Medicina[JOURNAL]
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200 papers
Predictive Performance of Oocyte Count for Clinical Pregnancy in GnRH Antagonist IVF Cycles: A Multivariable Analysis of 1171 Fresh Embryo Transfers over a 14-Year Period.
Eroğlu ÖO, Özelçi R, Pay RE … +1 more , Eroğlu C
Medicina (Kaunas) · 2026 Jun · PMID 42356123 · Full text
The optimal oocyte yield in gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles remains debated, and data specific to antagonist protocols are limited. This study evaluated the discrimina...
The optimal oocyte yield in gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles remains debated, and data specific to antagonist protocols are limited. This study evaluated the discriminative and independent predictive performance of oocyte count for clinical pregnancy in GnRH antagonist IVF cycles. This retrospective cohort included 1171 women undergoing their first GnRH antagonist IVF cycle with fresh embryo transfer at a single tertiary center (September 2007-December 2021). The primary outcome was an institutional composite pregnancy outcome (sustained β-hCG positivity with subsequent ongoing intrauterine pregnancy or live birth; biochemical and ectopic pregnancies were negative). Patients were grouped by oocytes retrieved (1-5, 6-10, 11-15, ≥16). Performance was assessed with logistic regression, ROC with 2000-iteration bootstrap, integrated discrimination improvement (IDI), continuous net reclassification improvement (NRI), and restricted cubic spline. Predefined subgroup analyses by age, regimen, and antral follicle count tertile were performed. A positive outcome occurred in 430 patients (36.7%). After adjustment, oocyte count was not an independent predictor (adjusted odds ratio 0.999, 95% CI 0.979-1.020; = 0.96). The full model (AUC 0.564, 95% CI 0.529-0.598) did not outperform oocyte count alone (AUC 0.532; bootstrap = 0.11). IDI (0.011) and NRI (0.135) were statistically detectable but clinically trivial. Spline regression showed no non-linearity ( = 0.47). Findings were consistent across subgroups, and the narrow confidence interval excluded per-oocyte effects ≥1.10. In GnRH antagonist IVF cycles, oocyte count showed weak discriminatory performance and was not independently associated with fresh-cycle pregnancy. Oocyte yield should be interpreted alongside-rather than as a substitute for-established parameters such as age and ovarian reserve. The principal clinical value of a higher oocyte response may lie in cumulative rather than fresh-cycle success. Live-birth outcomes were not available, and the source institution was permanently closed in 2025; these limitations define the boundary of inference.
Eccentric-Oriented Strength Training in Anterior Cruciate Ligament Rehabilitation: A Scoping Review.
Žigmund B, Zemková E
Medicina (Kaunas) · 2026 Jun · PMID 42356122 · Full text
Persistent quadriceps weakness, muscle atrophy, and functional deficits are common following anterior cruciate ligament (ACL) reconstruction and may compromise return to sport and increase the risk of reinjury. Eccentric...
Persistent quadriceps weakness, muscle atrophy, and functional deficits are common following anterior cruciate ligament (ACL) reconstruction and may compromise return to sport and increase the risk of reinjury. Eccentric-oriented strength training has been widely used to enhance muscle strength and hypertrophy in various musculoskeletal conditions; however, its specific application within ACL rehabilitation remains insufficiently explored. The aim of this scoping review was to map the existing evidence on the use of eccentric-oriented strength training in ACL rehabilitation, identify gaps in the current literature, and provide suggestions for future research. A scoping review search was conducted in PubMed, Scopus, Web of Science, and PEDro from inception to February 2026 using the following keywords and Boolean operators: ("anterior cruciate ligament", "ACL", "anterior cruciate ligament reconstruction", "ACLR") AND ("eccentric training", "eccentric exercise", "eccentric loading", "flywheel training", "isoinertial training"). Eligible studies included studies that investigated eccentric exercises as part of ACL rehabilitation and reported outcomes related to muscle strength, muscle morphology, functional performance, or return to sport. Data were extracted and synthesized descriptively in accordance with the PRISMA-ScR extension for Scoping Reviews guidelines. Methodological quality and risk of bias were evaluated using the PEDro scale (RCTs) and the ROBINS-I tool (non-randomized studies). Fifteen studies met the inclusion criteria. The included literature primarily examined isokinetic eccentric exercise, eccentric cycling, early progressive eccentric resistance training, Nordic hamstring exercise, eccentric ergometry, and flywheel strength training. Most studies reported improvements in quadriceps strength and muscle morphology, with additional benefits observed in functional performance measures (i.e., hop tests), gait mechanics, and limb symmetry. Evidence was unevenly distributed across rehabilitation phases, with relatively few studies focusing on the mid-phase of ACL rehabilitation. Eccentric-oriented strength training represents a promising but underexplored component of ACL rehabilitation. However, the existing literature lacks standardized protocols, comprehensive outcome measures, and phase-specific guidance, particularly during the mid and late stages of rehabilitation. Further high-quality studies are needed to clarify the optimal timing, dosage, and integration of eccentric training across rehabilitation phases.
Differential Associations of Oxidative Biomarkers with Symptomatic and Systolic Severity in Heart Failure.
Arsić A, Kisić B, Perić V … +8 more , Stevanović I, Radojević AS, Bukumirić Z, Dragojević I, Vasić M, Popević M, Rašić D, Hadžistević S
Medicina (Kaunas) · 2026 Jun · PMID 42356121 · Full text
: Oxidative stress is recognized as an important contributor to heart failure (HF) pathophysiology, but the relationships of individual oxidative and antioxidant biomarkers with symptomatic severity and systolic dysfunct...
: Oxidative stress is recognized as an important contributor to heart failure (HF) pathophysiology, but the relationships of individual oxidative and antioxidant biomarkers with symptomatic severity and systolic dysfunction remain insufficiently defined. This study examined circulating oxidative and nitrosative stress markers across New York Heart Association (NYHA) classes and left ventricular ejection fraction (LVEF) categories in HF and their associations with HF severity. : In this case-control study, 85 patients with HF and 33 healthy controls were included. Malondialdehyde (MDA), nitrates and nitrites (NOx), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), sulfhydryl (SH) groups, and NT-proBNP were measured. Group differences were analyzed using the Kruskal-Wallis test with post hoc comparisons. Adjusted ordinal logistic regression models examined associations with NYHA class and LVEF category, and receiver operating characteristic (ROC) analysis evaluated discriminatory performance. : Compared with controls, all biomarkers differed significantly across NYHA classes and LVEF categories (all < 0.001). In separate adjusted models, higher NOx, MDA, and NT-proBNP were associated with worse NYHA class and more impaired LVEF, whereas higher antioxidant marker levels were associated with lower odds of severe HF. In combined models, NOx remained independently associated with worse NYHA class (OR 1.07, 95% CI 1.04-1.11; < 0.001), while MDA remained independently associated with more impaired LVEF (OR 1.02, 95% CI 1.00-1.03; = 0.022). NT-proBNP showed the best discrimination for NYHA III/IV versus I/II (AUC 0.966), while among oxidative biomarkers NOx performed best for symptomatic severity (AUC 0.782) and MDA for LVEF ≤ 40% (AUC 0.751). : HF is characterized by increased oxidative and nitrosative stress together with reduced antioxidant defense. NOx appears more closely related to symptomatic severity, whereas MDA appears more closely related to systolic dysfunction. However, NT-proBNP remained the strongest overall discriminator. NOx and MDA may provide complementary mechanistic information on redox imbalance across HF severity categories.
Seropositivity and Acute Coronary Syndromes: A Case-Control Study of the Infectious-Inflammatory Axis.
Khalaf LF, Khalaf RF, Bagady SS … +5 more , Khalaf RF, Amin RA, Manaa AO, Bagady MS, Aljada A
Medicina (Kaunas) · 2026 Jun · PMID 42356120 · Full text
Classical cardiovascular risk factors account for only a fraction of acute coronary syndromes (ACSs), and chronic infection has been proposed as a contributor to atherogenesis through persistent inflammation and endothe...
Classical cardiovascular risk factors account for only a fraction of acute coronary syndromes (ACSs), and chronic infection has been proposed as a contributor to atherogenesis through persistent inflammation and endothelial dysfunction. We tested whether infection is independently associated with ACS by quantifying seroprevalence, inflammatory markers, and their relationship with conventional cardiovascular risk factors. In a prospective case-control design, we enrolled 47 patients with ACSs (29 with acute myocardial infarction and 18 with unstable angina) and 53 age- and locality-matched controls at Alexandria University Hospital. The clinical evaluation comprised electrocardiography, echocardiography, lipid profile, and high-sensitivity C-reactive protein (CRP). -specific IgG and IgM were measured by ELISA, with positive samples confirmed by microimmunofluorescence. Logistic regression models were adjusted for age, sex, hypertension, diabetes, dyslipidemia, and smoking. IgM was undetectable in all 100 participants, excluding acute infection. IgG seropositivity was higher in cases than in controls (83.0% vs. 60.4%; OR: 3.20; 95% CI: 1.23-8.30; = 0.017) and remained suggestive after multivariable adjustment (adjusted OR: 4.59; 95% CI: 1.33-18.28; = 0.021), although the estimate is imprecise and does not meet our prespecified multivariate threshold of < 0.01. Within the ACS cohort, IgG seropositivity was not significantly associated with CRP elevation (Fisher's exact = 1.000). CRP elevation was near-universal in cases (93.6%) and absent in controls (0%; < 0.001). Chronic infection was associated with ACS in unadjusted analysis, with a suggestive but underpowered signal after multivariable adjustment, although the observational design precludes causal inference, and reverse causality cannot be excluded. Prospective studies using direct pathogen detection are required to determine whether the association reflects a contributory mechanism or shared susceptibility.
The Role of Gut Microbiome in Mild Cognitive Impairment: A Twin Study.
Persely A, Piroska M, Zoldi L … +7 more , Beszedics B, Juhasz J, Makra N, Dunai ZA, Szabo D, Tarnoki DL, Tarnoki AD
Medicina (Kaunas) · 2026 Jun · PMID 42356119 · Full text
: Recent studies have revealed the potential roles of gut microbiota and microbial metabolites in influencing mild cognitive impairment (MCI) and Alzheimer's disease via the gut-brain axis. This relationship has not yet...
: Recent studies have revealed the potential roles of gut microbiota and microbial metabolites in influencing mild cognitive impairment (MCI) and Alzheimer's disease via the gut-brain axis. This relationship has not yet been investigated in monozygotic twin pairs, which represent an ideal model for minimizing genetic confounding. : Seven twin pairs discordant for ACE and 15 for MoCA were enrolled. Stool samples were subjected to 16S ribosomal RNA-based microbiome analysis. : No significant differences in alpha or beta diversity were observed between MCI-discordant twin pairs at the genus or family level. The most robust finding was a significantly lower abundance of in MCI-affected twins, identified independently by ANCOM-BC and LEfSe. Additional exploratory findings included higher abundances of , , , and . However, several taxa showed opposing patterns between ACE- and MoCA-derived cohorts, highlighting the methodological impact of cognitive instrument selection. : The convergent reduction of across two independent analytical methods represents the most substantive finding. The remaining results are exploratory, limited by small sample size, restricted statistical power, and lack of availability to fully control for dietary habits, physical activity, and medication use. Validation in larger longitudinal twin cohorts with a standardized cognitive assessment is warranted.
Antimicrobial Central Venous Catheters vs. Uncoated Central Venous Catheters in Reducing Catheter-Related Bloodstream Infections in ICU: A Retrospective, Multicenter Study.
Pota V, Imperatore F, Esposito R … +8 more , Cafora C, Golino L, Liguori G, Silvestro F, Passavanti MB, Sansone P, Pace MC, Coppolino F
Medicina (Kaunas) · 2026 Jun · PMID 42356118 · Full text
: Central venous catheters (CVCs) are widely used in intensive care units (ICUs) but are associated with catheter-related bloodstream infections (CRBSIs), which increase morbidity, mortality, and healthcare costs. Antimi...
: Central venous catheters (CVCs) are widely used in intensive care units (ICUs) but are associated with catheter-related bloodstream infections (CRBSIs), which increase morbidity, mortality, and healthcare costs. Antimicrobial-impregnated catheters, including chlorhexidine-silver sulfadiazine (CSS)-coated CVCs, have been proposed to reduce this risk. This study evaluated the effectiveness of CSS-coated CVCs in preventing CRBSIs in ICU patients. : A retrospective multicenter study was conducted in two ICUs in Naples, Italy. Patients admitted between October and December 2020 who received standard uncoated CVCs (Group A) were compared with patients admitted between October and December 2021 who received CSS-coated CVCs (Group B). Inclusion criteria were age 18-89 years, ICU admission with CVC placement, and negative blood cultures at admission. The primary outcome was the incidence of CRBSI, defined according to microbiological criteria consistent with current guidelines. The secondary outcome was the number of catheter removals due to confirmed CRBSI. : A total of 320 patients were included (170 in Group A and 150 in Group B). Baseline demographic characteristics and ICU admission diagnoses were comparable between groups. Microbiologically confirmed CRBSI incidence was significantly lower in Group B than in Group A (6.4% vs. 31.7%, < 0.0001), corresponding to infection rates of 1.48 vs. 6.95 per 1000 catheter-days, respectively ( < 0.0001). Patients in Group B also required fewer catheter removals due to CRBSI (mean 1.6 vs. 3.2 per patient, < 0.0001). Logistic regression confirmed a significantly lower risk of CRBSI with CSS-coated CVCs (OR 0.15; 95% CI 0.06-0.32). : CSS-coated CVCs were associated with a significant reduction in CRBSI incidence and catheter replacement rates in ICU patients. However, given the retrospective design, univariable analysis, and highly unequal pandemic-related systemic stressors between the two periods, these findings demonstrate a clinical association rather than direct causation, and should be interpreted with caution due to potential residual confounding.
Predictors and Clinical Impact of Positive Blood Cultures in Emergency Department Patients with Suspected Infection.
Covino M, Bonadia N, Celani L … +7 more , Della Polla DA, Maccauro V, Del Vecchio P, Simeoni B, Gasbarrini A, Murri R, Franceschi F
Medicina (Kaunas) · 2026 Jun · PMID 42356117 · Full text
Blood cultures are routinely obtained in emergency department (ED) patients with suspected infection; however, their real clinical impact on patient outcomes remains debated. Although current sepsis guidelines recommend...
Blood cultures are routinely obtained in emergency department (ED) patients with suspected infection; however, their real clinical impact on patient outcomes remains debated. Although current sepsis guidelines recommend obtaining blood cultures before antimicrobial therapy, the diagnostic yield is relatively low, and it remains unclear whether early microbiological results meaningfully influence prognosis. To evaluate the predictors and clinical impact of positive blood cultures in ED patients with suspected infection and to assess whether microbiological results that modify empiric antimicrobial therapy are associated with improved survival. : We conducted a retrospective cohort study of adult patients presenting to a tertiary-care ED with suspected infection between 2018 and 2024 who underwent blood culture sampling within the first six hours of ED stay. Blood culture results were classified as negative, positive non-actionable, or positive actionable depending on whether they led to modification of empiric antimicrobial therapy. The primary outcome was in-hospital mortality. Survival analysis was performed using Kaplan-Meier curves and multivariable Cox regression with a 72 h landmark approach to reduce immortal time bias. : The study included 13,591 patients with suspected infection who underwent blood culture testing. Blood cultures were negative in 11,475 patients, positive non-actionable in 1082 patients, and positive actionable in 1034 patients. Overall in-hospital mortality was approximately 14%. Kaplan-Meier analysis showed significant differences in survival across blood culture groups (log-rank < 0.001), with lower crude survival among patients with actionable positive cultures. However, after adjustment for demographic characteristics, comorbidity burden, illness severity, and laboratory markers in multivariable Cox regression models, the presence of an actionable blood culture result was not associated with improved prognosis compared with negative or non-actionable cultures. : In ED patients with suspected infection, actionable positive blood cultures were associated with higher crude mortality; however, after multivariable adjustment, this association was attenuated and did not remain statistically significant. These findings suggest that actionable blood culture results identify patients with greater illness severity and clinical complexity, while their direct patient-level survival benefit remains difficult to demonstrate in observational data. Further prospective studies are needed to clarify whether early blood culture acquisition can truly modify the clinical trajectory of patients with suspected infection.
Association Between Local Anesthetic Volume-Dose Combinations and Optic Nerve Sheath Diameter as an Indirect Marker of Intracranial Pressure During Ultrasound-Guided Supraclavicular Brachial Plexus Block: A Randomized Trial.
Çopur İ, Erbay RH, İlhan S … +1 more , Evran T
Medicina (Kaunas) · 2026 Jun · PMID 42356116 · Full text
: This prospective, randomized study aimed to evaluate the effects of different local anesthetic (LA) volume-dose combinations administered during supraclavicular brachial plexus block (SCBPB), a widely used technique in...
: This prospective, randomized study aimed to evaluate the effects of different local anesthetic (LA) volume-dose combinations administered during supraclavicular brachial plexus block (SCBPB), a widely used technique in upper extremity surgery. These effects were assessed by analyzing changes in the ratios of optic nerve sheath diameter (ONSD) to eyeball transverse diameter (ETD), obtained by ultrasound (US) and considered indirect measures of intracranial pressure (ICP). : Sixty four ASA I-II patients aged 18-50 years undergoing upper extremity surgery were randomized into four groups receiving 15 mL (Group A), 20 mL (Group B), 25 mL (Group C), or 30 mL (Group D) of LA (equal volumes of 0.5% bupivacaine and 2% prilocaine). ONSD/ETD ratios were measured bilaterally at baseline, 20, and 60 min. Perfusion index (PI), end-tidal carbon dioxide (EtCO), block onset times and block duration were also assessed. : Groups C and D showed significant bilateral increases in both ONSDint/ETD and ONSDext/ETD ratios at 20 and 60 min compared with baseline ( < 0.05). Group B demonstrated a significant increase only in the ONSDext/ETD ratio on the block side, whereas Group A showed no significant change. PI increased earlier and more markedly with increasing LA volume-dose. No significant intergroup differences were observed in EtCO. In pairwise comparisons, sensory block onset was significantly longer in Group A than in Groups B, C, and D ( < 0.001). Motor block onset was significantly longer in Group A than in Groups C and D, and in Group B than in Group D ( < 0.001). Analgesia duration was significantly shorter in Group A than in Groups B, C, and D, and in Group B than in Groups C and D ( < 0.001). : Increasing the LA volume-dose in US-guided SCBPB accelerates sensory and motor block onset and significantly prolongs block duration. A volume-dependent increase in ONSD/ETD ratios was observed on both the blocked and contralateral sides. PI showed an early and marked increase, particularly in high-volume-dose administrations, reflecting block success. Non-invasive EtCO monitoring did not detect significant changes.
Autonomic Non-Responsiveness in HRV Biofeedback: A Narrative Conceptual Review and Future Directions for AI-Guided Closed-Loop Adaptive Systems.
Burlacu A, Brinza C, Iftene A … +2 more , Bogdan-Goroftei RE, Geman O
Medicina (Kaunas) · 2026 Jun · PMID 42356115 · Full text
Heart rate variability (HRV) is widely used as a non-invasive marker of autonomic regulation and physiological adaptability, with relevance across cardiovascular, metabolic, neuropsychiatric, and stress-related condition...
Heart rate variability (HRV) is widely used as a non-invasive marker of autonomic regulation and physiological adaptability, with relevance across cardiovascular, metabolic, neuropsychiatric, and stress-related conditions. HRV biofeedback has emerged as a non-pharmacological intervention intended to influence autonomic function through paced breathing, resonance-frequency training, and real-time physiological feedback. Although this approach has shown promise in improving stress regulation, emotional symptoms, autonomic balance, and selected cardiovascular outcomes, its effects are not consistent across individuals or clinical states. The reasons for this variability remain insufficiently conceptualized. In this narrative conceptual review, we propose the concept of autonomic non-responsiveness during HRV biofeedback as a descriptive framework for situations in which expected autonomic engagement is weakened, absent, or fails to translate into meaningful physiological or clinical benefit. We discuss potential contributors to non-response, including reduced autonomic flexibility, impaired baroreflex function, disease burden, fatigue, stress-related overload, dysfunctional breathing, methodological limitations, and cognitive-behavioral constraints. We then consider the clinical implications of recognizing non-response as a potentially informative state rather than a simple negative outcome. Finally, we outline a future research agenda focused on operational definition, candidate biomarkers, temporal characterization, and minimally adaptive closed-loop systems.
Preoperative 3D-Planned S1 Corridors Transferred into 2D Fluoroscopy Allow for Safe Intraoperative Large-Diameter Implant Placement: Description of a Novel Sacroiliac Fixation Technique and Proof of Concept in 137 Implantations.
Bludau F, Schulz SH, Gravius S … +4 more , Fennema P, Rickert M, Vogel J, Dally FJ
Medicina (Kaunas) · 2026 Jun · PMID 42356114 · Full text
: Percutaneous iliosacral screw fixation is a standard treatment for posterior pelvic ring instability and sacral insufficiency fractures. However, conventional transsacral S1 screw fixation is associated with notable co...
: Percutaneous iliosacral screw fixation is a standard treatment for posterior pelvic ring instability and sacral insufficiency fractures. However, conventional transsacral S1 screw fixation is associated with notable complication rates, most commonly implant loosening; dysmorphic sacral anatomy increases the risk of iatrogenic L5 or S1 nerve root injury. This study presents a modified S1 trajectory to engage the high-density bone of the anterior and cranial S1 vertebral body (promontory) by transferring preoperative 3D planning to intraoperative 2D fluoroscopy. : This retrospective study analyzed implant placements for posterior pelvic ring instability, including high-velocity trauma and fragility fractures of the pelvis (FFPs). Preoperative computed tomography (CT) multiplanar reconstruction defined a modified corridor from a posterior-caudal iliac entry point directed cranially and ventrally into the S1 promontory. The 3D trajectory was transferred intraoperatively using standard 2D fluoroscopy (lateral, anteroposterior, inlet, and outlet views) with the patient prone. In cases of reduced bone quality or intended sacroiliac fusion, 3D-printed titanium implants (triangular or cylindrical threaded, 10.0-13.5 mm outer diameter) were selected over 7.5 mm cannulated screws. : Overall, 137 implants were placed in 71 patients: 13 cannulated screws in high-velocity pelvic ring trauma, 72 triangular titanium sacroiliac fusion implants (iFuse Implant System, SI-Bone), and 52 threaded titanium fusion implants (iFuse TORQ, SI-Bone) in patients with FFP. The modified trajectory consistently engaged the anterior and cranial S1 vertebral body. Postoperative 3D CT confirmed accurate placement of all implants. No iatrogenic nerve injuries or revisions for implant malposition occurred. Mean follow-up was 12 ± 9 months. : Preoperative 3D CT planning combined with standard 2D fluoroscopy guided a modified S1 trajectory toward the cranial S1 vertebral body. Accurate and safe implant placement was achieved in the prone position without navigation systems, providing a practical alternative when standard transverse trajectories are limited by narrow bony corridors or sacral or pelvic dysmorphy.
Sex-Specific Associations Between Sarcopenia and Obesity Parameters and Falls in Korean Older Adults: A Cross-Sectional Analysis of the Korean Frailty and Aging Cohort Study.
Rho Y, Choi S, Kim M … +2 more , Soh Y, Won CW
Medicina (Kaunas) · 2026 Jun · PMID 42356113 · Full text
: Aging is associated with sarcopenia and increased adiposity, which may impair mobility and increase fall risk. Although sarcopenic obesity is associated with an increased fall risk compared with either condition alone,...
: Aging is associated with sarcopenia and increased adiposity, which may impair mobility and increase fall risk. Although sarcopenic obesity is associated with an increased fall risk compared with either condition alone, evidence regarding sex-specific associations remains limited. This study aimed to examine the sex-specific associations between sarcopenia, obesity parameters, and falls among older Korean community-dwellers. : This cross-sectional study analyzed baseline data from the Korean Frailty and Aging Cohort Study, including 2039 participants aged 70-84 years (men, 973; women, 1066). Sarcopenia was defined using the Asian Working Group for Sarcopenia 2025 criteria, and obesity was categorized as general (body mass index and percentage body fat [PBF]) or central obesity (waist circumference [WC] and conicity index [C-index]). Falls were assessed by self-report. Logistic regression analyses were performed after adjusting for potential confounders. Among 2039 participants, 395 (19.4%) reported falls. In the total population, higher PBF and C-index were independently associated with increased fall risk after adjustment. Men showed significantly higher odds of falls with low handgrip strength, high WC, PBF, and C-index than women. In women, only low appendicular skeletal muscle mass index was independently associated with falls. Sarcopenic obesity was not significantly associated with falls in either sex. Although sarcopenic obesity itself was not independently associated with falls in either sex, distinct sex-specific associations were observed between individual components of sarcopenia, obesity, and fall risk among older Korean adults. Reduced muscle strength and central obesity were more strongly associated with falls in men, whereas reduced muscle mass was independently associated with falls in women. These findings suggest that sex-specific approaches targeting muscle function and body composition may be important for fall prevention in aging populations.
Determination of 8-OHdG and IL-6 Levels, and of APE1 and XRCC1 DNA Repair Gene Variants, in Patients with Migraine.
Gul T, Kaygisiz S, Gulbay G … +1 more , Kaya Y
Medicina (Kaunas) · 2026 Jun · PMID 42356112 · Full text
Migraine is a chronic, throbbing type of headache that affects large populations worldwide. This condition is associated with neuroinflammation. : In this study, polymorphism analyses were performed by KASP PCR. Serum in...
Migraine is a chronic, throbbing type of headache that affects large populations worldwide. This condition is associated with neuroinflammation. : In this study, polymorphism analyses were performed by KASP PCR. Serum interleukin-6 (IL-6) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels were measured using kits based on the enzyme-linked immunosorbent assay (ELISA) principle. In the Asp148Glu (rs1130409) gene polymorphism analysis, the frequency of the mutant G (Glu) allele was 93.1% and 48.0% in the control and migraine populations, respectively, while the frequency of the wild-type T (Asp) allele was 6.9% and 52.0% ( < 0.001). The frequency of the T/T (Asp/Asp) genotype was high in the migraine group ( < 0.001), while the frequency of the G/G (Glu/Glu) genotype was higher in the control group at 86.2%, compared to the migraine group ( < 0.001). The total frequency of the T/G+ G/G (Asp/Glu+Glu/Glu) composite genotype was determined to be 65.9% in the control group and 34.1% in the migraine group ( < 0.001). There was no statistical difference in allele and genotype frequency between the control and migraine groups for the Arg399Gln (rs25487) gene polymorphism. Serum 8-OHdG and IL-6 levels were comparable between the groups, with no statistically significant differences observed. Future studies with larger and more homogeneous populations are needed to further elucidate the potential interactions between inflammatory processes and DNA damage in migraine. Consideration of attack duration and environmental exposures may improve interpretation of biomarker variability. Expanding the analysis to additional DNA repair gene polymorphisms may also contribute to a better understanding of the molecular background of migraine and the evaluation of potential biomarkers.
Insomnia as a Public Health Issue: Sociomedical Determinants in the Adult Population of Serbia.
Murić N, Bukumirić Z, Murić M … +5 more , Radovanović S, Ristić J, Djoković D, Djordjić M, Janjić V
Medicina (Kaunas) · 2026 Jun · PMID 42356111 · Full text
: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symp...
: Insomnia is a prevalent sleep disorder with substantial public health implications, yet epidemiological data from Serbia remain limited. This study aimed to assess the prevalence of clinically significant insomnia symptoms in the adult population of Serbia and to examine associated sociodemographic, comorbidity, psychosocial, and lifestyle factors. : A cross-sectional study was conducted from September 2023 to September 2025, including 2577 adults aged 18-89 years across Serbia. Insomnia symptom severity was measured using the Insomnia Severity Index (ISI), with scores ≥ 15 indicating clinically significant insomnia symptoms. Sociodemographic, comorbidity, psychosocial, and lifestyle factors were assessed via self-reported questionnaires. Multivariable logistic regression with LASSO variable selection was used to identify factors independently associated with clinically significant insomnia symptoms. : The prevalence of clinically significant insomnia symptoms (ISI ≥ 15) was 10.9%. Independent factors associated with clinically significant insomnia symptoms included being single (OR = 1.54) or divorced (OR = 1.75), lower educational attainment (OR = 0.71 per level increase), being retired (OR = 1.83) or a student (OR = 1.66), dermatological comorbidities (OR = 2.99), use of anxiolytic medications (OR = 2.44), exposure to stressful life events (OR = 1.88), engagement in late-night activities (OR = 1.37), consumption of coffee/tea (OR = 2.22), energy drink consumption (OR = 1.52), and late-night eating habits (OR = 1.27). : Clinically significant insomnia symptoms among adults in Serbia are influenced by a complex interplay of sociodemographic, comorbidity, psychosocial, and lifestyle factors. These findings underscore the need for integrated approaches that address both medical and modifiable behavioral determinants in the prevention and management of insomnia symptoms.
Cervical Multifidus Fatty Degeneration and Bony Foraminal Stenosis Are Associated with Unsuccessful Response to Stellate Ganglion Block in Cervical Radicular Pain: A Retrospective Study.
Kwon HJ, Choi D, Yi SW … +5 more , Lee JS, Shin JW, Choi SS, Kim DH, Kim CS
Medicina (Kaunas) · 2026 Jun · PMID 42356110 · Full text
: Ultrasound-guided stellate ganglion block is a promising alternative intervention for cervical radicular pain. However, factors associated with treatment responses remain unknown. This single-center, retrospective stud...
: Ultrasound-guided stellate ganglion block is a promising alternative intervention for cervical radicular pain. However, factors associated with treatment responses remain unknown. This single-center, retrospective study aimed to identify clinical and radiological factors associated with treatment response to stellate ganglion block in patients with cervical radicular pain. : This study included patients with cervical radicular pain who underwent ultrasound-guided stellate ganglion block. Successful response was defined as a ≥4-point or ≥50% reduction in the numerical rating scale score at 3 months post-procedure compared with the pre-procedural baseline. Patients who did not meet these criteria or underwent additional interventional procedures for persistent cervical radicular pain within 3 months were classified as unsuccessful responders. Logistic regression analysis was performed to identify factors associated with treatment response. : Multivariable logistic regression analysis demonstrated that substantial cervical multifidus fatty degeneration, defined as Goutallier grade ≥2 of the cervical multifidus muscles (vs. minimal fatty degeneration, odds ratio (OR) 0.23, 95% confidence interval (CI): 0.08-0.66, = 0.007) and bony hypertrophy at the uncovertebral or facet joint as the primary etiology of foraminal stenosis (vs. disc herniation, OR 0.35, 95% CI: 0.14-0.87, = 0.024) were independently associated with lower odds of a successful response to stellate ganglion block. Steroid use was not significantly associated with treatment response (OR 0.52, 95% CI: 0.18-1.49, = 0.223). The successful response rate declined progressively with the number of risk factors: 94.7% (18/19), 50.0% (22/44), and 40.7% (11/27) for zero, one, and two factors, respectively ( < 0.001). : Substantial cervical multifidus fatty degeneration and foraminal stenosis attributable to bony hypertrophy may be associated with lower odds of a successful response to stellate ganglion block in patients with cervical radicular pain. These factors require prospective validation before routine clinical implementation.
Interactive Effects of HDL Cholesterol and hs-CRP in Relation to Cardiometabolic Risk Clustering Among Middle-Aged Adults.
Hwang H, Bae G, Jang K
Medicina (Kaunas) · 2026 Jun · PMID 42356109 · Full text
: Cardiometabolic risk factors frequently cluster and substantially increase the risk of cardiovascular disease. While high-density lipoprotein cholesterol (HDL-C) and systemic inflammation, measured by high-sensitivity...
: Cardiometabolic risk factors frequently cluster and substantially increase the risk of cardiovascular disease. While high-density lipoprotein cholesterol (HDL-C) and systemic inflammation, measured by high-sensitivity C-reactive protein (hs-CRP), are independently associated with cardiometabolic risk, whether systemic inflammation modifies the association between HDL-C and cardiometabolic risk clustering (CMRC) remains unclear. This study aimed to examine the independent associations of HDL-C and hs-CRP with CMRC and to evaluate the multiplicative product interaction between HDL-C and natural log-transformed hs-CRP in relation to CMRC among middle-aged adults. : This cross-sectional study used data from 2283 adults aged 40-64 years who participated in the 2024 Korea National Health and Nutrition Examination Survey. CMRC was defined as the presence of ≥2 cardiometabolic risk factors. HDL-C and hs-CRP were analyzed as continuous variables. Complex sample logistic regression analyses were performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs), including a multiplicative product interaction term calculated as HDL-C × ln hs-CRP. : The prevalence of CMRC was 46.4%. HDL-C was inversely associated with CMRC (OR = 0.946, 95% CI = 0.937-0.956, < 0.001), whereas ln hs-CRP was positively associated with CMRC (OR = 1.224, 95% CI = 1.020-1.468, = 0.030). The HDL-C × ln hs-CRP product interaction term was significantly associated with CMRC (OR = 1.005, 95% CI = 1.001-1.009, = 0.008). This finding indicates that the association between HDL-C and CMRC may vary across levels of ln hs-CRP, but it does not indicate a direct association between HDL-C and ln hs-CRP. : HDL-C and ln hs-CRP were independently associated with CMRC. The significant HDL-C × ln hs-CRP product interaction term suggests possible statistical effect modification of the HDL-C-CMRC association by systemic inflammatory status. These findings should be interpreted cautiously and do not establish a causal or mechanistic relationship.
Validation of Blood-Based Biomarkers After Mild Traumatic Brain Injury with GCS 15 in a Singapore Emergency Department: An Observational Study.
Kuan WS, Yau YW, Lim DXY … +4 more , Yeoh CK, Cheung NMT, Lim HXY, Chua MT
Medicina (Kaunas) · 2026 Jun · PMID 42356108 · Full text
: Traumatic brain injury (TBI) affects millions of people worldwide. The Glasgow Coma Scale (GCS) is commonly used to characterize its severity. Head computed tomography (CT) is frequently the diagnostic imaging modality...
: Traumatic brain injury (TBI) affects millions of people worldwide. The Glasgow Coma Scale (GCS) is commonly used to characterize its severity. Head computed tomography (CT) is frequently the diagnostic imaging modality of choice. Recently, blood-based biomarkers such as ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) have emerged as possible adjuncts to head CT in evaluating mild TBI (mTBI). We aim to validate the performance of the Abbott Alinity i TBI test (UCH-L1 and GFAP) compared to head CT in an Asian cohort with mTBI and GCS 15. : This prospective observational study was conducted at a tertiary academic medical center from 2 December 2024 to 19 March 2025. Patients aged 21 years and above who sustained head injury within 12 h of ED attendance had GCS of 15 and required head CT as per attending physician were eligible. Plasma was separated from whole blood within 10 min of collection and immediately stored at -20 °C. UCH-L1 and GFAP levels were analyzed in batches within 28 days of recruitment at the hospital central laboratory using the Alinity i TBI test. : Among 120 patients enrolled, there was predominance of males (55.8%, 67/120) and Chinese ethnicity (75.8%, 91/120). The median age was 73 (interquartile range [IQR] 56 to 79) years. Overall incidence of positive head CT was 9.2% (11/120); all 11 patients had positive Alinity i TBI tests. The sensitivity and negative predictive value of the biomarkers in our cohort were both 100% (95% confidence intervals [CIs] 71.5% to 100% and 78.2% to 100%, respectively), specificity 13.8% (95% CI 7.9% to 21.7%) and positive predictive value 10.5% (95%CI 5.4% to 18%). Exploratory post hoc analysis suggested that GFAP alone, at the prespecified assay threshold, was associated with modestly higher specificity [21.1% (95% CI 13.9% to 30.0%)] in this cohort. : The Alinity i TBI test can safely rule out intracranial injury in patients with mTBI and GCS 15 presenting within 12 h of injury. However, specificity was low, limiting its ability to reduce head CT use in its current form. Exploratory post hoc analyses of the individual biomarkers, particularly GFAP alone, should be interpreted cautiously. Future studies should focus on optimizing specificity while maintaining a high degree of sensitivity.
Prevalence and Factors Associated with Insomnia Among Healthcare Workers in Kazakhstan During the COVID-19 Pandemic: A Cross-Sectional Study.
Aryntayeva N, Shonbay K, Koru-Sengul T … +7 more , Bagiyarova F, Aimbetova G, Zhang G, Umbetkulova S, Zhumagaliuly A, Baisugurova V, Karibayeva I
Medicina (Kaunas) · 2026 Jun · PMID 42356107 · Full text
: Healthcare workers (HCWs) involved in the COVID-19 response are at increased risk of mental health disturbances, including sleep disorders. This study aimed to assess the prevalence and predictors of insomnia among HCW...
: Healthcare workers (HCWs) involved in the COVID-19 response are at increased risk of mental health disturbances, including sleep disorders. This study aimed to assess the prevalence and predictors of insomnia among HCWs in Almaty, Kazakhstan. : A cross-sectional study was conducted between 11 and 26 September 2021, including 553 HCWs. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI). The primary binary outcome was defined as an ISI score ≥ 10, while ISI ≥ 15 was used descriptively to indicate moderate-to-severe insomnia symptoms. Associations were evaluated using chi-square tests and multivariable logistic regression models. Statistical significance was set at < 0.05. : Overall, 38.10% of HCWs with complete ISI data had insomnia symptoms based on the predefined ISI ≥ 10 threshold. In multivariable analysis, Kazakh nationality (AOR = 2.11, 95% CI: 1.05-4.23), advanced education (AOR = 2.03, 95% CI: 1.13-3.65), physician role (AOR = 4.92, 95% CI: 1.25-19.30), and working with COVID-19 patients for >1 year (AOR = 2.28, 95% CI: 1.33-3.89) were significantly associated with increased odds of insomnia. : Insomnia symptoms were common among surveyed HCWs during the COVID-19 pandemic and were associated with selected demographic and occupational characteristics, including professional role, education level, and duration of work with COVID-19 patients. These findings highlight the need for targeted mental health interventions and structural support systems for HCWs in Kazakhstan.
Otogenic Lateral Sinus Thrombosis: Controversies and Current Management Strategies.
Bizdu-Branovici AM, Gherasie L, Zica MD … +4 more , Rusescu A, Ionița IG, Hainaroșie R, Zainea V
Medicina (Kaunas) · 2026 Jun · PMID 42356106 · Full text
: Otogenic lateral sinus thrombosis (OLST) is a rare but potentially life-threatening intracranial complication of middle-ear infection. Despite advances in imaging, antimicrobial therapy and otologic surgery, optimal ma...
: Otogenic lateral sinus thrombosis (OLST) is a rare but potentially life-threatening intracranial complication of middle-ear infection. Despite advances in imaging, antimicrobial therapy and otologic surgery, optimal management-particularly anticoagulation-remains controversial, and no standardized clinical guideline is available. : A structured narrative review was conducted using PubMed for English-language human studies published between 1 January 2015 and 31 January 2025. The search was repeated and documented during revision on 12 May 2026. Four searches were run separately; retrieved records were manually merged, and duplicate record occurrences were removed using PMID. The searches retrieved 83 records before deduplication; after removal of 19 duplicates, 64 unique records remained for title and abstract screening. Single case reports and review articles were excluded from the primary descriptive synthesis. SANRA principles guided review quality and transparency. Seven eligible studies comprising 140 confirmed OLST patients were analyzed descriptively; selected clinically relevant but non-comparable publications were retained for contextual discussion. : Most included cohorts were pediatric; one study included both pediatric and adult patients. Clinical presentation was heterogeneous and often attenuated by prior antibiotic exposure. Contrast-enhanced CT was frequently used initially, whereas MRI/MRV was most informative for confirming thrombus extent and follow-up. Broad-spectrum intravenous antibiotics and surgical source control represented core treatment. Anticoagulation was reported in six studies, most often with low molecular weight heparin, but indications and duration varied substantially. Outcomes were generally favorable, although visual impairment, hearing loss, behavioral sequelae and incomplete radiological recanalization were reported. : OLST management should be individualized according to disease severity, thrombus extent, septic status, and patient-specific risk factors. Antibiotics and source control are essential, while anticoagulation should be considered selectively. A practical management algorithm is proposed, but prospective multicenter data are needed.
Nutritional Status Is Associated with Bone Mineral Density, Vitamin D Levels, and Bone Turnover Markers in Patients with Proximal Femoral Fragility Fractures: A Retrospective Observational Study.
Iinuma M, Hideshima T, Machida S … +4 more , Uehara K, Karube T, Sato K, Haraguchi N
Medicina (Kaunas) · 2026 Jun · PMID 42356105 · Full text
: Malnutrition is common among older adults with fragility fractures and is linked to poor clinical outcomes in orthopedic surgery. However, the association between nutritional status and bone-related parameters, includi...
: Malnutrition is common among older adults with fragility fractures and is linked to poor clinical outcomes in orthopedic surgery. However, the association between nutritional status and bone-related parameters, including bone mineral density (BMD) and bone turnover markers, remains inadequately characterized in this population. This study evaluated these associations in patients with proximal femoral fragility fractures. : In total, 108 patients who underwent surgery for proximal femoral fragility fractures were retrospectively analyzed. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. BMD was measured at the femoral neck of the proximal femur and the lumbar spine using dual-energy X-ray absorptiometry. Serum 25-hydroxyvitamin D (25[OH]D) and bone turnover markers, including total procollagen type I N-terminal propeptide and tartrate-resistant acid phosphatase 5b, were also evaluated. Correlation analyses, group comparisons, and multivariate linear regression analysis were performed to identify factors independently associated with femoral neck BMD. : GNRI and PNI were significantly positively correlated with femoral neck BMD (r = 0.48 and r = 0.26, respectively; both < 0.01), while the CONUT score showed a significant negative correlation (r = -0.27, < 0.01). Nutritional indices were not significantly correlated with lumbar spine BMD. Patients classified as malnourished by GNRI or PNI had significantly lower femoral neck BMD and serum 25(OH)D and higher bone turnover markers than well-nourished patients. Multivariate linear regression analysis revealed that GNRI, PNI, and CONUT score remained independently associated with femoral neck BMD after adjusting for age, sex, and body mass index. : Nutritional status assessed by hematological indices was significantly associated with femoral neck BMD and bone metabolism markers in patients with proximal femoral fragility fractures. Findings underscore the importance of nutritional status in bone health and should be considered in the management of osteoporosis and fragility fractures.
Comparison of the Efficacy of Intra-Articular Polyacrylamide Hydrogel and the Cross-Linked Hyaluronic Acid/Chondroitin Sulfate Combination in Treating Advanced-Stage Knee Osteoarthritis.
Altıntaş M, Ateş O, Soy F … +2 more , Mirzaoğlu T, Sarıyıldız MA
Medicina (Kaunas) · 2026 Jun · PMID 42356104 · Full text
: Polyacrylamide hydrogel (PAAG) is still underresearched, and few human studies have validated its efficacy in knee osteoarthritis (OA), particularly in advanced stages. The aim of this study was to compare the efficacy...
: Polyacrylamide hydrogel (PAAG) is still underresearched, and few human studies have validated its efficacy in knee osteoarthritis (OA), particularly in advanced stages. The aim of this study was to compare the efficacy of intra-articular PAAG with that of the widely used cross-linked chondroitin sulfate/hyaluronic acid (HA/CS) combination in treating knee OA in a retrospective trial. : A total of 127 patients diagnosed with grade 3 or 4 knee OA according to the Kellgren-Lawrence scale were included. The first group received an intra-articular injection of the cross-linked HA (60 mg)/CS (90 mg) combination, whereas the second group was administered 6 mL of PAAG. The outcome measures, which were assessed at baseline, 3 months, and 12 months, were knee pain severity measured with the visual analog scale (VAS), range of motion (ROM), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale score, and the Pittsburgh Sleep Quality Index (PSQI). : At three months, the PAAG group demonstrated significantly lower pain and WOMAC scores than the HA/CS group, while ROM and sleep quality scores were not significantly different at either 3 or 12 months. Within-group comparisons revealed significant reductions in pain, WOMAC, and sleep scores in both groups over time, but no significant improvement in ROM was detected in either group. : Compared with HA/CS injection, intra-articular PAAG injection significantly improved the VAS and WOMAC scores in advanced knee OA patients at three months. However, the outcomes for all the parameters were similar in the two groups at 12 months.
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