Medicina[JOURNAL]
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200 papers
Buccal Bone Thickness of Maxillary Incisors Adjacent to Palatally Impacted Canines: A Split-Mouth CBCT Study.
Kanmaz MG, Agani Sabah G
Medicina (Kaunas) · 2026 Jun · PMID 42356203 · Full text
: To compare the buccal bone thickness of adjacent maxillary incisors between the impacted and contralateral control sides in patients with unilateral palatally impacted canines (PICs) using a split-mouth cone-beam compu...
: To compare the buccal bone thickness of adjacent maxillary incisors between the impacted and contralateral control sides in patients with unilateral palatally impacted canines (PICs) using a split-mouth cone-beam computed tomography (CBCT) design. : CBCT records of 26 patients with a unilateral PIC (18 females, 8 males; mean age, 17.35 ± 4.58 years) were retrospectively analyzed. Buccal bone thickness was measured at five equally spaced levels from the root apex (Level A) to the buccal alveolar crest (Level E) for the central and lateral incisors. Alveolar crest height, incisor torque and rotation, follicular width, canine localization, canine-to-root proximity, and root resorption were also assessed. : The impacted side showed significantly reduced buccal bone thickness at the two most apical levels of the lateral incisor: Level A (-0.81 mm; < 0.001) and Level B (-0.35 mm; = 0.004). No side differences were observed at the remaining lateral incisor levels or at any central incisor level. In the orientation-adjusted sensitivity model accounting for incisor torque and rotation, Level A remained significant (-0.75 mm; < 0.001), whereas Level B was attenuated ( > 0.005). Lateral incisors on the impacted side also showed reduced labial torque (-4.97°; = 0.001) and greater mesiobuccal rotation (-12.23°; < 0.001). : PICs were associated with localized apical reduction in buccal bone thickness of the adjacent lateral incisor, accompanied by reduced labial torque and greater mesiobuccal rotation. Buccal bone thickness may represent a relevant consideration during CBCT-based treatment planning for PICs.
Platelet-to-Lymphocyte Ratio as a Predictor of Lymphovascular Space Invasion in Endometrioid Endometrial Cancer: Development and Internal Validation of a Continuous Parameter-Based Nomogram.
Akay K, Ulger G, Yildiz H … +4 more , Kucukolcay Coskun Z, Gokulu SG, Ilhan TT, Aytan H
Medicina (Kaunas) · 2026 Jun · PMID 42356202 · Full text
: The relationship between preoperative inflammatory markers and lymphovascular space invasion (LVSI) in endometrioid-type endometrial cancer (EC) remains incompletely defined and warrants evaluation using robust statist...
: The relationship between preoperative inflammatory markers and lymphovascular space invasion (LVSI) in endometrioid-type endometrial cancer (EC) remains incompletely defined and warrants evaluation using robust statistical methods. This study aimed to evaluate the independent association of preoperative inflammatory markers, analyzed strictly as continuous variables, with the presence of LVSI, and to develop a refined predictive nomogram adjusted for established clinical confounders. : Data from 156 patients who underwent standard staging surgery for endometrioid-type EC were retrospectively analysed. To preserve statistical power and avoid structural artifacts from data forcing, preoperative glucose-to-lymphocyte ratio (GLR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were modeled on their original continuous scale. Multivariable logistic regression analysis was performed to identify independent risk factors for LVSI, adjusting for patient age and maximum tumor diameter. Internal validation was conducted using bootstrap resampling (1000 iterations). : In the multivariable logistic regression model, continuous PLR emerged as a significant independent risk factor for the presence of LVSI (adjusted OR: 1.013 per 1-unit increase, 95% CI: 1.001-1.024; = 0.033). Among clinical parameters, maximum tumor diameter demonstrated the strongest independent association with LVSI (adjusted OR: 1.595 per 1 cm increase, 95% CI: 1.211-2.099; = 0.001). Continuous NLR ( = 0.513) and GLR ( = 0.545) did not retain statistical significance due to overlapping explanatory variance and shared hematological components. The optimized 3-variable nomogram (PLR, tumor size, and age) demonstrated an apparent C-index of 0.816 (95% bootstrap CI: 0.719-0.920) and a robust optimism-corrected C-index of 0.794. The bootstrap-corrected calibration slope was 0.909, and Decision Curve Analysis (DCA) demonstrated a positive net clinical benefit across clinically relevant threshold probabilities. : Preoperative PLR, evaluated as a continuous parameter, provides a statistically stable framework for preoperative risk stratification in endometrioid EC. When integrated with tumor size and age, the proposed nomogram demonstrates promising discriminative performance and potential clinical utility pending external validation for predicting LVSI. However, given the limited number of LVSI-positive events ( = 17), these findings should be regarded as exploratory and hypothesis-generating and require external validation before clinical use.
Explainable Machine Learning Analysis of Perioperative Factors Associated with Clinically Significant Emergence Agitation After Pediatric Ophthalmic Surgery.
Lim JA, Kim J, Kong M … +1 more , Kwak SG
Medicina (Kaunas) · 2026 Jun · PMID 42356201 · Full text
Emergence agitation (EA) is a common neurobehavioral disturbance during recovery from sevoflurane anesthesia in pediatric patients, particularly after ophthalmic surgery. Clinically deployable and rigorously validated ri...
Emergence agitation (EA) is a common neurobehavioral disturbance during recovery from sevoflurane anesthesia in pediatric patients, particularly after ophthalmic surgery. Clinically deployable and rigorously validated risk stratification approaches remain limited. We aimed to develop and internally validate an explainable machine learning model to estimate individualized EA risk after pediatric ophthalmic surgery. This retrospective cohort study included 1029 children aged 3-7 years who underwent ophthalmic surgery under sevoflurane anesthesia between 2016 and 2025. EA was defined as clinically significant agitation requiring active management in the post-anesthesia care unit. Four machine learning algorithms (regularized logistic regression, random forest, XGBoost, and CatBoost) were developed using stratified patient-level 5-fold cross-validation. Performance was evaluated using pooled out-of-fold predictions. Discrimination, calibration, and classification metrics at the optimal Youden threshold were assessed. SHAP analysis was applied for interpretability. EA occurred in 543 patients (52.8%). XGBoost showed comparable discrimination with slightly higher AUPRC (0.827) and sensitivity (0.796) compared with other models, while maintaining acceptable specificity (0.728). Calibration demonstrated good agreement between predicted and observed risk. SHAP identified airway management and anesthetic-related variables as key contributors. ML-based analysis identified clinically relevant perioperative factors associated with emergence agitation and may provide preliminary insight into perioperative risk stratification pending external validation. External validation is required before clinical implementation.
The Use of Biomarkers to Justify the Choice of the Proper Biologic Agent for the Treatment of Chronic Rhinosinusitis with Nasal Polyps: A Systematic Review.
Papacharalampous GX, Deftereou TE, Chaidas K … +3 more , Vlastarakos PV, Constantinidis J, Katotomichelakis M
Medicina (Kaunas) · 2026 Jun · PMID 42356200 · Full text
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous type 2 inflammatory disease for which biologic therapies have expanded treatment options; however, biomarkers capable of guiding biologic selection rem...
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous type 2 inflammatory disease for which biologic therapies have expanded treatment options; however, biomarkers capable of guiding biologic selection remain poorly defined. This systematic review aimed to evaluate the available evidence regarding predictive and prognostic biomarkers associated with currently available biologic agents for CRSwNP (omalizumab, dupilumab, mepolizumab, benralizumab, reslizumab, and tezepelumab). A systematic search of PubMed/MEDLINE, Embase, Google Scholar, and the Cochrane Library identified studies published between January 2006 and September 2025. Twenty-five eligible studies, including 12 randomized controlled trials, 12 systematic reviews/meta-analyses, and one indirect treatment comparison study, were analyzed. Multiple biomarkers, including blood eosinophils, total IgE, periostin, eotaxins, eosinophil cationic protein, IL-5, TARC, PARC, and urinary leukotriene E4, were evaluated across biologics targeting IgE, IL-4/IL-13, and IL-5 pathways. Although several biomarkers reflected the modulation of type 2 inflammation and disease activity, no validated biomarker has reliably predicted the superiority of one biologic over another. Nasal IL-5 showed potential for predicting the response to anti-IL-5 therapy but requires further validation. Current evidence supports biomarker use primarily for confirming type 2 inflammation rather than guiding biologic selection. Prospective biomarker-driven and head-to-head comparative studies are needed to enable precision medicine approaches in CRSwNP.
Real-World Experience with Nintedanib in a Progressive Pulmonary Fibrosis Cohort.
Vicens-Zygmunt V, Bordas-Martínez J, Muñoz-Bolaño M … +9 more , Carmezim J, Llanos-González AB, Domingo-Carnice A, Rodríguez-Cumplido D, Bermudo-Peloche G, Tebé-Cordomí C, Peñafiel J, Llop-Rius R, Molina-Molina M
Medicina (Kaunas) · 2026 Jun · PMID 42356199 · Full text
Nintedanib is indicated for progressive pulmonary fibrosis (PPF) based on clinical trial results. The primary objectives of this study were to evaluate the effectiveness of nintedanib on forced vital capacity (FVC) and d...
Nintedanib is indicated for progressive pulmonary fibrosis (PPF) based on clinical trial results. The primary objectives of this study were to evaluate the effectiveness of nintedanib on forced vital capacity (FVC) and diffusing lung capacity for CO (DLCO) after one year of treatment, and to compare the annual rate of decline ("slope") for FVC, DLCO and 6 minute walking distance (6MWD) with the year prior to treatment. The secondary objectives were antifibrotic safety, tolerability, adverse events, immunosuppressant use, dyspnoea and survival. : This study was a single-centre, retrospective, observational cohort study that included consecutive patients with PPF treated with nintedanib. : Fifty-five patients with non-IPF fibrotic ILD initiated nintedanib due to fibrosis progression. Most patients (63.4%) stabilised/improved FVC after 1 year of treatment, and 82.5% stabilised/improved DLCO. The "slope" of FVC and DLCO was reduced after 1 year of treatment compared to the year before initiation, although the difference was not statistically significant: FVC slope was +0.61% in the year after initiation vs. -2.3% in the year prior (mean change: 2.94%, 95%CI [-4.74, 10.62]); DLCO slope was -3.8% after treatment vs. -7% before initiation (mean change: 3.24%, 95%CI [-7.43, 13.92]). Dyspnoea improved in 23.2% of patients. A reduction in immunosuppressant use was observed after nintedanib initiation. Forty-one patients (74.5%) experienced at least one side effect: diarrhoea (60%), hepatotoxicity (23.6%), or asthenia (12.7%). Fifteen patients required permanent or temporary treatment discontinuation. : In our real-world PPF cohort, most patients showed FVC and/or DLCO stabilisation or improvement after one year of nintedanib treatment. A non-significant reduction in the rate of FVC decline after one year of treatment was also observed, as was a reduction in symptom severity in our real-life PPF cohort.
A Bibliographic Review of Airborne Fungal Allergens from Dominant and Undercharacterized Genera.
Musta NT, Ianovici N
Medicina (Kaunas) · 2026 Jun · PMID 42356198 · Full text
Atmospheric fungi represent an important group of allergens with a major impact on public health, especially among sensitized or immunocompromised individuals. This article reviews the ubiquitous fungal taxa in the atmos...
Atmospheric fungi represent an important group of allergens with a major impact on public health, especially among sensitized or immunocompromised individuals. This article reviews the ubiquitous fungal taxa in the atmosphere-, , , -as well as the undercharacterized taxa-, , and -with an emphasis on the antigenic composition and protein structures involved in type I hypersensitivity reactions. Recent data from the scientific literature (2000-2025) is presented, along with the frequency of spores in the atmosphere and the global distribution of research, highlighted by the analysis of Google Scholar and PubMed results. While , , , and are recognized as major contributors to allergic sensitization worldwide, , , , and remain relatively undercharacterized, but associated with allergic reactions and cross-reactivity.
Endoscopic Hallmarks of Sessile Serrated Lesions: A Systematic Review of an Evolving Concept.
Mită A, Martin L, Criciotoiu O … +1 more , Pleşea IE
Medicina (Kaunas) · 2026 Jun · PMID 42356197 · Full text
: Sessile serrated lesions (SSLs) are increasingly recognized as relevant precursors in alternative pathways of colorectal carcinogenesis, yet their endoscopic recognition remains challenging. : We conducted a systematic...
: Sessile serrated lesions (SSLs) are increasingly recognized as relevant precursors in alternative pathways of colorectal carcinogenesis, yet their endoscopic recognition remains challenging. : We conducted a systematic review of studies reporting endoscopic and patient-related features associated with SSLs. PubMed/MEDLINE was searched for studies published between 2003 and November 2025. Eleven studies including 13,453 participants were identified. : Frequently reported endoscopic hallmarks included proximal colon location, larger lesion size, flat or slightly elevated morphology, indistinct borders, mucous cap, cloud-like surface, and pit-pattern features consistent with Kudo/Fujii types III-IV. Considerable heterogeneity in definitions and analytical reporting was observed. : Although several features may raise suspicion for SSLs, standardized evidence remains limited, supporting a cautious and comprehensive approach to polyp assessment.
Thyroid Autoimmunity in Polycystic Ovary Syndrome: Phenotype Distribution, HDL-Cholesterol, and Data-Driven Clusters in a Retrospective Cohort Study.
Mogoș RA, Carauleanu A, Vasilache IA … +7 more , Mogoș SJ, Ungureanu MC, Leustean L, Condriuc IP, Gavril ST, Anton ET, Preda C
Medicina (Kaunas) · 2026 Jun · PMID 42356196 · Full text
: Autoimmune thyroiditis (AIT) is often reported patients with PCOS, and may co-occur with altered metabolic risk markers. The aims of this study were to assess baseline differences according to thyroid autoimmunity stat...
: Autoimmune thyroiditis (AIT) is often reported patients with PCOS, and may co-occur with altered metabolic risk markers. The aims of this study were to assess baseline differences according to thyroid autoimmunity status, evaluate adjusted associations between thyroid autoimmunity and metabolic parameters, examine associations with PCOS phenotype distribution, and perform k-means clustering to explore data-driven subgroups and their autoimmune enrichment. : We performed a retrospective cohort study of 651 women with PCOS, comparing those without AIT (n = 506) versus with AIT (n = 145). Associations between AIT and continuous outcomes (HDL; composite metabolic score) were evaluated using robust linear regression with HC3 standard errors and age modeled with a natural cubic spline (3 knots). The association between AIT and phenotype A was assessed via logistic regression with exponentiated coefficients (odds ratios). Unsupervised phenotyping used k-means clustering with silhouette analysis across k = 2…6. : Patients with AIT were older (median 40 vs. 35 years; = 0.021). Phenotype distribution differed by AIT status (overall = 0.029), with phenotype A less frequent among AIT-positive women (27% vs. 40%). In adjusted robust regression, AIT was associated with lower HDL by β = -4.34 mg/dL (95% CI -9.18 to 0.51; = 0.081), while obesity (-7.04 mg/dL; < 0.001) and diabetes (-6.47 mg/dL; = 0.004) were associated with lower HDL. AIT was not associated with the composite metabolic score (β = -0.005; 95% CI -1.22 to 1.21; = 0.994), whereas obesity was associated with higher score (β = 1.76; = 0.003) and urban residence with lower score (β = -0.94; = 0.011). In logistic regression, AIT was associated with lower odds of phenotype A (OR 0.63; 95% CI 0.41-0.97; = 0.038), and hypertension was associated with higher odds of phenotype A (OR 1.91; 95% CI 1.20-3.04; = 0.006). Silhouette analysis supported k=3 clusters (silhouette 0.349), and AIT prevalence was highest in cluster 3 (26.4%) versus clusters 1 (19.9%) and 2 (18.3%). : AIT was associated with lower odds of phenotype A, and showed a borderline association with lower HDL-cholesterol but not with a composite metabolic score. Data-driven clustering identified a subgroup with higher autoimmune burden.
Myelin Repair as a Neuroprotective Strategy for Multiple Sclerosis: From Bench to Bedside.
Battah T, Mastorodemos V, Struecker E … +2 more , Mitsikostas DD, Papadopoulos D
Medicina (Kaunas) · 2026 Jun · PMID 42356195 · Full text
Multiple sclerosis (MS) is a neuro-inflammatory disease characterized by demyelination in the central nervous system (CNS). Although a substantial endogenous capacity for remyelination has been demonstrated, this process...
Multiple sclerosis (MS) is a neuro-inflammatory disease characterized by demyelination in the central nervous system (CNS). Although a substantial endogenous capacity for remyelination has been demonstrated, this process is frequently incomplete and exhibits marked intra- and inter-individual heterogeneity. Several factors influence the extent of spontaneous myelin regeneration, including age, sex, disease course, and lesion localization. Oligodendrocytes (OL), derived from oligodendrocyte progenitor cells (OPCs), are the principal myelinating cells of the CNS. The regenerative cascade involves several key stages, including OPC activation, recruitment, differentiation into oligodendrocytes (OL), and myelin deposition. This process is orchestrated in a spatiotemporal manner by a complex interplay of intracellular signaling pathways, genetic determinants, and dynamic microenvironmental cues, which together balance inhibitory and pro-remyelinating influences. Several lines of evidence indicate that chronically demyelinated axons are vulnerable to degeneration, whereas successful remyelination may confer neuroprotection. These observations underscore remyelination as a promising neuroprotective therapeutic target for preventing or slowing disability progression in MS, a condition in which gradual neuroaxonal degeneration is believed to underlie irreversible disability progression. In this review, we aim to bridge the gap between fundamental biological mechanisms of remyelination and their clinical relevance. We examine recent advances in in vivo techniques for assessing remyelination and discuss how these measures correlate with clinical and disability outcomes. In addition, we review recent clinical trials of remyelination-promoting therapies and analyze the challenges that have limited their advancement beyond phase II. Overall, we seek to provide a comprehensive overview of the remyelination process from bench to bedside, highlighting both the obstacles and the therapeutic potential of remyelination strategies in MS.
Effectiveness of Motivational Interviews for Alleviating Pre- and Postoperative Anxiety and Postoperative Pain Among Patients Undergoing Surgery: A Systematic Review and Meta-Analysis.
Villalba-Aguilar C, Laredo-Aguilera JA, Villalba-Aguilar L … +3 more , de Paz-Montón LP, Serrano-Fernández V, Carmona-Torres JM
Medicina (Kaunas) · 2026 Jun · PMID 42356194 · Full text
: Anxiety can influence the intensity of postoperative pain, anesthesia and the need for analgesia. Likewise, proper anxiety management can reduce hospital stays. Therefore, it is important to review the actions of nursi...
: Anxiety can influence the intensity of postoperative pain, anesthesia and the need for analgesia. Likewise, proper anxiety management can reduce hospital stays. Therefore, it is important to review the actions of nursing professionals and estimate the effect size of nursing interventions to reduce anxiety in pre- and postsurgical processes. Therefore, the objective of this study was to analyze the effectiveness of preoperative motivational interviews by nursing to reduce pre- and postoperative anxiety and postoperative pain after surgery. : A systematic review was carried out according to the PRISMA guidelines, with a record in PROSPERO using DeCS and Boolean operators OR and AND to increase the specificity of the search. In the EBSCOhost, Pubmed, Cochrane Library and Scopus databases, 104 studies were obtained. Patients ≥ 18 years of age with scheduled surgeries, communication skills, clinical trials or quasi-experimental studies were included. The risk of bias 2 (RoB2) tool was used to assess the risk of bias in the studies. A random effects meta-analysis was performed to analyze pre- and postoperative anxiety and postoperative pain. : A total of 6 studies were included (4 clinical trials and 2 quasi-experimental studies). All the studies analyzed preoperative anxiety, which was significantly lower (SMD = -1.53; 95% CI: -4.01 to -0.95; I = 40%). Postoperative pain (SMD = -0.74; 95% CI: -0.94 to -0.54; I = 35%) and postoperative anxiety (SMD = -0.48; 95% CI: -0.78 to -0.19; I = 0%) also decreased. : Motivational interviews by nurses may help provide clearer information and emotional support and allow patients to express doubts, reducing their fear of anesthesia, pain and the recovery process. Emotional control improved adaptation to the surgical environment, reducing postoperative pain. With respect to implications for clinical practice, it is necessary to use the same scales to measure anxiety to better compare the studies.
Early PSA Decline Predicts Survival Outcomes in Metastatic Castration-Resistant Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors: A Retrospective Single-Center Study.
Hendem E, Koçak MZ, Yıldız O … +5 more , Korkmaz M, Er MM, Araz M, Artac M, Karakurt Eryılmaz M
Medicina (Kaunas) · 2026 Jun · PMID 42356193 · Full text
: Metastatic castration-resistant prostate cancer (mCRPC) remains a clinically heterogeneous condition despite ongoing advances in systemic treatment. Androgen receptor pathway inhibitors (ARPIs), including abiraterone a...
: Metastatic castration-resistant prostate cancer (mCRPC) remains a clinically heterogeneous condition despite ongoing advances in systemic treatment. Androgen receptor pathway inhibitors (ARPIs), including abiraterone acetate and enzalutamide, have been associated with improved clinical outcomes; however, early identification of patients deriving limited benefit continues to be challenging. Prostate-specific antigen (PSA) kinetics may serve as a practical indicator of treatment response over time. This study aimed to examine the prognostic significance of achieving a ≥50% reduction in PSA levels at three months in patients with mCRPC treated with ARPIs in routine clinical practice. : In this retrospective single-center study, patients with mCRPC who received abiraterone acetate or enzalutamide between February 2015 and March 2024 were included. Patients were stratified according to PSA decline at three months (≥50% vs. <50%). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared with the log-rank test. Prognostic variables were subsequently examined using univariate and multivariate Cox proportional hazards models. : A total of 60 patients were included. At three months, 44 patients (73.3%) achieved a ≥50% decline in PSA levels. Patients reaching this level had longer PFS and OS than those with <50% decline, and the differences between groups were statistically significant. In multivariate analysis, early PSA decline remained significantly associated with improved survival outcomes. : A ≥50% decline in PSA levels at three months represents a simple and clinically meaningful indicator of treatment response in patients with mCRPC receiving ARPIs. Early PSA kinetics may assist in timely risk stratification and closer clinical monitoring in routine clinical practice.
Clinical and Inflammatory Predictors of Neurocognitive Decline in Long COVID: A Two-Year Longitudinal Study with Propensity Score Matching.
Diaconu IE, Onofrei MI, Vâță A … +5 more , Roșu FM, Ignat EB, Cuciureanu ID, Hurmuzache ME, Luca MC
Medicina (Kaunas) · 2026 Jun · PMID 42356192 · Full text
: Neurological complications of SARS-CoV-2 infection frequently impair patients' long-term quality of life. This study aimed to identify clinical and laboratory risk factors-including inflammatory markers and micronutrie...
: Neurological complications of SARS-CoV-2 infection frequently impair patients' long-term quality of life. This study aimed to identify clinical and laboratory risk factors-including inflammatory markers and micronutrients-for the occurrence or worsening of neurocognitive disorders in long COVID patients. : In this prospective observational study, patients presenting with long COVID neurological manifestations were stratified by baseline MoCA score into two groups (≥23 and <23). Clinical, laboratory (inflammatory markers, 25-hydroxy vitamin D, vitamin B12, folic acid), and neuroimaging assessments (global cortical atrophy scale, Fazekas score) were performed over 24 months. Propensity score matching (PSM) for age, gender, and neurological comorbidities yielded 54 patients per group. : In the MoCA ≥ 23 group, significant predictors of cognitive decline included severe COVID-19 (OR = 2.211, 95% CI = 1.819-5.973, = 0.012), autoimmune comorbidities (OR = 1.676, 95% CI = 1.191-2.390, = 0.043), and elevated neutrophil-to-lymphocyte ratio (NLR; OR = 1.586, 95% CI = 1.431-2.122, = 0.011). In the MoCA < 23 group, independent predictors were diabetes mellitus (OR = 3.021, 95% CI = 2.65-14.004, = 0.016), autoimmune comorbidities (OR = 4.987, 95% CI = 1.412-6.033, = 0.021), and NLR (OR = 5.944, 95% CI = 2.353-19.321, = 0.015). Serum vitamin D levels were significantly associated with MoCA scores in both groups. : COVID-19 severity, autoimmune comorbidities, NLR, and serum vitamin D represent key risk factors for neurocognitive decline in long COVID, highlighting potential targets for early intervention.
Precision Medicine in Temporomandibular Joint Disorders: A Synovial Fluid Biomarker-Based Literature Review.
Maffìa F, Salvado F, Bonavolontà P … +6 more , Cardoso HJ, Sanz D, Troise S, De Fazio GR, Dell'Aversana Orabona G, Ângelo DF
Medicina (Kaunas) · 2026 Jun · PMID 42356191 · Full text
Temporomandibular disorders (TMDs) encompass a broad spectrum of functional and structural abnormalities of the temporomandibular joint (TMJ). Conventional diagnostic tools, although essential, often fail to capture the...
Temporomandibular disorders (TMDs) encompass a broad spectrum of functional and structural abnormalities of the temporomandibular joint (TMJ). Conventional diagnostic tools, although essential, often fail to capture the underlying biochemical mechanisms driving disease progression. Synovial fluid (SF), by virtue of its direct proximity to intra-articular tissues, represents an accessible biological matrix for identifying molecular signatures of inflammation, cartilage degradation, lubrication failure, oxidative stress, and angiogenic activation. The objective of this review is to synthesize current evidence on SF proteomics in TMD and evaluate its potential translational value in precision medicine. A narrative review of the literature was conducted on PubMed to identify human studies focused on SF proteomic and biochemical biomarkers in TMD. Eligible studies included original research articles assessing SF composition in relation to specific TMJ pathologies, diagnostic categories, or clinical phenotypes. Extracted data included study design, sample characteristics, analytic methodology, biomarkers investigated, and key findings. Google Gemini (Google LLC, Mountain View, CA, USA) was used as an AI-assisted tool to support language editing and manuscript writing during the preparation of this article. The use of this tool was limited to linguistic refinement; all scientific content, data interpretation, and conclusions were formulated and verified by the authors. Across the analyzed studies, TMD phenotypes-particularly disc displacement with or without reduction (DDwR, DDwoR) and osteoarthritis (OA)-were characterized by consistent alterations in cytokines (IL-1β, IL-6, IL-8, TNF-α), extracellular matrix (ECM) components (aggrecan, glycosaminoglycans (GAGs), decorin, MMP-2, MMP-9), lubrication molecules (lubricin/PRG4), oxidative stress mediators (myeloperoxidase (MPO), nitric oxide (NO), glutathione peroxidase (GPX)), adipokines (chemerin, resistin, adiponectin), and angiogenic factors (vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF-2)). Recent liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses further revealed phenotype-specific protein clusters and pathways related to inflammation, ferroptosis, hypoxia signaling, and proteoglycan metabolism. Current evidence suggests that SF proteomics and multi-analyte biomarker profiling offer a promising, hypothesis-generating approach for understanding the biological mechanisms underlying TMD. The integration of proteomic, metabolic, and inflammatory markers holds future potential for diagnostic panel development; however, prospective clinical validation is still required before SF-based molecular profiling can be implemented as a precision medicine tool in TMJ disorders.
Prevalence of Autoimmune Diseases in Individuals Living with HIV in Korea: A Nationwide Population-Based Study.
Kim D, Seok H, Jung JH
Medicina (Kaunas) · 2026 Jun · PMID 42356190 · Full text
: Human immunodeficiency virus (HIV) infection is associated with immune dysregulation, which may influence the development of autoimmune diseases. However, population-based evidence on the prevalence of autoimmune disea...
: Human immunodeficiency virus (HIV) infection is associated with immune dysregulation, which may influence the development of autoimmune diseases. However, population-based evidence on the prevalence of autoimmune diseases in individuals living with HIV remains limited, particularly in Asian populations. This study aimed to evaluate the prevalence of autoimmune diseases in individuals living with HIV in Korea using nationwide population-based data. : We conducted a cross-sectional analysis using the Health Insurance Review and Assessment Service National Patient Samples from 2012 to 2015, including 4,851,064 individuals aged ≥15 years. HIV infection and autoimmune diseases were identified using ICD-10 codes. The prevalence of autoimmune diseases in individuals with HIV infection was compared with that in the general population. Antiretroviral therapy (ART) status was determined based on prescription records. : A total of 1023 individuals were identified with HIV infection, all of whom were receiving antiretroviral therapy. The overall prevalence of autoimmune diseases was 4.4% in males and 3.6% in females with HIV, without significant differences compared to controls. However, the prevalence of ulcerative colitis in males ( = 0.030) and of dermatomyositis in females ( = 0.011) was higher in individuals with HIV. : Although the overall prevalence of autoimmune diseases was not significantly increased in individuals living with HIV, certain autoimmune diseases-particularly ulcerative colitis in men and dermatomyositis in women-showed a higher prevalence. As these findings were based on small case numbers, they should be approached with caution. The results are best regarded as hypothesis-generative observations that warrant further investigation rather than findings on which clinical practice should currently be based. Further research using large datasets is warranted to confirm these associations and clarify the underlying immunological mechanisms.
The Effects of Low-Dose Remimazolam Adjunct on Propofol-Remifentanil Anaesthesia in Day Case Gynaecological Surgery: A Retrospective Cohort Study.
Kazokas D, Kaveckaitė D, Kraujutaitytė S … +3 more , Razlevičė I, Macas A, Lukošienė L
Medicina (Kaunas) · 2026 Jun · PMID 42356189 · Full text
Recent studies suggest that remimazolam, a novel ultra-short-acting benzodiazepine, has an excellent pharmacokinetic and safety profile, favourable for ambulatory procedures. Although remimazolam has been studied as a so...
Recent studies suggest that remimazolam, a novel ultra-short-acting benzodiazepine, has an excellent pharmacokinetic and safety profile, favourable for ambulatory procedures. Although remimazolam has been studied as a sole agent for anaesthesia in day case gynaecological surgery, studies assessing its use in combination with other anaesthetics remain scarce. The aim of this study was to investigate the effects of a low-dose remimazolam adjunct on the characteristics of an intravenous propofol-remifentanil anaesthesia regimen. A single-centre retrospective observational cohort study was conducted on patients who underwent brief day case gynaecological surgery under general intravenous anaesthesia using remifentanil and propofol from November 2024 to January 2025. The patients were divided into two groups depending on whether they received remimazolam as an adjunct. To account for confounding, propensity scores (PSs) were estimated from baseline characteristics and used to derive stabilised inverse probability of treatment weights (IPTWs). Weighted regression models were then applied to estimate treatment effects on postoperative recovery time measures, consumption of anaesthetics, and incidence of any adverse effects intraoperatively and postoperatively. Cost effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER). The clinical data of 51 patients were retrospectively examined: 32 patients were assigned to the intervention group, and 19 patients were assigned to the reference group; after IPTW and PS trimming, the sum of weights was 22 in the intervention group and 58.8 in the reference group. The use of remimazolam as an adjunct was associated with 3.5 min shorter time to eye opening ( < 0.001) and 3.6 min shorter time to full consciousness ( = 0.002); the total consumption of propofol was decreased by 3 mg/kg ( < 0.001); the median dose of remimazolam adjunct was 0.12 mg/kg, or 10 mg per case. There were no statistically significant adverse effects. ICER was 2.35 € per minute of operating room (OR) time saved. In the setting of day case gynaecological surgery, the addition of remimazolam to a propofol-remifentanil regimen reduced propofol requirements and shortened recovery time without an increase in adverse effects. This may represent a more efficient anaesthetic approach for ambulatory procedures with a comparable safety profile.
Type I Atelocollagen Interposition Within the ACL Graft During ACL Reconstruction: An Exploratory Clinical and MRI-Based Study.
Jung SH, Lee HS, Jung M … +3 more , Chung K, Moon HS, Kim SH
Medicina (Kaunas) · 2026 Jun · PMID 42356188 · Full text
: Atelocollagen, a purified collagen derivative, has demonstrated potential benefits in various orthopedic applications; however, its role in anterior cruciate ligament (ACL) reconstruction remains unclear. This study ai...
: Atelocollagen, a purified collagen derivative, has demonstrated potential benefits in various orthopedic applications; however, its role in anterior cruciate ligament (ACL) reconstruction remains unclear. This study aimed to compare magnetic resonance imaging (MRI) graft signal following ACL reconstruction with and without atelocollagen interposition and to evaluate its effects on knee joint laxity and clinical outcomes. : A retrospective review was conducted on patients who underwent primary ACL reconstruction using hamstring autografts between March 2015 and July 2023. Patients were divided into two groups: without atelocollagen (Group N) and with atelocollagen interposition (Group C). The primary outcome was ACL graft signal intensity (intra-articular and intra-tunnel) on 1-year postoperative MRI. Secondary outcomes included tunnel widening, knee joint laxity, and patient-reported outcome measures (PROMs). : A total of 57 patients (Group N: 34; Group C: 23) were analyzed. Baseline characteristics were comparable between groups. Group C had a higher proportion of thicker graft constructs (quintuple/sextuple: 73% vs. 17.6%, < 0.001) and more frequent concomitant anterolateral ligament reconstruction (78.3% vs. 8.8%, < 0.001). No significant difference in intra-articular graft signal was observed. However, femoral intra-tunnel graft signal was significantly lower in Group C ( = 0.018), accompanied by reduced femoral tunnel widening ( < 0.001). Tibial tunnel widening, knee joint laxity, and PROMs did not differ significantly at 1 and 2 years. In multivariable analysis, atelocollagen interposition was associated with reduced femoral tunnel widening (B = -1.1, = 0.025). : Atelocollagen interposition during ACL reconstruction was associated with more favorable intra-tunnel graft healing signals and reduced femoral tunnel widening, although it did not appear to influence short-term clinical outcomes.
Quality of Life and Psychological Factors in Patients with Metastatic Prostate Cancer Receiving Androgen Receptor-Targeted Therapies: A Prospective Cross-Sectional Real-World Study.
Çelik S, Karatlı S, Atak M … +3 more , Sevim HA, İmamoğlu Gİ, Rahatlı S
Medicina (Kaunas) · 2026 Jun · PMID 42356187 · Full text
: Quality of life (QoL) has become an essential outcome in patients with metastatic prostate cancer, particularly in the era of androgen receptor (AR)-targeted therapies. Although these agents improve survival, their dif...
: Quality of life (QoL) has become an essential outcome in patients with metastatic prostate cancer, particularly in the era of androgen receptor (AR)-targeted therapies. Although these agents improve survival, their differential impact on QoL and the role of psychological factors remain incompletely understood. This study aimed to evaluate QoL, functional outcomes, and psychological status, and to identify factors associated with poor QoL in a real-world cohort. : This prospective cross-sectional, single-center observational study included 130 patients with metastatic prostate cancer receiving AR-targeted therapies (abiraterone, enzalutamide, or apalutamide/darolutamide). QoL was assessed using the EORTC QLQ-C30 questionnaire, and psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS). Patients were stratified according to treatment groups, and comparisons were performed using appropriate statistical tests. Logistic regression analyses were conducted to determine factors independently associated with poor QoL. : Exploratory differences in global QoL were observed among treatment groups ( = 0.007), with lower global QoL scores in the abiraterone group and numerically higher emotional and cognitive functioning scores in the enzalutamide group. Symptom analysis demonstrated higher nausea/vomiting scores in the abiraterone group ( = 0.022), whereas other symptom domains were comparable across treatment groups. In multivariable analysis, anxiety (odds ratio [OR]: 6.62) and depression (OR: 3.40) were independently associated with poor QoL, while treatment type was not independently associated with poor QoL after multivariable adjustment. : Although unadjusted QoL scores differed across AR-targeted therapy groups, psychological factors-particularly anxiety and depression-were significantly associated with poorer QoL in patients with metastatic prostate cancer. These findings highlight the importance of integrating routine psychosocial assessment and supportive care strategies into clinical practice to optimize patient-centered outcomes. However, given the cross-sectional and exploratory nature of the study, the findings should be interpreted cautiously.
Cross-Cultural Adaptation and Psychometric Validation of the Serbian Version of the Back Beliefs Questionnaire in Patients with Chronic Low Back Pain.
Minaković I, Janković T, Smuđa M … +4 more , Kolarš B, Šili M, Jovin VM, Zvekić-Svorcan J
Medicina (Kaunas) · 2026 Jun · PMID 42356186 · Full text
The Back Beliefs Questionnaire (BBQ) is a patient-reported outcome measure used to assess beliefs about back pain. This study aimed to cross-culturally adapt the BBQ into Serbian and evaluate the psychometric properties...
The Back Beliefs Questionnaire (BBQ) is a patient-reported outcome measure used to assess beliefs about back pain. This study aimed to cross-culturally adapt the BBQ into Serbian and evaluate the psychometric properties of the Serbian version (BBQ-Srb) in patients with chronic low back pain. A cross-sectional study involving cross-cultural adaptation and psychometric validation was conducted in 143 patients with chronic low back pain. The adaptation process included forward and backward translation, expert review, and pilot testing. Psychometric evaluation included assessment of floor and ceiling effects, internal consistency, test-retest reliability, measurement error, exploratory and confirmatory factor analyses, and construct validity testing using predefined hypotheses. Construct validity was examined through associations between BBQ-Srb scores and pain intensity, disability, pain catastrophizing, and work absenteeism. The BBQ-Srb showed acceptable internal consistency, with Cronbach's alpha of 0.728 and McDonald's omega of 0.735. Total-score analyses were based on the preliminary exploratory 8-item BBQ-Srb version excluding BBQ13, whereas floor and ceiling effects were examined for the original 9-item scored BBQ-Srb version. Test-retest reliability was excellent (ICC = 0.916). Exploratory factor analysis suggested a predominantly one-factor structure, but the explained variance was modest. Confirmatory factor analysis of the 8-item version provided only partial support for unidimensionality, with marginal model fit and a low average variance extracted. The 8-item BBQ-Srb total score showed significant negative correlations with pain intensity, disability, and pain catastrophizing, confirming three of four predefined hypotheses. The BBQ-Srb demonstrated acceptable reliability and preliminary evidence of construct validity as a Serbian patient-reported outcome measure for assessing beliefs about back pain. However, structural validity was only partially supported, and the exploratory 8-item structure requires confirmation in larger, independent, and more diverse Serbian-speaking samples.
Robotic-Assisted Total Knee Arthroplasty: Current Evidence on PROMs, Functional Outcomes, Neuromotor Recovery, and Complications-A Narrative Review.
Capitanu BS, Dragosloveanu S, Nedelea DG … +3 more , Dragosloveanu CI, Cergan R, Scheau C
Medicina (Kaunas) · 2026 Jun · PMID 42356185 · Full text
: Robotic-assisted total knee arthroplasty (rTKA) is being increasingly used to improve surgical precision, soft-tissue balancing, and functional recovery. However, evidence comparing rTKA with conventional manual TKA (m...
: Robotic-assisted total knee arthroplasty (rTKA) is being increasingly used to improve surgical precision, soft-tissue balancing, and functional recovery. However, evidence comparing rTKA with conventional manual TKA (mTKA) across functional, patient-reported, neuromotor, and safety outcomes remains heterogeneous. : This narrative (non-systematic) review synthesises studies evaluating functional outcomes, patient-reported outcome measures (PROMs), joint awareness, range of motion (ROM), neuromotor recovery, and complications following rTKA versus mTKA. Study inclusion was based on author judgement and data accessibility. The reviewed evidence included five randomised controlled trials, 9 retrospective studies, six prospective non-randomised studies, two meta-analyses, one cross-sectional study, and one umbrella review, covering CT-based and imageless robotic platforms, including semi-active and active systems such as MAKO, NAVIO, CORI, ROSA, ROBODOC, CUVIS Joint, SkyWalker, TSolution One, AKEC, JIANJIA, and YUANHUA. : rTKA consistently demonstrated outcomes comparable to mTKA in PROMs (OKS, KOOS, WOMAC, KSS), with some studies reporting modest early improvements in pain and function. Joint awareness and patient satisfaction showed the most consistent early advantages for rTKA. Early postoperative ROM and neuromotor recovery, including balance and gait symmetry, were improved with rTKA, likely due to enhanced alignment and soft-tissue balancing; however, mid- and long-term outcomes were similar. Complication rates were low and comparable, with robotic-specific issues being rare and self-limited. : rTKA provides small but reproducible early benefits in joint awareness, neuromotor function, and patient satisfaction, without clear long-term superiority. These early advantages may translate into meaningful population-level benefits, including faster recovery and potential healthcare cost reduction. Further high-quality studies are needed to assess long-term clinical and economic outcomes.
Determinants of Vitamin D Status: An Analysis in a Primary Care Setting in Lithuania of Age, Gender and Seasonality.
Martinkienė B, Bachmetjev B, Piličiauskienė R … +1 more , Sragauskienė G
Medicina (Kaunas) · 2026 Jun · PMID 42356184 · Full text
: Vitamin D deficiency is a pervasive public health issue in high-latitude regions, yet large-scale population data for the Baltic states remain sparse. This study aimed to determine the prevalence of vitamin D status an...
: Vitamin D deficiency is a pervasive public health issue in high-latitude regions, yet large-scale population data for the Baltic states remain sparse. This study aimed to determine the prevalence of vitamin D status and identify its primary determinants within a primary care setting in Lithuania. : We conducted a retrospective cross-sectional analysis of serum 25-hydroxyvitamin D [25(OH)D] concentrations from 14,330 unique patients (aged 1-101 years) collected during 2025 at a major clinic in Vilnius. Vitamin D status was categorized according to the Central and Eastern European Expert Consensus thresholds. : The overall median 25(OH)D concentration was 68.3 nmol/L, placing it in the "insufficiency" range (50-75 nmol/L). Seasonality emerged as the most significant predictor of deficiency; multivariable logistic regression showed a maximal risk reduction in September (OR 0.33; 95% CI: 0.27-0.41) and August (OR 0.34) compared to January, while June and November provided no significant protection. Age-specific analysis revealed a non-linear "U-shaped" distribution: children aged 0-6 years had the highest levels (median ~87-91 nmol/L), likely due to rickets prophylaxis, whereas adolescents (12-18 years) exhibited the highest vulnerability, with approximately 80% suffering from deficiency or insufficiency. Males faced a 13.9% higher likelihood of deficiency than females (OR 1.14; = 0.0036), potentially due to lower rates of elective supplementation. : These findings suggest that current supplementation strategies successfully protect infants but fail to sustain adequacy through adolescence and adulthood, particularly during the "vitamin D winter." Targeted public health interventions for adolescents and year-round monitoring are recommended to mitigate the high prevalence of suboptimal vitamin D status in Lithuania.
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