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Medicina, Volume 62, Issue 6 (June 2026) – 6 articles

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12 pages, 529 KB

Open AccessArticle

Prognostic Value of C-Reactive Protein–Albumin–Lymphocyte (CALLY) Index for Survival in Nivolumab-Treated Metastatic Renal Cell Carcinoma

by Ali Fuat Gürbüz, Mehmet Zahid Koçak, Oğuzhan Yıldız, Ömer Genç, Bahattin Engin Kaya, Talat Aykut, Melek Karakurt Eryılmaz, Murat Araz and Mehmet Artaç

Medicina 2026, 62(6), 1009; https://doi.org/10.3390/medicina62061009 - 22 May 2026

Abstract

Background and Objectives: Metastatic renal cell carcinoma (mRCC) remains a lethal disease despite advances with immune checkpoint inhibitors such as nivolumab. However, a substantial proportion of patients exhibit primary resistance or early progression, highlighting the need for reliable and easily accessible prognostic biomarkers. The C-reactive protein–albumin–lymphocyte (CALLY) index is a novel immunonutritional biomarker integrating systemic inflammation, nutritional status, and immune competence. Materials and Methods: In this retrospective single-center study, 91 patients with mRCC treated with nivolumab were analyzed. Patients were stratified into low and high CALLY index groups based on a receiver operating characteristic-derived cut-off (0.322). Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. Results: Patients with a low CALLY index demonstrated significantly shorter progression-free survival (4.5 vs. 13.5 months, p < 0.001) and overall survival (9.1 vs. 25.5 months, p = 0.003). Multivariate analysis confirmed the CALLY index as an independent prognostic factor for both progression-free survival (HR: 2.63, p = 0.002) and overall survival (HR: 1.88, p = 0.035). Conclusions: The CALLY index is a simple, cost-effective, and reproducible biomarker that independently predicts survival in nivolumab-treated mRCC. It may serve as a practical tool for risk stratification and personalized treatment planning in the immunotherapy era. Full article

(This article belongs to the Section Oncology)

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13 pages, 1850 KB

Open AccessArticle

Continuous Monitoring of Positive Airway Pressure Therapy with a Smartphone-Based Home Sleep Apnea Test

by Sungjin Heo, Seunghun Kim, Sungeun Moon, Sujin Lee, Dongheon Lee, Joonki Hong, Yoo-Sam Chung, Hyun Jik Kim, Jung Kyung Hong, In-Young Yoon and Jeong-Whun Kim

Medicina 2026, 62(6), 1008; https://doi.org/10.3390/medicina62061008 - 22 May 2026

Abstract

Background and Objectives: Adherence to positive airway pressure (PAP) is often suboptimal, and current monitoring relies on device logs that, by design, cannot detect respiratory events outside the therapy window. This creates a physiological blind spot during periods of non-usage. This study aimed to demonstrate the clinical necessity of independent, continuous monitoring using a smartphone-based home sleep apnea test (S-HSAT) by validating treatment effectiveness on adherent nights and quantifying the untreated apnea burden caused by partial adherence. Methods: We prospectively monitored 63 obstructive sleep apnea (OSA) patients commencing PAP therapy. Nightly apnea–hypopnea index (AHI) and usage time were recorded simultaneously by an S-HSAT (ApnoTrack) and the PAP device over a 30-day period. Nights were categorized by the duration discrepancy between S-HSAT and PAP (full-use, ≤5 min; intermediate-use, 5–30 min; partial-use, >30 min) using physiologically and operationally derived thresholds. Results: Final analysis included 39 participants contributing 667 nights (24 participants excluded due to non-use of one or both devices). Full-use nights (46.2%) showed close agreement between S-HSAT and PAP mean AHI (2.8 ± 4.3 vs. 2.5 ± 2.0 events/h; p = 0.13). On intermediate-use and partial-use nights (20.7% and 33.1%, respectively), substantial AHI discrepancies emerged (7.3 ± 5.5 vs. 3.8 ± 3.3 and 11.0 ± 7.4 vs. 2.8 ± 2.5 events/h, respectively; both p < 0.001). Conclusions: Independent S-HSAT monitoring quantified an untreated apnea burden that is invisible to PAP logs alone, while confirming therapeutic efficacy on well-adherent nights. These findings suggest that continuous independent monitoring may help bridge the gap between prescribed therapy and actual physiological outcomes in OSA care. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Obstructive Sleep Apnea)

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15 pages, 11351 KB

Open AccessArticle

Effects of External Load and Holding Duration on PAPE and Muscle Activation During Isometric Split Squat Conditioning Activity

by Mingu Kang, Minsang Kim, Yujin Jeong and Sanghee Park

Medicina 2026, 62(6), 1007; https://doi.org/10.3390/medicina62061007 - 22 May 2026

Abstract

Background and Objectives: Conditioning activities (CAs) are commonly used to induce post-activation performance enhancement (PAPE); however, it remains unclear whether load-dependent responses established in bilateral, predominantly isotonic models extend to unilateral split squat conditions. In particular, evidence regarding holding isometric muscle action (HIMA) is limited, and it is unknown how external load and holding duration interact to influence both performance outcomes and phase-specific muscle activation. Therefore, this study examined the acute effects of HIMA duration and external load during unilateral split squat CA on jump performance and phase-specific electromyographic (EMG) activity. Materials and Methods: Twenty recreationally active men completed a randomized, counterbalanced crossover design involving four split squat CA conditions, unloaded 3 s, unloaded 5 s, 3 s loaded (60% 1RM), and 5 s loaded (60% 1RM), each performed as three sets of three repetitions. To minimize fatigue effects, standardized rest intervals and familiarization sessions were implemented prior to testing. Single-leg jump (SLJ) and countermovement jump (CMJ) were assessed before and after CA, with post-activation measurements conducted at 3 min (SLJ) and 4 min (CMJ), consistent with established PAPE time windows. Surface EMG was time-normalized across the split squat cycle and analyzed using phase-specific area under the curve. Results: CMJ significantly increased following both loaded conditions (p < 0.05; moderate to large effect sizes), whereas no differences were observed between unloaded durations. External load consistently elevated EMG amplitude across all measured muscles (moderate to large effects). Extending duration under load further increased activation in the hamstrings, stabilizers, vastus medialis, and gastrocnemius medialis (p < 0.05; small to moderate effects), whereas unloaded conditions showed minimal neuromuscular differences. Conclusions: External load, rather than isometric holding duration, appears to be a key factor influencing acute PAPE responses in unilateral split squat HIMA, whereas prolonged holding duration may primarily modulate muscle recruitment patterns without additional performance gains. However, given the acute experimental design and a recreationally active sample, these findings should be interpreted with caution and considered exploratory. Further studies are warranted to confirm these effects across different populations and longer-term training conditions. Full article

(This article belongs to the Special Issue Optimizing Athlete Health and Performance: Multidisciplinary Perspectives in Sports Medicine)

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19 pages, 3082 KB

Open AccessArticle

Variations in S-100Β and Neuron-Specific Enolase Levels During Functional Endoscopic Sinus Surgery Under Moderately Controlled Hypotension Using Four Distinct Anesthetic Protocols: A Randomized Controlled Study

by Sotiria Rizopoulou, Spyridon Lygeros, Anne-Lise de Lastic, Dimitra Georgakopoulou, Gerasimos Daniilidis, Athanasia Voulgary and Diamanto Aretha

Medicina 2026, 62(6), 1006; https://doi.org/10.3390/medicina62061006 - 22 May 2026

Abstract

Background and Objectives: Controlled hypotension during functional endoscopic sinus surgery (FESS) improves surgical field visibility but may pose a risk of subclinical cerebral hypoperfusion. Serum S100Β and neuron-specific enolase (NSE) are established biomarkers of glial and neuronal injury and may reflect perioperative neuroprotection associated with different anesthetic regimens. This study evaluated the effect of four anesthetic protocols on perioperative brain biomarker release during FESS. Materials and Methods: In this single-center, randomized, controlled trial, 88 adult patients (ASA I–III) undergoing FESS under moderately controlled hypotension (mean arterial pressure < 55 mmHg) were allocated to one of four groups: propofol–remifentanil, propofol–remifentanil with ketamine–magnesium, sevoflurane–remifentanil, or sevoflurane–remifentanil with ketamine–magnesium. Serum S100Β and NSE concentrations were measured at three timepoints: early intraoperatively, during hypotension, and at the end of surgery. Biomarker data were analyzed using nested ANOVA and linear mixed-effects models adjusted for relevant covariates. Secondary outcomes included recovery characteristics, surgical field quality, bleeding scores, and perioperative hemodynamics. Results: Baseline demographic and perioperative characteristics were comparable across groups. The group receiving sevoflurane–remifentanil combined with ketamine–magnesium showed the lowest S100B levels (p = 0.01 compared to the propofol–remifentanil group; p = 0.04 compared to the sevoflurane–remifentanil group). Additionally, NSE concentrations were markedly lower in both sevoflurane groups (sevoflurane–remifentanil and sevoflurane–remifentanil plus ketamine–magnesium) compared to the propofol–remifentanil group (p = 0.003 and p = 0.007, respectively). No intergroup differences were observed at baseline and surgical field quality, bleeding, and hemodynamic parameters did not differ significantly among groups. Recovery and extubation times were shortest with propofol–remifentanil, whereas ketamine–magnesium prolonged emergence. Conclusions: Anesthetic technique significantly influences perioperative brain biomarker release during FESS. Sevoflurane-based regimens, with or without ketamine–magnesium, demonstrate more favorable neurobiological profiles under controlled hypotension, although propofol-based anesthesia offers faster recovery. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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12 pages, 4551 KB

Open AccessArticle

Protective Effects of Sitagliptin on Dextran Sulfate Sodium-Induced Colitis via Modulation of Inflammatory and Oxidative Stress

by Vivian Soetikno, Mawar Subangkit, Andika Yusuf Ramadhan, Somasundaram Arumugam and Remya Sreedhar

Medicina 2026, 62(6), 1005; https://doi.org/10.3390/medicina62061005 - 22 May 2026

Abstract

Background: To examine the antioxidant and anti-inflammatory effects of sitagliptin in restoring the intestinal mucosal barrier in rats with colitis induced by dextran sulfate sodium (DSS). Methods: Male Sprague-Dawley rats were administered 5% DSS in their drinking water to induce colitis. Sitagliptin was administered intragastrically at a dose of 15 mg/kg/day for a duration of eight days. Changes in the colon tissue were histologically examined, and the disease activity index (DAI) score was measured. The levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase were evaluated. Gene expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, tight junction proteins occludin and ZO-1 was assessed. Levels of SGOT, SGPT, and serum iron were also measured. Results: Sitagliptin diminished DAI and histological index scores, as well as MDA levels, while augmenting SOD, GPx, and catalase levels over an eight-day period. Based on proinflammatory cytokines, sitagliptin reduced colon inflammation. Compared to the untreated DSS group, sitagliptin increased serum iron and lowered SGOT and SGPT. Conclusions: The present results indicate that administering sitagliptin orally for a week could aid in the recovery from DSS-induced colitis by reducing oxidative stress and pro-inflammatory cytokines. Additional studies are required to make this applicable for patients suffering from colitis. Full article

(This article belongs to the Section Pharmacology)

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18 pages, 1146 KB

Open AccessArticle

Prognostic Significance of Preoperative PET-CT SUVmax in Resected Non-Small Cell Lung Cancer: A Single-Center Retrospective Study

by Alper Yaşar, Zeynep Yüksel Yaşar, Sedat Yıldırım, Akif Doğan, Tuğba Kaya, Miray Aydoğan, Tuğba Başoğlu, Deniz Işık, Hatice Odabaş and Nedim Turan

Medicina 2026, 62(6), 1004; https://doi.org/10.3390/medicina62061004 - 22 May 2026

Abstract

Background and Objectives: Positron emission tomography with 18F-FDG (PET-CT) provides a quantitative measure of tumor metabolic activity through the maximum standardized uptake value (SUVmax) of lung tumors—a measure of metabolic activity that may have prognostic value in non-small cell lung cancer (NSCLC). This study evaluated whether preoperative tumor SUVmax predicts outcomes in resected NSCLC. Materials and Methods: This single-center retrospective study included 209 consecutive patients with resected NSCLC who had preoperative FDG PET-CT. SUVmax of the primary tumor was recorded, and patients were stratified into low- and high-SUVmax groups to evaluate survival outcomes. Results: Median age was 62 years and 77% were male. Histologic subtypes were adenocarcinoma (44%), squamous carcinoma (43%), and others (13%), with stage I–III distribution of 39.7%, 33.5%, and 26.8%, respectively. SUVmax demonstrated moderate discrimination for mortality (AUC = 0.652), with an optimal cutoff of 11.14. Patients with SUVmax ≥ 11.14 had significantly worse OS and DFS. However, on multivariate analysis, SUVmax was not an independent predictor of outcomes, while extracapsular invasion (OS) and adjuvant chemotherapy (DFS) remained significant. Conclusions: In this cohort of resected NSCLC, high preoperative SUVmax (≥11.14) was associated with more advanced tumor stage and worse OS/DFS but was not an independent prognostic factor after accounting for other variables. Tumor invasiveness and use of adjuvant therapy were stronger outcome predictors. Preoperative SUVmax may help identify high-risk patients when considered alongside established clinicopathologic factors. Full article

(This article belongs to the Special Issue Advances in Cancer Imaging, Radiomics, and Radiotherapy)

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