascular reactivity dysfunction (odds ratio, 1.120; 95% confidence interval, 1.016-1.235; = 0.023) or poor vascular reactivity (odds ratio, 1.445; 95% confidence interval, 1.179-1.772; < 0.001). : Serum galectin-3 is independently associated with reduced VRIs and endothelial dysfunction in patients with CAD.
Heart Failure Etiology and 6-Month Cardiorenal Recovery Patterns After Early In-Hospital SGLT2 Inhibitor Initiation in HFrEF: A Prospective Real-World Cohort.
Radić M, Jurin I, Rode F … +10 more , Šimunović L, Kolundžić P, Hadžibegović I, Manola Š, Vitlov P, Ivanović Mihajlović V, Grizelj D, Falak H, Udovičić M, Letilović T
Medicina (Kaunas) · 2026 May · PMID 42356030 · Full text
: SGLT2 inhibitors improve outcomes in heart failure with reduced ejection fraction (HFrEF), but whether early recovery patterns after initiation differ according to HF etiology in real-world practice remains uncertain....
: SGLT2 inhibitors improve outcomes in heart failure with reduced ejection fraction (HFrEF), but whether early recovery patterns after initiation differ according to HF etiology in real-world practice remains uncertain. : To evaluate whether ischemic versus non-ischemic etiology is associated with different 6-month cardiac, renal, biomarker, and exploratory metabolic trajectories after early in-hospital SGLT2 inhibitor initiation in HFrEF. : In this prospective single-center observational cohort (2022-2025), consecutive adults hospitalized with first-presentation acute HFrEF who initiated empagliflozin or dapagliflozin within 48 h of admission were enrolled. Patients were classified as having ischemic cardiomyopathy (ICM) or non-ischemic cardiomyopathy (NICM). The primary analytic cohort included patients with paired baseline and 6-month echocardiography. The primary outcome was change in left ventricular ejection fraction (LVEF); eGFR and NT-proBNP were secondary outcomes. Exploratory metabolic/laboratory variables were summarized descriptively using paired available-case follow-up. The study was approved by the institutional ethics committee and registered in ClinicalTrials.gov under the CaRD registry framework (NCT06090591). : The paired 6-month echocardiographic analytic cohort comprised 241 patients who survived to reassessment (ICM = 90; NICM = 151). NICM showed greater improvement in LVEF than ICM (ΔLVEF +10% [IQR 0-18] vs. +5% [IQR 0-12]; = 0.049) and a more favorable eGFR trajectory (ΔeGFR 0.30 [IQR -5.90 to 6.60] vs. -2.70 [IQR -12.60 to 3.40] mL/min/1.73 m; = 0.038). NT-proBNP declined substantially in both groups, with no between-group difference in change magnitude ( = 0.845), although 6-month values remained higher in ICM ( = 0.034). However, after multivariable adjustment, ischemic etiology was no longer independently associated with 6-month LVEF or eGFR outcomes. Exploratory metabolic findings varied descriptively by etiology but should be interpreted cautiously because follow-up completeness and background treatment intensity varied across variables. : In this real-world cohort of patients with HFrEF who initiated SGLT2 inhibitors during hospitalization, HF etiology was associated with different short-term cardiorenal recovery patterns, whereas NT-proBNP reduction was similar across groups. These findings characterize etiology-related recovery within a treated cohort rather than differential SGLT2 inhibitor efficacy and should therefore be considered as hypothesis-generating.
Surgical Burden of Breast Cancer Treatment: Implications of Mastectomy, Breast Conservation, and Reconstruction Choices.
Wojtalik L, Sorenson TJ, Verma A … +2 more , Karp N, Shapiro R
Medicina (Kaunas) · 2026 May · PMID 42356029 · Full text
Breast cancer surgical management encompasses a spectrum of options that extend beyond oncologic control and carry substantially different cumulative surgical burdens. Although breast-conserving therapy (BCT) and mastect...
Breast cancer surgical management encompasses a spectrum of options that extend beyond oncologic control and carry substantially different cumulative surgical burdens. Although breast-conserving therapy (BCT) and mastectomy offer equivalent survival outcomes in many clinical scenarios, the downstream implications of these choices, including the number of operations, complication profiles, recovery timelines, and need for revision, are often underrecognized during initial treatment planning. This review aims to provide non-plastic surgeons with a practical framework for understanding the surgical burden associated with BCT compared with mastectomy and, when mastectomy is selected, the implications of subsequent reconstructive pathways. By discussing breast cancer surgery through the lens of cumulative surgical burden rather than isolated procedural choices, this review seeks to support more informed, multidisciplinary counseling and shared decision-making. A clearer understanding of reconstructive trajectories may help align surgical recommendations with patient values, optimize expectations, and reduce unanticipated downstream interventions across the continuum of breast cancer care.
Assessment of Risk Factors Correlated with Satellites and In-Transit Metastases in Primary Cutaneous Melanomas.
Natarâş BR, Tăban SM, Jurescu A … +7 more , Viţa OC, Cornea RF, Hurmuz I, Vidac A, Grujic D, Popa VT, Dema ALC
Medicina (Kaunas) · 2026 May · PMID 42356028 · Full text
This study aimed to identify the risk factors of primary cutaneous melanomas associated with microsatellites, satellites, and in-transit metastases. : We performed a retrospective study on patients diagnosed with invasiv...
This study aimed to identify the risk factors of primary cutaneous melanomas associated with microsatellites, satellites, and in-transit metastases. : We performed a retrospective study on patients diagnosed with invasive primary cutaneous melanomas in two pathology departments. The cases were distributed into two groups, comparing the clinical-pathological features of cases that presented microsatellites, satellites, and in-transit metastases with cases that did not present microsatellites, satellites, and in-transit metastases. : From the total number of primary invasive cutaneous melanomas diagnosed (n = 204), 22% presented microsatellites, satellites, and in-transit metastases (n = 46). The presence of microsatellites, satellites, and in-transit metastases was strongly correlated with a Breslow index > 4 mm, a Clark level of IV or V, and a pT3 or pT4 pathological stage ( < 0.0001). Those cases were also associated with lymphovascular invasion ( = 0.0013), ulceration of the primary melanoma ( = 0.0037), and an increased mitotic rate ( = 0.0078). The presence of microsatellites, satellites, and in-transit metastases is associated with higher rates of lymph node metastases ( = 0.0006) and recurrence ( = 0.0282). : The most important risk factors associated with microsatellites, satellites, and in-transit metastases are represented by a Breslow index > 4 mm, a Clark level of IV or V, and an advanced pathological stage.
The Association Between Serum C-Reactive Protein Levels and Body Fat Parameters: Results from the Korean National Health and Nutrition Examination Survey.
Jeong H
Medicina (Kaunas) · 2026 May · PMID 42356027 · Full text
: C-reactive protein (CRP), a marker of systemic inflammation, is frequently elevated in individuals with excessive adiposity. However, the relationship between specific body fat parameters and CRP levels across sexes an...
: C-reactive protein (CRP), a marker of systemic inflammation, is frequently elevated in individuals with excessive adiposity. However, the relationship between specific body fat parameters and CRP levels across sexes and age groups remains unclear. This study aimed to investigate the association between CRP levels and body fat parameters using data from the 2022 Korea National Health and Nutrition Examination Survey. : A total of 3369 participants (representing 32,635,626 Korean adults) were included. Demographic, lifestyle, and clinical data were collected, and body composition parameters were measured using bioelectrical impedance analysis. The primary exposure variables included fat mass index (FMI; total body fat mass/height) and trunk fat mass. The primary outcome was log-transformed high-sensitivity CRP (ln[hsCRP]). Pearson correlation and sex-stratified multivariate linear regression analyses were performed. : The mean age of participants was 49.6 years, and 53.3% were male. ln[hsCRP] was positively associated with body mass index, waist circumference, total body fat mass, FMI, appendicular fat mass, and trunk fat mass in both sexes (all < 0.001). FMI showed a stronger association with ln[hsCRP] in females (r = 0.373) than in males (r = 0.232). In multivariable analyses, FMI remained independently associated with ln[hsCRP] in both males (β = 0.10) and females (β = 0.14), with a stronger effect observed in females. Trunk fat mass was also independently associated with ln[hsCRP] (β = 0.06 in males; β = 0.10 in females). Age-stratified analyses demonstrated that these associations were more pronounced in younger adults (19-40 years old) than in those aged 41-70 years. : In Korean adults, total and truncal fat masses were independently associated with systemic inflammation, and this association was stronger among females and younger adults.
Can FoCUS Speed Up the Management of Acute Coronary Syndrome in the Emergency Department?
Karaolia M, Bezati S, Papasolomou K … +3 more , Kiouri E, Verras C, Polyzogopoulou E
Medicina (Kaunas) · 2026 May · PMID 42356026 · Full text
Focused Cardiac Ultrasound (FoCUS) is a targeted bedside imaging modality with an established role in the management of critically ill patients. Acute Coronary Syndrome (ACS) is a common cause of presentation to the Emer...
Focused Cardiac Ultrasound (FoCUS) is a targeted bedside imaging modality with an established role in the management of critically ill patients. Acute Coronary Syndrome (ACS) is a common cause of presentation to the Emergency Department (ED), and although electrocardiography (ECG) and cardiac biomarkers are the cornerstones for its diagnosis, FoCUS may facilitate diagnostic evaluation and disposition of patients in different levels of care. Initially, FoCUS plays a crucial diagnostic role through the identification of Regional Wall Motion Abnormalities (RWMAs), enabling direct visualization of the ischemic region and corroboration of ECG findings. Moreover, in patients with ACS complicated by cardiogenic shock, FoCUS is indispensable for determining the extent of ischemia and detecting mechanical complications, including ventricular septal or free wall rupture, or papillary muscle rupture. Likewise, FoCUS aids in the differential diagnosis of patients with ECG abnormalities mimicking ACS. This comprehensive review synthesizes the most recent evidence on the role of FoCUS in accelerating the management of patients with ACS presenting to the ED.
Efficacy and Safety of Tirbanibulin 1% Ointment for Actinic Keratosis at 1-Year Follow-Up: A Real-Life Extension Study.
Li Pomi F, Vaccaro M, Rottura M … +2 more , Irrera N, Borgia F
Medicina (Kaunas) · 2026 May · PMID 42356025 · Full text
: Tirbanibulin 1% ointment has demonstrated short-term efficacy and excellent tolerability in the treatment of actinic keratosis (AK) on the face and scalp. However, data on long-term efficacy are still lacking. : This p...
: Tirbanibulin 1% ointment has demonstrated short-term efficacy and excellent tolerability in the treatment of actinic keratosis (AK) on the face and scalp. However, data on long-term efficacy are still lacking. : This prospective, single-center, 12-month extension study included patients with facial and scalp AKs previously treated with tirbanibulin 1% ointment once daily for 5 consecutive days. Long-term analysis was restricted to lesions that had achieved complete clinical and dermoscopic clearance at the 2-month follow-up. At 12 months, the treated areas were reassessed clinically and dermoscopically. High-resolution images obtained at baseline, 2 months, and 12 months were compared lesion by lesion to distinguish sustained clearance, recurrence at the same anatomical site, and the development of new AKs within the treated field. : Thirty-seven patients were reassessed at 12 months. Of the 228 AKs treated at baseline, 116 lesions had achieved complete clearance at 2 months and were therefore eligible for long-term evaluation. At 1 year, 70/116 lesions (60.3%) remained free of recurrence, whereas 46/116 (39.7%) relapsed. Sustained clearance was observed in 35/51 grade 1 lesions (68.6%), 32/57 grade 2 lesions (56.1%), and 3/8 grade 3 lesions (37.5%). In addition, 35 new AKs developed within the previously treated field. No delayed local or systemic adverse events and no progression to invasive cSCC were observed during follow-up. Patient-reported satisfaction was high, and 94% of patients stated they would be willing to repeat the treatment. : Tirbanibulin was associated with sustained lesion clearance at one year, particularly in lower-grade AKs. While recurrence remains relatively common-especially in thicker lesions-the treatment was well tolerated and associated with no delayed adverse effects. Its short application regimen and excellent safety profile support tirbanibulin's role in the long-term management of field cancerization.
Allergy in the Elderly: A Broad Clinical Spectrum Beyond Atopy.
Kalkan F, Gorgulu Akin B, Maden S … +4 more , Durmaz MSB, Ozdel Ozturk B, Efe O, Soyyigit S
Medicina (Kaunas) · 2026 May · PMID 42356024 · Full text
This study aimed to evaluate referral reasons, distribution of allergic diseases, atopic status, and comorbidity associations among patients aged 65 years and older presenting to a tertiary allergy clinic. This retrospe...
This study aimed to evaluate referral reasons, distribution of allergic diseases, atopic status, and comorbidity associations among patients aged 65 years and older presenting to a tertiary allergy clinic. This retrospective study included all geriatric patients (≥65 years) who attended the Immunology and Allergy outpatient clinic at Ankara Bilkent City Hospital between January 2024 and December 2025. Demographic characteristics, comorbidities, referral complaints, and allergic diagnoses were recorded. Allergen sensitization was assessed using skin tests and/or allergen-specific IgE measurements. A total of 1302 geriatric patients were included (mean age 70.9 years; 59.8% female). At least one comorbidity was present in 62.6% of patients, with hypertension being the most common(39.4%). The leading referral complaints were rhinorrhoea/sneezing (22.8%), pruritus (19.1%), drug allergy/adverse drug reactions (14.8%), and chronic urticaria (10.9%). The most common diagnoses were rhinitis (63.2% non-allergic), non-allergic pruritus, drug allergy, and chronic urticaria. Among inhalant allergens, pollen sensitivity (42.2%) was most frequent, followed by house dust mite (32.5%). The most frequently implicated drug groups were antibiotics (42.4%) and analgesics (21.7%). Chronic urticaria and ACE inhibitor-associated angioedema showed significant gender differences: 68.6% female ( = 0.001) and 66.7% male ( = 0.008), respectively. Patients with asthma, rhinitis, or angioedema frequently had comorbid conditions (91.1%, 55.8%, and 83.7%, = 0.001, = 0.013, and = 0.001, respectively). Allergy clinic presentations in elderly patients reflect a broad clinical spectrum, including non-allergic conditions, frequent drug-related reactions in elderly patients with multiple comorbidities, and age-related immunological changes alongside atopic diseases. A comprehensive, individualized diagnostic approach is essential when evaluating allergic complaints in the geriatric population.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe