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Medicina

Medicina is an international, peer-reviewed, open access journal covering all problems related to medicine, published monthly online. 
It is the official journal of the Lithuanian University of Health Sciences (LUHS). The Lithuanian Medical Association (LMA)Vilnius UniversityRīga Stradiņš UniversityUniversity of Latvia, and University of Tartu are affiliated with Medicina, serving as their official journal. Members of these organizations receive discounts on the article processing charges.
Indexed in PubMed | Quartile Ranking JCR - Q1 (Medicine, General and Internal)

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All Articles (12,915)

Transcatheter Versus Sutureless Aortic Valve Replacement: A Propensity-Matched Single-Center Cohort Study

  • Nikoleta Stanitsa,
  • Emmanouel Tempelis and
  • Panagiotis Dedeilias
  • + 5 authors

Background and Objectives: Over the past decade, transcatheter aortic valve replacement (TAVI) has evolved from a treatment for inoperable patients to an established option across all risk categories. In parallel, the Perceval sutureless valve has demonstrated safety and efficacy especially for minimally invasive surgical aortic valve replacement (AVR). Despite the advances of both TAVI and Perceval, robust long-term data and clear patient selection criteria are still lacking. This retrospective single-center study reports the outcomes of patients undergoing isolated AVR with the Perceval sutureless valve or with TAVI. Materials and Methods: We retrospectively reviewed consecutive patients undergoing isolated AVR at our institution between April 2013 and December 2024. Of 1006 eligible patients (424 TAVI; 582 Perceval), propensity score matching was performed for age, sex, EuroSCORE II, body surface area, and comorbidities, yielding 197 matched pairs. Primary endpoints were all-cause and cardiovascular mortality. Secondary endpoints included acute kidney injury, permanent pacemaker implantation, stroke, pericardial effusion, ICU stay, and overall hospital stay. Clinical and echocardiographic follow-up was obtained by medical-record review and routine echocardiography, with an additional prospective clinical and echocardiographic evaluation at 6–12 months. Results: Postprocedural paravalvular leak was significantly more frequent after TAVI than after Perceval AVR (23.4% vs. 2.5%; p < 0.001). At 6–12 months, TAVI was associated with greater aortic regurgitation and higher rates of para- and intra-prosthetic leak (both p < 0.001) and higher mean transvalvular gradients, particularly in small and medium valve sizes. ICU and overall hospital stay were longer after Perceval implantation (both p < 0.001). New permanent pacemaker implantation was numerically higher after TAVI (11.2% vs. 5.6%; p = 0.063). Early mortality was similar; however, 1-year mortality was higher after TAVI (16.2% vs. 9.1%; p = 0.045), and Kaplan–Meier analysis demonstrated better overall survival with Perceval (p < 0.001), while cardiovascular survival did not differ significantly (p = 0.851). Conclusions: Our study underscores the importance of meticulous patient selection when choosing between TAVI and Perceval. Perceval implantation was associated with better long-term overall survival than TAVI in the propensity-matched cohort. Paravalvular leaks were more frequent after TAVI and associated with poorer survival. Both approaches achieve excellent outcomes; however, differences in long-term survival and valve performance highlight the need for a personalized treatment strategy guided by a multidisciplinary heart team.

3 March 2026

Kaplan–Meier survival curves for overall survival (a) and for disease-specific survival (b) by procedure.

Background and Objectives: Medial opening wedge high tibial osteotomy (OWHTO) requires careful management of medial soft-tissue tension to achieve effective decompression and maintain knee stability. While superficial medial collateral ligament (sMCL) release is commonly performed, the role of pes anserinus release remains unclear. This study investigated the effect of pes anserinus release on postoperative pain, clinical outcomes, and medial stability in patients undergoing OWHTO. Materials and Methods: A retrospective analysis was performed on 80 knees (80 patients) that underwent OWHTO between 2012 and 2017. Patients were divided into two groups: Group A (n = 38, sMCL release only) and Group B (n = 42, sMCL + pes anserinus release). Immediate postoperative pain was assessed using visual analog scale (VAS) scores and rescue analgesic use. Clinical outcomes were evaluated with Knee Society Scores (KSSs). Radiographic medial joint opening (MJO) was measured on valgus stress radiographs preoperatively and at one year postoperatively. Results: Group B demonstrated significantly lower VAS pain scores at postoperative days (PODs) 1, 3, 5, 7, and 14 (p < 0.05) and required fewer rescue analgesics (5.5 ± 2.1 vs. 7.6 ± 3.7; p < 0.05). Both groups achieved comparable KSS improvement and radiographic correction (postoperative mechanical femorotibial angle: 2.1° valgus vs. 2.5° valgus). No significant intergroup or intragroup differences were observed in MJO at one-year follow-up (p > 0.05). Conclusions: Combined release of the superficial medial collateral ligament and pes anserinus during medial opening wedge high tibial osteotomy significantly reduces early postoperative pain and improves short-term functional recovery without compromising medial stability or alignment correction, although no significant long-term differences in functional outcomes or radiographic alignment were observed.

3 March 2026

Pancreatic Neuroendocrine Tumors: From Benchside to Surgical Treatment

  • Giovanni Conzo,
  • Federico Maria Mongardini and
  • Renato Patrone
  • + 7 authors

Pancreatic neuroendocrine tumors (pNETs) are rare, clinically heterogeneous neoplasms with rising incidence linked to improved diagnostics. This review examines pNET management, addressing epidemiology, classification, diagnosis, treatment, and emerging therapies. Epidemiologically, pNETs show higher prevalence in Western populations, with emerging associations to metabolic disorders. The 2022 WHO classification highlights distinct prognoses for well-differentiated NETs versus poorly differentiated NECs, guided by Ki-67 and mitotic indices. Non-functional tumors often present late, while functional variants manifest hormonal syndromes, necessitating tailored approaches. Advanced imaging (contrast-enhanced CT/MRI, 68Ga-DOTATATE PET) and endoscopic ultrasound-guided biopsy enable precise localization and grading. Surgical resection remains curative for localized disease, with minimally invasive techniques reducing morbidity. Active surveillance is favored for small (<2 cm), low-grade, non-functional tumors, while larger or aggressive lesions require resection. Systemic therapies, including mTOR inhibitors (everolimus), anti-angiogenics (surufatinib), and peptide receptor radionuclide therapy (PRRT), extend survival in advanced cases, though immunotherapy efficacy remains limited. Future strategies emphasize molecular profiling, biomarker development, and multidisciplinary integration to optimize outcomes. This evolving paradigm prioritizes precision medicine, balancing oncologic control with quality of life and functional preservation.

3 March 2026

Background and Objectives: Prostate cancer exhibits substantial biological heterogeneity. Although several biomarkers reflecting aggressive tumor behavior have been identified, molecular indicators related to biological adaptation to androgen deprivation remain limited. This study aimed to comparatively evaluate ISM-1 and B7-H3 expression in localized prostate cancer (LPC) and the pre-CRPC group (pre-treatment diagnostic biopsy tissue from patients who subsequently developed CRPC), and to investigate their clinicopathological associations in the pre-CRPC group. Materials and Methods: This retrospective study included 30 surgically treated LPC cases and 32 pre-CRPC cases with available prostate tissue samples obtained prior to the development of castration resistance. ISM-1 and B7-H3 expression levels were evaluated immunohistochemically using the H-score method (intensity 0–3 × proportion score 0–3 [0%, 1–19%, 20–50%, >50%]). Expression patterns were compared between LPC and pre-CRPC groups. Within the pre-CRPC group, associations with clinicopathological parameters were evaluated using H-scores as continuous variables, and time to castration resistance was analyzed using Cox regression. Results: ISM-1 expression was generally low in LPC cases, with a median H-score of 0, whereas pre-CRPC biopsy tissues demonstrated a marked increase in ISM-1 expression. B7-H3 expression was higher and more homogeneous in the pre-CRPC group compared with LPC. In the pre-CRPC group, ISM-1 and B7-H3 H-scores showed a strong positive correlation. No statistically significant associations were identified between ISM-1 or B7-H3 expression levels and most conventional clinicopathological parameters; however, both markers differed significantly across Grade Groups. Neither marker showed a statistically significant association with time to castration resistance, although ISM-1 demonstrated a non-significant trend toward a longer time to resistance. Conclusions: ISM-1 and B7-H3 exhibit distinct expression patterns across different stages of prostate cancer but show associated expression profiles in the pre-CRPC group. While B7-H3 appears to reflect aggressive tumor biology, the independent expression pattern of ISM-1 and its non-significant trend toward a longer time to resistance suggest a potential role in the clinical trajectory toward castration resistance. Combined assessment of ISM-1 and B7-H3 may contribute to a better understanding of tumor biology in patients who subsequently develop CRPC. These findings are descriptive and hypothesis-generating.

3 March 2026

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Medicina - ISSN 1648-9144