Medicina

15 pages, 1069 KB

Open AccessArticle

Association of Cancer Stage and Comorbidity Burden with 12-Month Clinically Significant Cognitive Decline After Gynecologic Cancer Surgery: A Competing-Risk Retrospective Cohort Study

by Jaehak Jung, Byoungryun Kim, Taewan Won, Gyumin Choi, Kyongseo Kim and Cheol Lee

Medicina 2026, 62(5), 988; https://doi.org/10.3390/medicina62050988 (registering DOI) - 19 May 2026

Abstract

Background and Objectives: We aimed to determine whether gynecologic cancer–related factors are associated with postoperative clinically significant cognitive decline (CCD) after accounting for age and comorbidity using competing-risk models. Materials and Methods: We performed a retrospective cohort study of adult women undergoing index [...] Read more.

Background and Objectives: We aimed to determine whether gynecologic cancer–related factors are associated with postoperative clinically significant cognitive decline (CCD) after accounting for age and comorbidity using competing-risk models. Materials and Methods: We performed a retrospective cohort study of adult women undergoing index surgery for gynecologic cancer at a tertiary university hospital. CCD was defined as new clinician-documented cognitive impairment, neurology/psychiatry consultation, or initiation of cognition-targeted pharmacotherapy ≥30 days postoperatively. Competing events were all-cause death and major neurologic events/hospice. We fit Fine–Gray subdistribution hazard models adjusted for age, Charlson Comorbidity Index (CCI), cancer stage, and treatment intensity, and evaluated a prespecified age × stage interaction. Results: Among 1023 eligible patients (mean age 62.4 ± 11.8 years; 41.3% International Federation of Gynecology and Obstetrics [FIGO] stage III–IV; median CCI 3 [IQR 2–5]), CCD occurred in 98 (9.6%). The 12-month cumulative incidence of CCD was 11.2% accounting for competing risks. Advanced stage was independently associated with higher CCD risk (sHR 1.85, 95% CI 1.27–2.69; p = 0.001). A significant age × stage interaction was observed (p < 0.001), with the strongest association in patients ≥70 years (sHR 2.48, 95% CI 1.61–3.81). Perioperative factors associated with CCD included open surgery (sHR 1.54) and postoperative delirium (sHR 2.76); these findings should be interpreted as associative signals rather than validated causal treatment targets. A stratified blinded chart review of 160 patients (80 flagged-positive and 80 unflagged controls) supported the CCD definition (PPV 88.8%; sensitivity 72.1%; specificity 94.3%; NPV 91.5%). Visit-frequency adjustment confirmed robustness (advanced stage sHR 1.78; p = 0.003). Conclusions: Gynecologic cancer–related factors, particularly advanced stage, are independently associated with CCD after accounting for competing risks, and high-risk phenotypes (age ≥70, FIGO III–IV) may benefit from perioperative pathways integrating cognitive screening, delirium prevention, and neurocognitive follow-up. Full article

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

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11 pages, 544 KB

Open AccessArticle

Does the Duration of FLOT Infusion Change the Outcome of Perioperative Treatment for Gastric Cancer? Comparing 24- and 48-h Infusions

by Hacer Demir, Canan Yıldız, Yusuf İlhan, Murat Araz, Ali Fuat Gürbüz, Semiha Urvay, Muslih Urun, Berrak Mermit Ercek, Onur Yazdan Balçık, Beyza Ünlü, Sena Ece Davarcı, Ramazan Cosar, Meltem Baykara and Ismail Beypinar

Medicina 2026, 62(5), 987; https://doi.org/10.3390/medicina62050987 (registering DOI) - 19 May 2026

Abstract

Background and Objectives: FLOT is a highly effective first-line treatment for metastatic gastric cancer and offers a favorable safety profile. Clinical studies investigating the FLOT regimen have reported varying outcomes depending on the infusion duration and have highlighted possible differences in complication rates [...] Read more.

Background and Objectives: FLOT is a highly effective first-line treatment for metastatic gastric cancer and offers a favorable safety profile. Clinical studies investigating the FLOT regimen have reported varying outcomes depending on the infusion duration and have highlighted possible differences in complication rates and the efficacy of neoadjuvant therapy. The choice between 24 h or 48 h infusion durations for fluorouracil can be influenced by several factors, such as the patient’s overall health status, their tolerance to treatment, and the specific treatment protocol determined by the medical team. In this study, we aimed to evaluate the effects of different infusion durations (24 and 48 h) on clinical response, toxicity, and survival in patients with gastric and gastroesophageal junction (GEJ) adenocarcinoma. Materials and Methods: This retrospective multicenter study included 113 patients with gastric or gastroesophageal junction adenocarcinoma who received neoadjuvant FLOT chemotherapy (24 h infusion: n = 28; 48 h infusion: n = 85). Propensity score matching (PSM) was performed to balance baseline characteristics, yielding a matched cohort of 90 patients. The primary endpoints were the pathologic complete response (pCR) and toxicity. Secondary endpoints included disease-free survival (DFS) and overall survival (OS). Results: Significant baseline imbalances existed (cT stage p < 0.001). After PSM, the balance improved (cT stage p = 0.009). In the matched cohort, pCR 11.1% (24 h) vs. 12.1% (48 h), p > 0.99. The median DFS was 27.4 mo (24 h) vs. NR (48 h), p = 0.847. The median OS was 32.8 mo in both, p = 0.797. Multivariate analysis (baseline variables) indicates that infusion duration is not prognostic (DFS HR = 0.77, p = 0.453; OS HR = 0.72, p = 0.328). Power was ~10% for a 1% pCR difference. Conclusions: The 24 h infusion protocol was associated with similar outcomes to the 48 h protocol after PSM adjustment. However, residual confounding persists (cT stage p = 0.009 despite PSM), and the combination of this study’s retrospective design and severe underpowering (~10%) precludes definitive conclusions. As a result, the findings are hypothesis-generating. Full article

(This article belongs to the Special Issue Prophylaxis, Diagnosis, and Treatment Strategies of Gastric Cancer)

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25 pages, 1096 KB

Open AccessReview

Metabolic Dysfunction-Associated Steatotic Liver Disease and Incretin Receptor Agonists: A Metabolic Approach to Halting Liver Disease Progression

by Ludovico Abenavoli, Anna Giulia Loricchio, Ivo Lopez, Domenico Morano, Abdulrahman Ismaiel, Dan Lucian Dumitrascu and Francesco Luzza

Medicina 2026, 62(5), 986; https://doi.org/10.3390/medicina62050986 (registering DOI) - 18 May 2026

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with metabolic abnormalities, shares pathophysiological pathways with metabolic syndrome, and has become a leading cause of chronic liver disease in industrialized nations. In the absence of approved pharmacological treatments and due to its high [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with metabolic abnormalities, shares pathophysiological pathways with metabolic syndrome, and has become a leading cause of chronic liver disease in industrialized nations. In the absence of approved pharmacological treatments and due to its high risk of progression to advanced fibrosis, MASLD represents a significant clinical challenge. Incretin-based therapies, originally developed for the treatment of type 2 diabetes mellitus and obesity, have recently gained attention as promising therapeutic strategies in hepatology. Among them, GLP-1 receptor agonists have shown efficacy in reducing hepatic steatosis, inflammation, and fibrosis-related biomarkers, primarily through weight loss and enhanced insulin sensitivity. Dual agonists targeting both GLP-1 and GIP receptors, such as tirzepatide, have demonstrated superior outcomes in improving hepatic and metabolic parameters. Emerging agents like cotadutide (a GLP-1/glucagon receptor agonist) and retatrutide (a GLP-1/GIP/glucagon triagonist) represent a novel therapeutic frontier, with early clinical data indicating potent hepatoprotective effects and favorable metabolic remodeling. This narrative review examines the hepatoprotective potential of incretin-based therapies, highlighting how targeted intervention on the underlying metabolic dysfunction may lead to significant improvements in MASLD. These therapies may also exert beneficial effects on fibrosis progression; however, the currently available evidence remains limited. Full article

(This article belongs to the Special Issue Advances in GLP-1 Agonists and Liver Disease)

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13 pages, 657 KB

Open AccessArticle

Dietary Approaches to Stop Hypertension (DASH) Diet, Incident Heart Failure and Its Associated Risk Factors in Australian Women

by Lee Patricia Liao, Simone Marschner, Gary C. H. Gan, Liza Thomas, Allison Hodge, Haeri Min, Luigi Fontana, Sarah Zaman and Anushriya Pant

Medicina 2026, 62(5), 985; https://doi.org/10.3390/medicina62050985 (registering DOI) - 18 May 2026

Abstract

Background and Objectives: There is limited evidence supporting the incorporation of dietary patterns into heart failure (HF) management. The Dietary Approaches to Stop Hypertension (DASH) diet is linked to cardiovascular disease prevention, but evidence correlating DASH adherence to HF risk is sparse. This [...] Read more.

Background and Objectives: There is limited evidence supporting the incorporation of dietary patterns into heart failure (HF) management. The Dietary Approaches to Stop Hypertension (DASH) diet is linked to cardiovascular disease prevention, but evidence correlating DASH adherence to HF risk is sparse. This study is the first prospective investigation into the relationship between the DASH diet, incident HF and its associated risk factors—hypertension and diabetes mellitus (DM)—in Australian women. Materials and Methods: Survey data (2001–2022) from the Australian Longitudinal Study on Women’s Health (ALSWH) was analysed, where DASH diet scores were calculated from food frequency questionnaire (FFQ) responses and categorised into quintiles. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between DASH adherence and incident HF. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% CIs for secondary endpoints, hypertension and DM, and dietary exposure was modelled as a time-varying covariate. Results: 10 594 women (mean age 52.5 ± 1.45 years) participated and, at 21-year follow-up, there were 136 (1.3%) cases of HF, 2182 (20.6%) and 994 (5.7%) cases of hypertension and DM, respectively. After adjustment for covariates (including age and socioeconomic factors), no association was found between the highest DASH quintile and incident HF [OR 0.73, 95% CI: 0.37–1.43; p = 0.20]. However, adjusted HRs for hypertension and DM—0.73 (95% CI: 0.63–0.84; p < 0.001) and 0.65 (95% CI: 0.53–0.81; p < 0.001), respectively—indicated significant associations. Conclusions: In Australian women, DASH diet adherence was associated with a significantly lower risk of hypertension and DM, both of which are HF risk factors. The finding of no direct statistically significant association between the DASH diet and incident HF might reflect the small incidence of HF in our cohort. Full article

(This article belongs to the Special Issue New Insights into Heart Failure: 2nd Edition)

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18 pages, 1401 KB

Open AccessArticle

First-Line Treatment After Perioperative FLOT in Recurrent Gastric and Gastroesophageal Junction Cancer: A Turkish Oncology Group (TOG) Multicenter Real-World Analysis

by Mustafa Seyyar, Pervin Can Şancı, Abdullah Sakin, Ayberk Bayramgil, Özgecan Dülgar Kaya, Erdem Sünger, Özgür Açıkgöz, Teyfik Demir, Recep Türkel, Bahiddin Yılmaz, Faruk Recep Özalp, Hüseyin Salih Semiz, Gül Sema Yıldıran, Musa Barış Aykan, Görkem Turhan, Atila Yıldırım, Serkan Menekşe, Engin Kut, Mehmet Çakmak, Efnan Algın, Elif Şahin, Anıl Karakayalı, Aysel Oğuz, Mehmet Artaç, Mehmet Cihan İçli, Burak Paçacı, Murat Sarı, Teoman Şakalar, Murad Guliyev, Nebi Serkan Demirci, Eyyüp Çavdar, Ömer Faruk Elçiçek, Ali İnal, Hatice Bölek, Pınar Kubilay Tolunay, Ali Kalem, Melike Yazıcı, Ayşegül Merç Çetinkaya, Sinem Akbaş, Sedat Biter, Sait Kitaplı, Merve Kuday Özkan, Lamia Şeker Can, Nargiz Majidova, Hacı Arak, Hasan Çağrı Yıldırım, Devrim Çabuk, Kazım Uygun, Sema Sezgin Göksu, Özgür Tanrıverdi, Fatih Selçukbiricik, Mehmet Uzun, İlker Nihat Ökten, Burak Mete, Tolga Köşeci, Ahmet Bilici, Tülay Kuş, Ömer Dizdar, Şuayib Yalçın and Umut Kefeli Show full author list Hide full author list

Medicina 2026, 62(5), 984; https://doi.org/10.3390/medicina62050984 (registering DOI) - 18 May 2026

Abstract

Background and Objectives: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for resectable gastric and gastroesophageal junction adenocarcinoma; however, up to 50% of patients develop metastatic recurrence. These patients have prior exposure to platinum and taxane agents, and [...] Read more.

Background and Objectives: Perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) is the standard of care for resectable gastric and gastroesophageal junction adenocarcinoma; however, up to 50% of patients develop metastatic recurrence. These patients have prior exposure to platinum and taxane agents, and optimal first-line treatment in the metastatic setting remains undefined. This study aimed to characterize real-world treatment patterns and outcomes in patients progressing after perioperative FLOT, focusing on relapse timing and HER2 status. Materials and Methods: This retrospective, multicenter cohort study included 296 patients from 31 centers across Türkiye, stratified into early relapse (≤6 months, n = 114) and late relapse (>6 months, n = 182) groups. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Results: Median PFS and OS for the entire cohort were 6 and 9 months, respectively. Early relapsers had significantly shorter median PFS (4 vs. 6 months, p = 0.029) and OS (8 vs. 12 months, p = 0.047); however, early relapse timing did not retain independent prognostic significance on multivariable analysis. No significant difference in PFS or OS was observed between cytotoxic chemotherapy regimens in either relapse group. HER2 positivity was the only independent predictor of improved PFS on multivariable Cox analysis (HR 0.48, 95% CI 0.29–0.81; p = 0.006). In the late relapse group, trastuzumab-based chemotherapy achieved a median PFS of 14 months and OS of 18 months, significantly superior to all cytotoxic regimens (PFS p = 0.007; OS p = 0.029). Conclusions: In patients progressing after perioperative FLOT, cytotoxic chemotherapy regimen selection did not demonstrate a statistically significant survival difference in this retrospective cohort, regardless of relapse timing. HER2 positivity is the dominant predictive biomarker, and trastuzumab-based therapy suggests a potential survival benefit that warrants prospective validation. Comprehensive biomarker profiling at metastatic diagnosis and prospective trials designed for this post-FLOT population are needed to establish evidence-based treatment standards. Full article

(This article belongs to the Section Oncology)

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14 pages, 5597 KB

Open AccessArticle

Subcortical Bone Cysts at the Medial Meniscus Posterior Root Are Associated with Longer Symptom Duration but Not with Healing Status or Meniscal Extrusion After Root Repair

by Young-Mo Kim, Yong-Bum Joo and Young-Cheol Park

Medicina 2026, 62(5), 983; https://doi.org/10.3390/medicina62050983 (registering DOI) - 18 May 2026

Abstract

Background and Objectives: Subcortical bone cysts at the tibial attachment of the medial meniscus posterior root (MMPR) may reflect chronic degenerative changes; however, their clinical significance in medial meniscus posterior root tear (MMPRT) remains unclear. This study assessed whether bone cysts are [...] Read more.

Background and Objectives: Subcortical bone cysts at the tibial attachment of the medial meniscus posterior root (MMPR) may reflect chronic degenerative changes; however, their clinical significance in medial meniscus posterior root tear (MMPRT) remains unclear. This study assessed whether bone cysts are associated with symptom duration and whether their presence influences healing status or medial meniscus extrusion (MME) after transtibial pullout repair (TPR). Materials and Methods: Seventy-four consecutive patients who underwent arthroscopic TPR for MMPRT between January 2022 and December 2024 were retrospectively reviewed. After applying exclusion criteria, 50 patients were included and divided into cyst-positive (n = 20) and cyst-negative (n = 30) groups based on preoperative MRI findings. Clinical outcomes, MME, and second-look arthroscopic healing status at 6 months postoperatively were compared between groups. Multivariable linear regression analysis was performed to identify independent predictors of postoperative MME. Results: The cyst-positive group had significantly longer symptom duration than the cyst-negative group (13.8 ± 3.0 vs. 8.8 ± 2.8 weeks, p < 0.001) and demonstrated higher grades of MMPR degeneration (p < 0.05). Complete healing was observed in 60.0% of patients in each group, and no failed healing cases were noted. Postoperative MME at 6 months was comparable between groups (3.8 ± 0.8 vs. 3.8 ± 1.0 mm). Multivariable regression analysis identified baseline MME as the strongest independent predictor of postoperative MME (β = 0.67, p < 0.001), whereas bone cyst presence was not independently associated with postoperative extrusion. Conclusions: Subcortical bone cysts at the MMPR attachment are associated with longer symptom duration and more advanced root degeneration. However, their presence was not significantly associated with healing status or postoperative MME after MMPRT repair. These findings suggest that bone cyst formation may be associated with chronic degenerative changes at the root attachment, but should not discourage surgeons from performing root repair. Full article

(This article belongs to the Special Issue Advances in Knee Surgery: From Diagnosis to Recovery)

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16 pages, 1463 KB

Open AccessArticle

Evaluation of Pancreatic Lesions: Comparative Analysis of Endoscopic Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging

by Seher Hekimsoy, Aliye Soylu, Mehmet Bayram, Hafize Uzun and Omur Tabak

Medicina 2026, 62(5), 982; https://doi.org/10.3390/medicina62050982 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: This study aimed to evaluate the diagnostic performance of endoscopic ultrasound (EUS) in comparison with computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of pancreatic lesions, and to assess the concordance of imaging findings with histopathological outcomes. [...] Read more.

Background and Objectives: This study aimed to evaluate the diagnostic performance of endoscopic ultrasound (EUS) in comparison with computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of pancreatic lesions, and to assess the concordance of imaging findings with histopathological outcomes. Materials and Methods: A total of 76 patients who underwent EUS for pancreatic lesions between April 2021 and April 2022 were retrospectively analyzed. EUS findings were compared with CT and/or MRI in terms of lesion size, localization, and morphological characteristics. Histopathological results and laboratory parameters, including serum amylase, lipase, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA 19-9), were evaluated. Diagnostic performance metrics, including sensitivity, specificity, and accuracy, were calculated. Results: The study included 76 patients (55.3% male; mean age 59.93 ± 14.03 years). EUS demonstrated superior detection of lesions smaller than 2 cm (42.1% vs. 35.5%; p < 0.01) and a higher ability to identify solid components (17.1% vs. 9.7%; p < 0.01) compared to cross-sectional imaging. While overall sensitivity for malignancy was comparable between modalities, EUS showed higher specificity (58.33%) and diagnostic accuracy (55.26%). Pancreatic duct dilation, solid lesion morphology, larger lesion size, and elevated CA 19-9 levels were significantly associated with malignant pathology (p < 0.05). A descriptive agreement analysis revealed moderate concordance between EUS and radiological imaging in lesion size classification and morphological characterization. Conclusions: EUS demonstrates superior performance in detecting small pancreatic lesions and identifying solid components associated with malignancy. Although its sensitivity is comparable to CT and MRI, its higher specificity and diagnostic accuracy support its important role in lesion characterization. However, EUS should be considered complementary to cross-sectional imaging within a multimodal diagnostic approach. Integration of imaging findings with biochemical markers may further enhance diagnostic accuracy and clinical decision-making. Larger prospective studies with standardized protocols are warranted to validate these findings. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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18 pages, 695 KB

Open AccessArticle

Prognostic Factors and Recurrence in Papillary Thyroid Microcarcinoma

by Aydan Farzaliyeva, Feride Pınar Altay, Ozlem Turhan Iyidir and Neslihan Bascil Tutuncu

Medicina 2026, 62(5), 981; https://doi.org/10.3390/medicina62050981 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Papillary thyroid microcarcinoma (PTMC) is generally indolent; however, a subset exhibits aggressive features, reflecting biological heterogeneity. In the era of treatment de-escalation and active surveillance, accurate risk stratification is essential. We aimed to evaluate recurrence, identify factors associated with [...] Read more.

Background and Objectives: Papillary thyroid microcarcinoma (PTMC) is generally indolent; however, a subset exhibits aggressive features, reflecting biological heterogeneity. In the era of treatment de-escalation and active surveillance, accurate risk stratification is essential. We aimed to evaluate recurrence, identify factors associated with recurrence, determine predictors of lymph node metastasis (LNM) at diagnosis, and assess management strategies at our center. Materials and Methods: This retrospective study included 302 patients with PTMC. Associations between clinicopathological variables and outcomes were evaluated using chi-square test, Spearman correlation, and univariate and multivariate logistic regression analyses. Results: The cohort included 240 females (79.5%) and 62 males (20.5%), with a median age of 47 years. Total thyroidectomy was performed in 97.7%, and radioactive iodine (RAI) in 64.2%. LNM was identified in 26 patients (8.6%). Recurrence occurred in 4 patients (1.3%), and 98.0% were alive at last follow-up. Recurrence was associated with LNM at diagnosis, higher ATA risk categories, and positive surgical margins (p < 0.005). Younger age, larger tumor size, and vascular invasion independently predicted LNM (all p < 0.05), while autoimmune thyroiditis was associated with a reduced risk (p = 0.020). Conclusions: PTMC demonstrates clinically relevant heterogeneity, particularly in patients with LNM. However, given the limited number of recurrence events, recurrence-related findings should be interpreted cautiously and considered exploratory. These findings support risk-adapted management and careful patient selection in the era of treatment de-escalation. Full article

(This article belongs to the Section Endocrinology)

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26 pages, 4386 KB

Open AccessArticle

Combined Exposure to Ragweed and House Dust Mite Exacerbates Airway Epithelial Barrier Dysfunction: A Multimodal Approach

by Elena-Larisa Zimbru, Răzvan-Ionuț Zimbru, Manuela Grijincu, Florina-Maria Bojin, Maria-Roxana Buzan, Sorin Dan Chiriac, Gabriela Tănasie, Laura Haidar, Crenguta Livia Calma and Carmen Panaitescu

Medicina 2026, 62(5), 980; https://doi.org/10.3390/medicina62050980 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Dysfunction of the airway epithelial barrier is increasingly recognized as an early pathogenic mechanism in allergic respiratory diseases. Although individual aeroallergens such as ragweed (RW) pollen and house dust mite (HDM) are known to impair epithelial integrity, the effects of [...] Read more.

Background and Objectives: Dysfunction of the airway epithelial barrier is increasingly recognized as an early pathogenic mechanism in allergic respiratory diseases. Although individual aeroallergens such as ragweed (RW) pollen and house dust mite (HDM) are known to impair epithelial integrity, the effects of combined exposure, more reflective of real-world conditions, remain insufficiently characterized. This study aimed to evaluate the impact of single versus combined allergen exposure on airway epithelial barrier function using a multimodal experimental approach. Materials and Methods: Differentiated normal human bronchial epithelial (NHBE) cells were exposed to RW (100 µg/mL), HDM (100 µg/mL), or a combined extract (RW + HDM; total 100 µg/mL). Barrier function under air–liquid interface conditions was assessed by transepithelial electrical resistance (TEER), while real-time cellular responses were evaluated using xCELLigence impedance monitoring. Structural alterations were examined by occludin-based immunofluorescence imaging, and transcriptional changes associated with epithelial stress and inflammation were analyzed by RT-qPCR. Results: Allergen exposure induced time- and concentration-dependent impairment of epithelial barrier function. Combined exposure resulted in the most pronounced and sustained reduction in TEER and impedance measurements. These functional changes were accompanied by disruption of tight junction organization and coordinated transcriptional modulation of genes involved in inflammatory and stress responses. Conclusions: Combined exposure to RW and HDM extracts induced more severe and persistent epithelial barrier dysfunction than individual allergens. These findings support the role of the airway epithelium as a central regulator of allergic airway disease and highlight barrier disruption as an early pathogenic event. The multimodal framework applied in this study provides an integrated platform for investigating epithelial responses to complex environmental exposures. Full article

(This article belongs to the Special Issue Updates on Allergies and Immunodeficiencies)

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18 pages, 8060 KB

Open AccessArticle

The Role of Cardiovascular Risk Prediction Model Selection in Primary Prevention: An Observational Study of Statin Eligibility Agreement Across Nine Scores in a Lithuanian Primary-Prevention Cohort

by Petras Navickas, Sigita Glaveckaitė, Laura Lukavičiūtė-Navickienė, Agnė Šatrauskienė, Arvydas Baranauskas, Egidija Rinkūnienė, Emilija Meškėnė, Vaida Šileikienė, Edita Lycholip and Aleksandras Laucevičius

Medicina 2026, 62(5), 979; https://doi.org/10.3390/medicina62050979 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Cardiovascular risk prediction models (RPMs) are widely used to guide statin initiation in primary prevention, yet the extent to which different models produce concordant treatment decisions in the same population remains insufficiently characterized. We compared statin eligibility across nine [...] Read more.

Background and Objectives: Cardiovascular risk prediction models (RPMs) are widely used to guide statin initiation in primary prevention, yet the extent to which different models produce concordant treatment decisions in the same population remains insufficiently characterized. We compared statin eligibility across nine commonly used RPMs: SCORE2, PREVENT, PCE, ASSIGN, FRS-hCHD, AusCVDRisk, MESA, QRISK3, and RRS. Materials and Methods: We performed a cross-sectional analysis of 11,174 adults aged 40–65 years with metabolic syndrome enrolled in the Lithuanian High Cardiovascular Risk primary prevention program (LitHiR) and evaluated them at a single tertiary center during 2006–2023. Statin eligibility was determined for each RPM using guideline-mapped treatment thresholds. Pairwise agreement was assessed using Cohen’s κ, Gwet’s AC1, Positive and Negative Percent Agreement (PPA/NPA), the Jaccard index, and McNemar testing. Analyses were repeated by sex. Consensus eligibility was defined as treatment recommended by at least k of nine models. Results: Eligibility varied more than twenty-fold, from 67.39% (7530/11,174) with SCORE2 to 3.03% (339/11,174) with AusCVDRisk; intermediate estimates included PREVENT at 44.83%, QRISK3 at 39.00%, and PCE at 37.97%. Overall pairwise agreement was modest: κ ranged from 0.03 (SCORE2 vs. AusCVDRisk) to 0.67 (QRISK3 vs. ASSIGN), with a median κ of 0.38 (IQR: 0.19–0.51). Median AC1 was 0.58 (IQR 0.37–0.68). Agreement was stronger for non-eligibility than for eligibility (median NPA: 0.82 vs. median PPA: 0.53). Consensus eligibility declined from 73.5% at k = 1 to 45.1% at k = 3, 30.0% at k = 5, and 1.87% at k = 9, with the greatest sex divergence at intermediate stringency. Conclusions: In this real-world cohort with elevated cardiometabolic risk, statin eligibility was highly dependent on RPM choice and showed only modest inter-model concordance. Increasing consensus stringency rapidly reduced eligibility, indicating that RPM selection and embedded thresholds substantially influence statin treatment decisions in primary prevention. Full article

(This article belongs to the Special Issue The Challenges and Prospects in Clinical Cardiology and Angiology: 2nd Edition)

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15 pages, 1324 KB

Open AccessArticle

Lumbar and Thoracolumbar Curves Are Associated with Coronal Lower Limb Malalignment in Adolescent Idiopathic Scoliosis

by Ahmet Serhat Aydin, Emre Kocazeybek, Ahmet Mücteba Yildirim, Onur Kutlu, Serkan Bayram and Turgut Akgul

Medicina 2026, 62(5), 978; https://doi.org/10.3390/medicina62050978 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and [...] Read more.

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and to determine whether these parameters differ according to main curve location. Materials and Methods: In this retrospective study, 70 AIS patients treated surgically (n = 52) or with brace therapy (n = 18) between 2010 and 2020 were analyzed. Patients were grouped according to main curve location as thoracic (n = 28), lumbar (n = 21), or thoracolumbar (n = 21). Pre-treatment standing full-spine radiographs were used to assess Cobb angle, coronal balance, and pelvic coronal obliquity angle (PCOA). After completion of spinal treatment, full-length weight-bearing lower-limb radiographs were evaluated for femoral and tibial lengths, mechanical axis deviation (MAD), femoral neck–shaft angle (NSA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA). Additional treatment-stratified, treatment-adjusted, and threshold-based analyses were performed. Results: PCOA, coronal balance, bilateral MAD, right aLDFA, and right mLDFA differed significantly among the three curve-location groups. The lumbar group demonstrated more negative MAD values than the thoracic group, indicating a tendency toward valgus alignment (right MAD: −5.88 ± 8.8 mm vs. 3.65 ± 7.9 mm, p = 0.004; left MAD: −3.5 ± 7.5 mm vs. 3.75 ± 7.0 mm, p = 0.005). After adjustment for treatment modality, age, and main Cobb angle, curve location remained significantly associated with right MAD, left MAD, right aLDFA, and right mLDFA. However, the proportion of patients with clinically relevant malalignment, defined as MAD exceeding ±10 mm in at least one limb, did not differ significantly among the groups. Conclusions: AIS patients show subtle but measurable differences in coronal lower-limb alignment after completion of spinal treatment. Lumbar and thoracolumbar curves are associated with greater pelvic obliquity and a tendency toward more valgus mechanical-axis alignment, whereas limb lengths and NSA remain comparable among curve-location groups. These findings appear to represent mainly radiographic or biomechanical variations rather than overt clinically relevant deformity in most patients. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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12 pages, 896 KB

Open AccessSystematic Review

Radiation Exposure in Minimally Invasive Cervical Spine Surgery: A Systematic Review

by Dong Hun Kim, Jung-Woo Hur and Jae Taek Hong

Medicina 2026, 62(5), 977; https://doi.org/10.3390/medicina62050977 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Minimally invasive cervical spine surgery (MIS-CSS) relies heavily on intraoperative fluoroscopic imaging, raising concerns about radiation exposure to patients and surgical staff. Unlike lumbar MIS, cervical-specific radiation exposure has not been systematically reviewed, despite distinct anatomical considerations, including proximity [...] Read more.

Background and Objectives: Minimally invasive cervical spine surgery (MIS-CSS) relies heavily on intraoperative fluoroscopic imaging, raising concerns about radiation exposure to patients and surgical staff. Unlike lumbar MIS, cervical-specific radiation exposure has not been systematically reviewed, despite distinct anatomical considerations, including proximity to the thyroid gland and lens of the eye. This review aims to quantify intraoperative radiation exposure during MIS cervical spine procedures and evaluate available dose-reduction strategies. Materials and Methods: A systematic literature search was conducted across PubMed/MEDLINE, Scopus, and Google Scholar in April 2026 following PRISMA 2020 guidelines. Studies reporting original quantitative radiation data during minimally invasive cervical spine procedures in adult patients (≥10 patients) were included. Quality was assessed using the MINORS tool and the JBI checklist. Results: Seven studies encompassing 380 patients were included. Procedures comprised ACDF (four studies), minimally invasive posterior cervical laminoforaminotomy (two studies), and CT-navigated cervical instrumentation (one study). Patient effective doses during ACDF ranged from 0.015 to 1.3 mSv, with thyroid doses of 0.194–0.290 mGy. Standalone ACDF reduced patient dose by 36–58% compared to plated ACDF (p < 0.001). Navigation-assisted posterior cervical foraminotomy achieved a median fluoroscopy time of 10 s with negligible staff exposure. Surgeon per-procedure exposure during cervical discectomy (chest 0.122 µSv, lens 3.1 µSv, hands 7.1 µSv) was approximately half that of lumbar discectomy. Conclusions: Radiation doses during individual MIS cervical procedures appear to be within occupational safety limits, though the current evidence is insufficient to establish definitive dose thresholds. Standalone implant designs and intraoperative navigation represent effective, complementary dose-reduction strategies. Standardized prospective research is needed to establish cervical-specific radiation safety benchmarks. Full article

(This article belongs to the Special Issue Advances in Minimally Invasive Spine Surgery: Technology Innovations and Complications Management)

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13 pages, 3860 KB

Open AccessArticle

Needle Trajectory Influences Foraminal Contrast Distribution and Pain Reduction Following Paramedian Cervical Interlaminar Epidural Steroid Injection: A Retrospective Study

by Seounghun Lee, Jiho Park, Juyeon Kim and Yeojung Kim

Medicina 2026, 62(5), 976; https://doi.org/10.3390/medicina62050976 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Paramedian cervical interlaminar epidural steroid injection (CESI) is commonly used for cervical radicular pain and is considered safer than the transforaminal approach. However, its clinical effectiveness may be influenced by contrast distribution patterns, although these may not fully reflect [...] Read more.

Background and Objectives: Paramedian cervical interlaminar epidural steroid injection (CESI) is commonly used for cervical radicular pain and is considered safer than the transforaminal approach. However, its clinical effectiveness may be influenced by contrast distribution patterns, although these may not fully reflect actual drug delivery. This study aimed to evaluate the association between needle trajectory, foraminal or periradicular contrast distribution patterns, and short-term pain reduction following paramedian cervical interlaminar CESI. Materials and Methods: This single-center retrospective study included 109 patients who underwent paramedian cervical interlaminar CESI. Needle trajectory was classified as inward or outward. Contrast distribution was graded based on anteroposterior (AP) spread patterns. Pain intensity was assessed using a numeric rating scale (NRS) at baseline and 2 weeks after the procedure. Group comparisons were performed using Welch’s t-test and chi-square or Fisher’s exact test, as appropriate. Effect sizes were calculated using Cohen’s d and η². Multivariable linear regression analysis was performed adjusting for age, sex, baseline NRS, and target level. Results: The outward trajectory group demonstrated a significantly higher proportion of Grade 2 contrast spread compared to the inward group (69.8% vs. 8.9%, p < 0.001). Higher AP contrast spread grades were associated with greater pain reduction (β = 0.83, 95% CI: 0.44–1.22, p < 0.001; η² = 0.14). In addition, patients in the outward trajectory group showed greater NRS reduction than those in the inward group (2.96 vs. 1.71, mean difference: 1.25, 95% CI: 0.74–1.76, p < 0.001; Cohen’s d = 0.96). In multivariable analysis, needle trajectory remained significantly associated with pain reduction, whereas AP contrast spread grade was not independently associated. Conclusions: Needle trajectory was associated with contrast distribution patterns and short-term pain reduction following paramedian cervical interlaminar CESI. An outward-directed trajectory was associated with greater foraminal or periradicular contrast spread and greater pain reduction. These findings suggest that needle trajectory may represent a clinically relevant procedural factor influencing clinical outcomes. Full article

(This article belongs to the Special Issue Precision and Regenerative Interventional Pain Medicine: Imaging-Guided, Neuromodulatory and Minimally Invasive Advances)

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14 pages, 323 KB

Open AccessReview

5 Alpha Reductase Inhibitors (5ARIs) Monotherapy and Combinations: Current Role in Benign Prostatic Hyperplasia (BPH) Management

by Christos Roidos, Petros Sountoulides, Konstantinos Papathanasiou, Asterios Symeonidis and Ioannis Mykoniatis

Medicina 2026, 62(5), 975; https://doi.org/10.3390/medicina62050975 (registering DOI) - 17 May 2026

Abstract

Background and Objectives: Benign prostatic hyperplasia (BPH) is a progressive, androgen-dependent condition driven by dihydrotestosterone (DHT). 5α-reductase inhibitors (5-ARIs), including finasteride and dutasteride, target this pathway and provide disease-modifying effects. Materials and Methods: This narrative review summarizes evidence from randomized trials, [...] Read more.

Background and Objectives: Benign prostatic hyperplasia (BPH) is a progressive, androgen-dependent condition driven by dihydrotestosterone (DHT). 5α-reductase inhibitors (5-ARIs), including finasteride and dutasteride, target this pathway and provide disease-modifying effects. Materials and Methods: This narrative review summarizes evidence from randomized trials, meta-analyses, and observational studies evaluating the efficacy, timing, and safety of 5-ARIs in the management of LUTS due to BPH. Results: 5-ARI therapy reduces prostate volume by 18–28% and serum PSA by approximately 50% within 6–12 months. Landmark trials (MTOPS, CombAT) demonstrate significant reductions in acute urinary retention (AUR) and BPH-related surgery (>50% RR reduction). Combination therapy with α-blockers provides superior symptom control and greater prevention of clinical progression, particularly in men with prostate volume ≥ 30–40 mL or PSA ≥ 1.5 ng/mL. Early initiation of combination therapy improves long-term outcomes, while α-blocker withdrawal may be feasible in selected patients. Adverse events are mainly sexual, with emerging data suggesting a possible association with depression. Conclusions: 5-ARIs are central to BPH management, offering sustained clinical benefits and prevention of progression. Optimal outcomes depend on appropriate patient selection, early treatment in high-risk individuals, and individualized long-term strategies. Full article

(This article belongs to the Special Issue Recent Advances in Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia)

16 pages, 316 KB

Open AccessArticle

Association Between DASH Diet Quality and 24 h Ambulatory Blood Pressure in Treatment-Naive Adults Referred for Diagnostic Monitoring: A Cross-Sectional Study

by Nezihe Otay Lule, Mert Deniz Savcilioglu, Kemal Ozan Lule and Mehmet Murat Sucu

Medicina 2026, 62(5), 974; https://doi.org/10.3390/medicina62050974 (registering DOI) - 17 May 2026

Abstract

Background/Objectives: Dietary adherence to the Dietary Approaches to Stop Hypertension (DASH) pattern is associated with lower blood pressure; however, most prior studies have relied on office-based measurements and non-specific dietary assessment tools. This study examined the association between DASH diet quality, assessed [...] Read more.

Background/Objectives: Dietary adherence to the Dietary Approaches to Stop Hypertension (DASH) pattern is associated with lower blood pressure; however, most prior studies have relied on office-based measurements and non-specific dietary assessment tools. This study examined the association between DASH diet quality, assessed by the validated DASH-Q questionnaire, and 24-h ambulatory blood pressure in treatment-naive adults referred for diagnostic ambulatory blood pressure monitoring (ABPM). Materials and Methods: This cross-sectional study enrolled 227 consecutive treatment-naive adults referred for diagnostic 24-h ABPM at a cardiology outpatient clinic. DASH diet quality was assessed using the validated Turkish version of the DASH-Q questionnaire and categorized as low (<36), moderate (36–49), or high (≥50). Hypertension was defined by ABPM-based thresholds. Multivariable linear regression was performed to identify independent predictors of 24-h mean systolic and diastolic blood pressure, and binary logistic regression was used to evaluate independent predictors of ABPM-defined hypertension, with both models adjusted for age, sex, BMI, smoking, physical activity, and self-reported discretionary salt-adding behavior. Results: DASH-Q total score was the sole statistically significant independent predictor of both 24-h mean systolic blood pressure (B = −1.068, 95% CI: −1.270 to −0.866; β = −0.589; p < 0.001) and diastolic blood pressure (B = −0.560, 95% CI: −0.706 to −0.414; β = −0.470; p < 0.001) in the adjusted models. Each one-unit higher DASH-Q score was also associated with 14.6% lower odds of ABPM-defined hypertension (OR = 0.854, 95% CI: 0.820–0.890; p < 0.001). Higher DASH-Q scores were further associated with a more favorable metabolic profile, including lower LDL cholesterol, triglycerides, glucose, and C-reactive protein levels. Conclusions: DASH diet quality was independently and inversely associated with 24-h ambulatory blood pressure and the odds of ABPM-defined hypertension in this treatment-naive population. Given the cross-sectional design and the possibility of reverse causality, these results should be interpreted as hypothesis-generating and require confirmation in prospective studies. Full article

(This article belongs to the Section Cardiology)

15 pages, 1269 KB

Open AccessArticle

Weighing the Risks: The Impact of Body Mass Index on Outcomes After Frozen Elephant Trunk Aortic Arch Repair

by Tim Walter, Joseph Kletzer, Tim Berger, Salome Chikvatia, Magdalena Bork, Sophie Kunzmann, Mario Lescan, Stoyan Kondov, Aleksandar Dimov, Martin Czerny, Maximilian Kreibich and Dalibor Bockelmann

Medicina 2026, 62(5), 973; https://doi.org/10.3390/medicina62050973 (registering DOI) - 16 May 2026

Abstract

Background and Objectives: This study aimed to evaluate the impact of body mass index (BMI) on post- operative outcomes in patients undergoing aortic arch repair with the frozen elephant trunk technique (FET). Materials and Methods: A total of 387 patients who [...] Read more.

Background and Objectives: This study aimed to evaluate the impact of body mass index (BMI) on post- operative outcomes in patients undergoing aortic arch repair with the frozen elephant trunk technique (FET). Materials and Methods: A total of 387 patients who underwent an FET procedure between 04/2014 and 11/2024 were retrospectively analyzed. Patients were divided into four groups according to BMI: underweight (BMI < 18.5, n = 12) normal weight (BMI: 18.5 to <25, n = 150), overweight (BMI: 25 to <30, n = 154), and obese (BMI: ≥30, n = 71). Patient characteristics and clinical outcomes were compared across groups. Multivariable Cox regression, interaction analysis, and restricted cubic spline modelling were performed using R (Version 4.4.3). Results: Interaction analysis revealed BMI-dependent effect modification for several predictors. Insulin-dependent diabetes mellitus was associated with increased mortality only in patients with BMI < 25 kg/m² (interaction p = 0.003). Transfusion of packed red blood cells (PRBCs) also showed a significant interaction with BMI (p = 0.016), with a stronger effect in patients with BMI < 25 kg/m², although significant in both strata. Moreover, cross-clamp time demonstrated a BMI-dependent interaction (p = 0.047), with numerically higher mortality hazards in overweight patients (BMI > 25 kg/m²), but without statistically significant subgroup effects. Spline analysis indicated a non-linear, threshold-based association between overall mortality and BMI but does not reach statistical significance. Kaplan–Meier analysis showed no significant difference in 5-year survival among BMI categories. Conclusions: BMI should not be used as a primary risk stratification tool for survival after an FET procedure. Rather, attention should be paid to comorbid conditions and intraoperative factors that interact with BMI. For patients with lower BMI (<25 kg/m²), optimizing glycemic control and minimizing transfusion may improve outcomes. Data suggests that a reduction in cross-clamp time may be particularly beneficial in patients with higher BMI (>25 kg/m²). Future studies should aim to clarify the impact of BMI on outcomes after FET, particularly in the context of patient selection and perioperative optimization strategies. Full article

(This article belongs to the Section Surgery)

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12 pages, 524 KB

Open AccessArticle

A Randomized, Double-Blind, Placebo-Controlled Trial of an Ayurvedic Herbal Formulation and Vitamin C/E on Vascular Function in Patients with Cardiovascular Disease

by John W. Salerno, Shichen Xu, Maxwell Rainforth, Sanford I. Nidich and Robert H. Schneider

Medicina 2026, 62(5), 972; https://doi.org/10.3390/medicina62050972 (registering DOI) - 15 May 2026

Abstract

Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death globally. The World Health Organization has called for investigations into traditional systems of medicine for CVD prevention. Ayurveda includes a classical herbal formulation called Maharishi Amrit Kalash (MAK) traditionally used [...] Read more.

Background and Objectives: Cardiovascular disease (CVD) is the leading cause of death globally. The World Health Organization has called for investigations into traditional systems of medicine for CVD prevention. Ayurveda includes a classical herbal formulation called Maharishi Amrit Kalash (MAK) traditionally used for disease prevention, health promotion and healthy aging. The study objective was to evaluate MAK effects on biomarkers of vascular function and structure compared to vitamin C and E supplementation in a high CVD risk population. Materials and Methods: In this double-blind randomized controlled trial, 138 Black men and women (mean age 65 ± 7 years) with established CVD or high CVD risk were assigned to either MAK (n = 46), vitamin C/E (n = 46), or placebo (n = 46) for 12 months. The primary outcomes were change in brachial artery reactivity testing (BART) with flow-mediated dilation (FMD, endothelium-dependent) and nitroglycerin-mediated dilation (NMD, endothelium-independent). Other outcomes included carotid intima-media thickness (cIMT), blood pressure, and serum lipids. ANCOVA and pairwise comparisons were performed. Results: After 12 months of intervention, the MAK group demonstrated significant improvement in BART-NMD compared to placebo (mean change + 4.18% vs. +2.95%, p = 0.018) and numerical but non-significant improvement compared to the +3.32% mean change for the Vitamin C/E group (p = NS). There were no significant group differences for BART-FMD, cIMT, blood pressure, and lipids. Intervention compliance ranged from 70–80%. Conclusions: In this randomized controlled trial, 12 months of MAK supplementation improved endothelium-independent vascular smooth muscle function (BART-NMD) in Black adults at high CVD risk. The MAK group achieved a mean BART-NMD of approximately 15.6%, reaching the established threshold for normal vascular smooth muscle function. This selective improvement in smooth muscle responsiveness without changes in endothelial function, vascular structure, or conventional risk factors suggests MAK may influence specific pathways relevant to vascular aging. Larger studies with clinical outcomes are needed to further evaluate this effect on cardiovascular health in aging and high-risk populations. Full article

(This article belongs to the Special Issue Updates on Risk Factors and Prevention of Coronary Artery Disease)

11 pages, 450 KB

Open AccessArticle

Comparative Neurocognitive Outcomes Following Holmium Laser Enucleation and Transurethral Resection of the Prostate: A Prospective Cohort Study

by Orkunt Özkaptan, Cengiz Çanakcı, Erdinç Dinçer, Osman Murat İpek, Mehmet Burak Doğrusever, Oğuz Türkyılmaz, Alper Coşkun and Sare Dilek Özkaptan

Medicina 2026, 62(5), 971; https://doi.org/10.3390/medicina62050971 (registering DOI) - 15 May 2026

Abstract

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 [...] Read more.

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 patients undergoing surgical treatment for BPH; 132 patients (66 HoLEP, 66 TURP) completed baseline and 3-month follow-up evaluations. The Montreal Cognitive Assessment (MoCA) served as the primary measure of cognitive function, while the Mini-Mental State Examination (MMSE) functioned as a secondary measure. The Beck Anxiety Inventory and Beck Depression Inventory were utilized to assess individuals’ mental states. We employed repeated-measures General Linear Models, adjusted for age and educational attainment, to examine temporal variations. Results: Baseline demographic, clinical, cognitive, and psychological characteristics were comparable among the groups. The modified analysis revealed no significant interaction between time and surgical procedure for MoCA (p = 0.405), indicating that both groups exhibited comparable cognitive trajectories. No significant differences were seen between the groups in the adjusted MoCA scores (p = 0.162). A minor, statistically insignificant temporal effect was observed (p = 0.058; partial η² = 0.028). Educational attainment independently forecasted cognitive performance (p = 0.024). The MMSE demonstrated a slight temporal effect (p = 0.015) with no interaction of approaches. Anxiety and depressive symptoms persisted uniformly and comparably among the groups. Conclusions: Three months post-surgery, neither HoLEP nor TURP was associated with a notable deterioration in cognitive performance. The surgical modality did not independently influence cognitive trajectory after adjusting for demographic variables. Contemporary endoscopic BPH surgery appears to be neurocognitively safe during the medium-term postoperative period. Full article

(This article belongs to the Section Urology & Nephrology)

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12 pages, 281 KB

Open AccessArticle

Clinical Assessment of Thromboembolic Risk in Patients Undergoing Elective Electrical Cardioversion with or Without Transesophageal Echocardiography: A Real-World Observational Study

by Ana Petretić, Fabio Kadum, Paulina Kušan, Gordana Žauhar, Lara Batičić and Robert Bernat

Medicina 2026, 62(5), 970; https://doi.org/10.3390/medicina62050970 (registering DOI) - 15 May 2026

Abstract

Background and Objectives: Elective electrical cardioversion (eECV) in patients with atrial fibrillation (AF) or atrial flutter is associated with a low risk of thromboembolic events (TEs) when adequate anticoagulation is provided. However, the role of routine transesophageal echocardiography (TEE) prior to eECV remains [...] Read more.

Background and Objectives: Elective electrical cardioversion (eECV) in patients with atrial fibrillation (AF) or atrial flutter is associated with a low risk of thromboembolic events (TEs) when adequate anticoagulation is provided. However, the role of routine transesophageal echocardiography (TEE) prior to eECV remains uncertain. This study aimed to assess thromboembolic outcomes in patients undergoing eECV with or without TEE guidance in a real-world clinical setting. Methods: A single-center, combined retrospective–prospective observational study including 296 adequately anticoagulated patients with AF or atrial flutter scheduled for eECV was conducted. The retrospective cohort (n = 220) underwent eECV without routine TEE, while the prospective cohort (n = 85) underwent TEE prior to eECV. The primary outcome was the occurrence of thromboembolic events (ischemic stroke or systemic embolism) within 30 days after eECV. Arrhythmia recurrence at 30 days was assessed as a secondary, exploratory outcome. Results: Among patients undergoing eECV, thromboembolic events were rare. In the retrospective cohort, 3/220 patients (1.36%) experienced a TE, whereas no events were observed in the prospective cohort (0/76). Due to the low number of events, the study was underpowered to detect meaningful differences between strategies (RR 2.44; 95% CI 0.13–46.7; p = 0.55). TEE identified left atrial appendage thrombus in 9/85 screened patients (10.6%), who were subsequently excluded from cardioversion. Arrhythmia recurrence at one month was more frequent in the prospective cohort (19.7% vs. 7.3%), likely reflecting differences in baseline clinical characteristics. Conclusions: Thromboembolic events after eECV in adequately anticoagulated patients were infrequent in this real-world cohort. While the study design limits direct comparison between strategies, the results indicate that a conventional anticoagulation-based approach without routine TEE is associated with a low risk of thromboembolic events in most patients. At the same time, the detection of left atrial appendage thrombus in a subset of patients underscores the importance of individualized risk assessment and supports the selective use of TEE in higher-risk clinical settings. Full article

(This article belongs to the Section Cardiology)

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