Medicina

15 pages, 1267 KB

Open AccessArticle

One-Year Comparative Outcomes of Conventional Versus Accelerated Corneal Cross-Linking in Progressive Keratoconus

by Iva Bešlić, Sania Vidas Pauk, Martina Tomić, Miro Kalauz, Tomislav Kuzman, Sonja Jandroković, Ivan Škegro, Antonela Geber, Lorena Karla Šklebar, Dina Lešin Gaćina, Petar Bešlić and Sanja Masnec

Medicina 2026, 62(6), 1209; https://doi.org/10.3390/medicina62061209 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Corneal collagen cross-linking (CXL) halts keratoconus progression, yet potential differences between conventional and accelerated protocols at one year remain uncertain. We analyzed the completed 12-month follow-up of a previously reported 6-month cohort to compare conventional (3 mW/cm² × [...] Read more.

Background and Objectives: Corneal collagen cross-linking (CXL) halts keratoconus progression, yet potential differences between conventional and accelerated protocols at one year remain uncertain. We analyzed the completed 12-month follow-up of a previously reported 6-month cohort to compare conventional (3 mW/cm² × 30 min; CXL 30) versus accelerated (9 mW/cm² × 10 min; CXL 10) CXL, interpreting outcomes within the ABCD framework alongside Kmax and curvature radii. Materials and Methods: In this single-center retrospective longitudinal analysis of prospectively collected routine clinical data, 22 eyes were included, with assessments performed at baseline and at 1, 3, 6, and 12 months of follow-up. Evaluated outcomes comprised ABCD stages (A–D), anterior and posterior radius of curvature (ARC and PRC), Kmax, pachymetric and elevation indices, as well as UDVA and BCVA. Within-group change used Friedman with Wilcoxon post hoc; between-group differences used Mann–Whitney (α = 0.05). Results: Both protocols resulted in significant visual improvement and Kmax reduction at 12 months (overall time effect: CXL 30 p < 0.001; CXL 10 p = 0.026). Median Kmax decreased 56.5 → 52.3 D (CXL 30) and 59.3 → 58.3 D (CXL 10). UDVA improved 0.2 → 0.6 (CXL 30) and 0.2 → 0.3 (CXL 10); BCVA 0.4 → 0.8 (CXL 30) and 0.2 → 0.5 (CXL 10). Tomographic analysis showed predominantly anterior changes, with a significant decrease in A stage in the CXL 30 group and an increase in ARC in both groups, more pronounced in CXL 30. In the late 6 → 12-month window, posterior metrics (PRC and posterior elevation) were largely stable; raw PRC change did not reach significance. Conclusions: Conventional and accelerated CXL both stabilized keratoconus at one year with meaningful functional gains. Beyond 6 months, remodeling was predominantly anterior; within-group findings suggested a more pronounced anterior tomographic response in the CXL 30 group. The 12-month visit may be useful for reassessing stability after CXL, although this study was not designed to determine optimal retreatment timing or optical rehabilitation strategy. Longer-term studies with standardized biomechanical and densitometric endpoints are warranted to assess durability and refine protocol selection. Full article

(This article belongs to the Special Issue Anterior Eye Segment Advances: Diagnosis and Treatment of Corneal Diseases, Cataracts and Glaucoma)

30 pages, 511 KB

Open AccessReview

Beyond the Intestinal Mucosa in Long-Standing Inflammatory Bowel Disease: Consequences of Chronic Inflammation and Endoscopic Approaches to Diagnosis and Management

by Sabina Gabriela Luca, Oana Cristina Petrea, Cristina Muzica, Ana Maria Singeap, Ana Maria Buzuleac, Adriana Dunca, Alexandru Sebastian Cotleț, Simona Stefania Juncu and Anca Trifan

Medicina 2026, 62(6), 1208; https://doi.org/10.3390/medicina62061208 (registering DOI) - 22 Jun 2026

Abstract

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC), chronic immune-mediated conditions of the gastrointestinal tract characterized by alternating periods of disease activity and remission with a complex multifactorial pathogenesis. Persistent intestinal inflammation in IBD is a key driver of [...] Read more.

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC), chronic immune-mediated conditions of the gastrointestinal tract characterized by alternating periods of disease activity and remission with a complex multifactorial pathogenesis. Persistent intestinal inflammation in IBD is a key driver of disease progression and is strongly associated with the development of complications such as dysplasia, colorectal cancer (CRC), intestinal strictures, and fistulas. It may also result in changes in anorectal function, identifiable and classifiable using high-resolution anorectal manometry. Histologic and endoscopic assessments are essential for the evaluation of intestinal inflammation. Cumulative inflammatory burden (CIB) is an important concept that quantifies inflammatory exposure in IBD over time by integrating the severity and duration of histologic inflammation across the disease course, highlighting the importance of long-term inflammatory activity in the development of CRC. Histologic healing may be an important therapeutic target in IBD to reduce the risk of long-term complications. In parallel, emerging precision medicine approaches aim to improve risk stratification and enable early, individualized interventions to reduce disease-related outcomes. Endoscopy also plays a fundamental role in monitoring high-risk patients and guiding treatment decisions. This review aims to characterize the main intestinal complications extending beyond the mucosa that are associated with cumulative chronic inflammation in patients with IBD, including dysplasia, CRC, strictures, fistulas, and anorectal dysfunction in an era increasingly focused on achieving complete mucosal healing. Particular attention is drawn to the significant role of persistent histologic and endoscopic inflammation in disease progression and development of complications, highlighting the specific features and associated risk factors of these disease-related outcomes. Throughout, this review emphasizes the fundamental role of endoscopy in the timely detection, monitoring, and therapeutic management of IBD-related complications, thereby reinforcing its role in comprehensive patient care. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Inflammatory Bowel Disease (IBD))

18 pages, 1458 KB

Open AccessArticle

Biological and Metabolic Correlates of Psychological Resilience in Maintenance Hemodialysis: An Exploratory Gender-Based Study

by Gloria María Zaragoza Fernández, Avinash Chandu Nanwani, Elena Jiménez Mayor, Celia Rodríguez Tudero, Esperanza Moral Berrio, Alonso González de Gregorio, Marco Vaca Gallardo, Enrique Antonio Florit, José C. De La Flor and Rafael Fernández Castillo

Medicina 2026, 62(6), 1207; https://doi.org/10.3390/medicina62061207 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Psychological resilience is central to emotional adaptation in patients undergoing maintenance hemodialysis (HD). Although psychosocial determinants have been widely studied, the role of routinely monitored biochemical markers remains insufficiently defined. Materials and Methods: This study examined the [...] Read more.

Background and Objectives: Psychological resilience is central to emotional adaptation in patients undergoing maintenance hemodialysis (HD). Although psychosocial determinants have been widely studied, the role of routinely monitored biochemical markers remains insufficiently defined. Materials and Methods: This study examined the associations between selected metabolic–inflammatory biomarkers and psychological resilience in adults receiving maintenance HD and explored potential gender-related differences. Resilience was assessed using the Resilience Scale–14 (RS-14). β₂-microglobulin, serum albumin, calcium, and 25-hydroxyvitamin D were analyzed as continuous predictors. Multiple linear regression models with heteroscedasticity-consistent robust standard errors (HC3) were adjusted for age, HD vintage, diabetes, and cardiovascular disease. Two interaction terms (Gender × β₂-microglobulin and Gender × albumin) were specified a priori. Model stability was evaluated using nonparametric bootstrap resampling (5000 iterations) and penalized regression with cross-validation. Results: In bivariate analyses, higher β₂-microglobulin levels were associated with lower resilience (ρ = −0.24; p = 0.041), whereas serum albumin showed a positive but non-significant association (p = 0.14). These relationships did not remain statistically significant in fully adjusted models (β₂-microglobulin: p = 0.107). No Gender × Biomarker interaction reached statistical significance (p = 0.162). Stratified analyses showed consistent directional patterns across gender groups. Conclusions: Metabolic–inflammatory biomarkers, particularly β₂-microglobulin and serum albumin, may be associated with psychological resilience in HD. However, gender-specific effects were not supported in adjusted analyses. These findings require validation in larger, longitudinal, multicenter studies. Full article

(This article belongs to the Section Urology & Nephrology)

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18 pages, 1047 KB

Open AccessArticle

Influence of Mitral Annular Calcification Assessed by Cardiac Computed Tomography on Procedural and Clinical Outcomes of Transcatheter Aortic Valve Implantation

by Yusuf Ziya Şener, Sadberk Lale Tokgözoğlu, Selin Ardalı Düzgün, Uğur Nadir Karakulak, Ahmet Hakan Ateş, Mehmet Levent Şahiner, Ergün Barış Kaya, Enver Atalar, Necla Özer, Tuncay Hazırolan and Kudret Aytemir

Medicina 2026, 62(6), 1206; https://doi.org/10.3390/medicina62061206 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Transcatheter aortic valve implantation (TAVI) is the standard therapy for patients with severe aortic stenosis at intermediate or high surgical risk. Mitral annular calcification (MAC) is frequently observed in this population and has been linked to adverse cardiovascular outcomes. [...] Read more.

Background and Objectives: Transcatheter aortic valve implantation (TAVI) is the standard therapy for patients with severe aortic stenosis at intermediate or high surgical risk. Mitral annular calcification (MAC) is frequently observed in this population and has been linked to adverse cardiovascular outcomes. This study evaluated the association between MAC and TAVI-related complications and mortality, and identified predictors of all-cause mortality and permanent pacemaker implantation (PPI) following TAVI. Materials and Methods: Patients undergoing self-expanding TAVI between January 2010 and June 2020 were retrospectively analyzed. Outcomes included TAVI-related complications, in-hospital and long-term mortality, and predictors of all-cause mortality and PPI. Results: A total of 245 patients (98 men [40%], mean age 76.3 ± 8.3 years) were included. Mean left ventricular ejection fraction was 54.8 ± 11.4%, and aortic valve area was 0.74 ± 0.14 cm². MAC was present in 148 patients (60.4%). Pericardial effusion (26.4% vs. 12.4%, p = 0.013) and acute kidney injury (21.6% vs. 7.2%, p = 0.005) were significantly more frequent in patients with MAC. PPI was required in 42 patients (17.8%). In-hospital mortality occurred in 14 patients (5.7%), and all-cause mortality was observed in 89 patients (36.3%) during a median follow-up of 23.1 months (IQR, 11.6–44.3). MAC extension into the left ventricular outflow tract was the only independent predictor of PPI (OR: 3.32, p = 0.002). Independent predictors of all-cause mortality included use of renin–angiotensin–aldosterone system blockers (HR: 0.54, p = 0.012), hemoglobin level (HR: 0.79, p = 0.006), severe MAC (HR: 1.94, p = 0.024), and post-TAVI atrial fibrillation (HR: 2.39, p = 0.002). Conclusions: MAC is common in TAVI patients and is associated with increased procedural complications, including higher rates of pericardial effusion and acute kidney injury. Greater MAC severity independently predicts higher all-cause mortality. In addition, MAC extension into the left ventricular outflow tract is an independent predictor of PPI following self-expanding TAVI, emphasizing the importance of comprehensive pre-procedural imaging. Full article

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27 pages, 3712 KB

Open AccessReview

When Breast Cancer Meets the Uterus: A Quantitative Review of 105 Cases Spanning Four Decades

by Tiberiu Augustin Georgescu, Antonia Carmen Georgescu and Maria Victoria Olinca

Medicina 2026, 62(6), 1205; https://doi.org/10.3390/medicina62061205 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Uterine metastasis from breast carcinoma is rare but poses substantial diagnostic and therapeutic challenges. Invasive lobular carcinoma (ILC) demonstrates a documented predilection for unusual metastatic patterns including the female genital tract, while tamoxifen-associated endometrial pathology may complicate diagnosis in breast [...] Read more.

Background and Objectives: Uterine metastasis from breast carcinoma is rare but poses substantial diagnostic and therapeutic challenges. Invasive lobular carcinoma (ILC) demonstrates a documented predilection for unusual metastatic patterns including the female genital tract, while tamoxifen-associated endometrial pathology may complicate diagnosis in breast cancer survivors. Materials and Methods: We performed a structured PubMed/MEDLINE and Google Scholar search (1980–2025) for cases with histologically confirmed breast primary and uterine involvement; a pooled analysis of demographic, histological, molecular, and clinical variables was performed. Results: 105 individual cases were identified. ILC accounted for 58.0% of histologically classified cases despite representing only 10–15% of breast cancers. Endometrial involvement was present in 68.6%, myometrial in 25.7%, and cervical in 26.7%. Tamoxifen exposure was strongly associated with polyp-substrate metastasis (29.3% vs. 4.7%; Fisher’s exact p = 0.0009; OR 8.41, 95% CI 2.20–32.14). Abnormal uterine bleeding was the dominant presentation (68.1%); 19.8% were asymptomatic. Median latency was 36 months (range from 24 months before to 360 months after the breast cancer diagnosis). Conclusions: Uterine metastasis from breast carcinoma is dominated by invasive lobular histology and frequently involves tamoxifen-associated polyps. A combined immunohistochemical panel (GATA3, TRPS1, E-cadherin, hormone receptors, PAX8) is essential for distinguishing metastatic disease from primary uterine pathology. Endometrial sampling should be considered with a low threshold in breast cancer survivors with abnormal uterine bleeding, and breast imaging is warranted when discohesive cells are encountered without a known breast primary. These proportions describe the published case literature rather than population-based prevalence; because the evidence is limited to case reports and small series, they should not be read as the true frequency of uterine involvement among women with breast cancer. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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13 pages, 2745 KB

Open AccessPerspective

Clinical Use of Infrared Thermography: Where Are We and Where Are We Going

by Agnieszka Wnuk-Scardaccione and Jan Bilski

Medicina 2026, 62(6), 1204; https://doi.org/10.3390/medicina62061204 (registering DOI) - 22 Jun 2026

Abstract

Medical infrared thermography, which involves the use of infrared thermal cameras for the non-invasive assessment of skin surface temperature distribution, has gained increasing interest in recent years as a tool supporting diagnosis and treatment monitoring. The aim of this article is to present [...] Read more.

Medical infrared thermography, which involves the use of infrared thermal cameras for the non-invasive assessment of skin surface temperature distribution, has gained increasing interest in recent years as a tool supporting diagnosis and treatment monitoring. The aim of this article is to present the historical background and critically reassess the current role of infrared thermography in medicine, with particular emphasis on standardization as a key determinant of its clinical utility. This Perspective highlights the fundamental impact of methodological variability on diagnostic performance and reproducibility. A structured framework for standardization is proposed, encompassing patient preparation, environmental conditions, device parameters and calibration, image acquisition protocols, region-of-interest definition and analysis, as well as reporting and clinical interpretation. The analysis demonstrates how inconsistencies at each of these levels reduce measurement reliability, limit inter-study comparability, and weaken clinical confidence in infrared thermography. The article also addresses the growing availability of mobile thermal imaging systems and their integration with artificial intelligence, while emphasizing the need for stronger evidence-based support across all methodological domains. The presented analysis suggests that, despite existing limitations, medical infrared thermography holds considerable potential as a supportive clinical tool. However, its broader clinical implementation remains limited by several factors, with the lack of standardized protocols constituting a major and practically addressable translational barrier. Wider adoption will require standardization efforts alongside rigorous validation studies and application-specific interpretative guidelines. Addressing these challenges through technological advances and coordinated international standardization may facilitate meaningful progress over the next decade. Full article

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10 pages, 873 KB

Open AccessArticle

Bone Defect Regeneration and Donor-Site Morbidity After Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study

by Milan Milinkov, Oliver Dulić, Mile Bjelobrk, Milan Tošić, Branko Baljak, Mihail Mirković and Mirko Obradović

Medicina 2026, 62(6), 1203; https://doi.org/10.3390/medicina62061203 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: This prospective cohort study aimed to assess patellar and tibial donor-site bone defect volume and regeneration on MRI at 4 weeks and 12 months after bone–patellar tendon–bone anterior cruciate ligament reconstruction and to determine their association with knee function [...] Read more.

Background and Objectives: This prospective cohort study aimed to assess patellar and tibial donor-site bone defect volume and regeneration on MRI at 4 weeks and 12 months after bone–patellar tendon–bone anterior cruciate ligament reconstruction and to determine their association with knee function and donor-site morbidity at 12 months. Materials and Methods: This single-center prospective observational cohort study included 30 patients who underwent ACL reconstruction with a BTB autograft. Donor-site bone defect volume was estimated on MRI using a triangular prism approximation at 4 weeks and 12 months by two independent evaluators blinded to patient-reported outcome scores. Clinical outcomes were assessed at 12 months using the International Knee Documentation Committee (IKDC) subjective knee form and the Donor Site Morbidity Questionnaire (DSMQ). Associations between MRI-derived parameters and patient-reported outcomes were analyzed using Spearman’s rank correlation coefficient. Results: At 4 weeks, mean donor-site bone defect volume was 2602.4 ± 684.7 mm³ in the patella and 2993.9 ± 714.3 mm³ in the tibia. At 12 months, defect volume decreased to 628.0 ± 279.7 mm³ and 980.8 ± 488.2 mm³, respectively. Tibial defects were significantly larger than patellar defects at both time points, while regeneration was significantly greater in the patella than in the tibia (74.8 ± 11.5% vs. 67.2 ± 15.1%; p = 0.0264). Regeneration was not significantly associated with IKDC or DSMQ scores (all p > 0.05). Larger patellar defect volume at 4 weeks was associated with worse subjective outcomes (both p = 0.0107). Conclusions: After BTB ACL reconstruction, tibial donor-site bone defects were larger, whereas patellar defects showed greater regeneration over time. Larger patellar defect volume at 4 weeks, but not regeneration percentage, was associated with worse subjective outcomes at 12 months. Full article

(This article belongs to the Section Sports Medicine and Sports Traumatology)

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22 pages, 1211 KB

Open AccessArticle

CYP3A4, CYP3A5, and CYP4F2 Polymorphisms and Bleeding Risk in Ticagrelor-Based Dual Antiplatelet Therapy

by Sonja Dakić, Zoran Perišić, Svetlana Apostolović, Tomislav Kostić, Goran Koraćević, Tatjana Jevtović, Boris Đinđić, Nikola Stefanović, Danijela Đorđević-Radojković, Bojan Maričić, Dragana Stanojević, Maša Jović, Jelena Perišić and Tamara Filipović

Medicina 2026, 62(6), 1202; https://doi.org/10.3390/medicina62061202 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Ticagrelor reduces ischemic events in acute coronary syndrome (ACS) but increases bleeding risk. Clinical predictors of bleeding are well established; the contribution of cytochrome P450 polymorphisms involved in ticagrelor metabolism remains uncertain, with conflicting reports in the literature. We [...] Read more.

Background and Objectives: Ticagrelor reduces ischemic events in acute coronary syndrome (ACS) but increases bleeding risk. Clinical predictors of bleeding are well established; the contribution of cytochrome P450 polymorphisms involved in ticagrelor metabolism remains uncertain, with conflicting reports in the literature. We examined the association of CYP3A4* 22 (rs 35599367), CYP3A5* 3 (rs 776746), and CYP4F2 (rs3093135) with bleeding in a Serbian ACS cohort. Materials and Methods: This prospective, single- center observational study enrolled 105 consecutive ACS patients undergoing percutaneous coronary intervention (PCI) or medical management after coronary angiography and receiving dual antiplatelet therapy (DAPT) with acetylsalicylic acid and ticagrelor at the University Clinical Center Niš between January 2024 and the end of May 2025. Bleeding events occurring during the index hospitalization and the six-month follow-up were classified according to the Bleeding Academic Research Consortium (BARC) criteria. Genotyping used TaqMan assays. Associations with bleeding were assessed using Firth’s penalized logistic regression, with multivariable adjustment for age and renal function. Severity-stratified analyses and gradient-boosted machine learning (XGBoost with SHAP) were performed as exploratory analyses. Results: Thirteen patients (12.4%) experienced bleeding (nine minor [BARC 1/2], four major [BARC 3/5]). Age ≥ 75 years (univariable OR 7.62, p = 0.001) and eGFR < 60 mL/min/1. 73 m ² (OR 3.68, p = 0.006) were the strongest predictors. CYP3A5 *1 carrier status was univariably associated with bleeding (OR 4.16, p = 0.043) but did not remain significant after adjustment for age and renal function, and *1 carriers were significantly older and more likely to have impaired renal function. No genotype was associated with major (BARC 3/5) bleeding. The apparent effect was concentrated in minor bleeding (BARC 1/2 rate: 30.8% versus 5.5%), with no major events among *1 carriers. CYP 3 A 4* 22 (OR 1.37, p = 0.109) and CYP 4 F 2 (OR 1.17, p = 0.111) showed no association. Machine-learning analyses confirmed eGFR and age as the dominant predictors. Conclusions: In this Serbian ACS cohort, clinical factors—particularly advanced age and impaired renal function—dominated the prediction of bleeding risk. The CYP3A5 signal was largely explained by baseline imbalances in age and renal function. CYP 3 A 4* 22 and CYP 4 F 2 polymorphisms did not contribute additional predictive information. Preemptive genotyping for these variants is unlikely to materially improve bleeding-risk assessment beyond standard clinical evaluation in patients of this type. Full article

(This article belongs to the Special Issue Advances in Acute Myocardial Infarction)

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22 pages, 2479 KB

Open AccessArticle

Gender-Specific Trends and Determinants of Daily Smoking in Latvia (2009–2019): A Population-Based Cross-Sectional Study

by Peteris Apinis, Iveta Bajare, Vilnis Dzerve, Sanda Jegere, Lilian Tzivian, Baiba Kokina, Artis Luguzis, Anda Caksa and Andrejs Erglis

Medicina 2026, 62(6), 1201; https://doi.org/10.3390/medicina62061201 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Cigarette smoking remains a leading modifiable cardiovascular risk factor. This study aimed to analyze decade trends in daily smoking prevalence and its association with education level and physical activity by gender and age groups in Latvia. Materials and Methods [...] Read more.

Background and Objectives: Cigarette smoking remains a leading modifiable cardiovascular risk factor. This study aimed to analyze decade trends in daily smoking prevalence and its association with education level and physical activity by gender and age groups in Latvia. Materials and Methods: We analyzed data from two distinct waves of a population-based cross-sectional study conducted in Latvia. The study included a stratified random sample of adults aged 25–74 (N = 3807 in 2009; N = 4070 in 2019). Smoking status and education level were self-reported in both years; physical activity data were collected only in 2019. Multivariable logistic regression identified independent factors associated with smoking. Results: From 2009 to 2019, smoking prevalence decreased among men (from 43.6% to 36.0%, p < 0.01) and increased among women (from 15.0% to 18.1%, p < 0.01). Men and women with higher education were significantly less likely to be daily smokers (2019, Men: odds ratio (OR): 0.48, 95% confidence interval (CI) 0.38–0.59; Women: OR: 0.39, 95% CI 0.29–0.50). Among men, the proportion of daily smokers was higher in physically inactive (39.8%) and active (39.0%) groups compared to the moderately active group (31.4%, p < 0.01). However, physical activity level was not a significant predictor of smoking in the multivariable analysis. Conclusions: Over the decade, daily smoking prevalence decreased in men but increased in women in Latvia, with education level being a strong independent predictor. Although the proportion of smokers among men differed across physical activity groups, this factor was not an independent predictor of smoking. These findings underscore the need for targeted public health interventions in Latvia, specifically focusing on individuals with lower education levels to reduce the long-term cardiovascular burden. Full article

(This article belongs to the Section Epidemiology & Public Health)

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12 pages, 878 KB

Open AccessArticle

Pure Nodal Small Lymphocytic Lymphoma: Clinical, Pathologic, and Outcome Features in a Single-Center Cohort

by Andreea Georgiana Stoica, Mariana Așchie, Miruna Gherase-Cristian, Anca Florentina Mitroi, Georgeta Camelia Cozaru, Mădălina Boșoteanu, Cristina Cioti, Sorin Deacu and Irina Tica

Medicina 2026, 62(6), 1200; https://doi.org/10.3390/medicina62061200 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Small lymphocytic lymphoma (SLL) represents the tissue-based manifestation of chronic lymphocytic leukemia (CLL). Despite their shared biological background, patients with SLL have been underrepresented in CLL-focused clinical trials, and data addressing the clinical behavior of pure nodal SLL remain [...] Read more.

Background and Objectives: Small lymphocytic lymphoma (SLL) represents the tissue-based manifestation of chronic lymphocytic leukemia (CLL). Despite their shared biological background, patients with SLL have been underrepresented in CLL-focused clinical trials, and data addressing the clinical behavior of pure nodal SLL remain scarce. The present study aimed to identify factors associated with time to first treatment (TTFT) and progression-only survival in patients with pure nodal SLL. Materials and Methods: In this prospective observational study, 46 patients with pure nodal SLL were included and followed for a median duration of approximately 5 years. Clinical, laboratory, histopathological, and TP53-related parameters were evaluated for their prognostic impact on TTFT and progression-only survival. Results: On univariable analysis, advanced-stage disease, hemoglobin < 10 g/dL, elevated serum β2M, elevated lactate dehydrogenase, del(17p), and aberrant p53 immunohistochemical expression were significantly associated with shorter TTFT and progression-only survival. Conclusions: Pure nodal SLL is a heterogeneous entity with a variable clinical course. Easily assessable clinical and biological parameters, including TP53 abnormalities, may help predict treatment requirement and disease progression, thereby contributing to better risk stratification and more individualized management. Kaplan–Meier analysis demonstrated significantly shorter time-to-first-treatment (TTFT) among patients with elevated β2M levels (≥3.5 mg/L), bulky lymphadenopathy (≥5 cm), and advanced-stage disease. Full article

(This article belongs to the Section Hematology and Immunology)

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12 pages, 561 KB

Open AccessSystematic Review

Hyperbaric Oxygen Therapy Is Associated with Lower Mortality in Patients with Fournier’s Gangrene: A Meta-Analysis

by Chienhsiu Huang, Lichen Lin and Tiju Tang

Medicina 2026, 62(6), 1199; https://doi.org/10.3390/medicina62061199 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: The therapeutic management of Fournier’s gangrene involves the use of broad-spectrum antibiotics and adequate surgical debridement; however, the overall mortality rate remains high globally. Hyperbaric oxygen therapy may serve as an adjunct treatment modality for reducing mortality in patients [...] Read more.

Background and Objectives: The therapeutic management of Fournier’s gangrene involves the use of broad-spectrum antibiotics and adequate surgical debridement; however, the overall mortality rate remains high globally. Hyperbaric oxygen therapy may serve as an adjunct treatment modality for reducing mortality in patients with Fournier’s gangrene, but its efficacy remains debatable. Consequently, this meta-analysis assessed the effect of hyperbaric oxygen therapy on mortality in patients with Fournier’s gangrene. Materials and Methods: To assess the effect of hyperbaric oxygen therapy on patients with Fournier’s gangrene, various databases were meticulously searched by focusing on the study population, intervention, control, and mortality outcomes. Results: Fourteen studies, enrolling a total of 793 patients, including 356 in the hyperbaric oxygen therapy cohort and 437 in the nonhyperbaric oxygen therapy cohort, were included in this meta-analysis. Compared with the mortality rate of 27.45% in the control cohort, the rate in the hyperbaric oxygen therapy cohort was 9.55%. This difference between patients with Fournier’s gangrene who underwent conventional therapy with hyperbaric oxygen therapy and those receiving only conventional therapy was significant (RR = 0.33; 95% CI 0.23–0.48; p < 0.001). Conclusions: Hyperbaric oxygen therapy may serve as an adjunct intervention to mitigate the increased risk of mortality among patients with Fournier’s gangrene. Methodologically rigorous randomized controlled trials must be conducted to determine the appropriate dosage and therapeutic efficacy of hyperbaric oxygen therapy in these patients and identify specific patient cohorts poised to obtain a benefit from this treatment. Full article

(This article belongs to the Section Urology & Nephrology)

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9 pages, 489 KB

Open AccessReview

Uveitis Associated with Conventional Cigarette Smoking and E-Cigarette Use: A Narrative Review

by Alan Y. Hsu, Chun-Ju Lin, Ning-Yi Hsia, Yi-Ching Shao, Chun-Chi Chiang, Chun-Ting Lai, Chia-Yun Chen and Yi-Yu Tsai

Medicina 2026, 62(6), 1198; https://doi.org/10.3390/medicina62061198 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: Uveitis is an inflammatory condition of the uveal tract and has been associated with cigarette smoking. However, the relationship between uveitis and electronic cigarette (e-cigarette) use remains poorly understood. This review aims to give a brief overview of the [...] Read more.

Background and Objectives: Uveitis is an inflammatory condition of the uveal tract and has been associated with cigarette smoking. However, the relationship between uveitis and electronic cigarette (e-cigarette) use remains poorly understood. This review aims to give a brief overview of the current evidence regarding the association between uveitis and both conventional cigarette smoking and e-cigarette use. Materials and Methods: A narrative literature review was conducted using PubMed and Scopus databases. Relevant peer-reviewed publications were identified using the search terms “vaping,” “cigarette,” and “uveitis.” Results: Multiple studies have demonstrated a significant association between cigarette smoking and an increased risk of uveitis. In contrast, evidence examining the relationship between e-cigarette use and uveitis is limited. Conclusions: Uveitis is a potentially vision-threatening ophthalmologic condition, and improved understanding of its risk factors is essential for optimal patient care. While the association between conventional cigarette smoking and uveitis is well established, current evidence regarding e-cigarette use remains insufficient. Further research is needed to clarify the potential role of e-cigarette use in the development of uveitis. Full article

(This article belongs to the Section Ophthalmology)

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13 pages, 3621 KB

Open AccessArticle

The Role of Lung Volume, Age, and Body Mass Index in Determining Obstructive Sleep Apnea Severity

by Enes Gul, Ömer Tamer Doğan, Neslihan Taş, Irfan Atik and Ismail Salk

Medicina 2026, 62(6), 1197; https://doi.org/10.3390/medicina62061197 (registering DOI) - 22 Jun 2026

Abstract

Background and Objectives: It is well established that obstructive sleep apnea syndrome (OSAS) is associated with functional lung volumes. The aim of this study was to investigate the relationship between morphological lung volume and the severity of OSAS. Materials and Methods: Adult patients [...] Read more.

Background and Objectives: It is well established that obstructive sleep apnea syndrome (OSAS) is associated with functional lung volumes. The aim of this study was to investigate the relationship between morphological lung volume and the severity of OSAS. Materials and Methods: Adult patients evaluated for sleep disorders between January 2020 and January 2024 were retrospectively reviewed. Patients with an AHI greater than 5, who underwent both spirometry and thoracic CT within a three-month interval, were included. Spirometric functional volume and morphological CT lung volume were assessed. Associations between OSAS severity and both functional and morphological lung volumes were analyzed. Results: A total of 195 patients were enrolled, of whom 166 had CT scans suitable for lung volume assessment. Among all patients, 20 (10.3%) were in the mild, 39 (20.0%) in the moderate, and 136 (69.7%) in the severe OSAS group. Ordinal regression analysis was performed to evaluate the factors influencing these categories. Age (p < 0.001) and BMI (p < 0.001) were positively correlated with disease severity, whereas female sex was associated with a lower risk of severe disease (p = 0.003). Conclusions: Functional and morphological lung volumes did not affect OSAS severity. Functional and morphological lung volumes were positively correlated with each other. Both morphological and functional lung volumes showed negative correlations with BMI. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea: New Insights and Future Directions)

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21 pages, 533 KB

Open AccessArticle

by Anastasia Karagiannaki, Vasiliki Michou, Evangelia Antoniou, Menelaos Zafrakas and Panagiotis Eskitzis

Medicina 2026, 62(6), 1196; https://doi.org/10.3390/medicina62061196 (registering DOI) - 21 Jun 2026

Abstract

Background and Objectives: Quality of life (QoL) is an important issue for breast cancer (BC) survivors. The objective of this study was to assess health-related QoL (HRQoL) of BC patients and investigate the impact of different demographic and clinical factors on physical and [...] Read more.

Background and Objectives: Quality of life (QoL) is an important issue for breast cancer (BC) survivors. The objective of this study was to assess health-related QoL (HRQoL) of BC patients and investigate the impact of different demographic and clinical factors on physical and social functioning and BC-related symptoms. Materials and Methods: In this cross-sectional study, 107 BC patients undergoing chemotherapy in Greece completed a questionnaire collecting sociodemographic and clinical information and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (EORTC QLQ-C30) in order to assess HRQoL. Descriptive statistics and multiple linear regression analyses were used to identify factors linked to HRQoL outcomes. Results: Overall, participants reported moderate HRQoL, with high physical and social functioning and moderate emotional, cognitive, and role functioning. Fatigue was the most common symptom, whereas other symptoms were generally uncommon. Multiple regression analyses showed that marital status, place of residence, time since diagnosis, and type of surgery were significantly associated with the global QLQ-C30 score (R² = 0.337, p < 0.001). Physical functioning was associated with comorbidity burden, time since diagnosis, and employment status (R² = 0.155, p = 0.035), and social functioning with marital status and type of surgery (R² = 0.171, p = 0.011). Emotional functioning showed exploratory associations with place of residence and type of surgery; however, the overall regression model for emotional functioning did not reach statistical significance. No symptom model reached overall significance, but time since diagnosis, treatment type, and surgery were linked to distinct symptoms. Conclusions: BC patients undergoing chemotherapy in Greece report an overall moderate level of HRQoL, which is significantly influenced by a combination of demographic and clinical factors; physical and social functioning were high, with moderate emotional, cognitive, and role functioning. These findings highlight the importance of individualized supportive care strategies in order to improve QoL of BC patients. Full article

(This article belongs to the Special Issue New Developments in Diagnosis and Management of Breast Cancer)

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20 pages, 1115 KB

Open AccessArticle

Smartphone-Derived Movement Analysis for Musculoskeletal Assessment: Smartphone-Estimated Relative Vertical Power During the Sit-to-Stand Test as an Accessible Predictor of Knee Extensor Strength in Older Adults

by Chanon Fapinyo, Weerasak Tapanya, Nitiphoom Sinnathakorn, Pasa Sukson, Warunyou Ngiamphaisan and Noppharath Sangkarit

Medicina 2026, 62(6), 1195; https://doi.org/10.3390/medicina62061195 (registering DOI) - 21 Jun 2026

Abstract

Background and Objectives: Assessing knee extensor (KE) strength is important for detecting muscle weakness in older adults, yet dynamometry is often impractical in community settings. This study examined whether smartphone-derived kinematics during the Five Times Sit-to-Stand Test (FTSST) could predict seated isometric KE [...] Read more.

Background and Objectives: Assessing knee extensor (KE) strength is important for detecting muscle weakness in older adults, yet dynamometry is often impractical in community settings. This study examined whether smartphone-derived kinematics during the Five Times Sit-to-Stand Test (FTSST) could predict seated isometric KE strength. Materials and Methods: A cross-sectional study included 105 community-dwelling older adults (68.19 ± 5.85 years). A smartphone application extracted rising time, vertical velocity, and smartphone-estimated relative vertical power during the FTSST. KE strength was measured as maximum voluntary isometric contraction (MVIC) using fixed-frame dynamometry with a Lafayette dynamometer head. Bioelectrical impedance-derived body composition variables were reported descriptively but excluded from the primary prediction models to maintain a transparent movement-based model independent of device-specific body-composition estimates. Hierarchical regression models used smartphone-derived variables and transparent non-BIA covariates. Agreement was examined using Bland–Altman analysis. Results: Smartphone-estimated relative vertical power showed the strongest correlation with MVIC (r = 0.787, p < 0.001). The combined model including sex, age, femur length, and smartphone-estimated relative vertical power explained 71.6% of MVIC variance (adjusted R² = 0.716, SEE = 3.276 kg), outperforming vertical velocity, rising time, and total FTSST time models. Internal validation using repeated 10-fold cross-validation showed CV-R² = 0.701, CV-adjusted R² = 0.689, CV-RMSE = 3.343 kg, and CV-MAE = 2.739 kg. Bland–Altman analysis showed minimal mean bias (0.00 kg), 95% limits of agreement from −6.296 to 6.296 kg, and significant proportional bias (slope = −0.172, p = 0.002), indicating overestimation in weaker individuals and underestimation in stronger individuals. Conclusions: Consistent with our hypothesis, smartphone-estimated relative vertical power was the strongest kinematic predictor of seated isometric KE strength among the evaluated FTSST-derived variables. This approach may support community screening and monitoring, but it should not replace standardized dynamometry for precise individual-level strength quantification. Full article

(This article belongs to the Special Issue Recent Trends in Physical Therapy for Musculoskeletal Disorders)

13 pages, 305 KB

Open AccessArticle

Factors Associated with Frailty in Patients with Active Inflammatory Bowel Disease: A Single-Center Observational Study

by Mihaela Topala, Victor Ionescu, Ioana Gabriela Lupescu, Gabriel Becheanu and Cristian Gheorghe

Medicina 2026, 62(6), 1194; https://doi.org/10.3390/medicina62061194 (registering DOI) - 21 Jun 2026

Abstract

Background and Objectives: Frailty is increasingly recognized as a clinically relevant condition in inflammatory bowel disease (IBD), yet available data remain limited and are often derived from indirect assessment methods. This study aimed to assess frailty using a Fried-derived index and to identify [...] Read more.

Background and Objectives: Frailty is increasingly recognized as a clinically relevant condition in inflammatory bowel disease (IBD), yet available data remain limited and are often derived from indirect assessment methods. This study aimed to assess frailty using a Fried-derived index and to identify factors associated with frailty in adults with active IBD. Materials and Methods: We analyzed baseline data from a prospective, single-center cohort of adult patients hospitalized with active IBD who required initiation of biologic therapy or small molecules. Frailty was assessed using a modified Fried frailty index comprising shrinking, exhaustion, weakness, slowness, and low physical activity. Patients fulfilling ≥3 criteria were classified as frail, while those meeting 1–2 criteria were classified as pre-frail. Clinical, anthropometric, functional, laboratory, and questionnaire-based patient-reported measures were compared between frail and non-frail patients. Multivariate logistic regression was used to identify factors independently associated with frailty. Results: Seventy-five patients were included, of whom 45 (60%) were male and 44 (58.7%) had ulcerative colitis. The median age was 37 years. Frailty was identified in 17 (22.7%) patients, and 47 (62.7%) were pre-frail. Frail patients were younger (p = 0.001) and had a shorter disease duration (p = 0.036), higher disease activity scores (p = 0.005), higher C-reactive protein levels (p = 0.006), lower hemoglobin levels (p = 0.030) and serum albumin concentrations (p < 0.001), and lower body mass index (p < 0.001). In multivariate analysis, shorter disease duration (OR = 0.83, 95% CI: 0.70–0.97, p = 0.021) and lower serum albumin levels (OR = 0.17, 95% CI: 0.05–0.59, p = 0.005) were independently associated with frailty, whereas severe disease (OR = 2.14, 95% CI: 0.52–8.86, p = 0.294) was not significant after adjustment. Conclusions: Frailty and pre-frailty were highly prevalent in this selected cohort of relatively young adults with active IBD. Shorter disease duration and lower albumin levels were independently associated with frailty. Assessing frailty status may help identify vulnerable patients who could benefit from closer monitoring and multidisciplinary interventions. Full article

(This article belongs to the Special Issue New Advances in Inflammatory Bowel Disease and Diarrheal Disorders)

18 pages, 764 KB

Open AccessArticle

Unsupervised Clinical Phenotyping Identifies Distinct Risk Profiles in Incisional Hernia Repair

by Laurențiu Augustus Barbu, Daniel Ioan Mihalache, Liviu Vasile, Stelian-Stefaniță Mogoantă, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu and Gabriel Florin Răzvan Mogoș

Medicina 2026, 62(6), 1193; https://doi.org/10.3390/medicina62061193 (registering DOI) - 21 Jun 2026

Abstract

Background and Objectives: Patients undergoing incisional hernia repair constitute a clinically heterogeneous population with variable postoperative outcomes. Conventional risk models based on isolated risk factors may inadequately capture this complexity. This study aimed to identify data-driven clinical phenotypes and evaluate their association [...] Read more.

Background and Objectives: Patients undergoing incisional hernia repair constitute a clinically heterogeneous population with variable postoperative outcomes. Conventional risk models based on isolated risk factors may inadequately capture this complexity. This study aimed to identify data-driven clinical phenotypes and evaluate their association with surgical outcomes. Methods and Materials: A retrospective cohort of 1262 patients undergoing retromuscular incisional hernia repair (Rives–Stoppa technique) was analyzed. Unsupervised clinical phenotyping was performed using latent class analysis based on seven preoperative variables. Model selection was guided by Akaike information criterion (AIC), Bayesian information criterion (BIC), entropy, and clinical interpretability. Postoperative outcomes were compared across phenotypes. Results: Three distinct phenotypes were identified: metabolic (34.6%), structural (33.9%), and frailty (31.5%). The structural phenotype showed the highest complication (22.7%) and recurrence rates (8.6%), while the frailty phenotype had the lowest complication burden (14.6%). The metabolic phenotype was characterized by obesity and diabetes, consistent with increased wound-related morbidity. Cluster robustness was supported by internal validation metrics and sensitivity analyses. Conclusions: In this retrospective single-center cohort, distinct clinical phenotypes with different outcome profiles were identified among patients undergoing incisional hernia repair, supporting the concept that this population comprises clinically heterogeneous subgroups with distinct patterns of vulnerability. These findings should be considered preliminary and hypothesis-generating. Further external validation and prospective studies are required to determine the clinical utility of phenotype-based risk stratification. Full article

(This article belongs to the Special Issue Abdominal Surgery: Clinical Updates and Future Perspectives)

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15 pages, 318 KB

Open AccessArticle

Reversal of Frailty and Improvement in Quality of Life Following Advanced Therapy Initiation in Patients with Inflammatory Bowel Disease: A Prospective Cohort Study

by Mihaela Topala, Victor Ionescu, Monica Cojocaru, Razvan Iacob, Liliana Simona Gheorghe, Roxana Vadan and Cristian Gheorghe

Medicina 2026, 62(6), 1192; https://doi.org/10.3390/medicina62061192 (registering DOI) - 21 Jun 2026

Abstract

Background and Objectives: In recent years, frailty has emerged as a prognostic factor in inflammatory bowel diseases (IBD), particularly among patients with active disease. However, evidence regarding its reversibility after treatment optimization remains limited. This study aimed to assess frailty in active [...] Read more.

Background and Objectives: In recent years, frailty has emerged as a prognostic factor in inflammatory bowel diseases (IBD), particularly among patients with active disease. However, evidence regarding its reversibility after treatment optimization remains limited. This study aimed to assess frailty in active IBD and determine whether frailty status improved after 6 months of clinical management and the achievement of clinical remission. Materials and Methods: This prospective, single-center, observational cohort study included adults with active IBD requiring escalation to advanced therapy who achieved clinical remission at the 6-month follow-up. Patients were evaluated at baseline and after 6 months using a modified Fried frailty phenotype. Quality of life was assessed using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Univariate and multivariate logistic regressions were utilized to identify independent factors associated with frailty improvement. Results: The analysis included 54 patients (61.1% male; 42.6% with Crohn’s disease). At baseline, 20.4% were classified as frail, 72.2% as pre-frail, and 7.4% as robust. Following 6 months of clinical management and the achievement of clinical remission, a 100% resolution of frailty was observed, with the robust cohort expanding to 42.6%. Significant improvements occurred across clinical parameters, including handgrip strength, 400 m walk times, and median SIBDQ scores (increasing from 4.4 to 5.9, p < 0.001) alongside a substantial decline in CES-D scores (p = 0.017). Multivariate logistic regression revealed that severe disease at baseline (aOR = 4.51, 95%CI: 1.26–16.18, p = 0.020), anti-TNF therapy initiation (aOR = 3.69, 95%CI: 1.04–13.18, p = 0.044), and higher baseline CES-D scores (aOR = 1.06, 95%CI: 1.00–1.13, p = 0.038) were independently associated with higher odds of frailty improvement. Conclusions: Among patients who achieved clinical remission, frailty and pre-frailty demonstrate substantial short-term improvement following advanced therapy. Functional and psychological recoveries are associated with successful control of baseline disease severity and systemic inflammation. Full article

(This article belongs to the Special Issue New Advances in Inflammatory Bowel Disease and Diarrheal Disorders)

15 pages, 2201 KB

Open AccessArticle

Buccal Bone Thickness of Maxillary Incisors Adjacent to Palatally Impacted Canines: A Split-Mouth CBCT Study

by Mehmet Gümüş Kanmaz and Genta Agani Sabah

Medicina 2026, 62(6), 1191; https://doi.org/10.3390/medicina62061191 (registering DOI) - 20 Jun 2026

Abstract

Background and Objectives: To compare the buccal bone thickness of adjacent maxillary incisors between the impacted and contralateral control sides in patients with unilateral palatally impacted canines (PICs) using a split-mouth cone-beam computed tomography (CBCT) design. Materials and Methods: CBCT records [...] Read more.

Background and Objectives: To compare the buccal bone thickness of adjacent maxillary incisors between the impacted and contralateral control sides in patients with unilateral palatally impacted canines (PICs) using a split-mouth cone-beam computed tomography (CBCT) design. Materials and Methods: CBCT records of 26 patients with a unilateral PIC (18 females, 8 males; mean age, 17.35 ± 4.58 years) were retrospectively analyzed. Buccal bone thickness was measured at five equally spaced levels from the root apex (Level A) to the buccal alveolar crest (Level E) for the central and lateral incisors. Alveolar crest height, incisor torque and rotation, follicular width, canine localization, canine-to-root proximity, and root resorption were also assessed. Results: The impacted side showed significantly reduced buccal bone thickness at the two most apical levels of the lateral incisor: Level A (−0.81 mm; p < 0.001) and Level B (−0.35 mm; p = 0.004). No side differences were observed at the remaining lateral incisor levels or at any central incisor level. In the orientation-adjusted sensitivity model accounting for incisor torque and rotation, Level A remained significant (−0.75 mm; p < 0.001), whereas Level B was attenuated (p > 0.005). Lateral incisors on the impacted side also showed reduced labial torque (−4.97°; p = 0.001) and greater mesiobuccal rotation (−12.23°; p < 0.001). Conclusions: PICs were associated with localized apical reduction in buccal bone thickness of the adjacent lateral incisor, accompanied by reduced labial torque and greater mesiobuccal rotation. Buccal bone thickness may represent a relevant consideration during CBCT-based treatment planning for PICs. Full article

(This article belongs to the Section Dentistry and Oral Health)

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