Medicina[JOURNAL]
Sun
200 papers
The Right Ventricle in Cardiac Critical Care: Pathophysiology, Evaluation and Management.
Boulmpou A, Alevroudis I, Karagiannidis E … +5 more , Mouratoglou SA, Nasoufidou A, Fragakis N, Papadopoulos C, Vassilikos V
Medicina (Kaunas) · 2026 Jun · PMID 42356083 · Full text
The right ventricle (RV) is a primary determinant of outcomes in cardiac critical care. RV dysfunction independently predicts morbidity and mortality in conditions such as acute coronary syndromes, pulmonary embolism, an...
The right ventricle (RV) is a primary determinant of outcomes in cardiac critical care. RV dysfunction independently predicts morbidity and mortality in conditions such as acute coronary syndromes, pulmonary embolism, and cardiogenic shock. This review synthesizes RV evaluation and management by integrating physiologic principles with bedside diagnostic and therapeutic strategies. The RV is exceptionally sensitive to acute afterload increases due to its adaptation to low-pressure pulmonary circulation. Evaluation utilizes a multimodal approach combining echocardiography, invasive hemodynamics, and specifically the pulmonary artery pulsatility index and central venous pressure/pulmonary capillary wedge pressure (CVP/PCWP) ratio and biomarkers. Management focuses on three pillars: individualized preload optimization, afterload reduction via selective pulmonary vasodilators, and contractility augmentation with inotropes. For refractory cases, mechanical circulatory support options like Impella RP, ProtekDuo, and VA-ECMO provide critical bridges to recovery or transplantation.
Comparison of Strength Adaptation Responses Among Individuals with Different Muscle Fiber Type Profiles.
Beltekin E, Berk Y, Kuyulu İ … +5 more , Alexe DI, Isac T, Lupu GS, Tomozei RA, Ciobanu AEP
Medicina (Kaunas) · 2026 Jun · PMID 42356082 · Full text
: Muscle hypertrophy and strength increase are significantly influenced by the distribution of muscle fiber types in individuals. Individuals exposed to similar training intensity in fitness and bodybuilding exhibit diff...
: Muscle hypertrophy and strength increase are significantly influenced by the distribution of muscle fiber types in individuals. Individuals exposed to similar training intensity in fitness and bodybuilding exhibit different levels of adaptation suggesting that muscle fiber type may influence training outcomes. The aim of this study is to comparatively examine the strength development that occurs in fitness and bodybuilding athletes with different muscle fiber types (Type I, Type II, and Mixed) following a standardized resistance training program. : The study was conducted using a quasi-experimental design based on a single-group pre-test-post-test model, with no control group. A total of 48 male athletes aged 19-26 years (22.75 ± 1.68) who had been regularly training in fitness and bodybuilding for at least two years voluntarily participated in the study. Muscle fiber types of the participants were indirectly estimated based on the number of repetitions performed at 80% of one-repetition maximum (1RM) in the bench press exercise, and individuals were divided into three groups: Type I, Type II, and mixed. All participants underwent a resistance training program for 6 weeks, 3 days a week, at 80% 1RM intensity and in the range of 8-12 repetitions. Data were analyzed using Shapiro-Wilk normality test, Wilcoxon Signed-Rank Test, and Mann-Whitney U. : The findings showed statistically significant increases between pre-test and post-test measurements in all groups. When percentage improvements were examined, the highest increase was observed in individuals with Type II muscle fiber type, and the lowest increase was observed in individuals with Type I muscle fiber type. : In conclusion, the findings indicate that resistance training increases strength development in all muscle fiber types, but the level of development differs depending on the muscle fiber type. These findings highlight the importance of training programs based on individual muscle fiber type characteristics.
Glucocorticoid Receptor Gene Polymorphisms and Femoral Head Osteonecrosis.
Liu DY, Lai IC, Ku NE … +5 more , Hsu CY, Wang CC, Hsu SC, Ko JY, Kuo SJ
Medicina (Kaunas) · 2026 May · PMID 42356081 · Full text
: Non-traumatic osteonecrosis of the femoral head (ONFH) is a multifactorial disorder influenced by both environmental and genetic factors. The nuclear receptor subfamily 3 group C member 1 () gene encodes the glucocorti...
: Non-traumatic osteonecrosis of the femoral head (ONFH) is a multifactorial disorder influenced by both environmental and genetic factors. The nuclear receptor subfamily 3 group C member 1 () gene encodes the glucocorticoid receptor, which plays a key role in bone metabolism, vascular regulation, and stress response. This study aimed to investigate the association between polymorphisms and susceptibility to ONFH, with particular emphasis on age-related genetic effects. : A hospital-based case-control study was conducted using genotyping data from the Taiwan Biobank version 2 (TWBv2) custom array. A total of 609 patients with ONFH and 2436 age- and sex-matched controls were included. Forty-nine single-nucleotide polymorphisms (SNPs) within or near the gene with a minor allele frequency greater than 5% were analyzed. Logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) under multiple genetic inheritance models. Age-stratified analyses were also performed. : Among the analyzed SNPs, rs28593206 and rs315199 demonstrated nominally significant differences in allele distributions between cases and controls ( = 0.024 and = 0.009, respectively), with minor alleles showing nominal associations with increased odds of ONFH. Additional exploratory analyses under different genetic models identified several SNPs with nominal associations with ONFH susceptibility, while rs7709864 showed a possible nominal protective association. In age-stratified analyses, several SNPs showed nominal associations with ONFH risk among individuals older than 40 years, whereas no nominally significant associations were observed in younger individuals. : This exploratory study suggests that polymorphisms may be nominally associated with susceptibility to ONFH, particularly among individuals older than 40 years. However, because no formal correction for multiple comparisons was performed and detailed etiological data were unavailable, these findings should be interpreted cautiously and regarded as hypothesis-generating rather than clinically applicable evidence. Further studies incorporating larger cohorts, etiological stratification, multiple-testing correction, replication analyses, and functional validation are required to confirm these observations and clarify the underlying biological mechanisms.
Peripheral Vestibular Dysfunction and Postural Control Impairments in Adolescents with Idiopathic Scoliosis: A Multimodal Clinical and Instrumental Analysis.
Vlădăreanu L, Amaricai E, Minea M … +3 more , Danteș E, Andronache IT, Iliescu MG
Medicina (Kaunas) · 2026 May · PMID 42356080 · Full text
: Idiopathic scoliosis (IS) has been conceptualized as a structural spinal deformity; emerging evidence suggests that postural control and vestibular mechanisms may contribute to curve development and functional severity...
: Idiopathic scoliosis (IS) has been conceptualized as a structural spinal deformity; emerging evidence suggests that postural control and vestibular mechanisms may contribute to curve development and functional severity. This study investigated the relationship between radiological parameters, postural stability, and vestibular dysfunction in adolescents with IS. : A retrospective cohort of 177 patients aged 8-22 years was analyzed between 2022 and 2024. Standard radiography was performed on 135 participants to evaluate the major curve as established by the Cobb method, Nash-Moe classification, and Risser stage. Peripheral vestibular syndrome (PVS) was investigated using the Fukuda (FST), video-nystagmography (VNG), and instrumental Romberg tests on a stable and unstable platform. Associations between vestibular variables and radiographic parameters were explored using Mann-Whitney U and Kruskal-Wallis tests, supported by non-parametric correlations. : Female participants (63%) exhibited significantly higher initial major curve angle value compared with males (median 14° vs. 10.5°, = 0.004). Positive FTS findings and the presence of peripheral vestibular syndrome were strongly associated with higher baseline and final major curve angles (both < 0.001). Romberg performance showed significant correlations with major curve angle across stable and unstable conditions (r = 0.298-0.396, all < 0.001). VNG identified multi-canal vestibular involvement, particularly anterior-horizontal combinations on the right ear, as being associated with substantially greater curve magnitude; left-ear impairment demonstrated similar non-significant trends. Curve localization did not differ by vestibular involvement. : Patients with idiopathic scoliosis (IS) display consistent associations between vestibular dysfunction, impaired postural control, and greater curve severity. These findings support the clinical relevance of vestibular assessment in scoliosis evaluation and suggest a potential role for sensorimotor rehabilitation strategies. Integrating vestibular screening into standard care may enhance risk stratification and inform the clinician on individualized conservative management.
Enhancing Cardiopulmonary Function Through Spasticity Reduction-Effects of Botulinum Toxin A After Stroke: A Prospective Before-After Study.
Alexa LM, Palcău AC, Păduraru LF … +6 more , Alexa D, Palcău CA, Leon MM, Roca M, Ilieșiu AM, Dima-Cozma LC
Medicina (Kaunas) · 2026 May · PMID 42356079 · Full text
: Post-stroke spasticity is a frequent complication that contributes to impaired mobility, reduced functional independence, and decreased exercise tolerance. While botulinum toxin A (BoNT-A) is widely used to improve mus...
: Post-stroke spasticity is a frequent complication that contributes to impaired mobility, reduced functional independence, and decreased exercise tolerance. While botulinum toxin A (BoNT-A) is widely used to improve muscle tone, its effects on cardiopulmonary exercise capacity remain insufficiently characterized. This study aimed to evaluate the impact of BoNT-A treatment on cardiopulmonary performance and functional outcomes in patients with post-stroke spasticity. : A prospective before-after study was conducted including 50 patients with post-stroke spasticity. Cardiopulmonary exercise testing was performed before and after BoNT-A administration. The primary outcome was peak oxygen consumption (VO peak), while secondary outcomes included anaerobic threshold (AT), exercise duration, maximal workload, 10 m walk test time, Barthel Index, and modified Rankin Scale (mRS). Paired comparisons and multivariable linear regression analyses were performed to assess changes and associated factors. : VO peak increased significantly following treatment (12.96 ± 2.70 vs. 13.55 ± 2.85 mL/kg/min; mean change 0.59 mL/kg/min, 95% CI 0.36-0.82; < 0.001). Similar improvements were observed for AT (10.47 ± 2.77 vs. 10.97 ± 2.97 mL/kg/min; < 0.001), exercise duration (6.70 ± 1.48 vs. 7.11 ± 1.55 min; < 0.001), and maximal workload (44.70 ± 10.97 vs. 48.06 ± 12.60 W; < 0.001). Functional performance improved, as indicated by reduced 10 m walk time (18.33 ± 4.67 vs. 17.36 ± 4.82 s; < 0.001) and increased Barthel Index (57.62 ± 19.18 vs. 61.92 ± 21.10; < 0.001). A modest but significant reduction in disability was observed on the mRS ( = 0.003). Baseline values were the strongest predictors of post-treatment outcomes, while smoking status was associated with worse walking performance. : BoNT-A treatment was associated with modest but consistent improvements in cardiopulmonary exercise capacity and functional performance in patients with post-stroke spasticity. These findings suggest that spasticity management may be associated with functional and exercise-related benefits extending beyond local neuromuscular effects, although causal relationships cannot be established based on the present study design. Further controlled studies are needed to confirm these findings and evaluate their long-term clinical significance.
Autonomic Vulnerability Phenotype, Regional Cerebral Oxygen Saturation, and Postoperative Delirium in Elderly Patients Undergoing Non-Cardiac, Non-Neurological Surgery: A Propensity Score-Matched Cohort Study.
Lee C, Jo Y, Choi G
Medicina (Kaunas) · 2026 May · PMID 42356078 · Full text
We investigate whether a preoperative autonomic vulnerability phenotype and intraoperative regional cerebral oxygen saturation (rcSO) variables are associated with postoperative delirium (POD) in elderly patients undergo...
We investigate whether a preoperative autonomic vulnerability phenotype and intraoperative regional cerebral oxygen saturation (rcSO) variables are associated with postoperative delirium (POD) in elderly patients undergoing non-cardiac, non-neurological surgery, and whether autonomic vulnerability modifies the association between cerebral desaturation and POD. This retrospective propensity score-matched cohort study included patients aged 65 years or older who underwent general anesthesia with intraoperative rcSO monitoring. The preoperative autonomic vulnerability phenotype was defined using clinical features documented before surgery, including autonomic neuropathy, diabetic autonomic neuropathy, orthostatic hypotension, syncope or presyncope suggestive of autonomic dysfunction, and unexplained resting bradycardia or chronotropic incompetence not attributable to rate-limiting medication. The primary outcome was POD within 5 postoperative days. Patients were matched 1:1 using nearest-neighbor propensity score matching with a caliper of 0.2 standard deviations of the logit of the propensity score, and conditional logistic regression was used in the matched cohort. A total of 412 patients were included; 112 had the phenotype and 300 did not. After matching, 98 pairs were analyzed. POD occurred in 27.6% of patients with the phenotype and 14.3% of patients without it. In the matched cohort, the phenotype (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.18-3.82, = 0.012), rcSO decrease ≥20% (OR 2.45, 95% CI 1.31-4.58, = 0.005), and longer duration of rcSO < 80% of baseline (OR 1.02 per min, 95% CI 1.01-1.04, = 0.008) were independently associated with POD. The phenotype-by-desaturation interaction was exploratory (OR 2.10, = 0.032) and was not uniformly robust across sensitivity analyses. A preoperative autonomic vulnerability phenotype and intraoperative cerebral desaturation were independently associated with POD. The association between rcSO decrease and POD appeared stronger in patients with autonomic vulnerability, but this interaction should be interpreted as hypothesis-generating rather than confirmatory.
Ergonomic Implants: A Single Centre Experience in Post-Mastectomy Breast Reconstruction.
Fusario D, Alessandrini S, Lolli G
Medicina (Kaunas) · 2026 May · PMID 42356077 · Full text
: Implant-based breast reconstruction is nowadays the most commonly used reconstructive technique and offers a safe and relatively simple surgical approach. Textured, anatomically shaped implants have been the primary op...
: Implant-based breast reconstruction is nowadays the most commonly used reconstructive technique and offers a safe and relatively simple surgical approach. Textured, anatomically shaped implants have been the primary option for women undergoing breast reconstruction for decades. However, anatomically shaped implants are form-stable devices, providing firmness and rigidity, and can cause malrotation, requiring revision surgery. Ergonomic round silicone gel implants began to gain popularity due to the capacity to adapt to gravity and the patient's position, providing a natural, "anatomical" appearance in an upright position. The objective of this study was to describe our two-year experience with Motiva Ergonomix Round Silksurface™ implants and to evaluate their safety and efficacy for immediate and delayed breast reconstruction procedures. : An observational retrospective study was conducted on a population of patients undergoing mastectomy for breast cancer and immediate or delayed reconstruction with Motiva Ergonomix Round Silksurface™ implants. We enrolled 61 patients from December 2023 to December 2025: a total of 87 ergonomic prostheses were implanted. : The average implant volume was 269 ± 105 (105-510) cc. One surgical infection occurred (1.1%); three persistent seromas (3.4%); and two cases of rippling (2.3%). Only one CTCAE G3 complication was recorded, a grade IV Baker capsular contraction (1.1%). The BREAST-Q results after surgery showed a high rate of patient satisfaction. : Ergonomic round implants with a nano-textured surface were developed to give a natural breast appearance following mastectomy, as well as to prevent rotation, one of the complications that can affect anatomical implants. Our data have demonstrated low complication rates and high patient satisfaction. These results encourage us to expand our experience with these ergonomic, round, nano-textured implants and seriously consider them as an increasingly important device in breast reconstruction after mastectomy to be placed alongside more well-known anatomical implants.
Drug Utilization, Anticholinergic Burden and Predictors of Length of Stay in a Psychiatric Hospital: A Retrospective Observational Study.
Özdemir Sincar ZA, Ertuna E, Altıparmak Ö … +2 more , Koç A, Arun MZ
Medicina (Kaunas) · 2026 May · PMID 42356076 · Full text
: Mental illnesses place a substantial burden on healthcare systems and often require complex pharmacological management. However, it remains unclear whether early antipsychotic polypharmacy independently predicts length...
: Mental illnesses place a substantial burden on healthcare systems and often require complex pharmacological management. However, it remains unclear whether early antipsychotic polypharmacy independently predicts length of stay after adjusting for important confounders. This study aimed to investigate drug utilization patterns, including polypharmacy and drug-drug interactions (DDIs), assess anticholinergic burden, and identify predictors of the length of hospital stay in a psychiatric inpatient setting. : This retrospective, observational study was conducted at Bolu İzzet Baysal Mental Health and Diseases Hospital with 280 adult patients admitted during 2022. Medication data were extracted from electronic medical records based on medication orders within the first 72 h of admission. Potential DDIs were assessed using Lexi-Interact, and anticholinergic burden was calculated using the ACB, ADS, and ARS scales. Predictors of the length of stay (LOS) were modelled using negative binomial regression. : The mean age of the population was 38.65 ± 13.86 years, and 62.1% were male. Polypharmacy was present in 37.9% of patients, while antipsychotic polypharmacy was observed in 63.9%. Potential DDIs were identified in 88.9% of patients, with a significantly higher prevalence in those with polypharmacy. Mean ACB and ADS scores were high at 5.56 ± 3.32 and 4.15 ± 2.79, respectively. Multivariable regression analysis revealed that antipsychotic polypharmacy was the primary independent predictor of prolonged hospitalization, associated with a 20.9% increase in LOS (IRR = 1.209, 95% CI: 1.044-1.400, = 0.011). While age was also statistically significant (IRR = 1.006, 95% CI: 1.001-1.012, = 0.019), its clinical impact was minimal, representing only a 0.6% increase in LOS per year. : Antipsychotic polypharmacy within the first 72 h of admission is a significant independent predictor of prolonged hospitalization. The high prevalence of drug interactions and substantial anticholinergic burden highlight the need for systematic early medication review. Instead of general monitoring, targeted medication therapy review focusing on antipsychotic polypharmacy in the early period of admission may be essential to identify and mitigate modifiable risk factors for prolonged hospitalization, thereby optimizing pharmacotherapy in psychiatric inpatient settings.
Sector-Specific Patterns of RNFL and Ganglion Cell Complex Thinning Across the Myopia Spectrum: A Cross-Sectional OCTA Study.
Veselinović M, Trenkić M, Cekić S … +2 more , Jocić Djordjević J, Veselinović A
Medicina (Kaunas) · 2026 May · PMID 42356075 · Full text
: Myopia is a rapidly growing global health burden driven primarily by axial elongation, which exerts mechanical stress on the inner retina, leading to progressive thinning of the retinal nerve fiber layer (RNFL) and the...
: Myopia is a rapidly growing global health burden driven primarily by axial elongation, which exerts mechanical stress on the inner retina, leading to progressive thinning of the retinal nerve fiber layer (RNFL) and the ganglion cell complex (GCC). The sector-specific pattern of these changes across the full spectrum of myopia remains incompletely characterized. This study aimed to provide a comprehensive, sector-level analysis of RNFL and GCC changes across four myopia severity grades using optical coherence tomography angiography (OCTA), and to quantify their correlations with axial length (AL) and central foveal thickness (CFD). : A total of 260 eyes of 130 participants were enrolled in a prospective cross-sectional study. Eyes were classified into four groups: emmetropia (EM, n = 74), low myopia (LM, n = 68), moderate myopia (MM, n = 64), and high myopia (HM, n = 54). All participants underwent cycloplegic refraction, AL measurement, and RTVue XR Avanti OCTA imaging. RNFL thickness was assessed across five peripapillary sectors, and GCC thickness across twelve macular zones. Between-group differences were analyzed using one-way ANOVA with Bonferroni post hoc correction or Kruskal-Wallis/Dunn-Bonferroni tests. Pearson correlations were used to assess associations among structural parameters, AL, and CFD. : Both the RNFL and GCC showed progressive, statistically significant thinning with increasing myopia severity. The superior RNFL was the only peripapillary sector that differentiated EM from LM ( = 0.039), with total thinning of 18.8 μm from EM to HM. The paratemporal GCC zone showed the earliest macular structural signal (EM vs. LM, = 0.049). Temporal and nasal RNFL sectors showed relative preservation, with differences restricted to comparisons involving HM. AL correlated negatively with the RNFL and GCC across all sectors (r = -0.46 to -0.71), with the strongest correlation observed for the superior RNFL in HM (r = -0.71, < 0.001). CFD demonstrated progressively stronger coupling with GCC thickness as myopia severity increased, peaking in HM (r = 0.72, < 0.001). : The RNFL and GCC thinning in myopia follows a progressive, sector-specific pattern driven by axial elongation. The superior RNFL and paratemporal GCC are the earliest structural indicators of inner retinal change, detectable already at the low-myopia grade. These findings support a neural-first model of myopia-related retinal remodeling and advocate for multiparametric, stage-targeted structural monitoring in clinical practice.
Optimal Surgical Margin After Breast-Conserving Surgery in Pure Ductal Carcinoma in Situ: Is a 1 mm Margin Sufficient? A Retrospective Single-Center Cohort Study.
Karabacak U, Derebey M, Tarim IA … +3 more , Yuruker SS, Gungor BB, Kamali Polat A
Medicina (Kaunas) · 2026 May · PMID 42356074 · Full text
The optimal surgical margin width after breast-conserving surgery (BCS) for pure ductal carcinoma in situ (DCIS) remains controversial; although current guidelines consider a surgical margin of ≥2 mm sufficient, the clin...
The optimal surgical margin width after breast-conserving surgery (BCS) for pure ductal carcinoma in situ (DCIS) remains controversial; although current guidelines consider a surgical margin of ≥2 mm sufficient, the clinical safety of narrower margins is unclear. This study aimed to evaluate the association between surgical margin width and ipsilateral breast tumor recurrence (IBTR), with a focus on the 1 mm threshold. In this retrospective single-center cohort study, 107 patients with pure DCIS treated with BCS followed by adjuvant radiotherapy (RT) between 1 January 2009 and 1 January 2025 were analyzed. Final surgical margins were categorized as <1 mm, 1-2 mm, and ≥2 mm. The primary endpoint was IBTR. Kaplan-Meier analysis was performed. The median age of the study population was 52 years (IQR: 46-61). High-grade DCIS was present in 48 patients (44.9%), comedo necrosis in 68 (63.6%), and estrogen receptor positivity in 87 (81.3%). Overall, 10 patients (9.3%) underwent re-excision for margin widening. Final surgical margin widths were <1 mm in 36 patients (34%), 1-2 mm in 18 (17%), and ≥2 mm in 53 (49%). IBTR occurred in seven patients (6.5%) during a median follow-up of 48 months (range, 12-217 months), with a median time to recurrence of 33 months. Kaplan-Meier analysis showed no significant difference in recurrence-free survival according to a 2 mm margin threshold, whereas margins < 1 mm were associated with significantly worse outcomes ( = 0.002). Margins < 1 mm were associated with increased IBTR risk, whereas margins < 2 mm did not appear to confer uniform risk. These findings suggest that margin widths between 1 and 2 mm may represent a heterogeneous group, and clinical decision-making in this range should be individualized. However, further studies are needed to validate these outcomes.
Temporal Stability of Nasal Tip Rotation and Projection Following Rhinoplasty Using a Novel Integrated Pentagonal Tip Support Technique.
Şahin Ş, Erkmen B, Elgörmüş MN … +3 more , Koçer YEY, Duymaz YK, Çekin İE
Medicina (Kaunas) · 2026 May · PMID 42356073 · Full text
Achieving long-term stability of nasal tip rotation and projection remains a challenge in rhinoplasty because of postoperative remodeling processes such as edema resolution, soft tissue redraping, and scar maturation. Th...
Achieving long-term stability of nasal tip rotation and projection remains a challenge in rhinoplasty because of postoperative remodeling processes such as edema resolution, soft tissue redraping, and scar maturation. This study evaluated the temporal changes in nasal tip rotation and projection following rhinoplasty using the Pentagonal Tip Support Technique (PTST). : A retrospective analysis was conducted on patients undergoing primary rhinoplasty using PTST, with standardized photographic assessments performed intraoperatively and at 6 and 12 months postoperatively. Nasal tip rotation and projection were quantified using the nasolabial angle and Goode ratio, respectively, and temporal changes were analyzed across postoperative intervals. Both parameters demonstrated statistically significant reductions over time. However, the majority of changes occurred within the first 6 months, whereas later follow-up intervals demonstrated smaller changes and a reduced rate of change. Similar temporal patterns were observed across different skin types, and skin type was not significantly associated with late postoperative changes in rotation or projection. : The findings of the present study suggest that PTST is associated with a temporal pattern characterized by greater early postoperative changes followed by smaller interval changes during later follow-up. These findings may reflect postoperative healing dynamics and structural support behavior following rhinoplasty. However, further prospective comparative studies are needed to better define the clinical behavior of PTST over extended follow-up periods relative to established structural rhinoplasty techniques.
AI-Assisted Identification of the Medial Lingual Foramen on CBCT: A Deep Learning Approach for Preoperative Implant Assessment.
Ban A, Mureşanu S, Roman R … +5 more , Iacob L, Hedeşiu M, Dinu C, Almăşan O, On Behalf Of Team Project Group
Medicina (Kaunas) · 2026 May · PMID 42356072 · Full text
: Although the anterior mandible is generally considered a safe region for implant placement, injury to the medial lingual foramen (MLF) may result in significant vascular complications. Accurate identification of this s...
: Although the anterior mandible is generally considered a safe region for implant placement, injury to the medial lingual foramen (MLF) may result in significant vascular complications. Accurate identification of this structure is challenging due to its small size, low volumetric representation, and anatomical variability. This study aimed to evaluate the anatomical characteristics of the MLF using cone-beam computed tomography (CBCT) and to develop and validate a deep learning-based approach for its automated detection and segmentation. : A total of 106 CBCT scans were retrospectively analyzed to assess the morphology and position of the MLF. Manual pixel-wise annotations of the complete canal trajectory were performed on sagittal slices and used to train convolutional neural network models based on a U-Net-derived framework. Multiple configurations, including multi-class, binary, two-dimensional, and three-dimensional approaches, were evaluated. Given the extremely limited volumetric representation of the MLF, severe class imbalance represented a major challenge during model training and evaluation. Model performance was assessed using the Dice similarity coefficient, precision, recall, and Hausdorff distance. External validation was performed on an independent dataset of 10 CBCT scans. : The MLF was identified in all patients, with a single canal observed in 63% of cases. The sagittal-plane binary segmentation model achieved the best performance, with a test Dice score of 0.79, precision of 0.88, and recall of 0.73. External validation demonstrated a Dice score of 0.81, precision of 0.89, and recall of 0.71. The 95th percentile Hausdorff distance was 2.6 mm, and the mean center-point localization error was 1.2 mm. The model correctly detected the MLF in 90% of external cases. : Deep learning-based segmentation of the MLF is feasible and may support automated localization assistance during preoperative CBCT assessment. Performance was influenced by the alignment between the annotation strategy and model input, highlighting an important consideration for small-structure segmentation. Further validation on larger multicenter datasets is required before clinical implementation can be considered.
Relationship Between Head Trauma History and Motor Subtype in Early Parkinson's Disease.
Lee HL, Choi SM, Cho SH … +1 more , Kim BC
Medicina (Kaunas) · 2026 May · PMID 42356071 · Full text
Head trauma (HT) has been suggested as a risk factor for Parkinson's disease (PD), but its impact on the motor and non-motor manifestations remains unclear. We investigated whether patients with early PD and a history of...
Head trauma (HT) has been suggested as a risk factor for Parkinson's disease (PD), but its impact on the motor and non-motor manifestations remains unclear. We investigated whether patients with early PD and a history of HT differ from those without HT in terms of their motor and non-motor symptom profiles. We enrolled patients with early PD (disease duration of ≤5 years, modified Hoehn and Yahr stages [mHY] 1-3). HT history was ascertained by structured questionnaire. Motor and non-motor symptoms were evaluated using standardized clinical rating scales. Motor subtypes-tremor-dominant (TD), akinetic-rigid (AR), and mixed-were determined according to established criteria based on the tremor-to-AR score ratio. Subtype distribution and motor scores were compared between HT and non-HT groups using univariate tests, mHY-adjusted ANCOVA, and multivariable models adjusting for age, sex, disease duration, education, mHY stage, MMSE, and BDI score. Of 237 patients, 35 (14.8%) reported HT. The HT group had a higher mHY stage than the non-HT group and showed lower total and rest tremor scores on the Unified Parkinson's Disease Rating Scale, whereas rigidity scores were similar. Bradykinesia and gait/posture scores tended to be higher in the HT group, but these differences did not persist after adjustment for disease severity. The TD subtype was less frequent in the HT group than in the non-HT group (5.7% vs. 30.2%), whereas the AR subtype was more common (82.9% vs. 61.9%). The categorical subtype redistribution remained significant after multivariable adjustment (adjusted OR for AR vs. TD = 4.61, 95% CI 1.28-16.67). No detectable between-group difference in non-motor symptom burden was observed. In this single-center cross-sectional cohort, a self-reported history of HT in early PD was associated with a redistribution of motor phenotype categories toward AR-predominant presentations, with no detectable difference in non-motor symptom burden. Given the retrospective binary exposure assessment, these findings should be interpreted as hypothesis-generating, and prospective studies with structured exposure ascertainment are needed to clarify how HT may shape PD motor phenotype expression.
Development and Preliminary Validation of a MALDI-TOF MS Assay Using KTI as an Internal Standard for Serum M-Protein Light Chain Analysis in Multiple Myeloma: A Pilot Study.
Wang J, Zhao Y, Xie S … +8 more , Liu H, Di M, Wang B, Tang B, Xie W, Yang X, Lai Z, Dong Y
Medicina (Kaunas) · 2026 May · PMID 42356070 · Full text
: Conventional assays for M-protein detection in multiple myeloma (MM), including serum immunofixation electrophoresis (sIFE) and serum free light-chain (sFLC) assays, have limitations in selected clinical settings. This...
: Conventional assays for M-protein detection in multiple myeloma (MM), including serum immunofixation electrophoresis (sIFE) and serum free light-chain (sFLC) assays, have limitations in selected clinical settings. This pilot study aimed to develop and preliminarily validate a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based workflow using Kunitz trypsin inhibitor (KTI) as an internal standard for patient-specific serum M-protein light-chain tracking, particularly in low-level post-treatment samples in which conventional assays may be negative or difficult to interpret. : A total of 55 serum samples from 25 patients with MM were analyzed. Serum immunoglobulin light-chain species were enriched using mixed κ/λ affinity beads, followed by reduction, KTI-based calibration, and MALDI-TOF MS analysis. Quantitative performance was evaluated using purified IgG1 κ standards. Time-matched sIFE and sFLC ratio results were used for descriptive comparison. : After KTI-based calibration, patient-specific M-protein light-chain molecular masses could be consistently identified. The assay showed good linearity over the range of 0.20-10.00 μg/mL, with a calibration equation of y = 6.0228x + 0.1063 and an R of 0.9961. The limit of detection and limit of quantification were 0.002 μg/mL and 0.008 μg/mL, respectively. Intra-day and inter-day precision were acceptable, and recovery ranged from 96.0% to 101.2%. In selected low-level or discordant samples, including cases with therapeutic interference, polyclonal background, or non-secretory disease, MALDI-TOF MS provided exploratory complementary monitoring information. : This KTI-calibrated MALDI-TOF MS workflow showed preliminary analytical performance within the validated low-concentration range and may serve as a complementary approach for patient-specific serum M-protein light-chain monitoring in selected clinical settings of MM. Larger independent studies are required before its clinical utility can be established.
CD20 × CD3 Bispecific Antibodies in B-Cell Non-Hodgkin Lymphomas: Current Evidence, Therapeutic Integration, and Future Directions.
Giamaiou P, Fioretzaki R, Vassilakopoulos TP … +1 more , Dimou M
Medicina (Kaunas) · 2026 May · PMID 42356069 · Full text
: Relapsed or refractory (R/R) B-cell non-Hodgkin lymphomas (B-NHL) remain associated with poor outcomes despite advances in chemoimmunotherapy and chimeric antigen receptor (CAR) T-cell therapy. Many patients are inelig...
: Relapsed or refractory (R/R) B-cell non-Hodgkin lymphomas (B-NHL) remain associated with poor outcomes despite advances in chemoimmunotherapy and chimeric antigen receptor (CAR) T-cell therapy. Many patients are ineligible for or relapse after cellular therapies, highlighting the need for effective off-the-shelf immunotherapeutic approaches. CD20 × CD3 bispecific antibodies (BsAbs) redirect endogenous T cells against malignant B cells and have emerged as a promising therapeutic class in B-NHL. To summarize current clinical evidence regarding mosunetuzumab, glofitamab, epcoritamab, and odronextamab in B-NHL, focusing on efficacy, safety, and emerging therapeutic applications. : A structured review of published phase I-III clinical trials evaluating the four currently approved CD20 × CD3 BsAbs in B-NHL was conducted. Efficacy outcomes, durability of response, and safety data were assessed across indolent and aggressive lymphoma subtypes. : CD20 × CD3 BsAbs demonstrated substantial and durable clinical activity in heavily pretreated B-NHL, including patients with prior CAR T-cell exposure. Mosunetuzumab showed high response rates and durable remissions in follicular lymphoma (FL), while glofitamab demonstrated significant efficacy in aggressive lymphomas, particularly diffuse large B-cell lymphoma (DLBCL). Epcoritamab exhibited consistent activity across lymphoma subtypes with favorable tolerability supported by subcutaneous administration and step-up dosing. Odronextamab also demonstrated clinically meaningful responses in both FL and DLBCL, including high-risk populations. Across studies, cytokine release syndrome (CRS) was the most common adverse event, predominantly low grade and manageable with established mitigation strategies. Immune effector cell-associated neurotoxicity syndrome (ICANS) was uncommon. Infections and hematologic toxicities, particularly neutropenia, represented clinically relevant adverse events across all treatment programs, highlighting the need for special supportive care. : CD20 × CD3 BsAbs represent a major therapeutic advancement in R/R B-NHL, combining high clinical activity, manageable toxicity, and off-the-shelf availability. Their expanding integration into earlier treatment settings and combination strategies is expected to further reshape the therapeutic landscape of B-NHL.
How Has the COVID-19 Pandemic Been Associated with Emergency Department Leave Without Being Seen Rates? A Comparison Between Hospitals in Ancona (Italy) and Gran Canaria (Spain).
Roncarati I, Tomaino L, Rodríguez-Mireles S … +8 more , Rivas-Wagner E, La Vecchia C, Negri E, Di Maio V, Contucci S, Falsetti L, Moroncini G, Serra-Majem L
Medicina (Kaunas) · 2026 May · PMID 42356068 · Full text
: The COVID-19 pandemic was associated with major disruptions, not only at the environmental, social, and economic levels but also in the public health systems and, therefore, emergency care utilisation. Prior to the pan...
: The COVID-19 pandemic was associated with major disruptions, not only at the environmental, social, and economic levels but also in the public health systems and, therefore, emergency care utilisation. Prior to the pandemic, one of the most significant issues in the ED was overcrowding, with a consequent percentage of people leaving the ED without being seen (LWBS). The aim of this study was to assess the association between the 2020 COVID-19 pandemic and the number of LWBS, compared with the rates recorded during the same period in 2019 and 2021. A retrospective comparative observational study of ED admissions was conducted in two university hospitals in Ancona (Italy) between 9 March and 3 May 2020 and in Gran Canaria (Spain) between 14 March and 10 May 2020, corresponding to the lockdown in the two countries, respectively. ED visits were assessed during the defined periods, separately for the Italian and Spanish contexts and between groups, comparing the two contexts for each year. In Italy, during the 2019 timeframe, 597 (7.0%) of 8568 patients who arrived in the ED left before being seen; during the same period in 2020, 100 (3.2%) of 3100; and in 2021, 334 (6.0%) of 5555. In Spain, patients leaving the ED prior to medical consult in 2019 were 567 (4.0%) out of 14,034 visits; in 2020, they amounted to 185 (2.6%) out of 7208; and in 2021, they were 528 (4.0%) out of 13,214. The results of the logistic regression analysis for Italy and Spain showed that male sex [odds ratio (OR), 95% confidence interval (CI): 1.38 (1.24-1.53)], age group between 17 and 43 years compared to those subjects older than 74 years old [OR (95%CI): 4.04 (3.34-4.88)] and a lower priority code at triage were significantly associated with a higher odds of LWBS. The findings suggest that the COVID-19 pandemic was associated with changes in only some characteristics of the profiles and types of patients leaving the ED, while it had a strong impact on the number of patients who left the ED before medical examination. The observed decrease in ED visits and LWBS rates in 2020 suggests that the COVID-19 pandemic has changed the population's use of the ED, highlighting the potential need for improved public and professional awareness of appropriate care pathways and the role of health professionals in them.
Robotic-Assisted Tubal Reanastomosis After Sterilization in the IVF Era: A Narrative Review.
Papageorgiou D, Pergialiotis V, Papapanagiotou IK … +6 more , Zachariou E, Plevris N, Petrogiannis S, Salakos N, Kykalos S, Kontzoglou K
Medicina (Kaunas) · 2026 May · PMID 42356067 · Full text
: Robotic-assisted tubal reanastomosis (RATR) remains a clinically relevant option for selected women seeking fertility after sterilization. In the era of IVF, surgical reversal continues to be discussed because it may r...
: Robotic-assisted tubal reanastomosis (RATR) remains a clinically relevant option for selected women seeking fertility after sterilization. In the era of IVF, surgical reversal continues to be discussed because it may restore the possibility of spontaneous conception rather than offering only cycle-dependent treatment. However, the available evidence on RATR is heterogeneous and derives predominantly from observational studies. The aim of this narrative review with a structured literature search was to synthesize the published evidence on the operative, reproductive, and economic outcomes of RATR and to contextualize its role in contemporary fertility counseling. : A structured literature search of PubMed/MEDLINE, Scopus, and Google Scholar was performed from database inception to 20 December 2025. Data were synthesized descriptively without meta-analysis. Primary robotic clinical studies were interpreted separately from secondary and contextual publications. : In total, 16 studies were included in our study. The evidence base comprised predominantly retrospective cohorts and case series; no randomized controlled trials were identified. Reported tubal patency endpoints in robotic cohorts ranged from 81.0% to 94.1%, although denominators differed across studies and were reported either per patient or per tube. Reported pregnancy outcomes ranged from 25% to 80%, reflecting substantial heterogeneity in patient selection, follow-up duration, and outcome definitions. When woman-level delivery or live-birth outcomes were explicitly reported, they were generally encouraging in selected series, although not uniformly defined. Estimated blood loss was usually minimal when reported, and conversion to laparotomy was uncommon. Any comparison with IVF was indirect because no contemporary head-to-head comparative studies were identified. Economic data were sparse, institution-specific, and methodologically heterogeneous. : Available observational evidence suggests that RATR is a feasible minimally invasive option for fertility restoration in carefully selected women after sterilization. However, the evidence base remains limited by retrospective design, small cohorts, heterogeneous outcome reporting, variable follow-up, and indirect comparison with IVF. RATR should be considered within individualized fertility counseling rather than as a universal alternative to IVF. Prospective comparative studies with standardized outcome definitions, transparent reporting of prognostic factors, and robust economic evaluation are needed.
Age at Initial Surgery and Surgical Burden in Congenital Spinal Deformity.
Abdaliyev S, Yestay D, Bekarissov O … +4 more , Vissarionov S, Saginova D, Baidarbekov M, Serikov S
Medicina (Kaunas) · 2026 May · PMID 42356066 · Full text
: Congenital spinal deformities associated with multiple vertebral anomalies often require surgical correction during growth; however, the relationship between age at initial surgery and cumulative treatment burden remai...
: Congenital spinal deformities associated with multiple vertebral anomalies often require surgical correction during growth; however, the relationship between age at initial surgery and cumulative treatment burden remains insufficiently characterized. : To evaluate whether age at first surgery is associated with surgical burden and radiographic outcomes in children with congenital spinal deformity treated with conventional posterior instrumented fusion. : In this retrospective single-center cohort study, 32 children treated between 2019 and 2024 were stratified by age at initial surgery into two groups: ≤6 years (n = 13) and 7-12 years (n = 19). Planned staged procedures and growth-friendly techniques were excluded. Surgical burden was assessed as the total number of procedures, procedures per patient-year, and high surgical burden, defined as ≥3 procedures. Radiographic outcomes included postoperative Cobb angle and correction percentage. Adjusted analyses were performed using Poisson regression with log follow-up as an offset term, logistic regression, and linear regression. : Baseline deformity severity was similar between groups (mean preoperative Cobb angle, 45.2 ± 19.0° vs. 43.1 ± 21.6°; = 0.61). Both groups showed significant within-group improvement after surgery ( < 0.001), with no significant between-group difference in correction percentage (61.5 ± 35.2% vs. 64.8 ± 30.6%; = 0.78). The total number of procedures and procedures per patient-year were also comparable between groups ( = 0.21 and = 0.58, respectively). However, high surgical burden was more frequent in the younger group (38.5% vs. 10.5%; = 0.048). In adjusted analysis, older age at first surgery was associated with lower odds of high surgical burden (OR = 0.78; 95% CI: 0.61-0.99; = 0.042), whereas no variable independently predicted correction percentage. : Younger age at initial surgery was associated with a greater likelihood of high surgical burden, whereas the time-adjusted operation rate and early coronal correction were similar between groups.
Neurologic Evaluation of Premature Infants at Term Equivalent Age: Too Early or Too Late? A Scoping Review.
Toma AI, Dima V, Zaharie GC … +3 more , Necula A, Pavalache Stoiciu R, Bivoleanu AR
Medicina (Kaunas) · 2026 May · PMID 42356065 · Full text
: Early identification and referral for intervention of former premature infants at risk of neurodevelopmental impairment is considered a standard of care. The main purpose of this review was to assess the optimal timing...
: Early identification and referral for intervention of former premature infants at risk of neurodevelopmental impairment is considered a standard of care. The main purpose of this review was to assess the optimal timing of the first visit in a neurodevelopmental follow-up programme in order to identify at-risk infants in a timely and reliable manner. : We considered three possible moments for the first evaluation: before 37 weeks postmenstrual age, at Term Equivalent Age (TEA, also known as 40 weeks postmenstrual age) and at 3-5 months corrected age (CA). A structured scoping review, informed by PRISMA-ScR principles, was performed. We searched PubMed/MEDLINE, Web of Science Core Collection, and Scopus from database inception through March 2026, combined with a Wohlin-type snowballing strategy. Two assessment techniques were evaluated: the Amiel-Tison neurological examination of the newborn and infant, and the General Movements Assessment (GMA). We collected data on sensitivity, specificity, and positive and negative predictive values at each of the three moments, and reviewed whether early intervention was associated with improved prognosis. : Intervention initiated before 12 months of age was associated with improved cognitive and motor outcomes in infancy compared with standard care; an additional benefit was observed when intervention started before discharge, particularly for cognitive outcomes in infancy. Both examinations showed very good specificity and negative predictive value at all three evaluation moments, consistent with their shared optimality concept. Sensitivity and specificity increased with the infant's age. At each moment, the examinations identified (i) a high-risk group clearly requiring early intervention, (ii) a "grey zone" with uncertain evolution requiring closer surveillance, and (iii) a normal group with a very low risk of adverse outcomes. Combining two examination techniques at the same visit consistently improved discriminative and predictive performance. : Evaluation at TEA alone may be too early because some abnormal findings normalize by 3 months CA, yet also too late for the most severely affected infants, who may manifest abnormal signs before term. We propose a stratified approach, with repeated evaluations using both the Amiel-Tison examination and GMA at 35-37 weeks postmenstrual age, at TEA, and at 3-5 months CA, in order to progressively identify infants at risk and refer them to appropriate early intervention. This proposal requires validation through prospective, well-designed research.
Sexual Health, Quality of Life, and Fertility Counselling in Breast Cancer Survivors Younger than 40 Years.
Tanase-Damian C, Antone NZ, Paun DL … +2 more , Tanase I, Achimaș-Cadariu P
Medicina (Kaunas) · 2026 May · PMID 42356064 · Full text
: Young women treated for breast cancer often face persistent sexual and reproductive challenges post-treatment, which frequently remain unaddressed during routine follow-up. This study evaluated health-related quality o...
: Young women treated for breast cancer often face persistent sexual and reproductive challenges post-treatment, which frequently remain unaddressed during routine follow-up. This study evaluated health-related quality of life (HRQoL), sexual health, and fertility-related counselling in breast cancer survivors younger than 40 years. : We performed a single-centre cross-sectional study including 65 women with non-metastatic breast cancer (at least 12 months post-primary treatment). Patients completed the EORTC QLQ-C30 and SHQ-22 questionnaires, along with a pilot-tested 7-item fertility preservation survey. Data were analyzed using descriptive statistics and non-parametric tests to compare treatment subgroups (e.g., endocrine therapy vs. others). : Overall quality-of-life scores were relatively preserved (median 66.67), with high functional scores. However, patients reported symptomatic distress, particularly fatigue and insomnia (both median 33.33). Sexual health was significantly impacted: communication with healthcare professionals was the most impaired domain (median score 100), followed by low libido (66.7) and vaginal dryness (66.7). Women receiving endocrine therapy reported significantly lower functional scores and a higher symptom burden compared to those not on endocrine treatment ( < 0.05). While 60% of patients received fertility information, only 16.9% underwent preservation procedures. Notably, a significant association was observed between reproductive health actions and sexual behaviour; women who had undergone fertility preservation procedures reported higher levels of sexual activity ( = 0.015). : Despite relatively preserved functional status, young breast cancer survivors face significant symptomatic and sexual challenges. The profound lack of communication regarding sexual health and the gaps in fertility counselling highlight the need for a more integrative, multidisciplinary approach in survivorship care.
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