Medicina[JOURNAL]
Sun
200 papers
Comparative Impact of Clear Aligners and Traditional Fixed Appliances on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis.
Lalli E, Caramaschi E, Nieri A … +6 more , Vitale S, Ledda M, Porcu G, Delogu PL, Verdecchia A, Spinas E
Medicina (Kaunas) · 2026 Jun · PMID 42356103 · Full text
: The impact of orthodontic appliances on oral health-related quality of life (OHRQoL) has gained increasing attention, particularly in relation to patient-centered outcomes. Clear aligners (CAs) are often perceived as m...
: The impact of orthodontic appliances on oral health-related quality of life (OHRQoL) has gained increasing attention, particularly in relation to patient-centered outcomes. Clear aligners (CAs) are often perceived as more comfortable than fixed appliances (FAs), although evidence remains limited and heterogeneous. This systematic review and meta-analysis aimed to compare the effects of CAs and FAs on OHRQoL in patients with Angle class I malocclusion and to further evaluate the reliability of the findings using trial sequential analysis (TSA). : This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251051003). A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL was conducted. Only randomized controlled trials comparing CAs and FAs and reporting OHRQoL outcomes (OHIP-14) were included. Random-effects meta-analyses were performed on early changes in OHRQoL. TSA was applied to control for type I and II errors and to evaluate the sufficiency of the cumulative evidence. : Two randomized controlled trials (n = 74) were included in the quantitative synthesis. Both treatments were associated with a transient deterioration in OHRQoL after appliance placement. Meta-analysis showed statistically significant improvements favoring CAs in psychological discomfort ( = 0.007) and psychological disability ( < 0.001), while no significant differences were observed for other domains or for overall OHRQoL. Exploratory TSA suggested an early signal in favor of psychological outcomes, with the cumulative Z-curve crossing the monitoring boundary; however, given the very small number of included trials, these findings should be regarded as preliminary and hypothesis-generating rather than confirmatory. In contrast, for most other outcomes, the required information size was not reached and results remained inconclusive. For handicap, TSA suggested that a clinically relevant difference is unlikely. : Clear aligners may provide a modest short-term advantage over fixed appliances in psychological aspects of OHRQoL, while no consistent differences are observed in physical or overall domains, based on very limited evidence. TSA suggests a preliminary signal in psychological outcomes but highlights insufficient evidence for most other domains. These results should be interpreted with caution, and further high-quality randomized trials are needed.
Multiparametric MRI for Assessing the Tumor Microenvironment in Head and Neck Cancer: A Narrative Review.
Csutak C, Schiau C, Dinu C … +5 more , Stoia S, Rusu GM, Lenghel LM, Donci DD, Iojiban M
Medicina (Kaunas) · 2026 Jun · PMID 42356102 · Full text
Head and neck cancers are heterogeneous malignancies with variable biological behavior and treatment response, contributing to high morbidity and mortality. Conventional imaging techniques are limited in their ability to...
Head and neck cancers are heterogeneous malignancies with variable biological behavior and treatment response, contributing to high morbidity and mortality. Conventional imaging techniques are limited in their ability to capture tumor biology, highlighting the need for advanced functional imaging. This review aims to evaluate the role of multiparametric magnetic resonance imaging (MRI) in characterizing the tumor microenvironment. A narrative review was conducted based on a targeted literature search of databases, including PubMed and Google Scholar. Studies addressing advanced MRI techniques for assessing tumor cellularity, vascularity, molecular features, and oxygenation were selected and analyzed. Perfusion techniques, such as dynamic contrast-enhanced MRI (DCE-MRI) and arterial spin labeling (ASL), provide a quantitative assessment of tumor vascularity and show value in predicting treatment response. Diffusion-based methods, including diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), enable evaluation of tissue cellularity and heterogeneity. Molecular approaches, such as chemical exchange saturation transfer (CEST) and amide proton transfer (APT), offer insights into protein content and proliferation. Oxygenation-sensitive techniques, such as blood oxygenation level dependent MRI (BOLD MRI) and oxygen-enhanced MRI (OE-MRI), allow non-invasive assessment of tumor hypoxia. Multiparametric MRI provides a comprehensive and biologically relevant evaluation of the tumor microenvironment in head and neck cancer, with potential to improve treatment prediction and support personalized therapeutic strategies.
Nonoperative Management of Pediatric Liver Injury: Current Evidence, Clinical Indications, and Outcomes.
Dănilă MD, Țocu L, Ștefănescu BI … +9 more , Dimofte F, Luțenco V, Stavăr Matei L, Berbece SI, Chiscop I, Matei MN, Iacobescu P, Savastre VR, Țocu G
Medicina (Kaunas) · 2026 Jun · PMID 42356101 · Full text
: Pediatric liver injury is a frequent solid organ injury after blunt abdominal trauma, and its management has progressively shifted toward nonoperative care in hemodynamically stable children. This narrative review aims...
: Pediatric liver injury is a frequent solid organ injury after blunt abdominal trauma, and its management has progressively shifted toward nonoperative care in hemodynamically stable children. This narrative review aims to synthesize current evidence regarding diagnosis, eligibility for nonoperative management, inpatient monitoring, outcomes, complications, escalation criteria, and post-discharge care in pediatric liver trauma. : A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science, with supplementary screening through Google Scholar and reference lists. Publications from January 2000 to December 2025 were considered. The literature was analyzed descriptively and thematically, without formal risk-of-bias assessment, evidence grading, or quantitative meta-analysis. : The available evidence supports nonoperative management for most children with blunt liver injury who are hemodynamically stable or show a sustained response to initial resuscitation. Eligibility depends primarily on physiological status, clinical evolution, associated injuries, and institutional capability rather than imaging grade alone. Nonoperative management requires structured clinical, hemodynamic, and laboratory reassessment, with follow-up imaging reserved for selected cases based on clinical evolution or suspected complications. Delayed hemorrhage, bile leak, biloma, pseudoaneurysm, hemobilia, infection, and failure of nonoperative management remain clinically relevant and may require repeat imaging, interventional radiology, or surgery. : Nonoperative management should be understood as an active organ-preserving strategy based on careful selection, serial reassessment, and immediate access to escalation when needed. Further pediatric liver-specific studies are required to standardize monitoring, repeat imaging, intervention thresholds, activity restriction, and post-discharge follow-up.
Acute Cholecystitis in Pregnancy: A Review of Incidence, Risk Factors, Diagnostic Challenges, Management, and Maternal-Fetal Outcomes.
Sabonyte-Balsaitiene Z, Sleivyte U, Volochovic J … +1 more , Beisa A
Medicina (Kaunas) · 2026 Jun · PMID 42356100 · Full text
Acute cholecystitis occurs in approximately 0.3-0.6% of pregnant women and may pose significant risks to both the mother and the fetus. The condition is most commonly caused by gallstone-induced obstruction of the cystic...
Acute cholecystitis occurs in approximately 0.3-0.6% of pregnant women and may pose significant risks to both the mother and the fetus. The condition is most commonly caused by gallstone-induced obstruction of the cystic duct, with pregnancy-related hormonal and physiological changes contributing to its development. The aim of this review was to summarize current evidence on the pathogenesis, diagnostic challenges, and management of acute cholecystitis during pregnancy, as well as to evaluate associated maternal and fetal outcomes. This study was conducted as a structured narrative review incorporating elements of a systematic literature search. A comprehensive search was performed in PubMed (MEDLINE), with additional sources identified through Google Scholar. Articles published between 2015 and 2025 were included. Eligible studies addressed pathogenesis, risk factors, diagnosis, management, or maternal and fetal outcomes. A total of 55 studies were included and analyzed qualitatively. Acute cholecystitis during pregnancy presents diagnostic challenges due to nonspecific symptoms that may overlap with normal pregnancy-related conditions. Ultrasound remains the first-line imaging modality. Conservative management is associated with high recurrence and rehospitalization rates, as well as increased risks of adverse fetal outcomes, including preterm delivery, fetal growth restriction, and low birth weight. In contrast, laparoscopic cholecystectomy is associated with lower complication rates and improved outcomes, and can be safely performed during all trimesters when clinically indicated. Acute cholecystitis during pregnancy requires careful clinical evaluation and individualized management. Current evidence suggests that laparoscopic cholecystectomy is a safe and effective treatment option, and is widely considered the preferred approach in most cases. Conservative management may be appropriate in selected mild cases but is associated with a higher risk of recurrence and adverse outcomes.
Remineralization of Initial Carious Lesions Using Peptides: A Comprehensive Review.
Santamaría RM, Alkilzy M, Splieth CH … +1 more , Schmoeckel J
Medicina (Kaunas) · 2026 Jun · PMID 42356099 · Full text
Initial carious lesions represent a reversible stage of the caries process in which non-operative strategies can prevent lesion progression and preserve dental hard tissues. This comprehensive review provides an overview...
Initial carious lesions represent a reversible stage of the caries process in which non-operative strategies can prevent lesion progression and preserve dental hard tissues. This comprehensive review provides an overview of peptide-based approaches for the management of initial carious lesions, with emphasis on self-assembling peptides. The literature was identified through PubMed electronic searches complemented by manual screening of reference lists. Only randomized clinical trials and controlled clinical studies published in English were included. The PICOS framework guided the structure of the review, focusing on patients of any age with initial carious lesions, peptide-based interventions aimed at enamel remineralization, comparisons with placebo, alternative treatments, or standard preventive care (e.g., fluoride products), and outcomes related to de-/remineralisation. Overall, the available evidence suggests that peptide-based strategies can mimic natural biomineralization and promote subsurface hydroxyapatite formation. Among the investigated approaches, the self-assembling peptide P11-4 is the most extensively studied. Evidence supports its safety and its potential to enhance initial carious lesion remineralisation, with possible advantages over fluoride alone in selected cases. In conclusion, peptide-based potentially regenerative approaches, particularly P11-4, represent a promising adjunct in minimally invasive caries management, although further long-term and comparative clinical studies are needed to define their role in routine dental practice.
Electronic Medical Record Data-Based Analysis of Discharge Pathways and Functional Recovery by Surgical Procedure Among Patients with Hip-Related Fractures in a Convalescent Rehabilitation Hospital: A Retrospective Cohort Study.
Park YH, Woo BS, Lee JH
Medicina (Kaunas) · 2026 Jun · PMID 42356098 · Full text
: Discharge planning after hip-related fracture surgery may depend on both the surgical method and functional recovery achieved during convalescent rehabilitation. This single-center retrospective cohort study aimed to d...
: Discharge planning after hip-related fracture surgery may depend on both the surgical method and functional recovery achieved during convalescent rehabilitation. This single-center retrospective cohort study aimed to determine whether discharge pathways differed according to surgical procedure and whether functional recovery patterns differed according to surgical procedure and discharge pathways among patients admitted for convalescent rehabilitation after hip-related fracture surgery. : This retrospective cohort study reviewed the EMRs of patients admitted to a convalescent rehabilitation hospital between January 2021 and June 2025 after hip-related fracture surgery. Surgical groups were hip hemiarthroplasty (HA), total hip arthroplasty (THA), and internal fixation (IF). Discharge pathways were classified into three categories: home discharge, transfer to an acute-care hospital, and transfer to a long-term care hospital. In this study, home discharge was operationally defined as discharge to the patient's home or transfer to a nursing hospital. Functional outcomes included the functional ambulation category (FAC), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE); complete-case analysis was applied for functional outcomes. : In the overall postoperative cohort (N = 445), discharge pathway distributions differed across surgical groups. In the complete-case traumatic hip-related fracture cohort (N = 243), all groups showed significant improvements from admission to discharge in FAC, BBS, MBI, and MMSE. Between-group comparisons of change scores by surgical method were generally modest. In contrast, discharge pathways showed clearer associations with recovery. Patients achieving home discharge demonstrated greater improvements in FAC, BBS, and MBI measures than those transferred to acute care or nursing homes. : Functional recovery was observed across all surgical groups during convalescent rehabilitation. Discharge disposition appeared to be more closely associated with recovery in gait, balance, and ADL performance than with surgical method alone; however, this finding should be interpreted cautiously because discharge decisions may also be influenced by patient and social factors.
Calculation of Ejection Fraction Using Cardiac Computed Tomography: Clinical Evolution, Reliability, and Technological Challenges-A Narrative Review.
Steffani S, Piscione M, Gaudio D … +6 more , Meghnagi G, Crignola GG, Asmundo L, Tagliati C, Laudazi M, Chiocchi M
Medicina (Kaunas) · 2026 Jun · PMID 42356097 · Full text
: The Ejection Fraction (EF) represents a fundamental pillar for the phenotypic classification and clinical management of cardiovascular diseases. Although trans-thoracic echocardiography (TTE) acts as the first-line exa...
: The Ejection Fraction (EF) represents a fundamental pillar for the phenotypic classification and clinical management of cardiovascular diseases. Although trans-thoracic echocardiography (TTE) acts as the first-line examination and cardiac magnetic resonance (CMR) is the reference gold standard, cardiac computed tomography (CCT) has undergone a technological evolution. The advent of wide-detector scanners and artificial intelligence (AI) models has enabled CCT to transition from a purely morphological tool to a modality capable of comprehensive, three-dimensional morpho-functional assessments. : This narrative review evaluates the literature across Scopus, MEDLINE, and Web of Science regarding the calculation of biventricular function and EF using CCT. It provides an updated summary of current clinical applications, technological advancements, and comparative diagnostic reliability against TTE and CMR. : The CCT "one-stop-shop" concept allows for the simultaneous acquisition of anatomical data and systolic function metrics (EDV, ESV, SV, EF), optimizing clinical workflows at no additional cost. Being intrinsically three-dimensional, CCT bypasses the geometric assumptions and apical foreshortening artifacts typical of 2D-TTE, demonstrating high volumetric concordance with CMR. Nevertheless, structural limitations persist, primarily regarding ionizing radiation exposure, contrast media toxicity, dependence on heart rhythm stability, and lower temporal resolution compared to CMR. : EF determination via CCT has achieved technical maturity and clinical validation. While it does not intend to replace TTE or CMR, it offers synergistic data when integrated with primary anatomical indications. Furthermore, AI integration has been shown to potentially automate this workflow, transforming CCT into an opportunistic screening tool for subclinical cardiac dysfunction.
The Association Between Abnormal Electrocardiogram Findings and the Ankle Brachial Index.
Li B, Khalil AM, Bakeer A … +3 more , Zamzam A, Abdin R, Qadura M
Medicina (Kaunas) · 2026 Jun · PMID 42356096 · Full text
: Peripheral artery disease (PAD) is a common manifestation of systemic atherosclerosis associated with significant morbidity and mortality, yet it remains underdiagnosed due to limited routine screening and its often-as...
: Peripheral artery disease (PAD) is a common manifestation of systemic atherosclerosis associated with significant morbidity and mortality, yet it remains underdiagnosed due to limited routine screening and its often-asymptomatic presentation. Although the ankle-brachial index (ABI) is the gold standard diagnostic tool for PAD, its use may be limited in some settings because it requires specialized equipment and trained personnel. In contrast, the electrocardiogram (ECG) is widely available and routinely performed. Given that ECG abnormalities may reflect systemic cardiovascular disease, we investigated the association between ECG findings and ABI classification. : This retrospective case-control study analyzed patients with and without PAD who received care from outpatient vascular clinics between March 2018 and February 2022. PAD was defined as ABI ≤ 0.9 or toe-brachial index ≤ 0.67 with abnormal pedal pulses. The most recent ECG performed within one year of ABI measurement was retrieved for each patient and classified as normal, borderline, or abnormal according to standardized guideline recommendations. The association between ECG category and ABI classification was assessed using chi-square testing and multivariable logistic regression adjusted for age and sex, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Discriminatory performance of the ability of ECG findings to predict ABI classification was evaluated using the area under the receiver operating characteristic curve (AUROC) with 95% CI. Model calibration was assessed using the Hosmer-Lemeshow test. : Overall, 491 patients had paired ECG and ABI data. ECGs were categorized as abnormal (n = 345), borderline (n = 58), or normal (n = 88). The prevalence of abnormal ABI (≤0.9) was highest among patients with abnormal ECGs (45.8%), compared to borderline (34.5%) and normal ECGs (28.4%) ( = 0.0067). On multivariable logistic regression analysis adjusted for age and sex, abnormal ECG findings were associated with increased odds of abnormal ABI compared to normal ECGs (adjusted OR 2.07, 95% CI 1.24-3.46, = 0.005), whereas borderline ECGs were not (OR 1.31, 95% CI 0.64-2.68, = 0.455). ECG categorization demonstrated moderate discrimination (AUROC 0.73, 95% CI 0.68-0.78) and good calibration (Hosmer-Lemeshow χ 5.0, = 0.76) for predicting abnormal ABI. : In this retrospective case-control study, we found an association between abnormal ECG findings and abnormal ABI. These results support the concept that clinically significant ECG abnormalities may reflect systemic atherosclerotic burden rather than isolated cardiac pathology. Given the widespread availability and low cost of ECG testing, ECG interpretation may help identify patients who warrant further investigations, including PAD screening, vascular assessment, and risk-stratification, particularly in lower-resource settings without routine access to ABI testing. Prospective, multicenter studies are needed to validate these findings.
Psychological Burden and Psychosocial Stress in Younger and Middle-Aged Women with Prior Myocardial Infarction.
Stipčević M, Jurin I, Knežević Praveček M … +12 more , Selthofer-Relatić K, Dražić L, Lugarić M, Čančarević O, Manola Š, Hadžibegović I, Bešić KM, Matej Mahečić L, Radonić V, Pavlović A, Krčmar T, Trbušić M
Medicina (Kaunas) · 2026 Jun · PMID 42356095 · Full text
: Younger and middle-aged women may continue to describe psychological and psychosocial burden years after myocardial infarction (MI), yet multicenter real-world data remain limited on what women retrospectively report d...
: Younger and middle-aged women may continue to describe psychological and psychosocial burden years after myocardial infarction (MI), yet multicenter real-world data remain limited on what women retrospectively report during long-term follow-up. This study examined such reports in younger and middle-aged women with prior MI while explicitly accounting for delayed, heterogeneous follow-up timing and the non-standardized nature of symptom ascertainment. : We performed a cross-sectional analysis within a Croatian multicenter cohort of 957 women younger than 60 years hospitalized with STEMI or NSTEMI between 1 February 2020 and 28 February 2025. Psychological information was collected retrospectively during routine follow-up; the formal PHQ-4 instrument was not administered. A study-specific four-item summary informed by PHQ-4 content was described, and exploratory multivariable analyses modelled this summary as a continuous variable. Descriptive timing-stratified sensitivity analyses and a timing-restricted continuous-score sensitivity model were additionally performed. : Prior psychiatric diagnosis was recorded in 16.0% of women, post-MI psychiatric diagnosis in 31.4%, and any psychosocial stressor in 73.2%. Among women with complete item responses, the four-item summary showed a broad distribution rather than a discrete threshold pattern. In continuous-score analyses, higher observed summary values were associated with younger age, prior psychiatric diagnosis, any psychosocial stressor, non-partnered status, non-employment, pregnancy complications/adverse pregnancy outcomes, and greater peri-menopausal symptom burden. Median summary values were only modestly higher in the small ≤ 1-year stratum and were otherwise similar across the later follow-up strata. Higher summary values were also associated with lower odds of self-reported regular current statin-based lipid-lowering use. : These findings are best interpreted as exploratory data on retrospectively reported and currently endorsed long-term psychological and psychosocial burden years after MI, not as contemporaneous measures of recovery-phase psychopathology. Prospective studies with predefined assessment windows and validated instruments are needed.
Artificial Intelligence-Derived Electrocardiogram Analysis for Identification of Carbon Monoxide-Induced Cardiomyopathy: A Retrospective Study.
Yang H, Soh MS, Lee MS … +5 more , Choi S, Han S, Lee SE, Ko Y, Choi S
Medicina (Kaunas) · 2026 Jun · PMID 42356094 · Full text
: The diagnostic accuracy of an artificial intelligence (AI)-derived initial 12-lead electrocardiogram (ECG) analysis was evaluated for early carbon monoxide-induced cardiomyopathy (CO-CMP) risk detection. : Retrospectiv...
: The diagnostic accuracy of an artificial intelligence (AI)-derived initial 12-lead electrocardiogram (ECG) analysis was evaluated for early carbon monoxide-induced cardiomyopathy (CO-CMP) risk detection. : Retrospective medical data of carbon monoxide poisoning (COP) cases between 1 January 2015 and 31 December 2024 were screened for the primary outcome: odds ratio (OR) for echocardiographically confirmed CO-CMP among those with high-risk probability score per the AI-derived model. Secondary outcomes included left ventricular ejection fraction (LVEF) and AI-derived probability score, critical care requirements, including intubation and intensive care unit (ICU) admission, and cardiac arrest events. : A total of 51 patients with acute COP were included in the final analysis, with 13 (25.5%) being diagnosed with CO-CMP. The LVEF in the CO-CMP group was lower than that in the non-CO-CMP group (40.00 ± 13.80% vs. 63.76 ± 6.24%, < 0.001). The AI-derived probability score was higher in the CO-CMP group (11.3 [3.8-32.7] vs. 0.5 [0.2-2.2], < 0.001). Among cardiac biomarkers, troponin I (2.37 [0.32-7.88] vs. 0.06 [0.06-0.95] ng/mL, = 0.002) was higher in the CO-CMP group. Patients with CO-CMP required recurrent ventilator support (76.9% vs. 21.1%, < 0.001) and ICU admission (92.3% vs. 42.1%, = 0.003). In multivariable regression analysis, the AI-derived prediction model was independently associated with CO-CMP (OR 1.14; 95% confidence interval (CI) 1.02-1.27; = 0.017; Firth-penalized OR 1.11; 95% CI 1.03-1.25; < 0.001). Receiver operating characteristic analysis of the AI-derived model showed an area under the curve of 0.85 (95% CI 0.70-0.96) for the AI score alone and 0.92 (95% CI 0.83-0.99) for the Combined AI-cardiac marker model, with a sensitivity of 92.3% and specificity of 81.6%. Pairwise DeLong comparisons between the Combined AI model and comparator models did not reach statistical significance (Combined vs. AI-only, = 0.092; Combined vs. cardiac markers, = 0.052); however, the likelihood-ratio test for adding the AI probability score to the cardiac marker-only model demonstrated significant incremental information (χ = 13.68, < 0.001). : AI-based ECG analysis showed exploratory diagnostic association with LV systolic dysfunction observed in suspected CO-CMP patients. Given the limited sample size, low events-per-variable ratio, and lack of external validation, these findings suggest that AI-ECG analysis may provide incremental information for early cardiac risk stratification in selected patients.
Does Timing Matter? Impact of Time to Surgery on Pathologic Response in Gastric Cancer Patients Treated with Perioperative FLOT.
Dursun B, Kaya S, Aydın F … +1 more , Arıkök AT
Medicina (Kaunas) · 2026 Jun · PMID 42356093 · Full text
: The optimal timing of surgery after preoperative fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy (ChT) in gastric cancer (GC) remains unclear. We aimed to evaluate the association between time t...
: The optimal timing of surgery after preoperative fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) chemotherapy (ChT) in gastric cancer (GC) remains unclear. We aimed to evaluate the association between time to surgery (TTS) and pathological as well as survival outcomes in patients treated with perioperative FLOT. : This retrospective cohort study included 76 patients with locally advanced gastric or gastroesophageal junction (GEJ) adenocarcinoma who underwent curative-intent surgery after preoperative FLOT at a single tertiary center. TTS was defined as the interval between completion of preoperative FLOT and surgery. Patients were categorized into two groups according to TTS: ≤4 weeks and >4 weeks. Pathological response (PR) was assessed using the Becker tumor regression grading system. The primary endpoint was PR, including tumor regression grade and pathological complete response (pCR). Secondary endpoint was overall survival (OS). : The median TTS was 31 days (IQR, 21-47). Forty-five (59.2%) patients underwent surgery within 4 weeks. Favorable PR was more frequently observed in the ≤4-week group. Becker TRG 0-1 was significantly more common among patients undergoing surgery within 4 weeks compared with those undergoing surgery after more than 4 weeks (26.2% vs. 6.5%, = 0.03). Similarly, pCR was observed exclusively in the ≤4-week group (14.3% vs. 0%, = 0.02). ypN0 status was numerically higher in the ≤4-week group (54.7% vs. 32.2%, = 0.05). Postoperative complication rates did not differ significantly between groups (4.8% vs. 12.9%, = 0.17). In multivariable Cox regression analysis, TTS was not independently associated with OS, whereas poor tumor differentiation remained an independent predictor of worse survival (HR 2.57, 95% CI 1.17-5.63, = 0.01). : Among patients treated with preoperative FLOT, surgery within 4 weeks was associated with improved PR without an apparent increase in postoperative morbidity. However, earlier surgery was not independently associated with improved OS. These findings suggest that prolonged delay after preoperative FLOT may not be necessary in clinically recovered patients and support the need for prospective multicenter studies to define the optimal surgical interval in FLOT-treated GC.
Preoperative Hemoglobin Threshold as a Predictor of Transfusion Risk in Pregnant Patients: An Observational Study for Informing Patient Blood Management Strategies in a Tertiary Care Facility in Romania.
Marcu MA, Iacob A, Chițescu CL … +2 more , Olita MR, Tomescu DR
Medicina (Kaunas) · 2026 Jun · PMID 42356092 · Full text
Preoperative anaemia represents a key modifiable risk factor in obstetrics. Within the framework of Patient Blood Management (PBM), establishing precise hemoglobin (Hb) thresholds is essential for optimal clinical decisi...
Preoperative anaemia represents a key modifiable risk factor in obstetrics. Within the framework of Patient Blood Management (PBM), establishing precise hemoglobin (Hb) thresholds is essential for optimal clinical decision-making. This study aimed to assess the predictive value of preoperative hemoglobin levels and to determine the optimal cutoff associated with transfusion risk. A retrospective analysis was performed on 932 pregnant women. The association between preoperative hemoglobin, anticoagulant therapy, mode of delivery and maternal age with the need for red blood cell transfusion was evaluated using binary logistic regression and Receiver Operating Characteristic (ROC) curve analysis with the Youden index. Red blood cell transfusion was required in 5.2% (n = 48) of the study population. Logistic regression identified preoperative hemoglobin as the strongest independent predictor ( < 0.001, OR = 0.216, 95% CI: 0.153-0.306), indicating that each 1 g/dL increase in Hb reduced the likelihood of transfusion by 78.4%. Anticoagulant therapy and age were not significant independent predictors ( > 0.05). ROC analysis demonstrated excellent predictive performance, with an Area Under the Curve (AUC) of 0.875 (95% CI: 0.823-0.927, < 0.001). The optimal threshold for predicting transfusion risk was 10.9 g/dL (sensitivity: 89.6%, specificity: 60.5%). Preoperative hemoglobin concentration is the primary determinant of transfusion risk, outweighing the influence of clinical comorbidities. The integration of PBM protocols designed to sustain hemoglobin levels above 10.9 g/dL is essential to reduce perioperative transfusion requirements and to promote improved maternal safety and clinical outcomes.
Significance of the Aponeurotic Expansion of the Supraspinatus Tendon in Rotator Cuff Ruptures: An MR Arthrographic Study.
Ertogrul R, Ogul H, Yahsi Y … +4 more , Sakci Z, Dostbil A, Ozdemir M, Kantarci M
Medicina (Kaunas) · 2026 Jun · PMID 42356091 · Full text
: This study aimed to assess the association between the aponeurotic expansion of the supraspinatus tendon (AEST) and supraspinatus tendon tears utilizing magnetic resonance (MR) arthrography in an extensive patient coho...
: This study aimed to assess the association between the aponeurotic expansion of the supraspinatus tendon (AEST) and supraspinatus tendon tears utilizing magnetic resonance (MR) arthrography in an extensive patient cohort and to determine its clinical relevance. : All MR arthrography images were retrospectively assessed by two radiologists with expertise in arthrography. In both the AEST group and the comparison group consisting entirely of patients with rotator cuff tendon tears, the location and extent of the tear were documented, along with the distance between the tear and the AEST in the study group. In patients with AEST, it was also noted whether the tear extended to or structurally involved the AEST. : AEST was identified in 61 (7.4%) of the 827 MR arthrograms. The isolated supraspinatus tendon tear emerged as the most prevalent, representing 33.3% of patients with AEST. The triple combination of tears involving the supraspinatus, subscapularis, and infraspinatus accounted for 25.9% of patients with AEST. AEST tears alone were observed in just 3.3% of cases. The incidence of triple combination tears in patients with AEST was found to be significantly lower at 25.9% compared to 59.3% in the control group without AEST ( = 0.028). : In this study, the authors found that the incidence of combined tendon tears in patients with AEST was significantly lower compared to the control group. This result suggests that the AEST likely acts as a structural barrier limiting the anterior progression of rotator cuff tears, particularly toward the subscapularis tendon.
Multiparametric Ultrasound Assessment of Long-Term Liver Damage in COVID-19: Results of a Three-Year Follow-Up Study.
Radzina M, Putrins DS, Vanaga I … +4 more , Kolesova O, Buss A, Agera A, Viksna L
Medicina (Kaunas) · 2026 Jun · PMID 42356090 · Full text
Liver damage in COVID-19 is multifaceted, including liver steatosis and inflammation. Multiparametric ultrasound (mpUS) is an imaging modality that has the capacity to evaluate various facets of overall liver health and...
Liver damage in COVID-19 is multifaceted, including liver steatosis and inflammation. Multiparametric ultrasound (mpUS) is an imaging modality that has the capacity to evaluate various facets of overall liver health and is relatively accessible and thus is an excellent choice to determine parenchymal changes. A longitudinal prospective study was designed to evaluate long-term hepatic damage following COVID-19 using mpUS. Patients were assessed within a 3-6-month period after the initial episode of COVID-19 and subsequently had a follow-up after 3 years compared to a control group. Liver stiffness (2D-SWE), attenuation (ATI), and shear wave dispersion (SWD) were measured to quantify liver stiffness, steatosis, and tissue viscosity. A total of 129 patients were scanned at the baseline assessment, 90 patients in research group (58 patients had a follow-up) and 39 as a clinically healthy control group, and all were included in the follow-up for evaluation after 3 years. The mpUS evaluation in research group revealed a median SWE decrease from 5.04 ± 1.74 kPa to 4.59 ± 0.81 kPa and SWD decrease from 11.88 ± 1.73 m/s/kHz to 10.83 ± 1.49 m/s/kHz ( > 0.05); in contrast, median ATI values showed slight increase over time-0.56 ± 0.09 dB/cm/MHz to 0.60 ± 0.09 dB/cm/MHz ( > 0.05). Control group was stratified according to subsequent COVID-19 status. In both the COVID-negative and -positive subgroups SWE slightly increased from initial 4.55 ± 0.78 kPa to 4.8 ± 0.88 kPa and 4.7 ± 1.29 kPa, median SWD had a slight decrease from initial 10.80 ± 1.73 m/s/kHz to 10.15 ± 1.87 m/s/kHz and 10.6 ± 1.82 m/s/kHz ( > 0.05), and ATI increased significantly from initial 0.57 ± 0.08 dB/cm/MHz to 0.62 ± 0.09 dB/cm/MHz and 0.65 ± 0.07 dB/cm/MHz ( < 0.05), respectively. The study found that initially COVID-19-affected patients showed stable ATI and BMI values, no hepatic steatosis, normal SWE, and reduced dispersion which suggests resolving inflammation without fibrosis. Controls showed increased ATI and mild steatosis, likely linked to BMI and metabolic changes rather than direct viral liver injury.
Duraplasty Versus Bony Decompression in Adult Chiari I: Comparative Clinical and Morphometric Analysis.
Engin R, Tomakin F, Şener H … +5 more , Gökalp G, Köksal V, Baydın ŞS, Aras M, Çokluk C
Medicina (Kaunas) · 2026 Jun · PMID 42356089 · Full text
: The optimal surgical technique for Chiari type I malformation (CM-I) remains debated, particularly in patients without syringomyelia. While duraplasty (DP+) may enhance radiological outcomes, it can carry higher compli...
: The optimal surgical technique for Chiari type I malformation (CM-I) remains debated, particularly in patients without syringomyelia. While duraplasty (DP+) may enhance radiological outcomes, it can carry higher complication risks. We compared clinical, radiological, and morphometric outcomes after suboccipital decompression with DP+ and without duraplasty (DP-), with prespecified subgroup analyses by syringomyelia status. : Ninety-three consecutive adult CM-I underwent DP- (n = 54) or DP+ (n = 39) between 2014 and 2022. Pre- and post-operative MRI and neurological evaluations were obtained at 1 year. Functional recovery was assessed using the Chicago Chiari Outcome Scale (CCOS). Clinical and radiological outcomes, complication rates, and subgroup results (with vs. without syringomyelia) were compared. : Overall clinical improvement was observed in 92.5% of patients (DP-: 94.4%; DP+: 89.7%; > 0.05). Among patients without syringomyelia, clinical improvement remained high with DP-. Radiological benefit-including syrinx regression and mega cisterna magna formation-was greater with DP+ (64.1% vs. 24.1%; < 0.001), but this did not translate into improved functional outcomes ( > 0.05). Cerebellar slump occurred more often after DP+ (30.8% vs. 9.3%; < 0.05). Complication rates, particularly CSF-related events, were significantly higher with DP+ (17.9% vs. 3.7%, = 0.032). Morphometric expansion of the foramen magnum did not correlate with functional outcomes. : At 1-year follow-up, suboccipital decompression without duraplasty appears to provide comparable clinical improvement to DP+, with fewer complications, in selected CM-I patients without syringomyelia. Duraplasty offers radiological advantages, especially for syringomyelia, but at the cost of increased risk. Longer follow-up is necessary to determine the durability of these findings.
Predictive Value of End-Tidal CO, Arterial CO, CO Gap and Ratio for 30-Day Mortality in Emergency Department Intubations: A Prospective Analysis.
Efeoglu Sacak M, Unal E, Gorman O … +5 more , Ozkan A, Bayram N, Onur O, Akoglu H, Denizbasi Altinok A
Medicina (Kaunas) · 2026 Jun · PMID 42356088 · Full text
: To evaluate the prognostic value of end-tidal carbon dioxide (ETCO), arterial carbon dioxide (PaCO), their difference (ΔCO = PaCO-ETCO), and the ETCO/PaCO ratio for 30-day mortality in adult patients intubated for acut...
: To evaluate the prognostic value of end-tidal carbon dioxide (ETCO), arterial carbon dioxide (PaCO), their difference (ΔCO = PaCO-ETCO), and the ETCO/PaCO ratio for 30-day mortality in adult patients intubated for acute respiratory failure in the emergency department (ED). : In this single-center, prospective observational study, we enrolled consecutive adults intubated in the ED who had at least two paired arterial blood gas and capnography measurements within 90 min post-intubation. PaCO and ETCO were recorded at 0, 30, 60, and 90 min, and ΔCO and ETCO/PaCO were calculated at each time point. Between-group comparisons, repeated-measures analyses, and logistic regression were used to explore associations, and prognostic performance was assessed using receiver operating characteristic curves. : Among 100 patients (36% female); 30- and 90-day mortality were 64% and 70%, respectively. Non-survivors were older, had lower mean arterial pressure after intubation, higher inflammatory and coagulation markers, and more frequent pneumonia and pulmonary embolism. ETCO values were consistently lower in non-survivors at 0, 30, and 60 min, while PaCO was also lower at early time points. ΔCO and the ETCO/PaCO ratio did not differ between survivors and non-survivors. Among all CO metrics and time points, only ETCO showed low-to-moderate discrimination for 30-day mortality (area under the curve 0.65-0.70). : In ED patients emergently intubated for acute respiratory failure, absolute ETCO values in the early post-intubation period provide modest prognostic information for short-term mortality, whereas ΔCO and ETCO/PaCO do not appear to add prognostic value beyond ETCO alone.
Vitamin D Signaling from Nephrogenesis to Neoplasia: Spatial Protein Expression in Fetal Kidney and Transcriptomic Dysregulation in Renal Tumors.
Bevanda I, Filipović N, Kelam N … +3 more , Racetin A, Todorović P, Vukojević K
Medicina (Kaunas) · 2026 Jun · PMID 42356087 · Full text
: Vitamin D signaling plays critical roles in immune regulation, bone metabolism, and cellular differentiation across multiple tissues. However, the spatial and temporal expression patterns of key vitamin D signaling com...
: Vitamin D signaling plays critical roles in immune regulation, bone metabolism, and cellular differentiation across multiple tissues. However, the spatial and temporal expression patterns of key vitamin D signaling components-the vitamin D receptor (VDR) and the enzyme 1α-hydroxylase (encoded by )-during human nephrogenesis have not been mapped at the protein level. The primary objective of this study was to characterize VDR and 1α-hydroxylase expression across critical stages of human kidney development, complementing prior transcriptomic and single-cell descriptions, and to contextualize these developmental observations against the dysregulation of vitamin D pathway genes in adult renal and urothelial malignancies. : Immunofluorescence analysis was performed on FFPE kidney tissue from 12 specimens (3 per stage) at 10, 22 and 38 gestational weeks and postnatally at 1.5 years. For each specimen, at least three non-adjacent sections were stained and 6 non-overlapping cortical fields were imaged at ×40 (18 fields per stage). Fluorescence-area percentages were quantified in ImageJ 1.54g, and group differences were assessed by one-way ANOVA with Tukey's post hoc test at both field- and specimen-level. An accompanying bioinformatic analysis evaluated the differential expression of , , and in adult renal and urothelial malignancies (TCGA cohorts: KICH, KIRC, KIRP, BLCA) using unpaired Welch's t-test, with Benjamini-Hochberg FDR correction applied across all 16 tumor-versus-normal comparisons (12 gene-wise + 4 post hoc log(CYP24A1/CYP27B1) ratios). : VDR showed its highest mean fluorescence area at 10 weeks (3.40% (95% CI 3.24-3.56); field-level Tukey < 0.0001 versus other stages) and its lowest at 22 weeks (0.69% (0.64-0.74)). 1α-hydroxylase was also highest at 10 weeks (5.44% (5.29-5.60); < 0.0001) and stabilized at lower levels thereafter (3.04-4.26%). Co-expression of both proteins was observed throughout development except in 22-week glomeruli. In TCGA, all 12 significant gene-wise comparisons retained significance after BH FDR correction (q < 0.05). VDR showed cohort-specific dysregulation: reduced in KICH (q = 2 × 10) but increased in KIRC and KIRP (q = 2 × 10 for both). CYP24A1 was reduced in all three renal cohorts (q ≤ 0.029) and unchanged in BLCA. CYP27B1 showed cohort-specific direction (reduced in KIRC; increased in KICH, KIRP, and BLCA). : This study provides an initial immunofluorescence-based spatial description of VDR and 1α-hydroxylase across human kidney development, revealing a coordinated redistribution from immature glomeruli at 10 weeks to mature tubular segments at later stages. The TCGA analysis demonstrates that vitamin D pathway dysregulation in renal carcinoma is cohort-specific and is not abolished by multiple-testing correction. Together, these results indicate that the developmentally engaged vitamin D pathway retains kidney-specific functional relevance in adult renal pathology and provide a baseline reference for future mechanistic studies.
Microsurgical Anatomy of the Labyrinthine Artery: A Cadaveric Microdissection Study of Number, Origin and Course at the Cerebellopontine Angle.
Jeican II, Siserman CV, Toader C … +1 more , Trombitaș VE
Medicina (Kaunas) · 2026 Jun · PMID 42356086 · Full text
: The labyrinthine artery (LA) is a small but surgically important vessel encountered during procedures involving the cerebellopontine angle (CPA). Variations in its number, origin, and relationship to the facial-vestibu...
: The labyrinthine artery (LA) is a small but surgically important vessel encountered during procedures involving the cerebellopontine angle (CPA). Variations in its number, origin, and relationship to the facial-vestibulocochlear nerve complex may increase the risk of vascular injury during CPA surgery. The aim of this cadaveric microdissection study was to evaluate the number, origin, and course of the LA within the CPA and to characterize its relationship to the anterior inferior cerebellar artery (AICA) and the facial-vestibulocochlear nerve complex. : Microsurgical dissections were performed bilaterally in 45 formalin-fixed adult cadavers (90 CPAs) using an operating microscope and vascular injection. The number, origin, and course of the LA were analyzed together with its relationship to the AICA and the facial-vestibulocochlear nerve complex. : The LA was identified in all specimens. A single LA was observed in 57.8% of CPAs, whereas multiple LAs were identified in 42.2%. The artery most commonly originated from the AICA (65.6%), followed by a common trunk shared with the AICA (21.1%) and direct origin from the basilar artery (13.3%). In specimens with bifurcated AICAs forming double loops, multiple LAs frequently arose from both loops. Considerable variability was observed in the course of the LA relative to the facial-vestibulocochlear nerve complex, including superior, inferior, and interposed courses. Bilateral asymmetry was identified in 15.6% of cadavers. : The LA demonstrates substantial anatomical variability within the CPA regarding its number, origin, and neurovascular relationships. Although the artery most commonly arises from the apex or medial aspect of the AICA loop, its subsequent course may vary considerably. Careful microsurgical inspection remains essential during CPA surgery, as the configuration of the AICA alone is insufficient to reliably predict the distal trajectory of the LA.
Psychological Experiences of Pregnancy Following Transplantation: A Systematic Qualitative Review.
Papalois KB, Tsarna E, Vakas P … +3 more , Stavros S, Matsas A, Christopoulos P
Medicina (Kaunas) · 2026 Jun · PMID 42356085 · Full text
: To examine the psychological parameters among pregnant organ transplant recipients that are understudied compared to the physical health of women during post-transplantation pregnancy. : Systematic review based on PubM...
: To examine the psychological parameters among pregnant organ transplant recipients that are understudied compared to the physical health of women during post-transplantation pregnancy. : Systematic review based on PubMed, EMBASE, CINAHL, and PsycInfo that were searched until 15 January 2025. Quality Assessment and meta-aggregation were applied to qualitative studies. : Out of 4361 screened unique studies, six are included. Most studies were retrospective and focused on liver, kidney, and heart transplants. Meta-aggregation identified four synthesized findings: "Perception of Pregnancy after Transplantation", "Concerns about Maternal Physical Health", "Concerns about Fetal Health", and "Emotional Burden by Expectant Mothers and Coping Strategies". The review was constrained by the potential exclusion of relevant studies due to language restrictions and uncontrolled bias in the included studies. : Several psychological themes were identified, not all exclusive to transplant recipients. Developing a targeted questionnaire to gather primary data could enhance clinical practice and improve counseling services for this patient population.
Pectoralis Minor Tenotomy with Occasional Secondary Neurolysis Significantly Reduces Self-Reported Pain and Headaches Across Heterogenous Chronic Pain Disorders of the Upper Limb.
Sharma K, Friedman JM
Medicina (Kaunas) · 2026 Jun · PMID 42356084 · Full text
: Many patients suffer from chronic pain of the shoulder, neck, upper back, and/or arm. They may be diagnosed with fibromyalgia, complex regional pain syndrome, myofascial pain, thoracic outlet, subacromial pain, cervica...
: Many patients suffer from chronic pain of the shoulder, neck, upper back, and/or arm. They may be diagnosed with fibromyalgia, complex regional pain syndrome, myofascial pain, thoracic outlet, subacromial pain, cervical radiculopathy, cervicogenic headaches, post-mastectomy pain, and/or occupational shoulder disorder. The pectoralis minor (PM) is the only muscle of the scapula controlled by the lower trunk of the brachial plexus. In the Human Disharmony Loop (HDL), this neurologic asymmetry produces persistent protraction of the scapula. Protraction deforms the scapula's connections, generating headaches and neck stiffness, upper back tightness, shoulder weakness, and hand numbness. We hypothesize patients with the above who meet HDL diagnostic criteria will benefit from PM tenotomy with brachial plexus neurolysis (PM+ICN). : Patients diagnosed with the above disorders who also met HDL criteria of medial coracoid tenderness and scapula protraction on exam underwent PM+ICN, with secondary neurolysis after 3 months if needed. Clinical neuropathy was diagnosed via the scratch-collapse test. Outcomes included self-reported Visual Analogue Score pain scores, active shoulder abduction range of motion (ROM), prevalence of occipital headaches. : = 318 patients were included. Average age was 51; 68.0% were female. Following treatment, average pain decreased from 7.3/10 to 2.1/10 ( < 0.001), average shoulder ROM increased from 96 to 170 degrees ( < 0.001), and occipital headaches decreased from 76.7% to 1.6% ( < 0.001). Scapular protraction normalized from 98.8% static to 92.5% none ( < 0.001). Overall, 17% required subsequent neurolysis, chiefly of the axillary, radial, and ulnar nerves. The pain reductions were statistically indistinguishable across all diagnoses ( = 0.709, I = 0.02%). Average follow-up was 22 months. : PM+ICN significantly reduced self-reported pain and headaches in select intractable patients. The PM pathologizing the scapula may constitute a shared anatomic mechanism that contributes to chronic pain across heterogenous disorders of the upper limb.
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